The Dr. Hyman Show - The Functional Medicine Approach To Treating COVID-19 And Post-COVID Syndrome with Dr. Patrick Hanaway
Episode Date: December 23, 2020The Functional Medicine Approach To Treating COVID-19 And Post-COVID Syndrome | This episode is sponsored by Bioptimizers, Paleovalley, and Cozy Earth COVID has taught us a lot over the last year, and... continues to do so every day that we battle this pandemic. We’ve seen what an overburdened medical system looks like and been faced with the reality of social distancing for many months now. Perhaps one of the most important lessons we have learned, though, is that a body that’s already suffering from chronic disease has far greater risks of COVID severity and even death. In the US, where the majority of people are metabolically unhealthy, we’ve seen our population faring much worse than other countries against this virus. Here, there are 500 COVID deaths per million people (at the time of this episode recording). In China, that number is 3 per million. Look at that alongside the 42% obesity rate here and the 2.6% rate there. COVID has shown us just how out of balance we are as a nation and how our baseline of disease has gotten us into such a mess. I sat down with my colleague, good friend, and former roommate Dr. Patrick Hanaway to talk about the Functional Medicine approach to treating COVID-19. Dr. Patrick Hanaway is a board-certified family physician trained at Washington University. After 10 years as Chief Medical Officer at Genova Diagnostics, Dr. Hanaway became the Chief Medical Education Officer for the Institute for Functional Medicine. In 2014, Dr. Hanaway was the founding Medical Director of the Cleveland Clinic Center for Functional Medicine. His research focus is on nutrition, the microbiome, and evaluating value in Functional Medicine models of care. Currently, his teaching focus is on cancer, COVID, and uncertainty. This episode is brought to you by Bioptimizers, Paleovalley, and Cozy Earth. Right now you can try Bioptimizers Magnesium Breakthrough for 10% off, just go to bioptimizers.com/hyman and use the code HYMAN10 at checkout. Paleovalley is offering 15% off your entire first order. Just go to paleovalley.com/hyman to check out all their clean Paleo products and take advantage of this deal. Cozy Earth is offering Doctor’s Farmacy listeners an incredible 50%, and as part of their special holiday campaign. Just go to cozyearth.com and use the code HYMANPODCAST50 at checkout. Here are more of the details from our interview (video / audio): Rethinking our approach to COVID-19 by focusing on improving our overall health and well-being (9:12) Why does the United States have the highest number of COVID-19 cases in the world? (12:53) The Functional Medicine approach to preventing and treating COVID-19 and post-COVID syndrome (14:08) Is vitamin D effective as a treatment for COVID-19? (20:10) How COVID and chosen therapeutic models highlight our response to life’s uncertainty (24:30) How Dr. Hanaway treats COVID-19 patients (27:38) The role of mitochondrial function in relation to COVID-19 and post-COVID syndrome (31:26) The Functional Medicine approach to treating post-COVID syndrome, or long hauler syndrome (35:31) Dr. Hanaway’s personal journey facing stage IV cancer (46:07) Dr. Hanaway’s experience pairing a ketogenic diet, fasting, chemotherapy, and radiation therapy (52:41) Learn more about Dr. Patrick Hanaway at https://www.ifm.org/about/profile/patrick-hanaway-md/ Learn more about the Institute for Functional Medicine’s course, Resistance, Resilience, and Recovery: Patient Care in a Pandemic here: www.ifm.org/pandemic-courseÂ
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Coming up on this episode of The Doctor's Pharmacy.
These people who are having, let's say, the post-COVID syndrome,
they have other underlying issues that are going on.
They have other underlying triggers, and it may be related to, you know,
heavy metal toxins or organotoxins or mycotoxins or hidden infections
or antigens or celiac disease or some other process that's going on
that has to be taken care of and looked at also.
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All right, now let's get back to this week's episode of The Doctor's Pharmacy.
Welcome to The Doctor's Pharmacy.
I'm Dr. Mark Hyman, and that's pharmacy with an F, F-A-R-M-A-C-Y.
And if you've ever wondered about, maybe there's another way to deal with COVID
that we're not hearing about in the news that isn't drug-based, that isn't vaccine-based,
but that's based on fundamental principles of how to rejuvenate your immune system and how to become
COVID resilient, you should listen up to this conversation. And also, if you've ever had cancer
and wondered about some new ways that are being used to think differently about cancer, cancer prevention, treatment, you should listen up because this podcast is with a very special human being, my good friend, my colleague, Dr. Patrick Hannaway, who has been in my life for decades and decades now as one of the leaders in the movement of functional medicine
involved in every aspect of education, research, training. He's just one of the real dudes out
there. He's a board-certified family doc. He trained at Washington University, one of the best
medical schools in the country. He's had a clinical practice with his wife called Family to Family
in Asheville, North Carolina for decades. He was
the chief medical officer at Genova Diagnostics and was the chief medical education officer at
the Institute for Functional Medicine. And then also with me, started up the program at Cleveland
Clinic in functional medicine. He was the founding medical director. And we did a lot of stuff there
in a very short time, which really put functional medicine
on the academic map.
And without his help, we would not have been able to do it.
So I'm forever grateful to him.
He's focusing now his work on cancer and COVID.
And he himself developed cancer a few years ago.
And we're going to talk about his journey in cancer.
And lately, he's been doing something which is really important, which is trying to understand
a different framework for preventing, treating COVID, and even dealing with the aftermath
of what we call post-COVID syndrome.
And in his role leading the project at the Institute for Functional Medicine on COVID
and the functional medicine approach to COVID, he's been instrumental in providing education
to thousands and thousands of providers, and also building a course, which is now available online. It's an incredible course called Resistance,
Resilience, and Recovery, Patient Care in a Pandemic by the Institute for Functional Medicine.
You can go to ifm.org and learn more about it. And this is a course for professionals, but I
imagine anybody can take it who's really interested. And it's an attempt to try to put together the science of what we know about how to prevent
and treat and even deal with recovery from COVID. So Patrick, I can't tell you how excited I am to
have you on the podcast. It's been a long time in coming and we have lots to talk about.
Well, thanks so much, Mark. Yeah, we do have lots to talk about. We've had a lot of experiences shared, a lot of earned and learned wisdom that we've gone through together. And I'm looking forward to the conversation.
