The Dr. Hyman Show - The Love Diet: Healing Through Community with James Maskell and Tawny Jones

Starting point is 00:00:00 Coming up on this week's episode of The Doctor's Pharmacy. When you can turn people from doer to teacher in a short period of time, I think you have the basis for really an exponential transformation. Hey everyone, it's Dr. Mark Hyman. I have a goal to live to be 120 and I want to do it well, so I'm always looking for ways to support my mitochondria. You might be thinking, what's that? Well, mitochondria are your energy powerhouses.

Starting point is 00:00:27 They convert food and oxygen that you breathe into energy that you use for everything in your body. These mitochondria are also easily damaged. Things like sugar, processed food, toxins, allergen stress, and more all damage your mitochondria on an ongoing basis. And these problems all cause inflammation, which harms our mitochondria and makes us age faster. Ever wonder why little kids run around like the Energizer Bunny? And as we age, we slow way down? Well, it's all based on the health of our mitochondria. You see, aging has been called inflammation. Our mitochondria are damaged and stop functioning optimally as we age. And that means less energy and more free radicals or oxidative stress that creates a vicious cycle that leads to inflammation and aging. But I found an amazing new tool that makes it easy to support healthy mitochondria and fight inflammation.

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Starting point is 00:04:52 Welcome to The Doctor's Pharmacy. I'm Dr. Mark Hyman, and that's pharmacy with an F, F-A-R-A-M-C-Y, a place for conversations that matter. And if you've ever felt that it's hard to change your behavior and get healthy, this is the conversation that matters for you. And if you've ever felt that it's hard to change your behavior and get healthy, this is the conversation that matters for you. And the reason is we have two extraordinary guests, James Maskell and Tony Jones, both colleagues of mine and friends who are revolutionizing the way we think about delivering healthcare, not just what we do, but how we do it. And that matters because we are a nation that's sick and fat and getting worse every single day.

Starting point is 00:05:27 And the methods that we treat patients by, which is the one-on-one doctor visit just ain't working. Now I want to introduce Dr. Maskell. I mean, Dr. Maskell, I think he was a doctor. He's always talking about functional medicine, but he's actually not a doctor, but he should be. He's an entrepreneur. He's an advocate.

Starting point is 00:05:41 He's basically a business guy who understood the power of functional medicine and has been tirelessly, selflessly promoting functional medicine across the entire ecosystem in ways that I just think are fantastic. He's created something called the Functional Forum, which I've been on, and it's a world's largest functional medicine conference with a record-setting participation online. It's growing communities around the world. His organization and book of the same name, Evolution of Medicine, prepares healthcare professionals for this new era of predictive, preventive medicine. He's an in-demand speaker.

Starting point is 00:06:16 He's being featured on TEDMED, HuffPost Live, TEDx, as well as lecturing internationally. He lives in Sacramento with his wife and daughter, who are both very adorable. And Tawny Jones is my colleague here at the Cleveland Clinic. She's our administrator at the Center for Functional Medicine. She took a leap of faith, joined our team, and has been running full speed ever since in helping us to build from six people to almost 40 people and being one of the leading lights in the organization.

Starting point is 00:06:42 She's served here at Cleveland Clinic for over 19 years, is an incredible leader. And she heads up our center, which is not just about providing one-on-one care. It's about providing care in the community, about providing care in a different type of way. And she spearheaded the development of the Functioning for Life shared medical program for chronic disease. She's also on the African American Play Resource Group steering committee and is committed to helping minorities achieve their health career goals

Starting point is 00:07:09 and addressing health disparities in the community. So we're doing a lot of cool stuff in the community. We're going to talk about it. But I want to just start by telling a story and welcome James, welcome Tani. I want to tell a story because the reason that this is so important is because we can't solve our health care crisis by doing it in the traditional way. It's not really solved in the clinic. It's solved in the community. And unless we understand that behavior change is driven by our peers, by our friends, by our family, by our faith-based communities, we're really not going to

Starting point is 00:07:47 solve this burden of chronic disease. Just giving people more meds and running them through the healthcare system is not happening. And it addresses some of the biggest issues that are barriers to people changing their behavior. I mean, I know how to cure someone's diabetes through functional medicine. I know how to cure autoimmune disease and get people better from all sorts of chronic issues. But unless they do the things that I'm asking them to do, they're not going to do it. And the question is, how do you change behavior? And that's really at the key of functional medicine, which is a science of not only how to create health, but also how to change behavior in a way that's positive. And I came to this from my personal experience, which was as a functional

Starting point is 00:08:23 medicine practitioner, seeing thousands of patients over decades, you know, I had a lot of motivated patients and I was very motivating, but I was really into the minutiae. I was studying mitochondria and inflammation and metabolism, biochemistry, genetics. And I was just really in the weeds on trying to figure out how do we create a healthy human. And then one day i got this phone call uh after the earthquake happened in haiti and all of us had seen the television shows about the tragedy there and the 300 000 dead the 300 000 injured no services nobody was there and it was just like in the immediate aftermath and i wanted to go i was an er doctor trained in the

Starting point is 00:09:01 past and i wanted to go and i was married to an orthopedic surgeon at the time and we're like let's go but we how are we going to go so the airports are closed there's no flights in and out it's complete chaos and disaster and one of my patients emailed me and says hey you want to go to Haiti today and I'm like normally I would ignore it but he was a billionaire and he had his own private jet so I said okay so we pulled together a team went down there and it was it was a powerful experience. But I met this guy named Paul Farmer who was one of the pioneers in rethinking how we deliver healthcare in Haiti and around the world. And he, he basically said, you know, we should not give up on these populations in Haiti

Starting point is 00:09:39 that are super poor, underserved. It's the poorest country in the Western hemisphere. AIDS and TB were rampant in these communities and they were poor black communities that you know the rest of the world sort of gave up on and he's like no no we can change this and he said we have to understand that that it's our community that matters these people didn't have clean water they never watched you know i think they're tb meds or aids meds. And so they were really at a loss for how to fix this. And he's like, we need to help each other. So he created a model of healthcare called accompaniment.

