How Our Environment Shapes Our Health

Coming up on this episode of the Doctor's Pharmacy.

These simple things are vastly more powerful than we think. Waking up with a strong sense of purpose. We're eight years of life expectancy. A strong social circle around you. We're seven years of life expectancy.

Hey everyone, it's Dr. Mark. I know a lot of you out there are practitioners like me helping patients heal using real food and functional medicine as your framework for getting to the root cause. What's critical to understanding what each individual person and body needs is testing, which is why I'm excited to tell you about Rupa Health. Looking at hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, and so many other internal variables can help us find the most effective path to optimize health and reverse disease. But up till now, that meant you are usually ordering tests for one patient from multiple labs. and I'm sure many of you can relate how time consuming this process was, and then it could all feel like a lot of work to keep track of. Now there's Rupa Health, a place for functional medicine practitioners to access more than 2000 specialty labs from over 20 labs like Dutch, Vibrant America, Genova, Great Plains and more. Rupa Health helps provide a significantly better patient experience and it's 90% faster, letting you simplify the entire process of getting the functional medicine lab tests you need and giving you more time to focus on patients. this is really a much needed option in functional medicine space and I'm so excited about it. It means better service for you and your patients. You can check it out and look at a free live demo with a Q&A or create an account at RupaHealth.com that's R-U-P-A-Health.com People are always surprised when I tell them that even with a whole foods diet rich in plants, we can still be nutrient deficient. And addressing nutrient deficiencies is one of the lowest hanging fruits for optimizing our health and feeling better at any age. And that is why I'm a huge fan of AG1 from Athletic Greens. Since our soils are so damaged, the plants can't extract the nutrients because there's no living matter anymore. And we're up against issues like chronic stress and toxicity and sleep deprivation like never before. And our bodies need some extra help getting all the right information to work properly. Now, that information comes in the form of vitamins and minerals and phytonutrients. and good bacteria, all of which help ourselves remember how to efficiently tackle their important jobs. So one of the things I use every day to support my diet is AG1 from Athletic Greens. With just one scoop of AG1, I get 75 high quality vitamins, minerals, whole food source superfoods, probiotics, adaptogens and more to support my entire body. Even with a really healthy diet, it's hard to hit the mark for all our nutrient needs, so I feel better knowing I have some extra help from AG1. Unlike other supplements and powders out there, AG1 is third party tested and made without GMO, nasty chemicals or artificial anything. It actually tastes great, kind of like a tropical green drink. I like it on its own mixed with water, but it also works really well in most smoothies. If you're curious about trying AG1 from Athletic Greens for yourself, right now they're offering my community 10 free travel packs with your first purchase. All you have to do is visit athleticgreens.com forward slash Hyman. Again, that's athleticgreens.com forward slash Hyman to take ownership over your health and pick up the ultimate daily nutritional insurance. Now let's get back to this week's.

Episode of the Doctor's Pharmacy. Hi, this is Lauren Fein, one of the producers of the Doctor's Pharmacy podcast. It's no wonder that chronic disease is skyrocketing when we live in such a toxic landscape. We can't blame the individual when their environment is made up of a lack of healthy food options, pollution, stress, and social isolation. If we want to find our way back to health, we need to work together as a community. With some mindful steps to make positive changes in our environment, we can take back control and create greater health and longevity outcomes. In today's episode, we feature three conversations from the Doctor's Pharmacy on how healthy environments are necessary for healing and overall improved health. Dr. Hyman speaks with Dan Buettner about nine tips to living longer and healthier with James Maskell and Tawny Jones about creating community groups to catalyze healing with others, and with Dr. Gabor Maté on why we should not be trying to heal on our own. Let's jump in.

Tell us more about some of these, I think you said there's like nine characteristics in these blue zones that you identified that contribute to longevity.

Yes, so they tend to have vocabulary for purpose, they know why they wake up and they're not stressed out to, to figure out what their place in the world is. They tend to have very strong family values. They belong to faith. We know people belong to faith. Live 4 to 14 extra years. They have these sacred daily rituals that help unwind some of the stress of everyday living, including ancestor veneration, nap taking, prayer works, even happy hour, as you might have seen in Sardinia.