Yeah. So for those of you who don't know, we really, we live together. We're roommates in Cleveland Clinic. We share an apartment, which is something you do in college, but we got to do it as grown men, which was quite fun and really learned a lot about how we build something new in a very new environment at
Functional Medicine Clinic and also learned a lot about each other, which was really pretty awesome.
So I have huge respect for this guy. He's a man of integrity and wisdom. And by the way, he's also a... Marakame. Marakame is the word.
He's a shaman. He's initiated as a Marakame, indigenous healer by the Huichol people of the
Sierra Madres in Mexico. And he holds committee fires and ceremonies, traditional healing
sessions. So he's a multifaceted human being. And we first kind of had a mind meld when he
heard me speaking about Tibetan medicine decades ago at a conference.
And he's like, wait a minute, you're kind of like me. I'm like you, let's talk. So let's get right
into it. COVID has been devastating for humanity across the globe. 55 million cases as of this
recording, a quarter million deaths here, over a million three deaths around the world. This is a real problem. And
our tools are crude at best. Our therapies are, you know, minimally effective and people are still
dying at incredible rates and getting sick at incredible rates. Now, there's so many cases and
20% of those cases end up hospitalized. And those who are sick with a chronic disease or
obese, overweight, who are in poor metabolic health have much worse outcomes. So from your
perspective, from a functional medicine perspective, sort of what's the approach we should be taking?
Where are we at in our understanding? And how do we rethink our approach to COVID that includes a lot of elements
around lifestyle, nutraceuticals, and other therapies that are just absent from the
conversation, that are not on the news, that are not being talked about by the government,
and they're not in academic institutions for the most part.
Well, I mean, we have to come back and look at medicine in general and the way in which medicine
really doesn't focus on health and wellbeing. It's focused on once you get a disease and then we're going to give you
some medicines in order to be able to decrease the symptoms in regard to that. Whereas with a
functional medicine approach, just as with Tibetan medicine or Ayurveda or Chinese medicine,
it's focused on a big picture view of how all the pieces fit together and how are we in harmony.
So we have with COVID, you know, a fundamental aspect of us being in disharmony with the natural world.
You know, we don't know exactly, lots of theories of how it arose, but be that as it may, we were ripe.
You know, things were so out of balance within the world, within the natural world and within us as human beings, and particularly in the United States, where we're so metabolically unhealthy and
imbalanced that we're susceptible to what's happening here. And so we have an acute disease
on top of the complex chronic disease that is so rampant within our country and around the,
and that we've exported around the world. And so we see that begin to happen.
And the first thing is, well, what do we do?
Who's at risk?
Well, who's at risk?
As you've said, are those people who are diabetic and overweight and pre-diabetic and
hypertensive, as well as the elderly whose immune systems have aged.
They've become senescent.
Those are the ones who are at risk for having severe disease going on. So from a functional medicine perspective,
or just from a, you know, from a good medicine perspective, we'd say, well, how do we help the
people be healthy enough so that if, and when they get it, that they don't become overwhelmed by it. They don't have a severe
degree of illness. And if they progress from that, that they don't have a post-COVID syndrome.
And if they don't need to get that because there's a vaccine that's arising, that we actually
optimize their immune system so that they're able to respond to it in the most effective manner
with the least risk of harm. We can talk about all those aspects, but really we're able to respond to it in the most effective manner with the least risk of
harm. We can talk about all those aspects, but really we're trying to say, you know, how do we
have the rising tides lift all boats? How do we help people become healthier through the whole
thing so that as we're exposed to what's happening in the world, in this case, the SARS-CoV-2 virus, we don't have the severe
response to it, or we don't have the long-term sequelae from it, or we are not harmed by a
vaccine. That's right. I think that's a really important point. We're so focused on the killing
of the virus or the vaccination idea that we were kind of missing this fundamental conversation in our
society and around the world, which is who gets sick? Why are they getting sick? And is there
anything we can do to make the host less susceptible to getting sick, the host more likely to recover,
and the host less likely to get long-term consequences, which are quite significant
for many, many people. And I think that's really the beauty of functional medicine.
And, you know, I think there are many reasons why America has the highest rates of COVID infection.
Some of them are political, some of them are social, but a lot of them are medical. I mean, you know, I think in China, there's three cases
of death per million population. In America, there are 500 cases of death per million population.
What's the difference? I don't know, but China has an obesity rate of 2.6%. We have an obesity
rate of 42%. Maybe it has to do with our poor metabolic health, which is entirely tied to our lifestyle
and nutrition.
This is where functional medicine really focuses on because we're not so much focused on treating
disease.
We're focused on the science of creating health.
So can you talk about the functional medicine approach to this?
And what are the kinds of things in your research and pulling together the data on how to create
immune resilience
with functional medicine, what has sort of risen to the top as the strategies, both dietary,
lifestyle, and nutraceutical strategies to help patients become more immunoresilient,
to rejuvenate their immune systems, and to become resistant to the effects of COVID?
So there's a lot of pieces there.
Just let's, yeah, we got a while.
We got a while.
First, the functional medicine, you know, the operating system and the view is trying
to look at the whole person, you know, from illness to wellness and where they are.
And so we're doing that.
And so whether we're working on someone where we're trying to prevent them from having a
severe illness or treating them for post-COVID
syndrome, you know, or working with them at any point in severity, the approaches are actually
similar. The specifics change, but the approach is the same. And that is what we're working to do
is work with the system of what's happening with the gut microbiome and how it informs the immune
system. What's happening with the activation of the cytokines
and the overall inflammatory response process that's going on?
What's happening in relationship to the exposome and risk factors that you have?
What's happening with metabolic health in terms of the ability of the virus
to be able to attach to the receptor in the first place?
Taking all of these things into consideration,
we start looking at risk. And so from a nutritional standpoint, we're saying,
well, what can we do to mitigate risk of, as you said, of obesity, of metabolic syndrome
and work with that? You know, the kinds of approaches, a beautiful paper by Deanna Minnick
that I helped her out with, you know, goes into all of that. And we talk about,
you know, what ends up coming down to what looks like a, a low carb Mediterranean diet. You might
call it a pagan diet. Um, you know, it's like the, you know, it's that kind of approach that's
going to help our overall metabolic health and wellbeing. People say, ah, you know, we can't do
that, but we actually see that changes in metabolism happen within a couple weeks,
even a couple of days. Changes in the microbiome change very quickly. It's interesting you talk
about China. I was just reading a piece this morning that elderly Chinese people who are
healthy have the same microbiome as young Chinese people who are healthy. That's not the case in the United States.