Starting point is 00:10:12 We accompany each other to health. And he trained community health workers, people's neighbors and peers to make sure they went and take their medication. They had clean water. They had a watch. Basically basic simple things that weren't better drugs or surgery. And then I realized as I thought about this that he did it for infectious disease, but that chronic disease was also contagious. You know, we talk about this in the medical world as NCD or non-communicable

Starting point is 00:10:38 diseases, but that's absolutely wrong. They are communicable. And we know, for example, that if your friend are overweight, you're 170% more likely to be overweight than if your family member is overweight. Yet it's your social networks that are more powerful than your genetic networks in determining your healthcare and your health outcomes. That your zip code is a bigger determinant of your health than your genetic code. And so I began to think about this and I had, you know, read this book called Turning the World Upside Down, which was written by the head of the National Health Service from the UK, Nigel Crisp. And essentially the book was in order to solve our

Starting point is 00:11:17 first world problems, we need to learn from the developing world about how to put people and communities at the center of healthcare, not doctors and hospitals. And then this guy walks in my office, Rick Warren, who's the pastor of this big church in Southern California. And he's just like, well, I want to get healthy. I'm like, great. He was really overweight. I said, how about we have dinner after? He's like, sure. So we had dinner and I'm asking about his church. I'm like, I'm a Jewish doctor from New York. I don't know anything about evangelical churches in Southern California. So what's going on? He says, well, we got 30,000 and I'm asking about his church. I'm like, I'm a Jewish doctor from New York. I don't know anything about, you know, evangelical churches in Southern California.

Starting point is 00:11:47 So what's going on? He says, well, we got 30,000 people. I'm like, oh, 30,000 people. He's like, we meet five, every week in 5,000 small groups to help each other live better lives. And I was like, oh, this isn't a mega church. It's thousands of mini churches. So we created this program called the Daniel Plan.

Starting point is 00:12:02 I said, why don't we put in a faith-based wellness program? And he's like, great. Because I was baptizing my church last week. And after the 800th one, I'm like, we're fat. I'm all fat. We better do something about this. So we created the Daniel Plan. We thought a few hundred people would show up. 15,000 people signed up. It was bigger than anything they'd had the church, the 9-11 service, the Obama-McCain debates. They turned 2,000 people away. And after a year, people working together in small groups without even a health professional, they literally just had each other with content

Starting point is 00:12:32 and a curriculum and a little video. We created a year long course, initially it was six weeks. They lost 15,000 pounds, they reversed all sorts of diseases. One guy came up to me and says, you know, I was in the hospital nine times and on 10 medications, now I'm on one medication and I haven't been in the hospital all year. And I began to realize this is the solution for healthcare and we need to do this and we need to scale it. And we call it the Daniel plan. I wanted to call it the Jewish doctor's guide for Christian wellness.

Starting point is 00:12:57 We won the Christian book of the year award, which is pretty awesome. But it really led me to, to rethink how we need to take functional medicine and not just deliver it one-on-one in clinics, which can be very expensive and very difficult. But for 80% of the problems, functional medicine delivered through groups can be a powerful model for transforming people's health. And so when I got to Cleveland Clinic, I'm like, okay, we need to set up a system where nobody sees the doctor first. They go into a group for 12 weeks to get a lifestyle

Starting point is 00:13:25 change program. And then if they need to come to see us, they can come. But that didn't go over well at the beginning, but it took a few years and I got Tawny to actually get on board with this idea. She loved it and she literally took it and ran with it. And then we developed this incredible program here called Functioning Life, which we'll get in to as well. And I've talked to James about this over the years, and he just wrote an extraordinary book, which is coming out January 14th. You can pre-order it now. It's available. You can actually, it's going to be free from January 14th to the 18th. So you don't even have to pay for it if you don't want. And you can get on Amazon. And it's really a powerful description of how the community is the cure.

Starting point is 00:14:06 And it's called The Community Cure, Transforming Health Outcomes Together. And I always say, you know, getting healthy is a team sport. We do better together. And that we need to think about that as the future of healthcare. So let's talk about, first, James, how this epidemic of loneliness and lack of social support is such a big health risk factor and how people who are lonely visit health centers four to six times more than those who are not and visit emergency rooms two to three times more often. So loneliness is actually a huge risk factor for disease.

Starting point is 00:14:42 So tell us about Jeffrey Geller and how he first started medical groups and what you've learned about this. Yeah. So this story is beautiful because it encapsulates so much of what you just said. So here's a doctor starting residency and starting to realize that health isn't all about drugs, right? And starting to realize there must be more to health than that. And he starts to see patients who have drastically different outcomes, even though they have the same condition. So what's causing that? And at the same time, as he's starting to think about that, you know, he starts asking around, he's like, Hey, what do you think doc? And they, everyone agrees, right? That loneliness is a problem, but there's no billing code for loneliness,

Starting point is 00:15:18 right? So they're all, they don't know what to do. And I'll moderate, severe loneliness. No, we don't have that. Exactly had that exactly yeah so you know he at the same time he gets invited to a group by one of his patients because his patients see that he is burned out tired like first year resident not sleeping not doing that well and it's called it's a group of immigrants who are mainly uh not insured and it's called c2 puertas which is yes you can and this is just an empowerment. Si Tu Puedes. Exactly. Just an empowerment group of people. And he comes in and he's like, you know, he doesn't speak Spanish. So they're like, oh, we'll teach you Spanish.

Starting point is 00:15:51 And he teaches them some health. And straight away, he realizes that these people are getting more from each other than anything else. So this empowerment group is really focused. And so that formed the basis of his first group visit. So he went, he got some funding to start a group, started a group, brought people in. And, you know, through that journey lot along through the journey. And one of the key things I think that he learned that I think is really important is that at the beginning, because he was the doctor, he had the answers, right? And he was telling people what to do, eat this, not that, do this, not that. And over time, one of the things that he saw-

Starting point is 00:16:39 Like doctors like to do. Yeah. So one of the things that he saw was that, you know, he started this other group of friends after three years after that group starts, by the way, some of those groups are still going 20 years later. So after three years, the friends and family all want to join. There's like, well, we don't have a CDC grant for that. You can't just come in because we're in the middle of a study, but we've still got the space afterwards. Why don't you just come in afterwards? And they couldn't afford the Tai Chi trainer and they couldn't afford the cook. So they're like, well, what do you guys want to do and they're like we're going to do salsa

Starting point is 00:17:07 dancing because that's what we like to do now all the people in the first group are like hey that group looks way more fun than our group and what he started to realize was that if you let people come up with the ideas themselves they're that much bought into it right they're that much more engaged into the process and so you know that process has just led and now you know dr geller teaches this at integrated medicine for the underserved and you know thousands of doctors have gone through that training in his empowerment model so it was a there's so many amazing stories in this space and and so much of what you said is so true but i think they do that outside the health care system or within the health care system you know he was working in federally qualified health care centers so this is for people on medicare and medicaid these are the people you have to worry

Starting point is 00:17:47 about billing because it just gets paid and exactly you can do whatever you want creatively because it's not in the traditional yeah exactly out of the fifa service dealing with you know very impoverished part of boston and um you know it's been been exciting to see that but as i started getting into this book i wanted to learn everything so you know i've been here last year to see that. But as I started getting into this book, I wanted to learn everything. So, you know, I'd been here last year to see what you guys were doing at the Cleveland Clinic. And just in the last year, just spent as much time as I could interviewing anyone, everyone who was doing group visits in every conceivable way, just to see what was out there. And it's been a really great journey. So amazing. And, and how does treating loneliness for those groups help reverse chronic illness?