They.

They tend to have a very closely knit group of immediate friends. In Okinawa, we call this a moai, a group of friends who they can count on on a bad day, who are there to have a meaningful conversation with them and reinforce the right behavior. So friends, their idea of recreation tends to be gardening or walking. They already have this habit of eating mostly whole food plant-based. But the big inside mark to all these blue zones is these people don't possess better discipline than you or I. They don't have better diet plans. They don't have a better sense of individual responsibility when it comes to their health. All they do is live their life. And the insight is that if you want to get healthier, don't try to change your behavior because that fails for almost all the people almost all the time. Shape your ecosystem, shape your environment. And people in Blue Zones, the cheapest and most accessible foods are the food I write about in the Blue Zones American Kitchen. They're whole food plant based.

Yeah, it's so true. And I think, you know, I'm curious in your travels and explorations, was there anything super surprising that you found about these communities and some of the things that you found in the Blue Zones that maybe we wouldn't expect.

A couple interesting, Mark, when I started this work in 2002, I was really sort of looking for an herb or a compound that explained longevity, and none of that's true. They don't take supplements, they don't take pills. Yeah, but interestingly, we found in Sardinia, where I think you met Julia, that there's a strong correlation between how steep your village is, and your chance of making it to 100. There was a correlation between how many daughters. These guys who had five or more daughters were the most likely to make it to 100.

Wow. You know, I was- why?

It might be because daughters take care of their aging fathers or it might be a selection bias. If you can survive five adolescent girls, making it to 100 is no problem. But it's just a correlation. I can't explain why. But for me, the most, really the exciting thing, you know, I started out a very scientific hell bent to find the resveratrol or the metformin or one of these other magical compounds that we could put in a pill and sell. But what I found were that these counterintuitively simple things are vastly more powerful than we think. Waking up with a strong sense of purpose, we're eight years of life expectancy. a strong social circle around you, we're seven years of life expectancy. Eating a whole food plant-based diet as opposed to the standard American diet is worth 13 years of life expectancy for a 20 year old. So these are things that aren't sexy, that you can't make a lot of money off of them, but they are so powerful, they literally hold the answer to this $3.5 trillion healthcare bill we grapple with. and the pain and suffering of more than three-quarters of a million Americans dying prematurely every day because of eating the diet we're eating.

Yeah, so true. Well, you know, I think one of the things that people think about when they think about diet is it's hard to do it right. It's hard to shop and cook and do all these things. But you people, really are, I think, disenfranchised now from their kitchens. I mean, in the 50s, there were federal extension workers that went around America teaching young families and mothers how to cook and grow gardens and, you know, feed their families. And then the food industry came in and developed the Betty Crocker Cookbook, which was Betty Crocker was an invention of the food industry to insinuate processed food in the American kitchen. Basically, you know, put one can of Campbell's cream of mushroom soup in your casserole and one, you know, row of Ritz crackers on top of your broccoli casserole. Remember that? And so we've kind of, you know, and all the ideas that cooking was drudgery and cooking was difficult and it takes too much time and it's beneath most people, you deserve a break today, you know, remember all those ads. You know, what have you found about the correlation between cooking and longevity?

Well, first of all, in all blue zones, and I'm sure you observe this, people are cooking for themselves. You know, they might go out to dinner for a wedding or a birthday, but they're cooking three meals a day. so they get good at it. And, you know, once you gain the skill, it's actually very easy. Number two, every time you go out to eat in America, you consume about 300 more calories than you would if you just ate at home. And those calories tend to be laden with sodium, added sugars, added fats, and that's what's making us sick. So, you're right. And I think one of the silver linings to the pandemic, people were stuck at home and they relearned the art of cooking and the re-art of baking. And that's definitely the, the right direction.

And baking, I don't know. I wouldn't have that in there.

Well, yeah.

Cookies, cakes, pies. It's not definitely the longevity diet.