We see that the microbiome has degraded significantly by the time people age.
That has an effect on immune senescence. The immune system is getting old. It doesn't work
as well. And yet it is possible to be able to keep it healthy, to keep it resilient.
So what we did when we began this
process, and I recall I was up in upstate New York at a retreat center, the Blue Deer Center,
and coming back from that in the beginning of March, and I didn't really get it. I didn't
really get how, you know, I was reading in the news, but I didn't get how big it was.
And then as everything shifted those first two weeks in March, we said at the Institute for Functional Medicine, we have to do something about this. And so we dove into bringing about 20 different physicians and scientists together and said, let's look to be beneficial for viral infections. In particular,
let's look at the, you know, the original SARS virus and the MERS virus, the Middle Eastern
Respiratory Syndrome virus that were both coronaviruses and what's effective and how can
we dial that in? And so we put that all together. And in the beginning of April, you know, we laid
out for everybody and we said, well, the things that are going to be most helpful are going to be those things that are going to be able to be both
antiviral. They're going to decrease viral growth. They're going to improve the immune system and
they're going to decrease symptoms. And we laid out, we talked about vitamin D, we talked about
melatonin, things that are now like, oh, wow, this is a brand new thing in November.
And it's like we laid it out and we laid out the doses.
We said, you know, we want to work with quercetin, a bioflavonoid.
We want to work with vitamin A and vitamin C.
We want to be able to use anti-inflammatories like curcumin.
We want to be able to use green tea extract or green tea, another bioflavonoid, you know, to be able to help out.
And we could see like the data's there to be able to bring all of these components into,
into the mix, including things that I think are particularly important in the post COVID syndrome,
like N-acetylcysteine, that's a precursor for glutathione. And so we had an idea of what that was and we laid those things out. And
fortunately, thousands of clinicians have looked at that. And it wasn't just, we were grabbing any
ideas. We were going through it in a very rigorous way and setting up, here is the evidence that is
for this, and here is the risk of harm. And when we look at what's been done with, you know, hydroxychloroquine or
remdesivir, where the evidence is not that great and the risk of harm is significantly greater for
those things. So don't we want to, why wouldn't we use things where the risk of harm is very low
and there's very clear evidence, not only from a biological plausibility, you know,
like it makes sense because the research is there and the science fits, but from a scientific
evidence-based perspective around other kinds of viral infections, because none of us had data on
SARS-CoV-2 for the first six months. And what we found time again is this is helpful. And we've had, we've seen it
from clinicians. We see, I saw a piece yesterday that was comparing primary care practices to
integrative practices and the rates of, of, of hospitalization in those two groups. And there
was an eight fold reduction, eight X, eight times reduction in the hospitalization in people who are getting this kind of functional medicine approach.
Now, that's all reported data.
It's not a randomized trial, but it's like there's something here.
An 800% reduction.
That's a lot.
Yes, exactly.
We get excited if there's like a 20% reduction in, progression to the ICU or, I mean, a couple of
days less than the hospital. And we've seen that with the vitamin D data out of, out of Spain,
you know, where they were able to show that when people were, were getting adequate doses of vitamin
D and they were hospitalized, that those patients didn't end up getting into the ICU and didn't end up dying.
And the patients who were in the control arm who didn't get the vitamin D,
they had a much higher rate of going into the ICU.
And several of the patients in that small cohort died.
So it's like we're seeing this.
We're seeing the data is coming out.
But we know the information now.
And the interventions are not toxic.
And they're not expensive and they
can be broadly applied. And so we're looking for how do we, how do we do the research? You know,
how do we team up with academic centers to say, let's do the research on this? We,
unfortunately we haven't really had takers yet around doing that. Although people,
and it's interesting, it's like, like we found when we were
doing research at the Cleveland clinic, they want to isolate a specific variable or we'll do research
on vitamin D alone. It's like, well, you know, I'm not telling my patients just to take vitamin D.
I'm saying, Hey, take these bioflavonoids to help your gut microbiome, take these anti-inflammatories,
take vitamin D, help your overall metabolic health and eat this really good diet.
And they're doing better.
Yeah.
I mean, it's sort of the analogy I give is, you know, like Michael Jordan could be the
best basketball player in the world, but he's not going to win a championship on a team
by himself.
That all these things work in concert and synergy and have different mechanisms and
are additive or even, you know even synergistic in ways that
are more than that. And I think we really don't have the right paradigm. We're looking at the
single drug model, single disease. But then, of course, then we throw everything together at the
end. So when you look at what's actually happening, people's steroids and heparin,
and they're giving them IL-6 blockers, and they're giving them remdesivir, and they're giving them hydroxychloroquine,
they're just throwing the kitchen sink at it,
but they look at each one separately
to not see the combination of the effects.
And I think that's really functional medicine's
way different, it's like, how do we create a healthy human?
Well, you need high quality protein,
and high quality fats, and low glycemic carbs,
but you wouldn't just eat vegetables. And that's, even though
they're healthy, you need other components of your diet. And it's the same thing with creating
health and creating a robust system. The way I think about what we're doing and what you're doing
by assembling all this data is like, okay, what does the data show about how do you create a
healthy, robust immune system and a robust response to insults, whether they're lifestyle insults or whether they're viral or
infectious insults. And the data is increasingly clear that there are immunologically active
nutrients and polyphenols and plant compounds or phytochemicals that we can use that, like you said, are non-toxic, they're low cost,
they have evidence, they're widely available, and there's evidence for benefit. So why wouldn't we
use these? So what's your perspective on why we're so much in the dark about this? Because I was
reading the New York Times when President Trump got COVID, and I was like, oh, they're mentioning
he's taking this drug and that drug, and he's taking vitamin D and zinc. And I was like, oh, they're mentioning he's taking this drug and that drug,
and he's taking vitamin D and zinc. And I was like, wow, the president gets vitamin D and zinc.
Why doesn't everybody get vitamin D and zinc? Yeah, well, Anthony Fauci is taking vitamin D and vitamin C. You know, it's like he thinks there's enough data there to be able to help.
It's always been a curious thing to me, Mark, when I talk to physicians about nutrients
and nutrition, and they say, well, that sounds like, you know, like good for me, or, you know, I'm going to give that to
my wife and my kids and my mom, but you know, I would never give that to my patients. Like I try
to treat my patients like I treat my family. You know, it's like I care that much to give you the best knowledge that I have.