Starting point is 00:18:24 Well, first and foremost, you know, loneliness drives social stress, such a big driver of all-cause mortality. I think there's science shows that, you know, that it can be a bigger driver of mortality than what you eat and smoking and exercise. So it's dealing with it because you're introducing, creating new relationships for each other. But also what we found and what you see all the time is that that group structure is the best place to activate the healthy behaviors that you talk about on this show. Otherwise, that's the only way to have accountability of a group.

Starting point is 00:18:55 And so those two things together are a really powerful combination. So you visited groups, you tell us a little about your first encounter with a functional medicine group visit. Yeah. So six years ago, I spoke at a conference and another one of your colleagues, Dr. Shilpa Sachs in it. Oh, yeah. She had come up with a group visit model and she shared about it.

Starting point is 00:19:14 And straight away, I thought, this is amazing because I'd been in this world already for eight years and I saw doctors doing long one-on-one visits and I could see the potential for chronic disease reversal. But what I couldn't see was the potential for chronic disease reversal at scale across a whole population with that model. Yes. Right. So not enough of us, there's too many sick people. Exactly. And, you know, an hour with doctors or an hour and a half, it's just, it's not quite efficient enough to get us there. And so I thought, okay, there's some real efficiency gains by doing a one-off group, right? If you have, you know, if you have type 2 diabetes, sit around, learn how to eat and speak one-off.

Starting point is 00:19:49 But I always thought there was way more potential if you could actually get people, you know, to build relationships, right? Where there was real value in the peer-to-peer, not just efficient delivery of information, but recreating friendships, creating groups. And then this time last year, while I was on my bus tour, we came to Cleveland. I saw what you guys were doing. I saw, you know, the functioning for life. And I was like, this is it. Yeah. Fantastic. How about you, Tony? You, you, uh, came in here and you're an administrator in the hospital. You've been here for 19 years. I mean, this is not how things happen here. I mean, we don't, we don't do this here. Really.

Starting point is 00:20:24 There's, there was an impetus for shared medical appointments, but not in the way that you thought about. So how did you sort of get excited about this? And how do these group visits work? And why do patients benefit from it? Yeah, so the Cleveland Clinic has actually been doing group visits since 1999. And today, there's about 200 different shared medical appointments facilitated by about 100 practitioners. And so the idea of bringing groups together is not a foreign concept. We kind of jumped on the bandwagon as the industry shifted. However, doing it with a functional

Starting point is 00:20:59 medicine approach, this multidisciplinary- Nobody does it like we do it. Absolutely not. We're the gold standard in shared medical- It's true. Everybody's been looking to us. How do you do this? How. Nobody does it like we do it. Absolutely not. We're the gold standard in shared medical. It's true. Everybody's been looking to us. How do you do this? How are you doing? So we're going to set the bar a little bit higher for this type of initiative. And what we have done is embedded, obviously, lifestyle and behavior change, the medical management component. But the most powerful piece of it is the medicine that happens in the room amongst the patients. The community is medicine. The community is the medicine.

Starting point is 00:21:29 Who is medicine and who is medicine? Yes, absolutely. So patients walk in the door with an expectation, the doctor is going to cure me. He is going to heal my condition. And what we have done is shifted that thinking to say, actually, we're going to heal each other in this group setting. And we're all going to be part of the strategy for getting ourselves better. And they can not only do that here at the clinic, but they can adapt that same mindset in the communities they live in with their families,

Starting point is 00:21:54 with their friends. So you're absolutely right. It's a unique way of thinking and a unique approach for us, but it's peer-based learning that is the strongest component of it. I think that patients who are in the room listening to each other's stories can now put their own issues into perspective. That's not something that you get in a one-on-one visit. They learn self-management skills. Again, physicians think when they give the patient a treatment plan that that's adequate training and knowledge for that patient to walk away with and implement those changes. It's not. It's been proven again and again that it's not. And they're also learning from those practitioners who they otherwise, you know, wouldn't have asked those questions or wouldn't have considered certain aspects of what they're being asked to do to change their health. In addition to that, now, as James said, they have this new network of individuals, you know, people who share the same concerns, issues as they do. You as a physician don't know what it's like to potentially have diabetes because you don't have it.

Starting point is 00:23:10 But this person across from me does, and they know how difficult it is for me to be around my family and they're eating unhealthy, how to go to social settings and not know what to choose. They know what I'm talking about. You don't. And so there's a connection that happens between you and that person. And from that, there's an accountability. You take care of me. I take care of you. As humans, we're naturally inclined to take care of each other and you see that come through

Starting point is 00:23:35 in a real way in this group. We are social beings. Exactly. And we're not intended to be alone. And so loneliness is a problem. It should be a diagnosis for that because that is a problem. That's not how humans are designed. That's why we react to touch. That's why we react to a voice, because it's important for us to have those social connections and to build those relationships. way of thinking as far as creating a patient experience in this group way, stepping back from the physician, you know, taking that physician hat off and stepping back into those patient's shoes and saying, what is it that they want to help themselves become healthier? What is it that they want to improve their condition? Because we're learning from them all the time. That's 100% you're learning from them. And oftentimes the providers can elicit information from them in a way of, you know, just listening to their stories with the patients. They're like, well, they didn't tell me that.

Starting point is 00:24:35 They didn't, you know, so that oftentimes, yeah, they'll tell each other, but when the provider is standing there like, wow, if I'd have known that, I would have done X. So it's, again, them feeding off of each other. The provider can now ensure their health literacy. We take for granted that patients walk away understanding the terminology. They know what, you know, I need you to do as a physician, but they don't. They, you know, health literacy. It's also you get so much more time, right? I mean, you know, normally you see a doctor, you see an hour, but here you're doing two hours a week for weeks or longer. Yeah, significant amount of time that you get to spend.