I'm a fan of sourdough bread, though. I, I don't know if you taste the sourdough bread in Sardinia, but it's, it seems that people eat a, a true sourdough bread with the plant-based meal. They lower the glycemic load of the meal, you know, by quarters.

Yeah, it's true. Actually, I tell you a funny story. Paula and, and Elenora gave me as a present, the one you hooked me up with in Sardinia to go around to these places, they gave me this starter jar of sourdough starter that was 150 years old, right? And I brought it home with me, but the jar broke in my suitcase over everything, so I didn't get to use it. I have to go back. I'm actually going back next summer.

You can scrape off your underwear and bake a loaf of bread.

I don't know how that would taste, but I'm going back next summer, actually in April, I'm gonna go back and get some more, but yeah, I think, you know, also in Icaria, they made this incredible bread with Philip. Remember Philip in this blue, in this oven that was outdoor wood oven, but it was a Zia wheat, which was this ancient wheat that was used by Alexander the Great to, you know, fortify him on his expeditions to conquer the world. And, you know, it's high in protein, it's low in starch, full of minerals. It's really quite interesting. Very low in gluten. And it was delicious bread. It was very different. So, yeah, it's not to say bread is bad.

It's the kind of bread we're eating in America. Yeah. And how we bake it. And, yeah. And, but, but, you know, getting back to this notion of cooking.

Cooking.

I mean, it's. Well, if you've ever seen somebody bake bread, you know, the kneading takes a half hour and it's, they're in there. like getting a workout, breaking a sweat. Some of these old ladies have Popeye arms from kneading bread. So in blue zones, people really aren't exercising. I think you'll remember you didn't see any gyms in Ikaria or in Sardinia.

No.

People are staying in shape because they're moving naturally. So they're still doing things by hand. So they're getting that mindless physical activity, cooking, also tends to be a social activity. Ladies baking bread together, families cooking together, and they can control the ingredients. And you know, Mark, when it comes to longevity, there's no short-term fix. There's nothing you can do today, this week or this month that's going to make you live longer in 50 years short of not dying. So when it comes to longevity, you want to think of things that you're going to do for a long time and learning the skill of cooking. and learning how to cook with beans, I think are the greatest superfoods in the world. And the people in Blue Zones have a gift for making beans taste delicious. Getting your protein from beans soaked and well cooked, so the lectins aren't an issue, pairing them with the whole grain, adding some greens in there. Man, I'll tell you what, It's another 13 years of life expectancy.

So what I'm really excited about is your new book, which is the Blue Zones American Kitchen. So it's kind of like, wait a minute, blue zones are not in America because we're all sick and overweight and dying fast and early and it's getting worse. But you took a trip around America and you found four food traditions in America that match a longevity diet and they're kind of unexpected. I'd love you to tell us about these historical diets in various demographic groups in America and how they can help the average American live another decade or two or more. Yes.

So this, the Blue Zone Kitchen, which we talked about was number one New York and number one Wall Street Journal bestseller. And I thought, well, you know, if there's diets and longevity around the world, if you looked hard, maybe you could find diets of longevity in the United States. So we knew the dietary pattern from these other blue zones. And then I hired a researcher from NYU, Marion Nestle helped me on this. And we went deep in the archives and it turns out that there was a researcher named Atwater, Wilbur Atwater, who between 1890 and 1930 or so sent out teams of people in America to do dietary surveys. and we found not among my ancestors, the Central Europeans and Northern Europeans, they brought their pigs and their cows and their pickles over. They weren't eating such a healthy diet. But among the African, Asian, Latino, and Native Americans, according to these dietary surveys, they were eating a dietary pattern almost exactly the same way as the ones we, you and I observed in Ikaria. and Sardinia and even Costa Rica. So National Geographic photographer David McLane and I, after identifying this dietary tradition, then we, during the pandemic, we traveled from Maine to Miami, to Minneapolis, to Maui, and we found these chef historians who either could recreate or who never stopped cooking this way. and the Blue Zone American Kitchen is 100 recipes to live to 100 from Americans, and it's the lost diet of longevity.