And there's an element that is not only
about the whole fallacy of the randomized controlled trial
and the misunderstanding of what that is.
That's been, I would say, kind of foisted on us
by the drug companies because that helps them
to demonstrate the efficacy of their point source drug without any other factors that are going on. But I think
underlying all this as well is the amount of fear that we have about doing the wrong thing
and the amount of fear that both as clinicians and, you know, one of the big things within COVID to me is like,
life is uncertain and we're getting to see within that uncertainty, you know, how people respond
and are they, are they moving from a place of fear and pushing against, or are they moving
from a place of saying, well, wow, things are really different. I wonder why I'm curious and
I'm going to be courageous in going
forth in the world and trying some new things because the way in which we were doing it before
isn't working. And that's the way you and I have been in our practices and our careers.
You know, we're trying to say like, Hey, what works? You know, I'm trying, I'm, I'm back in,
you know, residency training. I'm like, these antihypertensives really aren't working very well.
They're not like shifting the disease for this person.
I wonder what would work.
What if, what if we, you know, dealt with heart rate variability and, and got more vagal
tone and didn't have them in fight or flight response.
Would that work?
Oh, wow.
That works.
Oh, they don't even need the medicine anymore.
That's right. Yeah. Amazing.
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Now let's get back to this week's episode of The Doctor's Pharmacy.
So Patrick, you know, you get these calls every day. I do for sure, I know, which is,
hey, my brother, he's got COVID.
My mother's got COVID.
What do I do?
You know, yes, we can do diet, lifestyle, stress reduction, sleep, and take a bunch
of vitamins and nutraceuticals as prevention, which is great.
And we should all be doing that, particularly now, given that this is so widespread.
But what happens when you get it?
And what do you tell people people given this amazing amount of
research that you and the institute for functional medicine is done looking at the data on this
yeah so there's the prevention piece of hey this these are some things that i think will help you
to not get it so severely but then once once you get it once you've got that you know pcr or you
know naa test positive then i say well let's let's go with what we know works. Okay.
Let's go with a vitamin D good data on that, you know, taking five, probably 10,000 units a day to
start off with. And I've seen people use significantly higher doses as loading doses,
but at least go there, you know, let's look at, at taking melatonin. We know it's anti-inflammatory
effect. Let's look at vitamin a it's effect on its effect on the mucosal immune system and using a pulse dose of a higher dose for the first five days. Yes,
it's true that vitamin A can cause liver damage if it's used in excessive doses for prolonged
periods of time. That's not what we're talking about. It's like, let's give you a little burst
of that to be able to help out with that. You know, then let's look at, you know, other things in terms of vitamin C, quercetin.
I love quercetin and I love antacetylcysteine.
You know, those are the things that are, you know, to me, the big pieces.
Now, if you start...
And by the way, I take those every day.
I take all those every day.
Me too.
Now, for other reasons, I've been taking them every day, but I'm taking them every day.
So then if there's other things that start emerging, GI problems or a significant respiratory problem,
then we may get into other kinds of herbs like skullcap and some of the Chinese herbs that can be very helpful in that regard. Now, if someone
progresses enough that they're going into being hospitalized, now that's a different story in
terms of how aggressive to be at that point in time. You know, we want to be able to do things
that are really going to dampen down the inflammatory response. We're not going to want to,
you know, kind of push the whole inflammatory response because those people usually have, you know, some kind of hyper inflammation that's going
on. I'm also in the, in the big mix and, and things that we've talked about, you know, I'm
going to be using prebiotics and even a specific probiotic, you know, to be able to help modify the
gut microbiome because the gut microbiome is related to the pulmonary microbiome.
They're connected to each other. So it's really a lot of the similar things you use for prevention,
you use for treatment, and that's the way it is in functional medicine. How do you prevent
diabetes? You eat a healthy diet. How do you reverse diabetes? You eat a healthy diet.
And I think the whole idea of prevention as treatment is really a very novel
idea, but it is the basis of functional medicine, which is we don't treat the disease. We treat
the system, the human, and we optimize their health and systems. And as a result, disease isn't
able to land and take hold and dig roots. Now there's a bunch of stuff going on out there. Some of it's researched,
some of it's anecdotal, but there's some interesting therapies around the world that
are being tried that are a little out of the box. And what have you come across in terms of things
that are promising out there that we should be thinking about and researching a little bit more?
I think we've talked about this in various domains in the past.
And one of the things where I think
one of the key impacts of the SARS-CoV-2 virus
is actually on mitochondrial health and wellbeing.
You know, and we see the changes in the mitochondria
and the ability to produce energy,
you know, being significantly impacted.
Now, whether that is a direct effect
from the SARS-CoV-2 virus, or it's a side effect or a sequelae from the hyperinflammation that's
going on, we see that being affected. And we see that also in so-called post-COVID syndrome or
working with long haulers. Now, interesting to me that when we look at places like Mount Sinai and other that
are setting up academic centers for this, they're thinking about it as we have a vascular problem,
you have a pulmonary problem, you have a GI problem, you have a cardiac problem, you have a
neurologic problem, you have a psychiatric problem. And I look at it, I'm saying like,
well, gosh, there's muscle problems, and there's cardiac problems, and there's muscle problems and there's cardiac problems and there's brain problems and
gosh those are the three places that use the most energy in the body maybe this is related to the
mitochondria so when you start talking about you know other kinds of outside the box therapies
ozone and things of that nature you know that are not that there are experimental they've done some
interesting studies in italy early on looking at that but to me that they're, they're working on the antioxidant capacity
and improving the efficiency of the mitochondria so that there's energy production. And we know
that mitochondrial health and immune health are intimate, really intimately related to each other.
So that's how I, you know, take off my hat and look at,
you know, what are other ways to be able to think about this? And, you know, I've
also learned from you, you're, you're great at, you know, trying to, hey, here's a new therapy.
And this makes sense from a biological plausibility standpoint, let's try it. And let's
start doing some, you know, first some case studies and then some N of one research where
I try it and then I take it off and then I try it again, or I try a variant and I'm able to dial in
on a very personal level. Is this working or not working? Those, those case study is an interesting
thing, but an N of one study where you're actually, you know, giving a treatment, taking it away,
giving another treatment, taking it away, adding it back, adding the second, the first treatment
back, you know, that gives really powerful data to be able to understand, is there something
real going on here? Because it moves it beyond any kind of placebo effect.