Starting point is 00:25:12 And it's less burdensome for the provider. So when you think about physicians who are under pressure to do more, our current healthcare system is designed on productivity and designed to meet the reimbursement standards, not designed for the time you need to really help a person change their health. We just don't have, you know, our insurance model is not moved in that direction yet. But in this model, you absolutely can give them the amount of time, not necessarily you, but as the group and amongst your colleagues in this multidisciplinary approach, because generally you have a nurse or a health coach or a dietician working with you. Between the two of you, you can ensure that they are getting the

Starting point is 00:25:58 information they need to make the changes. People have resistance. Like, oh, I don't want to be in a group and share all my private stuff stuff and like, I'm not going to tell her. I'm like... People think you actually have to take your clothes off in front of the group. We have to do an extensive amount of education for these patients. But then what happens? But you know, after the first couple of sessions, they realize, no, you don't have to do that. Confidentiality is always, you know, are they going to tell this person about my situation?

Starting point is 00:26:24 But those concerns dissipate very quickly after just a couple of weeks. They realize there is a level of trust and everybody there in the group is committed to their health. Otherwise you wouldn't show up, right? Our programs are different in that our retention rate is significant. We're 85% retention rate and our programs are generally between eight and 10 weeks. Yeah. I mean, that's a lot of people usually drop off, but they come and they come and they come. Well, you know, it's all about how you deliver the content and you have to do it in a way that is in small doses. So, you know, there's a didactic component. There is a learning,

Starting point is 00:27:00 experiential component, but you have to dose that to patients so that they understand it. They're not overwhelmed. They receive just enough information to entice them to come back the next time. And when you deliver the content in that way, such as how we have done, they will show back up. And not only will they show up, but they're eager to continue. We see many of our patients, three to four programs of our shared, shared medical. Yeah. We have a menu of about 10 different programs we're offering. And I've seen patients in two or three of those programs and some traveling about 4% of those patients traveling from out of state every week. It's incredible. People are just so hungry to connect and to be together and to share and to learn. And, you know, I think, you know, what's interesting is that, you know, from a traditional

Starting point is 00:27:48 health care point of view, well, that, you know, that's probably a money loser. But it turns out it's actually more profitable than the one-on-one visits. Yeah. So Duke just actually, Duke University just did a study. You probably saw that. But they just did an evaluation of the shared medical appointment experience. And what they learned is if you have at least six patients over the course of an eight-week period coming to a shared medical

Starting point is 00:28:11 appointment, 75% of the time is far more profitable than the one-on-one experience. So it has proven over, and this is the same type of result we see from a profitability scale. Doctors don't want to be widgets just running patients through the office one after the other. They get to be actually doing something quite different. Burnout is real in the healthcare industry. And what is the doctors and providers experience when they're doing these programs and the other nutritionists and health coaches?

Starting point is 00:28:36 Yeah. So they definitely experience a greater level of satisfaction. There's a level of gratitude because they get to see the fruits of their labor. They get to see the patients improve in real time. You know, by three, four weeks, you have a story to tell about how much better you are and how satisfying is that for a provider versus seeing you every two or three months where, you know, I may or may not even remember what your issue was, but here you have developed such a therapeutic partnership with not just the patients,

Starting point is 00:29:10 but the patients have developed that amongst themselves, and you witnessed that. And so there's a level of gratitude that just happens as a result. People often say, you know, there's, sounds good, but, you know, to really get real sounds good, but you know, you really, to really get real medical care, you need to do one-on-one visits because you're not going to get as good outcomes when you just go in a group with a bunch of people and talk. Right. So what have we found about that? Yeah. So that's actually not necessarily the case. You get better outcomes. Um,

Starting point is 00:29:41 so we evaluate all of the patients that come through our programs and we- Everybody's in the study. Everybody gets registered. Everybody's registered. We're tracking all the results. Patient reported outcomes, measures, NIH validated tool. We make sure we collect that data on these patients. It's important for us to continue to prove the efficacy of this model. And so what we're seeing is that 40% of the patients over 10 weeks, now again, this is just a small amount of time when you're talking about chronic conditions, and these people

Starting point is 00:30:10 are coming in with two or three chronic conditions. In that short period of time, 40% of those patients are achieving a clinically meaningful change between their starting point and their ending point when we evaluate, we give them the initial assessment and then the final assessment. And what that translates to is individuals who were chronically ill or they had debilitating circumstances when they walked in the door, they're starting to move towards reclaiming their life. They're starting moving towards true health. It's amazing how fast it is.

Starting point is 00:30:43 You know, when you combine like the superpowers of functional medicine to create health, along with the superpowers of the group to actually motivate and get people engaged and change behavior, it's like a rocket ship for people's health. Pretty amazing. Absolutely. And we're going to a little bit later tell a story of one of our patients there was pretty amazing. But yeah. So exactly what you're saying, the alchemy, the magic happens within that group setting. And they're so highly motivated

Starting point is 00:31:12 to support each other that they're truly advocating. And there's a healthy sense of peer pressure as well. So if I know I got to report back every week, I think differently about the choices I make in between my appointments. It's true. You know, peer pressure can be bad. You know, you're, everybody's vaping in high school. So you want to vape or everybody's drinking in college. You're going to drink, but it also works the other way. Positive peer pressure also works. And I know that's true because when I go out to dinner with people, uh, I don't say a word, but just cause I'm there and I know I'm interested in food, they like change what they order.

Starting point is 00:31:45 They don't have dessert. It's, you know, it's really fascinating to watch because I'm like, I don't care what they do. I mean, it's their life and their health, but people are changing their behavior because of external influence and wanting to be accepted and belong. It's really powerful. So this is a powerful program, Functioning for Life at Cleveland Clinic. We go to a whole range of

Starting point is 00:32:05 different conditions we take care of, but it's really the secret sauce of the functional medicine and these group models. And that's really what, James, you are so advocating for and what your book is about, that community cure. And you've done a lot of research on this and you've looked at practitioners all around the country and how people are using this model. How are these being adapted in community? And what are the ways that you're seeing healthcare groups being used in healthcare? Well, the exciting thing is that there's a lot of different ways in which people are using it to solve some of the problems. Like I've been in functional medicine for the last 10 years.