Amazing. So give us some examples of the traditions and what the foods were and what they're making. So.

There'S descendants of enslaved Americans in the Southeast known as the Gullah Geechee people. The Gullah Geechee were, imported, enslaved from West Africa, largely because of their rice growing ability. And they brought a type of rice, it's not an Asian strain, but an African strain of rice and started growing it. In fact, the biggest manmade feature in the world is called the Ace Basin. And they got very good at growing this type of rice called Carolina Gold, very healthy rice. and because they were so they were better at it than their than their masters were. They were afforded some freedoms. They they lived in buildings next to their rice paddies and they made friends with the Native Americans. They had European influences from their overlords and they fused a type of of cuisine that includes the black-eyed peas, the scotch bonnet peppers, the the the sesame seeds, the vinegar, the okra, that West African word for okra is gumbo, and they brought that back and they made these fusions of gumbo that, unlike New Orleans, which are filled with sausage, here they're filled with beans and, you know, so really healthy food that makes your eyes tear up with tears of joy.

That's quite amazing. You know, I actually just watched an amazing movie called Gather. I don't know if you've seen it, but it was a movie about reclaiming Native American food ways and the ways in which they were able to draw from the land these extraordinary foods that actually were far healthier. And I remember this one woman, it was teaching her niece actually how to find and get the mice. They were eating mice. not my thing. But she's like, we, we kind of look at where the, the plants are around where the mice are living, and we can tell how healthy that's going to be from the medicinal plants that the mouse eats that actually get in their system that we then benefit from. It was quite amazing. And, you know, I was recently reading about a, a Sioux Chef who has a restaurant in Minneapolis where you're from. The, I don't know how to say this. Oh, oh, a mini restaurant and this is a Lakota chef who's gone and actually created a restaurant where they cook only foods that are from America, that were here before, that were the, you know, delicious foods that were wild or that they cultivated. And they're quite amazing and delicious foods. So I think, you know, a lot of these cultural ancestral foods have been co-colonized. In other words, they've been displaced. And, and a lot of these people are reclaiming them, whether it's, it's the, you know, chokeberries they're eating or the various kinds of, you know, native foods that they find growing wild or even, you know, the bison that they grow. This is incredible in terms of their, their, their, their cultural food programs that they're now reclaiming. And I wonder what else you found in some of the Native American Explorations of their diets and a lot of these populations are extremely overweight, extremely obese, and have diabetes at rates far exceeding us. And, up to 80% of some Native American populations are diabetic by the time they're 30. And, that's compared to one in 10 of the rest of us, which is still a lot. So, what did you learn around their foods and their food ways?

So, the chef that you were talking about is Sean Sherman. Yeah. He's from Minneapolis. He actually, as part of this book, he contributed three recipes. And, as he'll point out to you, chickens and beef and pork were never part of the Native American diet, either was refined sugar. So, they've been victims of this food environment imposed upon them. Originally, you know, where I'm from Minnesota, they ate a lot of wild rice. You know, they had some wild game, but they were mostly hunting and gathering on the East Coast. Interestingly, part of this book, we found a Wampanoag Native American who lives up near Plymouth Rock and a modern day pilgrim named Paul Marcol, she's a historian, and they recreated a Thanksgiving, original Thanksgiving dinner. In other words, a meal that might have been served in the early 17th century. And contrary to what most of us believe, there was probably no turkey at the original Thanksgiving. There was no pumpkin pie. they didn't have flour, they didn't have eggs, they didn't have sugar. So what were they eating? Well, they were eating foods that these native Wampanoag people were providing. And it was probably foods like succotash, which is a stew made from beans, corns and squash. Also tamales, but maybe stuffed with hazelnuts, with squash stuffed with dried blueberries and maple syrup, which were all available. So, not at all the foods we think were at the original Thanksgiving. But all in all, it was a very healthy diet until processed food came on the scene. Hey everyone, it's Dr. Mark here. If you've been following me for a.

While, you know that I often talk.