It's true. And there are a lot of things out there that are being tried. And there's some really interesting early promising data on things like intravenous
vitamin C, intravenous glutathione, intravenous NAD, which is a mitochondrial therapy,
inhaled glutathione, inhaled N-acetylcysteine, which you talked about taking more early,
which we use in actually asthma. And even in some countries are even using inhaled steroids, like in Taiwan, where they're using nebulized steroids
and having incredible benefits. So there's a lot of things out there that aren't in the
traditional Western model that are actually being used and looked at around the world.
And unfortunately, not so much here. Although there again, those therapies are very
inexpensive, they're very safe, and they have the potential to be very effective. And I think,
you know, if I were putting together a whole protocol, it would include a lot of these things,
and it would be depending on the severity of each patient. Now, they're not accessible,
they're not covered by insurance, there's a lot of issues with it. But from a pure scientific
point of view, there's a lot of ways to actually address
this that are really being ignored.
And it just breaks my heart.
Even just the simple fact of telling Americans that their diet plays a role in their risk
of getting COVID and dying.
I mean, that is a huge thing that nobody can really disagree with.
And the data is there.
And yet it's not even being recommended.
It's just staggering to me.
You know, we've got Anthony Fauci taking vitamin D, but why doesn't the CDC say take vitamin D? You know, it's such a simple, simple thing, considering 80% of us are
insufficient or deficient. All right. So let's say someone gets COVID, they recover, and we're
seeing this phenomena in up to 87% of hospitalized patients. So it's probably less if you're not
hospitalized, but I see this in many of my patients who are not hospitalized, who get what we're calling post-COVID syndrome or long hauler syndrome. And it's very reminiscent of what
happened with Epstein-Barr and chronic fatigue syndrome. In fact, SARS, the original SARS,
40% of those who survived at three years had chronic fatigue syndrome. And that's a staggering
number. So what is the
functional medicine approach to looking and dealing with this post-COVID syndrome? And
what's the recovery model? Because a lot of this is in the course that's from the Institute for
Functional Medicine. And if you're a professional or you're just curious, or you want to know more,
Patrick and others were really instrumentally involved in this called Resistance, Resilience,
and Recovery, Patient Care in a Pandemic. You can go to ifm.org and learn more about it. But
tell us what you learned in that process. Well, first, I want to just give a big shout out to
our friends and colleagues, Dr. Robert Luby and Dr. Joel Evans. They were the principals behind
putting the course together. We've got over 20 different practitioners who are offering their knowledge and perspective as part of that course.
So a big shout out to them and to IFM for putting it together based upon the work of all the people
who were involved from early on. So I remember you saying one time, functional medicine is hard
to understand on the front end, but it's easy to do once you understand it. And it sometimes sounds like a broken record because I feel like I'm saying the same thing over and
over again, because it's, it's a value and obviously there's nuance. And, you know, so here
we are talking about, you know, for instance, those IB nutrients of vitamin C and, and NAC and
glutathione that are all going to have an impact mitochondrially, they're all going to have an
impact on oxidative stress. You know, it's a similar constellation of things that may actually
be used, you know, for, for cancer and for cancer scavenging in terms of vitamin C. So it's
fascinating there, but you know, with the, with the post COVID piece, I'm really focusing on
mitochondrial function and being able to mobilize and feel like that's really where the
essential aspect of it is, which as you said, is not dissimilar from the Epstein-Barr virus work
from the mid eighties with Paul Chaney and others in terms of what do we do? How do we actually help
those people who have some kind of post viral fatigue syndrome. And that one of the
interesting things and I've heard I've heard people say early on, oh, you know, this is a
nothing, you know, you know, half of the people who get it have hardly any symptoms at all,
I'm just going to get it and let's bounce up the herd immunity. But when you start looking at like
the German data that said 67% of the people who have had symptoms, only half of whom
were hospitalized, but 62 thirds of the people who had symptoms ended up having structural changes
on cardiac MRI three months out from what's going on. So that's terrifying to me. That's terrifying.
There there's significant alterations and why, you know, people are saying,
well, let's, let's get to the vaccine. And like,
I think the vaccine can be a good thing, but let's actually ensure let's,
let's know what's going to happen with it. Let's do the science, you know,
to see how long the antibodies last. And are there any side effects?
There's a difference between a study that looks at efficacy,
which is the gold standard
versus effectiveness.
How does it really work in the real world?
And so these 91 and 94% rates of benefit, we don't really know what's going to happen
in the real world, but those numbers were much better than anyone expected.
That being said, those mRNA viruses or vaccines have never, ever been used before in human beings. We don't know what I want to highlight is that what you and I are talking about is not either, or it's both. And, you know, so
when we're, when we're working with, you know, someone who's, who's severely ill with COVID or
who's got post COVID syndrome, we want to be able to take the best tools that are available,
but we want to be able to highlight those things that are going to really add emphasis in where I'm going with the patients that I'm seeing at this point in time
with post-COVID syndrome. And I've got a number of them now is really focusing on immune activation,
using mushrooms, using those kinds of things to help support their immune system, to reactivate it, as well as, um, as mitochondrial support and whether that's, uh, NAD, um, you know, various
vitamins and acetylcysteine CoQ10. Um, you know, there's a, there's a whole array of different
components that, that get built into that phosphatidylserine and others. And so I use products that are really focusing on that PQQ,
as well as CoQ10 and CoQ2. All of these things, you know, like we talk about CoQ10, I just,
maybe I'm getting too wonky about it, but you know, I heard about CoQ10 for a long time.
All of a sudden it's like, oh, this actually is the thing that carries the electron in the mitochondrial membrane that helps you to be able to create a waterfall, a waterfall. So
you can make ATP. And it's like, and of course, if it's deficient, you're going to have a problem.
And don't you want to optimize, make sure you got enough of that. It's just an example that
when you look at it, it makes so much sense.
Why aren't we doing this as standard of care? And you asked that as the question early on. And, you know, I think that, that there's just so much that we don't know. And the aspect of how powerful
nutritional interventions are, has been downplayed during the time that we've been in our medical training.
And in fact, they're unbelievably powerful.
And so I come back to the dietary aspects, really ensure that there's not high glycemic
foods, you know, no processed foods and focusing on good fats and good, good, pure amino acids,
clean amino acids or proteins that people are taking,
doing that, and then focusing on the immune system and the mitochondria. That's where I go.