Starting point is 00:32:50 And so a lot of the data that I got back was from functional medicine practices. So there's some real innovation in really solving the kind of bits of the one-on-one functional medicine process that's a bit cumbersome. So as an example, the intake, right? It can take an hour and a half to do a good history, do the whole functional medicine timeline and matrix. What if you get 18 people in a room together to sit around and do their intake together where they wrote it down, right? When a doctor's writing a prescription to take to the pharmacy, it makes total sense for the doctor to write it down. But in functional medicine, where the patient's doing the work, why shouldn't the patient be writing it down? So this one doctor, 18 spaces, just enough space in her waiting room at her clinic, 30 bucks each, all cash. People come down and they have a two hour visit and they fill out their timeline and matrix. They learn about

Starting point is 00:33:29 the antecedents, triggers and mediators. They learn about the timeline that, you know, all the questions that you would get there are really interesting and valuable for everyone to learn as a group and a much lower cost of an access point for functional medicine, which typically you'd have to go through an hour and a half interview with a doctor that costs X per hour. And it's kind of a barrier. It's a lot of people to come in. You know, another thing might be labs, right? Specialty lab review. So we met a doctor who every patient who gets recommended, say, a stool test during the week, they all have to come in and they get it

Starting point is 00:34:05 interpreted in a group because a lot of the questions they have, a lot of the information they have, what do the different ranges mean? Why are we doing this one-on-one? So, you know, way more efficient. So we've seen groups that are hybrids of in-person and virtual. So there's been, there's been, you know, so much innovation and also in all the specialties, right? You can, you can group people by disease category. So we're going to have a type 2 diabetes group. That was one of the things that Dr. Geller learned from the beginning is that no one's coming to a loneliness group, right?

Starting point is 00:34:34 You got to market it, right? You got to market it. People know that. You're in my list. Come visit. Yeah, exactly. So it's about marketing it. So a lot of people will come to one for their symptoms.

Starting point is 00:34:42 So that's a good way to group people but also by their interests you know if a group's gone for 20 years what are you doing in year 15 right typically you're gardening as a group or dancing or doing some healthy behavior because that it's it doesn't have to it's not in the medical system anymore this is just people getting together because they realize how valuable that is you can have a cookie night at home you have a garden you can have a you know group shopping ex you know totally and the potential for these groups you know ultimately the medical system and this is why i'm excited with functioning for life the medical system is the best place to have entry-level groups why because depressed lonely people end up in the medical system right so that's where they're going to

Starting point is 00:35:25 end up anyway. And two, there's already budget allocated for them, right? Medicare, Medicaid, insurance, there's money to pay for these groups to start. But the real potential of these groups is when they're disintermediated from the medical system altogether, like the Daniel Plan, right? That wasn't the medical system, that's a church doing it. And so what's really exciting in the book and sort of the journey that we go through is like, okay, here's how it's being done in medicine. And here are ways that medical systems can adopt it really easily. Here are all the different ways it can be done. But in the second half of the book, we start to look at the future and say, look, if we want health creation to reach its potential, it can't be done by people who don't really know how to do

Starting point is 00:36:01 it, aren't trained in it. It should be done by my groups themselves. And so the most exciting groups that we've seen are groups that are free and are put on by the community and have someone who's in the middle who's passionate for it, but are just getting groups together. They have a curriculum and that's why I think the real magic can happen. And when you can turn people from doer to teacher in a short period of time, I think you have the basis for really an exponential transformation, which is really the kind of change that we need. Are you saying that, you know, we don't even need health professionals? You actually can have peers that are trained up and be...

Starting point is 00:36:37 Well, I think, you know, so, you know, if people have serious chronic illnesses and they're on medication, the medical system is the right place for them. But I think if we want to move this along quickly, we have to get people in groups before they get sick. Right. And ultimately I think there's a role for, you know, you've seen a health coach. What's a health coach. It's someone, they're not a licensed provider, but they're there. They know enough to help people and answer questions and support people and provide them in that journey. So, you know, I think there's a role for definitely peer to peer support. You know, as Tony said, peers can be even more powerful and what this will end up looking like, who knows in the medical system, we need doctors, we need licensed professionals,

Starting point is 00:37:13 but ultimately if we're looking to create a system that creates health, you know, exponentially for everyone, it may look more like peer to peer support. Yeah. I think there are movements like that. There's peer-to-peer, which is a family practice, Academy family practice organization that works on peer support models. And there's, you know, movements for promotores, which are health promoters in the Hispanic community in Africa. They had an incredible study where they looked at, you know, four countries. I think it was Thailand, Cameroonon south africa and uganda and they basically found you know really poorly controlled diabetics uneducated they gave them all basically flip phones

Starting point is 00:37:52 which they could text with to connect with each other and they give them a curriculum and they found that they had dramatically better outcomes than traditional medical care yeah in controlling diabetes just by them cooking together, shopping together, doing gardens together, exercising. You know, coming up with innovative things. One woman in Thailand figured out how to make a bicycle thing that irrigated her little plot of land. She rode the bicycle and it would irrigate the land

Starting point is 00:38:17 because she didn't have a motor. And it was a tenfold cost reduction in health care costs just by having these peers. And these were not highly educated. And one of the studies I read was fascinating, was they looked at mentally handicapped, overweight, pre-diabetic, diabetic patients. They gave them some basic curriculum instructions, and they had them support each other in this group and just change their behavior.

Starting point is 00:38:42 They had far better outcomes than their own doctors treating them. Yeah. Which makes you think, well, gosh, how do we do this? Because right now in our Center for Functional Medicine, we have a model which has health providers. But in Daniel Plan, we didn't really have any health providers. And could it have been more effective, less effective? I don't know.

Starting point is 00:39:00 But it's a very scalable model. And I think many people think functional medicine is expensive. And yes, if you've seen 45 doctors and you're coming to see me and you need to figure it out, it can get expensive. But so can if you have a heart failure, you need a heart transplant. And Humira is pretty expensive. So yeah, if you have autoimmune disease, you go see the doctor, it's 50 grand a year for your meds. But if you actually look at most of the problems, they can be solved without necessarily advanced testing or supplements, just using food as medicine, basics, lifestyle changes, using the sort of intel inside of the science of functional medicine

Starting point is 00:39:40 to get people healthy. And we can see huge changes at scale. Because I know this is true. I've written so many books and people read my books. They say, I did what you said. I got better. I'm like, oh, great. Your diabetes is gone.