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The end result is an odorless, tasteless, burpless supplement that offers all the benefits of organ meats in an easy to swallow capsule form. if you're struggling with brain fog, low energy levels, or if you just want to optimize your health and vitality, try paleo Valley grass-fed organ complex. And right now, paleo Valley is offering my listeners 15 off their entire first order. Just go to paleovalley.com/hymen to check out all their clean paleo products and take advantage of this deal. And now let's get back to this week's episode of the doctor's Pharmacy. We can't solve our healthcare 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 gonna 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 gonna 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 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 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 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 how are we gonna 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 wanna 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 we went down there and 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 basically said, we should not give up on these populations in Haiti 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 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 it's our community that matters. These people didn't have clean water, they didn't have a watch, they don't have to take their 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. Accompaniment. We accompany each other to health. And he trained community health workers, people's neighbors and peers, to make sure they went and took their medication. They had clean water, they had a watch, basically the 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 diseases, but that's absolutely wrong. They are communicable. And we know, for example, that if your friend's overweight, you're 170% more likely to overweight than if you're family members overweight, yet it's your social networks that are more powerful than your genetic networks in determining your health care 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 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 you know, evangelical churches in Southern California. 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. 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 at church, the 911 service, the Obama McCain debates. They turned 2000 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 and a curriculum and a little video. We created a year long course initially with 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 health care 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. We won the Christian Book of the Year Award, which is pretty awesome. But it really led me 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 then 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, they get a lifestyle change program, and then if they need to come and see us, they can come. But that didn't go over well at the beginning. But, you know, it took a few years, and I got Tawny to, 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 into as well. And I've talked to James about this over the years 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 a 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. 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, he starts asking around. He's like, hey, what do you think, Doc? Everyone agrees, right, that loneliness is a problem, but there's no billing code for loneliness, right? So they don't know what to do.

Wild, moderate, severe loneliness, no one has that.

Exactly, yeah. So 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 not insured, and it's called C2P, which is Yes, you can.

And this is just an empowerment.

-Empowerment, yeah. -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. 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 ended up just in a few years getting to a point where they now had 50 groups per week on every imaginable kind of disease. And the results were so good and so powerful that you know, is carried on to this day. And, you know, he learned a 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, 'cause 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- 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.

Right.

So after three years, the friends and family all want to join. It'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 were like, we're going to do salsa 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 so much of what you said is so true.

But I think- Does he do that.

Outside the healthcare system or within the healthcare system? You know, he was working in federally qualified healthcare centers.

So this is for people on Medicare and Medicaid. This is the people you don't have to worry about billing. because it just gets paid and you can do whatever you want creatively because it's not in the traditional FIFA service.

Exactly. Out of FIFA service dealing with, you know, a very impoverished part of Boston. And, you know, it's been exciting 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 how does treating loneliness to those groups help reverse chronic illness?

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. And so those two things together are a really powerful combination. So you visited groups, you tell us.

A little bit 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 Saksena. Oh, yeah. She had come up with a group visit model and she shared about it. 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- There's not enough of us, and 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, if you have type 2 diabetes, sit around, learn how to eat and speak one-off. But I always thought there was way more potential if you could actually get people 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 the functioning for life, and I was like, this is it.

Yeah.

Fantastic. How about you, Tony? You, you 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. We don't, we don't do this here, really. 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, and how do these group visits work? And, 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 medicine approach, this multidisciplinary- Nobody does it like we do. Absolutely not. We're the gold standard and sharing- It's true.

Everybody's been looking to us. How do you do this?

How are you implementing it? Yeah, so we're gonna 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 where it's at.

The community is the medicine.

Food is medicine, the community 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, 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 the 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 so in that group setting, they absolutely can learn from each other and they're also learning from those practitioners who they otherwise 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 they, as James said, they have this new network of individuals, 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. 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. in a real way in this group.

We are social beings.

That's exactly. We're not intended to be alone. And so loneliness is a problem, 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. So it's just a completely different 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 patients' 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, you know, just listening to their stories with the patients. They're like, well, they didn't tell me that.

Yeah.

They didn't, you know, so that often times, 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 I need you to do as a physician, but they don't.

