Jeffrey Bland, PhD on The Future of Medicine

Welcome to the Doctor's Pharmacy. That's F-A-R-M-A-C-Y. This is Dr. Mark Hyman. This is a place for conversations that matter. And today we're going to talk about some things that really matter with Dr. Jeffrey Bland, who's not only an extraordinary scientist and innovator and entrepreneur, but a really close friend and my mentor who literally set me on the path to functional medicine. I want to just welcome you, Dr. Bland, to the Doctor's Pharmacy.

Oh, well just a second. Before we go any farther, Mark, I'd like to just take a moment. First of all, thank you very much. That was a very gracious introduction. But actually the most important thing for me, the most important thing, and I want to emphasize that between you and me, was your recognition of you being mentored by me. There is nothing that is more gracious, nor for me impactful than you to say that, because as a leader of our field and a person who I have such great respect for in your clinical wisdom and the people around the world, literally millions of people that you've helped with your work and your teachings, it's obviously to be given some attribution as part of your learning curve is a very high level of flattery. So thank you very, very much.

Well, the truth is, Jeff, without you, I wouldn't be doing what I'm doing. I had this incredible, unfortunate experience over 20 years ago of being very sick and I didn't know why and I had this mystery chronic illness, chronic fatigue, my gut wasn't working, my brain wasn't working, my immune system was going crazy with rashes and sores all over and I was in complete breakdown and had no idea what to do and a colleague of mine at Canyon Ranch at the time, Kathy Swift, dragged me to your lecture, it was 1997 over 20 years ago and I listened to you and I was like, The paradigm was so different. And I thought, wow, either this guy's a genius or he's crazy. And I need to figure out which one. Because if he's right, then everything I learned about medicine is challenged. And I owed it to myself and my patients to do this. And I started to try on these concepts and just to apply them in the practice with the patients I saw. And I saw amazing things. And I would never have believed. I saw someone with an autoimmune disease who had been six and she was nine years old and she was 30, she was on disability. And within like a few weeks she was completely recovered. I'm like, wow, this is amazing just by changing her diet and a few simple things that we did. And so I began to try this on myself and it was really through that learning process that I began to realize that there was something here and that it was the best kept secret in medicine and science and that there weren't really many people thinking about it. And I actually thought, oh, this is a great big field. Everybody's doing this. This is so awesome. And I looked around and there was like a couple of guys who were doing this, like Dr. Baker and Dr. Galland, and I would like literally go sit at their feet and I would listen to every talk you gave and I literally followed you around and just soaked it in like a sponge. And through that process, I really began to understand not just in my patients, but through my own biology how functional medicine works. And what was really fascinating to me was that Your ability, and this is, I think, really unique to you, is you have this incredible syncretic mind. You can synthesize enormous amounts of data across all sorts of disciplines, and you read across disciplines, which most people don't. The neurologists read the neurology literature, the cardiologists read the cardiology literature, but you're reading everything and you're seeing patterns in the data that no one else has seen. And decades and decades before anybody's talking about these ideas, you're bringing them to us, and then we're trying them, and they're working. Things like insulin resistance or talking about inflammation or leaky gut, which we used to be laughed at for talking about dysbiosis, which now you hear in major medical conferences in gastroenterology, which was again a quack term. You talked about omega-3 fats, you talked about heavy metals and environmental toxins, about mitochondria. These are all now these emerging concepts. Bill Gates just gave $50 million to the Dementia Discovery Fund to fund inflammation research and mitochondria research in dementia, which nobody was really talking about. So how do you kind of do this? How do you kind of create this this in your mind, these connections, and how did you come up with these discoveries?

Well, thank you. That was very, very gracious. And, you know, I'm part of this remarkable community of which you're a central member of which is this functional medicine community of really motivated, take no prisoners, self-learners, which is a perfect environment for me, obviously, because of the way that I think about things. But if I was to go back to the origin of how I got here, you know, each person has their central feature that they've been motivated by or been instructed by or they've wanted to model after. And I've been very, very fortunate to just be lucky to be in places to meet the right kind of people that stimulated me. So I could even go back to, you know, high school with, I just have, fortunately, had two great science teachers that saw something in me. They got me summer jobs, you know, that I was able to work with other people in the, in the medical and nutrition industry in summer jobs. And then later, when when I was an undergraduate, I happened to have an undergraduate thesis advisor who won a Nobel Prize in chemistry.