Starting point is 00:39:49 I'm like, I don't know who you are. I didn't treat you. You never saw a doctor, but your diabetes is cured. And it's that kind of thing that gives me so much hope. Because you're right. One, we don't have enough functional medicine providers for all the sick people. Two, it's not reimbursed right now by a health care system. And three, there's too many sick people for us to actually treat this way. So we've got to figure out a

Starting point is 00:40:09 different way of doing things, not just what we do, but how we do it. And that's really what's so exciting about your book, the community care transforming health outcomes together, because it's really all about how we scale this model. So what is your vision about this power of community to transform health and healthcare? And how do you see this scaling up? Because right now it's still on the margin. It's still small. There's some people talking about it, but it's not really caught on. Because I mean, I said to the CEFO here at Cleveland Clinic, I said, we need to hire 10,000 community health workers. And he kind of laughed at me. That was like, you know, five years ago. Now he's like, oh, it's probably a good idea. You know, a value-based healthcare system. Well, look, the first book that I wrote,

Starting point is 00:40:51 The Evolution of Medicine, the goal was, if I put it in the hands of a doctor, at the end of it, would they want to do functional medicine? Right? Could you make the right arguments in the right order so that any doctor would read it and go, oh, that makes sense, I want to do it. The second book, the goal is the same, but a different audience. It's like, if I give you

Starting point is 00:41:08 this book and you read it, it's two and a half hours to read it. It's not a thick compendium, but it ultimately- I should take notes from you on writing a book. Yeah. Because mine are like too long. At the end of it, I just like, do you want to participate in this new world? And I want to get this book into the hands of CEOs of health systems. And next year I'm going to Ted Med and JP Morgan to like go and actually physically do that. But also that if you read this and you're just a regular person, you see how powerful the power of community is and that you would start or join a local group. I mean, there are already

Starting point is 00:41:39 organizations that form groups that are free, that are, you know, forming in communities in every zip code of this country. And so I just wanted to create something that, you know, that would sell people into wanting this. And, you know, the structure of the book is such that you can deal with the objections of privacy and the challenges of executing it inside the system. But ultimately, you just hear stories and data and otherwise of every, you know, every, you know, every, every different disease type, every different type of issue that's coming up. How's it being used? How's it being run? And the common denominator, the common denominator is always groups.

Starting point is 00:42:16 So powerful. So exciting. Everybody should get the book, the community care. You can pre-order it now, January 14th to 18th. It's free. James is giving away free. He just wants it in the hands of everybody. So you can go on Amazon, order it and it's going to be free. Right? That's right. Pretty exciting. So have you got a sense that doctors are interested in this model that, that they like it or not? Well, it's interesting. You say the word doctor. So, you know,

Starting point is 00:42:40 when I came here last year, well, look, that's, it's an interesting, it's, it's, it's, it's interesting. Cause last year when I came to the Cleveland Clinic, I had a chance to interview a PA who was doing the groups. Now she had never heard of functional medicine and she had never heard of shared medical appointments when she got hired, but very quickly she was doing it and she loved it. Now, you know, and I think that's typical of most providers out there. However, you know, the community that I've been speaking to is functional medicine doctors who are sort of like Dr. House going after the minor cure.

Starting point is 00:43:10 So I don't think they're as into it, honestly, because they've spent 20 years learning how to go into the mitochondria and do it. But I don't think they have to do it, right? There's still a need for one-on-one doctors to solve these really chronic problems. There's not any less need for you to solve, you know, these really tough people. But I love doing the groups. I actually enjoy it. I solve, you know, these really tough people. But I love doing the groups. I actually enjoy it. I think, you know, it's a nice balance to everything.

Starting point is 00:43:30 Well, that is one thing that I've heard is that, you know, is that to give yourself an outlet during the week where you can actually be vulnerable in a group where you can share, because that builds trust, right? Being honest in those groups about what's going on for you helps these other people come up. It's a whole different type of medicine.

Starting point is 00:43:45 And I think that could be a solution to burnout. I agree. I think I get so much more out of it. I feel so much more satisfied. It's not as exhausting. It actually kind of revives your love of medicine because you're connecting with people. You're talking. You're laughing.

Starting point is 00:43:59 You're engaging. You're teaching. You're learning. It's really like a bi-directional experience. It's not that I don't agree with you. It's just when I've spoken to doctors, some of them are like, I can't wait. I'm into it. And some of them are like, no, I'm good. Yeah. Right. So I asked four questions. We entertain groups all the time who are interested in the functioning

Starting point is 00:44:18 for life or shared medical appointment experience. And the four questions you have to ask them, do you want to improve the efficiency of your practice? Do you want to improve the quality of the care that you're providing? Do you want to reduce the cost of the care that you're providing? And do you want to reduce burnout? When you can answer those four questions, which are ironically the same as the quadruple aim of health care, if you want to do those things right there, this is a model that you can adapt in your practice. Our physicians are actually jumping over each other. They're all functional

Starting point is 00:44:52 medicine trained, but they want to do it because they see the outcomes. They see those practitioners come out smiling like, yes, three of my patients are off their medication. Yes. Four of my patients have lost, you know, 10 pounds in the last 10 weeks. So when you are constantly experiencing that level of success with your patients, I want some of that. And so they're seeing it many times, you know, the patient in that room, in that one-on-one setting, they don't know how to deal with communication with that provider of all the issues that they have. And so the provider spends more time than not trying to figure that person out because they won't communicate, they won't share. The group model changes that. And so when we try to educate other practitioners on why this should be done, that's one of the reasons.

Starting point is 00:45:46 I guarantee you, you're not getting all the information from that patient that you could or that you would if they were in a comfortable environment or relaxed environment where the pressure of time is not a barrier. Functioning for Life has 14 hours of curriculum embedded in it. When are you going to see that physician 14, you won't see him 14 hours over the course of a year. So there's no way that a patient is going to get all that they could get from a one-on-one experience that they would get in a shared medical experience. And so I do think that- That's why the outcomes are better because if you have an hour with a doctor, great, or a provider, and every three months, if you have 20 hours over 10 weeks, it's an enormous amount of contact, health professionals,

Starting point is 00:46:32 and information, and learning, and experience. And it's what drives those outcomes. And I was shocked. I mean, we collected on every patient. And I was like, OK, well, this is going to be great. And I believe in it. And help people change behavior. But how could it be better than top what you do trained functional medicine doctors and

Starting point is 00:46:47 getting outcomes and it was like what this is anywhere from a third to two-thirds better than the outcome so if you're diabetic and you're treated with you know dr jones and that and one on one and that you do another patient with diabetes with dr jones and the group the group treatment with dr jones those patients do better yeah yeah and and that's do another patient with diabetes with Dr. Jones and the group, the group treatment with Dr. Jones, those patients do better. Yeah. And that's what I tell physicians as we're trying to convince them that this is the right model of care. It's a redesigned strategy. It changes the boundaries of healthcare and that you're a condition, your mind is conditioned for the one-on-one experience. But oftentimes that patient can't dial into their own strength.