I do believe that it's going to be a combination of foundational lifestyle therapies, diet,
exercise, sleep, relaxation, stress reduction, and then all the same nutraceuticals that you do
to prevent and treat it. And then for people that get stuck, I think there are adjunctive therapies like intravenous therapies of IV and AB,
IV vitamin C, IV glutathione, phosphocholine, and even things like ozone can be extremely effective.
Intravenously, there's also peptides and exosomes and a whole category of things that are used to
help people break the
cycle. And I've seen these therapies work in a number of patients. So I'm hopeful. I think there
needs to be more research on this. We need to move forward. The challenge is that I don't think that
many people are funding any research on this because it's not like at the end there's a
product or a drug or a vaccine that's going to make billions of dollars. So we're kind of stuck.
But I do believe that these therapies are out there now that they're available, that there there's enough evidence to create a
rationale for their use and that they're safe and potentially very effective. And one of the
things I wanted to add, I agree with you a hundred percent. And we also find that these people who
are having, let's say the post COVID syndrome, they have other underlying issues that are going on.
They have other underlying triggers and it may be related to, you know, heavy metal toxins or
organotoxins or mycotoxins or hidden infections or antigens or celiac disease or some other process
that's going on that has to be taken care of and looked at also. It's not like you're just going
to treat the post COVID separate from everything
else that's going on in their body. And so we've got to, we've got to dig into what is the root
source. And, you know, the way I think about it is I talk about, you know, those, those roots of
the tree, which are the intrinsic aspects of our lifestyle, but then there's the soil, right? It's
the exposome. If you're exposing the roots of the tree to poor soil, you're not going to be able to get
healthy. And that's where we want to bring our focus. So let's not forget that the environmental
side of it as well. Absolutely. I mean, when you're bringing up Patrick, it's really important
is that the body is a system and there are a lot of things that perturb or disturb the function of
that system. And functional medicine is about finding out what those things are that disturb
function. What are those things that optimize and enhance function and getting rid
of the things that are making your machinery gummed up and providing the things that help you
run optimally. And I think that's a very unique model. It's not something that we
learned in medical school, but it is really the foundation of functional medicine.
And it's super powerful for all sorts of things. And I believe that this is where functional medicine will shine as we start to see millions of people
with post-COVID syndrome. I mean, you know, if you're talking about, you know, 67% of patients
who have consequences, and we've got, let's say, 11 million people now in America. I mean, you're talking about seven plus million people with some
complication that makes them have a lower quality of life and some disability. I mean,
that's terrifying to me as a physician on the front lines, seeing how difficult these patients
can be and the need to really come up with a plan. So I'm just really in awe of the work you and IFM has done
to put together a strategy for clinicians.
And hopefully that'll lead to more information for patients
about how to prevent, treat, and recover from COVID-19.
So thank you for all that work.
I really appreciate it.
And so do millions of others.
Now I want to shift gears a little bit
and take it down a little personal journey of
health.
Now, both of us have learned so much by our own health struggles, unfortunately, or fortunately,
and has led us to discoveries that we probably wish we didn't make, but ended up actually
being for the better.
There's always a silver lining, or you can't always understand the evolution of your soul's
journey and why you end up getting the challenges you do.
But a couple of years ago, you were diagnosed with stage four laryngeal cancer, which is a big deal.
It's a serious cancer.
And the treatments are rough.
And, you know, it forced you to look at how to address this for yourself,
not only in terms of the medical treatments,
but in terms of your lifestyle and many other things.
So can you share a little bit about how you applied your knowledge
of functional medicine to your journey and how it's unfolded for you?
And you recently presented an incredible lecture
at the annual conference
of the Institute for Functional Medicine, where you went through the science around what you did,
which led to an incredible recovery and actually looking at you and knowing you for many years,
you're healthier now than I've ever seen you in my entire experience of you as a friend.
So I just sort of blown away by, by what you've learned and what
you discovered about, about this journey, about how to deal with cancer and how it could apply
to many other people with cancer. I'm just going to rest in that one for a minute because it's,
you know, the personal journey and, and I've watched you, you know, and for as long as I've
known you, I've heard, you know, the stories of, of being
poisoned and, and what you had to do to move through it. And I was always kind of like, man,
I'm glad I don't have to learn things. Be careful what you say. Yeah, exactly. So it's interesting. Uh, I was reflecting on it, um, this morning, um, two years ago tomorrow,
um, I had the biopsy, you know, two years ago, Friday, uh, I had the results, you know, that
they give you that. And, you know, I've said, I don't, I think if they had said I had stage three,
I would have said, eh, I can deal with this. I can, I got this, you know, and, and like stage
four, you start looking at it and, you know, it's like, I didn't have the risk factors,
you know, I kind of fit outside the box. So while head and neck cancers, you know, are not,
are not prominent, you know, of the kind that I had with no risk factors, it's like, oh, you're
in like 2%. That's the highest risk of this. And, you know, I'm still working. What does stage four mean? What does stage four mean?
Stage four means, it means, it means non-laser cancer. So there's a growth and, you know,
I got to see it on my, you know, the side of my vocal cord right there. And, but there were also
lymph nodes and that's what I felt initially. I felt a lymph node, you know, like a couple of
days before and it was hard and I'm like, oh, that's not good. It's not tender. And I
thought, Oh, maybe I'm coming down with a cold, you know, but the next day it was still there and
unchanged. And so I went in and was seen right away. So I had lymph nodes that were positive.
One of them, the one I felt was pretty big, greater than three centimeters.
And there were actually a few small lymph nodes on this side that they picked up on the PET scan. You know,
so it's, it's spread metastasis. So what that means is, you know, well, there's a tumor and
then there's spread. And generally when there's spread beyond the original tumor, that's, you
know, kind of in a generalized term, that's going to be a stage four cancer because it's all, it's,
it's, you know, the horse is out of the barn can't just cut it out so um i i got that and uh
i'm you you mentioned that i've been working with the widadica people the weechel people
and the sierra madres for the past 20 years and have been initiated. And I'm right now
preparing to go back down to go to some sacred sites and be able to make my offerings and say
prayers, the power of that. But I was planning to go down and the doctor said, well, look,
you're going right away. It's not going to change our timing of when we would give you chemo and radiation therapy.
So go for it.
So that was part of the process.