Health literacy- and also you've got 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- yeah, significant amount of time that you get to spend, 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, the, and if 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 dietitian working with you. Between the two of you, you can ensure that they are getting the information they need to make the changes.

People have resistance, like, oh, I don't want to be in a group and share my private 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 after the first couple of sessions, they realized, no, you don't have to do that. Confidentiality is always, are they going to tell this person about my situation? 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, man, 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's a learning 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 medical care.

And they're coming back.

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.

Yeah.

Every week.

It's incredible. People are just so hungry to connect and to be together and to share and to learn. When you talk about In your book, this sort of crisis of separation, both on an individual level and on a social level, we were disconnected and how that gives rise to disease.

And.

The beautiful frame that Paul Farmer talked about when he talked about healing was accompaniment, which is the opposite of separation, how we have to accompany each other to health.

I tell the story of that was told to me by Luis Maldonado, Luis is a lakota, part lakota.

I know him.

Yeah. Do you know him?

I met him many years ago.

Yeah. Long time ago. Yes. He's a physician, psychiatrist. Yeah. Trained in the Western model.

Yeah.

Like you and I both are. But he says in the Lakota tradition, when somebody gets ill, the community says, thank you. You're manifesting the dysfunction of the whole community. So your healing is our healing. Yeah. It's all about connection. Scientifically, that's absolutely correct.

Mm-.

Western medicine doesn't get it.

No. I mean, we're social beings and I think, you know, one of the interesting things to me when I look to sort of the literature around, you know, disease, you think, oh, it's smoking, it's diet, it's obesity, and yes, it's all that. But more predictive than that was a sense of a loss of disconnection and a loss of control and a sense of isolation and loneliness, which is a more powerful predictor.

Loneliness is an independent risk factor for for getting ill faster and for dying of illness faster. And it's probably as significant as smoking 15 cigarettes a day, according to some of the research.

I mean, do you think this is like a modern phenomena, this crisis of separation, or has this been there throughout human history? And what is the cause of this, the root cause of the separation that we're seeing?

Well, if you look at the the literature on loneliness, the number of people in the US who say that they're lonely went from 20% to 40% in a couple of decades. Not that long.

COVID, it's a lot worse. Yeah.

It's a product of this particular system. For example, Walmart. Okay, so Walmart opens a store in a community. and the local developers are happy. The local politicians are delighted to have this facility. People might even be pleased to have.

This big.

Convenience department store available to them at lower prices. But what's the price that we pay? Local businesses have to shut down. They can't compete.

Yeah.

The local baker, the local butcher and candlestick maker, they all have to close down. People no longer walk to where they shop in the neighborhoods, seeing each other, meeting their friends and neighbors in the store, dealing with the merchants they personally have known all their lives. The Mr. Hooper of Sesame Street, they drive, each of them gets into a car all by themselves. and drive to this windowless soulless facility where they're looked after by total strangers. So yes, you've gained a few pennies here and there and developers are happy because they sold the land. What happens to the community? And this is an inevitable product of globalized capitalism. It's happening all over the world. Hence the crisis of loneliness is burgeoning all over the world. Yeah.

So it's sort of a product of sort of the globalization and of the way in which our profit motive has sort of driven systems in society that disconnect us from each other.

Yeah. Once profit becomes the prime motive and is even justified as the highest possible endeavor, which it is in a society, then what are you gonna get? They need companies that this is your field. I mean, sometimes you must be so frustrated because you're so adapted understanding the essentials of human nutrition. But there are these companies that profit of delivering poisonous and developing and planning and concocting poisonous products. And I heard you talk yesterday, sugar has been called the most addictive substance in the world. And in that sense, America is the center of the world's drug trade when.

It comes to sugar. Yeah, absolutely.

You know, as somebody once pointed out, and they push these sugary products into the developing world where more and more people are dying as a result. And so, let alone the pharmaceutical companies that is publicly known now, created opiates that they told physicians were not addictive or less addictive, knowing full well that that wasn't the case. And look at the tens and hundreds of thousands of opiate deaths now. Not that they're making them fully responsible, but they sure profited off it and they drove the dynamic as well. So once profit becomes the ultimate motive, then human health becomes a byproduct and.