Starting point is 00:47:26 They have to tap into the strength of someone else. And the way to do that is to put them in a group setting where others who are experiencing the same thing can help them address those issues. And some are further along, right? Some people are halfway down reversing their diabetes, and some people are newbies. And that person who's halfway down is so their diabetes and some people are newbies and that person who's

Starting point is 00:47:45 halfway down is so much more powerful than the physician well 100 it's not the distance between you and your goal it's the direction you take to get there right so we help chart that direction and you right you may be here and that other person may be well down the line but when you're talking through the challenges and the experiences that other person is learning something from you that that physician can't offer. Yeah, so true. I mean, we had a patient come in who was severely obese. I mean, her BMI was 43. Normal is less than 25 and over 30 is obese.

Starting point is 00:48:18 She had type 2 diabetes on insulin. She had heart failure. She had high blood pressure. She had, you know, a whole host of things and medications. I was costing the healthcare system enormous amount of money. She was about 65 years old and she had been eating junk food her whole life because that's what her family taught her. She was very educated. She was doing great things in the world, but just could not function anymore. And probably maybe only had a few months to maybe live, she was on her way to a kidney transplant,

Starting point is 00:48:48 her kidneys were failing, and they're on her way to a heart transplant. And she joined one of our groups because she couldn't get into the one-on-one visit because we had a typical waiting list. And people think, oh, it's less than, oh, I'm gonna go to the group because I can't get in to see the real doctor

Starting point is 00:48:59 and real one-on-one visit. And it was extraordinary. In three days, she got off her insulin. In three months, she got off her insulin in three months she got off almost all her medications reversed almost all her diseases by a year she lost 116 pounds and had no more medications no more diabetes no more heart failure no more kidney failure no more liver failure i mean in traditional medicine there is no way to reverse diabetes there is no unless you get a gastric bypass there is no way to reverse heart failure there is no way to reverse diabetes. There is no, unless you get a gastric bypass, there is no way to reverse heart failure.

Starting point is 00:49:25 There is no way to reverse kidney failure. You manage those diseases. And so she was doing this in a group. She was so powerful in her willingness to make these changes with the group that she then began to send like 58 patients to us from everywhere because she saw how powerful this was. And we had an extraordinary experience of seeing that happen.

Starting point is 00:49:46 And, you know, so when you take even someone that sick, she wasn't getting one-on-one visits. I mean, she did a little checkup with the doctor in the group, but it was really minimal. And it was just the power of learning about food and self-care and basics. Well, I'm so invested in this group model that back in 2017, I even changed our one-on-one patient experience so that now a patient moves from the physician visit and all patients starting at 8 o'clock go into a group nutrition visit. And all those patients go into a group health coaching visit because we need to continuously reinforce the value of this model of care. The patients come in at 9 o'clock, they're all in the same group. So if I have four doctors, four or five doctors seeing these patients at these time intervals, they go right into the group. Our nutrition and our health care.

Starting point is 00:50:35 Yeah. Our team, they have adapted to this model. They almost don't know any other way because no patient that comes through is going through just a one-on-one experience. I want you to know that the value of the group is beyond just those individuals who are coming for chronic disease management. It's powerful just if you want to optimize your health. But we all have a starting point, so let's introduce you to this model of care. Let's give you the why before we teach you the how. Do you find they just say, oh, I kind of like this group.

Starting point is 00:51:09 Well, many of them have the relationship beyond that group. You know, they're out in the hallway talking about going to have coffee together. And so exactly the results that we want, you know, is for them to share that experience. And, you know, James, in your book, I'm sure you lay out ways in which providers or people can get connected into yeah yeah 100% well look i mean one of the things i just want to say is that for years we've been looking at ways to get this kind of medicine into the system right and one of the reasons why yeah i know yeah for you 20 years and more and i've been super inspired by your work mark so i just you know just have to say that.

Starting point is 00:51:48 All of this stuff, I found someone who was speaking my language. I was born in a commune. This is what I knew had to happen to a certain degree. Oh, that explains everything now. Okay. Yeah, so I guess I just want to say that the missing link for a lot of things has been, we've seen one-on-one integrative and functional medicine at centers that has not survived, right? They've brought it in. They're very excited, great outcomes, but then it dies because you can make more money doing heart

Starting point is 00:52:14 stents than talking to people one-on-one. So the key issue is not, does it work, but is it profitable to deliver? Because there are organizations in healthcare that want to reduce costs, but most of them want to make money. Hospitals, you know, insurance companies, all these systems. And so the fact that it's now profitable where it was no longer, where it wasn't profitable before is a huge deal because now all these hospital systems are like, I want this, like I want to be on the cutting edge and I want to make money with the space. And so that's what the, that's one of the things that's really exciting to me. And already we're starting to see hospital systems saying hey we've been trying to work this out for a long time this group thing sounds interesting we want in i mean essentially in our clinic and

Starting point is 00:52:52 the center for functional medicine here in cleveland you know we have regular one-on-one doctor's offices but we also have four group visit spaces and they're designed specifically for group visits yeah uh and And it's powerful. And, you know, what's really amazing is, is the work that Tony, our team have done to create this program called functioning for life, which is basically scalable in ways that treat all sorts of different

Starting point is 00:53:17 conditions. So we have different groups for different problems, but we basically built a product that if you're listening and you're a healthcare provider, if you're a healthcare institution, if you're listening and you're a healthcare provider, if you're a healthcare institution, if you're an insurance company, if you're a private business that provides healthcare for their employees, this model can be replicated. You don't have to vent it from scratch. We built the curriculum.