And for me, that was a huge part of the learning of being able to begin to receive help from
other people.
You know, I'm like a, you know, a bull, you know, I'll just put it on my back.
I'll carry it.
You know, I can do this. But now this was, okay, I'm not a bull. I'll just put it on my back. I'll carry it. I can do this.
But now this was, okay, I'm not helping anybody.
I'm receiving help from people.
And it was a huge lesson for me.
And then lessons also about bringing my voice forward about this part of myself that is
the tender, vulnerable aspect that within medical science, it's like, I'm going to show my armor and how strong I am.
You know, I'm never going to show that I'm weak.
But, you know, here I needed to be able to reveal this aspect to myself and to others.
And that was an important part of the journey. So when we talk about the functional
medicine model, and we talk about looking at antecedents, triggers, and mediators, I'm like,
I don't really have any major antecedents, you know, any genetics, any of the major risk factors
that are going on, you know, but there were triggers. There was like a lot of stress in my
life and a lot of trying to carry things all myself and not bringing my voice forth. And, you know, and even though I was doing good things, it wasn't the whole expression of who
I am. You know, few people know all these aspects of me, you know, and like they say, your friends
are the people who know you for who you truly are and like you anyways. But the, you know, it's like, oh, I can, I can
actually reveal myself. So those, that's a huge trigger, for example, you know, of imbalance.
What is cancer? Cancer is growth out of control. And it's also the invitation for transformation.
It's like, if you get that and you say, wow, I'm doing things that are so
unbalanced, how do I actually transform to what's going on? And so that was the seed of the change
of beginning to like, oh, I can live my life in a different way. In fact, if I want to live,
I have to live my life in a different way. And I don't really have a choice.
Now, within that, there's also, and I have no idea and I can have no expectation that
doing any given thing means I'll be healthy and fine.
And so dealing with that degree of uncertainty, you know, and so I did my thing.
You know, I talked to doctors at, you know, Stanford and MD Anderson and Cleveland Clinic
and Mount Sinai and Hopkins and in Israel and Mayo and one other, I can't remember,
UCLA, you know, and they're all saying the same thing.
And so I got to, okay, I need to actually do chemotherapy and radiation therapy.
That's going to be important, you know, but what are other things that I can do?
And I began to, you know, take my knowledge of nutrition and talk to the top people.
Now I would say that, that the people I talked to said, oh, you know, ketogenic diet, this
is what you need to do.
And this is a great thing.
And I've already prescribed that for patients had done it myself,
felt comfortable with it. We'll doing that while getting two feeds, because I may not be able to
swallow because of the radiation therapy. That's a different thing of trying to get a high fat diet
in through a tube, in through a feeding tube. And so we, we, I say we, because my wife, Lisa was
right there beside me.
Like, how do we figure this out?
Now it turns out that, you know, a ketogenic diet is not the answer for every kind of cancer, but it's really good for cancers where you're doing radiation therapy because it makes the
cancers much more radio sensitive because you're pulling all of the sugar out.
And, and so you have this
differential stress response. And so I'm like, Oh, that makes perfect sense. And so we did that.
I did that with, with them and vigor. Um, and as it turned out, I only lost like three pounds,
you know, through the whole thing and, and didn't have to use the
feeding tube very much at all. I used it because you just can't taste any food when you're getting
radiation and food, just, there's no taste. So you're just like taking food to, to, to get the
nutrients, but it did that. But I also did another thing, which was working with fasting before chemo and the work of Dr. Walter Longo.
And so we see all of the fasting mimicking diet stuff that's coming out now, but that's actually
all derived from their original work in the early 2000s up to 2009 of working with cancer patients
and saying, if we stop giving food before chemotherapy and the chemotherapy,
then that's going to slow down the metabolism of the normal cells, but the cancer cells aren't
going to be able to slow down their metabolism. And so the cancer will be more sensitive
and the normal tissue will be less sensitive. And so we get better tumorigenic effects or
tumor lysis effects, and we have decreased side effects from it. And so I went through that.
People are saying, really, you're getting chemo every week and you have a feeding tube
and you're eating keto and you're not eating any food for two of those seven days.
And you think that's going to be okay. Like, I don't know,
but I'm going to try it. And turns out it's very okay. Well, as a, and as it went through the
whole thing, through the radiation therapy, people were like, you're Irish. You like should be having
major burns from the radiation. Why is that not happening? Why are you still eating? Why are you not, why are you not losing weight?
You know, and they look at me and I share with them and they'd say, probably not.
Don't confuse me with the facts. My mind's made up.
Right. So anyways, the essence of functional medicine is being able to say, let's look at what's going
on here. Let's see what the triggers are. Let's see how I can work to modify lifestyle, to slow
down, to take time in nature, you know, which has this great effect that also is going to actually be a anti-cancer effect. You know, we can see that the,
the, the forest bathing increases the immune system and decreases, you know, the risk of
cancer. That's, that's data that's, that's actually published in Japan in 2009, you know,
so like that's already known there. So spending time listening, working with the lifestyle aspects to be able to do that and
working with the nutrition and working with, you know, the, the medicine that was there,
the radiation and chemo.
And so bringing all those together and, and focusing on, on the person, the mental, emotional
and spiritual aspects that are inside the middle of it.
Like that's what functional medicine is so you've heard me talk and i've heard you talk about you know tibetan
medicine and you know and that is you know an aspect of each of these other systems of healing
takes the whole person into account and they're looking at what are the therapeutic approaches from illness to wellness
across the whole continuum. And the mindset, the approach is similar. Now the specifics are going
to be different, but, but the mindset is going to be similar. So, you know, I took those nutritional
pieces and, you know, I went through it was seven weeks of radiation every day. And, you know, I went through, it was seven weeks of radiation every day.
And, you know, chemotherapy every week. And, you know, PET scan was negative,
you know, at three months and at 12 months, and the next one will be in a couple weeks.
But, you know, I get scoped every couple of months. They, you know,
it was two days ago, they looked down, you know, no lymph nodes, nothing going on. And I feel great
and I have to continue to work with it. And, you know, also, you know, I shout out to our
mutual friend who you introduced me to Nalini Chilkoff, who has been helping me along the way, you know, as, as a,
as a guide, you know, to be able to remember, not only remembering the aspect of,
of the nutrients and how to be able to optimize the terrain, optimize me, but also to help me,
you know, help me with my heart in the process, because after, you know,
cancer, this is a hard one to say, but you know, so after cancer, you know, it's like, okay,
what is my life? Where am I going? And, and then what happened in the experience with,
with, you know, working with IFM and being called to jump into helping with COVID is I did
what I've done before. And I just like put everything into it and it was great and helpful,
but all of a sudden it's like, oh, I'm out of balance again. I'm not actually caring for myself.