A.

Sunk cost, as it were, like which is, it's not a concern anymore.

Yeah, it's so true. And I think, you know, we, we have such a negative view of addiction, and in some ways, we, we blame the victim.

Yeah.

Just like we blame the victim for being obese. We blame the victim for addiction and say, well, you know, you need to deal with your problem. You need to admit you have a problem. I mean, that, in fact, that's the, you know, that's the, the first step of a 12-step program, which is, you know, I'm realize I'm powerless over alcohol. Like, there's some higher power I have to give up to. Well, you that may be a little perverted in a sense because it doesn't take into account the truth of why addiction happens, which is out of some injury to our soul, injury to our mind, injury to our bodies. It happens when we're young that is a source of discomfort and pain that we're trying to deal with and medicate. Well.

The very famous ACE Adverse Childhood Experiences Studies that looked at the correlation between childhood trauma and adversity and the later onset of addiction actually began when a physician acquaintance, maybe both of us, Dr. Vince Felitti, was working at an obesity clinic. And they found that they could help people lose weight but couldn't help them keep it off. And then they started actually, they did something that amazing for medical doctors. They started listening to the stories of these patients. Yes. And the stories that all had, they all had been traumatized, abused in childhood, suffered significant loss. The eating was their way of soothing themselves.

Yeah.

Which is any addiction is a way of soothing yourself. And that then gave rise to the ACE studies, which showed indisputably the connection between childhood trauma and loss and the adult onset of addictions, but also of mental health conditions. also of autoimmune conditions, also of cancer, relational issues and so on. So, heart disease, all of it. There's so much research now that, and when I worked in the downtown east side of Vancouver, which is east side of Vancouver, which is North America's most concentrated area of drug use, and I don't know if you've ever had a chance to visit Vancouver, but if you walk through the downtown east side, there's this open air drug market, people are shooting up in the back alleys. It's quite the scene, and I worked there for 12 years. In those 12 years, I did not have a single female patient who had not been sexually abused as a child.

Not a single female patient had not been abused.

No one out of hundreds. And that's also what the literature shows. So it's not just my anecdotal observation, it's also the studies over and over again show. And yet despite that, society still insists on looking at addiction as a choice that some people make. for which they are to be blamed and as you pointed out, stigmatized or ostracized. Or in the medical profession, we have a more humane and somewhat more forward-looking, but still completely in norious perspective that we're dealing with brain diseases with a large genetic component. No, we're not. We're dealing with people's response to human suffering.

Yeah.

And there's a whole field of medicine now emerging called narrative medicine, which is listening to people's story. What a novel concept, right? We should actually elicit a person's story. And it's one of the most important things I do as a functional medicine doctor, and I think that you do is we actually excavate and we start to dig, you know, what was your childhood like? Where were you born? What was it like? And what were your early life experiences? And you start to unpack things. And I have like trick questions in my questionnaire about, you know, trauma or abuse or little things that poke around. And it's amazing what you find when you start digging and you see the correlation between that and and the breakdown in the body. And I always say that disease is the body's best attempt to deal with a bad set of circumstances. Exactly.

And that's exactly what you're saying. I'm saying that very much. And I'm also saying that therefore the disease, and I have a chapter on this, the disease can actually act as a teacher. Now, as a teacher who guides you back to your reality. Now, I'm not recommending it. I don't recommend anybody get rheumatoid arthritis or multiple sclerosis or for that matter depression or anything is a way of learning anything. All I'm saying is I've talked to so many people who once they developed these conditions, they used it to learn about what dynamics in their lives triggered it. And when they change those dynamics, those illnesses have a very different course other than the usual ones if they just treated biologically. And so the disease is, is, is, can act as a big wake-up call for a lot of people. Again, I don't recommend it.

No.

One of my intentions, and I'm sure one of yours is as well, is to wake people up before disease comes knocking at their door. But once it does, it's astonishing what people are able to learn about themselves. And this has been documented as well.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in.

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