Starting point is 00:53:38 We built the training modules. It's going to launch in January 2020. And it's going to be available to scale. And our hope is that we can get this into everywhere i was just talking to someone from walmart they're talking about having health clinics in there i mean this could be imagine instead of them going to buy the soda they go to the group and they learn how to shop in walmart and buy the healthy stuff and take care of each other i mean it could revolutionize health care because i think

Starting point is 00:54:00 that health care is going to get disrupted by things that are happening outside of the health care system it takes the health care system a long time to change and i think that healthcare is going to get disrupted by things that are happening outside of the healthcare system. It takes the healthcare system a long time to change. And I think that's, you know, what we've seen in other businesses, you know, disruptive businesses like, you know, Uber and other things that are Airbnb that are just completely disrupting traditional models. And this has the potential to do that. It has a potential to scale.

Starting point is 00:54:21 You know, there are many, many ways to do this. And at the Center for Functional Medicine, we've created the Functioning for Life, which is a really scalable model that can be adapted by organizations and people all around the country and the world. And that's what we're really hoping to do because we are getting sicker and fatter. We're costing more and more. I mean, I give all these talks and I keep having to change my slides. You know, it used to be 65% of Americans when they're overweight. Then it was 68. Then it was 70.

Starting point is 00:54:51 Now it's 75%. It used to be, you know, one in four, you know, one in four were chronic disease. Then it was one in three. Then it was one in two. Now I just looked at it and it was like 60% of us have one or more chronic illness. And it's getting worse and worse. And the costs are skyrocketing. This means $95 trillion over the next 35 years spent to just deal with chronic illness in this country.

Starting point is 00:55:11 We need a solution. And I don't think this is the only solution. We have to fix our food system. We have to do many things. But within health care and within a model that actually uses this strategy of the community cure, we can solve a lot of these problems. Yeah, absolutely. And there's a physician shortage.

Starting point is 00:55:27 So don't lose sight of that. That's right. We have more and more sick people and less and less doctors. I think there's going to be 192,000 doctors short within a few years. Well, aging population, affordable care acts, more people have access to care. Just looked at an article in BMJ. We're trending towards 90,000 physician shortage by 2025. That's five years away.

Starting point is 00:55:47 So what do we do about it? The only way to do this is in a group setting and take your autoimmune patients, put them together, your digestive patients, put them together exactly the way we've done in functioning. And it doesn't even have to be in a healthcare setting. We do this in churches. We've got almost 30 churches in Cleveland, over a thousand people enrolled. You can do this in schools. You can do it in workplaces. You can do it in your grocery stores. You can do it in Walmart. I mean, this is the beauty of this model. It doesn't require a lot of technology. It doesn't require maybe, you know, a video screen and, you know, someone with a microphone or not, it was a small group and just some basic,

Starting point is 00:56:20 simple things. And it's, it's pretty extraordinary when we think about where we are now, where we have now, where we have to get to doing what we're doing incrementally better is not going to solve the problem. You guys are incredible pioneers. Any, any last thoughts, if you could do something to really change the world, if you were king for a day, what would you do? Well, I think, you know, one of the things that I've been, you know, since I embarked on this journey and saw just what an elegant solution this is to so many issues that plague us, I decided to, you know, to jump into it. So like, I don't go to personal trainer, I go to CrossFit, right? Small group.

Starting point is 00:56:55 And I don't have a therapist. I have a men's group because we all need a place to process emotions and deal with that kind of stuff. So if I'm king for a day, everyone's gotta be in some sort of empowerment group. Everyone's gotta be in some sort of group. It's in the medical system or not in the medical system. You gotta be part of it. It's so true. Community is so powerful. Yeah. How about you, Tani?

Starting point is 00:57:16 So if I were queen for a day, the first thing I'd do is implement everywhere there's a fast food restaurant within a mile, there would have to be a grocery store so that they had access to healthy food options. And then on top of that, I would really put a lot of effort into our minority communities because that's where your health care costs are being driven up. And this idea of group is already embedded in the minority communities because they're going to church, they're going to community clubs,

Starting point is 00:57:46 they're going to line dancing classes and salsa classes. So you're really already together, but just convincing them that there's a healthier way to do those things. I would really put some effort into that education. I think that's true. That's a very important point because African-American, Hispanic community

Starting point is 00:58:04 are far more affected by chronic disease. They're far more likely to suffer the consequences like kidney failure and amputations. And they're the ones who have the least access to care who are the most targeted and the most ignored. And in terms of the costs and the burden of disease, unless we address that, we're going to be in trouble. And we we've done that here at Cleveland Clinic.

Starting point is 00:58:26 You started this program at Langston Hughes, which is our underserved community center, mostly African-American. And we thought, you know, nobody's going to show up. It's going to be kind of weird. 100% attendance. And now we have a waiting list. We have the biggest group we've ever had. We have more people than we can handle. And the practitioners come back

Starting point is 00:58:45 so enthusiastic about the changes these individuals are making and cooking demonstration with them coming up tomorrow. So I'm excited to see them in the kitchen with you chopping and cutting and preparing several dishes, because I think that's an important component also if you don't know how to cut an avocado and you you feel a little bit ashamed of that you're not going to buy that in the grocery store but in this group setting you're all learning together so they'll get to do that with you it's true time my boss she's got me spending more time wearing a white chef jacket than a white doctor's coat so all doctors should wear i think that's good we should ditch our white coats for chef jackets.

Starting point is 00:59:25 Yes. So thank you both for being on The Doctor's Pharmacy. It's been a great conversation. If you love this conversation, please share it with your friends and family on social media. We'd love to hear from you. Please leave a comment and subscribe wherever you get your podcasts.

Starting point is 00:59:36 And we'd love to hear more from you and see you next time on The Doctor's Pharmacy. It's great. Thank you. Thank you. Hi, everyone. It's Dr. Mark Hyman. So two quick things. Number one, thanks so much for listening to this week's podcast. It really means a lot to me. If you love the podcast, I'd really appreciate you sharing with your friends and family. Second, I want to tell you about a brand new newsletter I started called Mark's Picks.

Starting point is 01:00:05 Every week, I'm going to send out a list of a few things that I've been using to take my own health to the next level. This could be books, podcasts, research that I found, supplement recommendations, recipes, or even gadgets. I use a few of those. And if you'd like to get access to this free weekly list, all you have to do is visit drhyman.com forward slash pics. That's drhyman.com forward slash pics. I'll only email you once a week, I promise. And I'll never send you anything else besides my own recommendations. So just go to drhyman.com forward slash pics.

Starting point is 01:00:40 That's P-I-C-K-S to sign up free today. Hi, everyone. I hope you enjoyed this week's episode. That's P-I-C-K-S to sign up free today. 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.

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