And so, and so how do I live the life, my life in this world in balance?
And those are lessons that I'll be continuing to learn.
But I feel like being able to begin to talk about it out loud and to be able to share
the importance of having balance in life and being able to connect to myself and to each other and to the
natural world in a way that is bringing balance. And that's part of what COVID is teaching us as
well. So I tie these two things together because they're really like both messengers of uncertainty
and you think you have certainty in the world and you don't, you never have. And if you think that
you're supposed to be certain about what's going on, how anxious anxiety provoking is that? Like,
I got to know everything about everything ain't going to happen. You know? So how do I rest into
the mystery? You know, there are guides and spirits all along the way who will befriend us. Like that's the conversation I'm interested in and being able to explore that, which also fits within this big picture that we
call functional medicine and feel blessed because to me, you know, it's like the modern day
manifestation of Tibetan medicine of bringing all these elements together to make sense of it.
Yeah, it's so true. It reminds me of the great spiritual teacher, John Lennon, who said,
life is what happens when you're making other plans. And I think that happens to all of us.
And it's really rare for someone to stop and take stock and look at their life and go,
wait a minute, I need to change everything. And I've seen people have quadruple bypass,
get their chest cut open,
be in the ICU for a month with infections, and then go back to eating the worst diet in the
planet and not thinking anything of it. So it takes a very special kind of human to go, wait a
minute, my life's out of balance. I need to focus on how do I recreate balance? How do I take
advantage of the science of how to be healthy, which you did. And you. Yeah, me too. Yeah. And I, you know,
I've, I've, I've had to do that and I continue to do that. It's a constant journey. And I,
I think it's a lesson for all of us with COVID that we need to sort of stop and take stock and
see what matters and what we care about and what, what's meaningful and let go of the things that
aren't. And we live in such a consumptive driven, fast-paced culture that just stopping and being is really hard for a lot of us.
And I'm really looking forward to the next little bit where I'm going to be dropping down into that.
And I've been listening to an audio book called Becoming Nobody.
And it's really about just being. And some of the things you're talking about is sort of right-sizing your relationship
to your life in a way that you can still be engaged and productive, but also you don't
lose yourself and you become nobody, which is really meaning you become your higher self,
not your lower self, which is what we're all so often operating from.
And I think I really saw how it shook you up and, and transformed
you and you were very humble in how you began to ask questions about what's out there and
what could help.
And, you know, I think the, the spiritual lessons that were in it for you were profound
and also the, the biology that you uncovered that you sort of revealed in the lecture you
gave at the Institute for Functional Medicine around ketogenic diets and cancer, both in
terms of improving,
just going through the chemo radiation experience,
but also improving outcomes and reducing recurrences
and increasing survival from cancer.
So I think we're on the verge
of an incredible era in medicine.
I think functional medicine has been at this for a while,
starting to get recognition.
And you've been such a central piece of that, Patrick. And I'm just really honored to know you, call you my friend,
my colleague, and to, you know, have your wisdom that is really informing this overall movement.
And then I just really thank you so much for what you've done and what you continue to do and
for being on the Doctors Pharmacy podcast. Well, Mark, you know, I know that, you know,
our friendship and, you know, as you know,
like we've had ups and downs, we've fought against each other, we have different opinions. And,
and we stayed in the conversation, you know, to be able to learn from each other, you know, to
not not assume, you know, that I know more, or and to be able to find our own voice and our own ways of being able to bring this
medicine forward. Because ultimately that's, you know, that's what I'm interested in. I know that's
what you're interested in, you know, and, and to watch the arc of how, how you've done that
is beautiful to be able to see and bringing new ideas forward and championing that in ways that,
that I feel like I could never do that, but it's like, it's not my, that's not my job. That's Mark's job. He's doing that, you know, and I'm,
and I'm doing something different and, you know, being, you know, as each being able to find,
well, what are the gifts that we, we bring forth and, and continue to deepen in what that is.
Cause it's not like, okay, got there. Greg Plotnikoff, a friend of both of ours,
you know, said, you know, that when you turn 60, that's when you could begin to actually,
everything else has been a dress rehearsal. Now, what are you going to do to bring it in the world
to really manifest the essence of who you are and how you do that. And, you know, these, these birthdays for
us are, are, are pivot points, you know, that helped to demonstrate like, wow, I, I actually
have something to give and I want to be able to give and offer that in a way that it can be
received. And it doesn't have to do with me. It's like, I'm, I i'm i'm receiving all kinds of support along the way and my job is to
be able to find a way to share that in a way that is a benefit to people and uh that's a that's a
great opportunity like how blessed am i uh and are we to be able to have the opportunity to be able
to do that and share that with other people. So true. Thank you, Patrick. Such a beautiful closing thought. If you've liked this podcast,
I encourage you to share with your friends and family. If you know people with COVID or who are
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Hey everybody, it's Dr. Hyman. Thanks for tuning into The Doctor's Pharmacy. I hope you're loving
this podcast.
It's one of my favorite things to do
and introducing you to all the experts that I know
and I love and that I've learned so much from.
And I wanna tell you about something else I'm doing,
which is called Mark's Picks.
It's my weekly newsletter.
And in it, I share my favorite stuff,
from foods to supplements to gadgets
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It's all the cool stuff that I use and that my team, to tools to enhance your health. It's all the cool stuff that
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forward slash pics, P-I-C-K-S, and sign up for the newsletter and
I'll share with you my favorite stuff that I use to enhance my health and get healthier and better
and live younger longer. Now back to this week's episode. Hi everyone. I hope you enjoyed this
week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is
not a substitute for professional care by a doctor
or other qualified medical professional.
This podcast is provided on the understanding
that it does not constitute medical
or other professional advice or services.
If you're looking for help in your journey,
seek out a qualified medical practitioner.
If you're looking for a functional medicine practitioner,
you can visit ifm.org
and search their Find a Practitioner database.
It's important that you
have someone in your corner who's trained, who's a licensed healthcare practitioner,
and can help you make changes, especially when it comes to your health.