Oh, that.

Yeah, Dr. Rowland, who won the Nobel Prize for his work on the Freon effect on the ozone layer. And so it was very, it got me into the whole environmental area through chemistry. And then I, of course, went on from there to meet Dr. Pauling, took chemistry courses from him, and then later as an assistant professor, I invited him to a lecture at our university, and we became then colleagues and friends, which then got me a sabbatical a couple of years with him where my office was right next to his. And so I had a chance to not just know him as a scientist, but knowing he and his wife Eva Hell and his people that were extraordinarily important in my learning about the broader way of thinking about the way we apply information. Because info, you know, the actual facts that we learn can be looked up. It's the context by how we learn them and how we connect them to other things. And that, that's really what I learned. from the Paulings. They were great examples. I mean, what I learned was this concept of structure and function. And it could apply at every level. It could apply to atoms, to molecules, to molecular structures, to cells, to organs, to tissues, to humans, to societies, to the planet. And get the structure right, the function will follow. So I think that for me, this insatiable thirst to kind of understand how this all fits together was the driving force. And there was one last part of this that I want to give an attribution to. As a young guy, I was very fortunate to actually start as an assistant professor at 25 years of age. So it was a pretty early start as a chemistry professor and environmental science professor. And it turned out that the president of the university was new at that time, had just come over from Wellesley as the dean there and was the president and really believed in kind of I guess you call it integrated thinking. And he liked cross-disciplinary thinkers. And he took a liking to me as this young junior professor and basically saw some potential in me, I guess, that I didn't fully yet have realized and wanted me to be able to stretch my wings. So I was able to teach courses in the philosophy of science. I taught in the business school about technology in the business community. And so I had the chance.

Chemistry and business.

Yeah. So I had the chance to do a history and science course, a philosophy and science course. I started a clinical chemistry program with the hospital.

I was teaching nursing students.

I mean, I was cross-fertilizing across all these disciplines. So, I had to read in all those areas and I listened to the.

Top professors in those areas.

I was actually like a student because they were co-teaching me.

So, like a renaissance man. I really benefited from that. So, I think that's how I got started basically. Yeah, it's amazing. And, you know, the ability that you have though to go into the literature and read across disciplines and see trends. I mean, like we've talked about this before, but now the microbiome is this incredible field of discovery and wonder and treatment. And I mean, they're talking about using fecal transplants for autism and Alzheimer's and fixing the gut as a way of treating autoimmune disease and treating obesity and diabetes and cancer. These were ideas that you were teaching us 30 years ago. And Nobody was talking about it. Nobody was talking about permeability, leaky gut. I mean, how did you kind of come to recognize that the gut was the center of so much of what's wrong with us?

Yeah, so isn't it interesting? And I'm sure what I'm going to say, you will identify within your search and pursuit of understanding as well. So once you start opening yourself up to not invalidate anything you learn, to say, oh, that's an interesting concept. I need to know more about it. Rather than to say, well, I don't know about it. It must not be that useful, because if if it was, I would already know about it. So once you open yourself up to that, and the reason I think a lot of people don't is it can be pretty complex if you're receptive to all new information, because then you have to learn how to filter. You can't be a sponge or you just be all saturated. But then how do you filter by being open to every new thing that someone says to you so you don't reject it right out of hand? So something you think is audacious, rather than just saying, well, that's stupid, I'm not even going to give it consideration. Say, well, that doesn't sound like anything.

I know, but maybe I'll look into it.

That'S a whole different approach.

Curiosity.

Well, and then taking off the blinders of saying, maybe I don't know everything I think I know.

Well, that's what RD Laing said, scientists can't see the way they see with their way of seeing. They have a certain paradigm and you only believe what you see, what you believe, you don't believe what you see. And that's the difference with you, you actually start to notice these patterns.

So let me talk specifically about your question about the gut concept. So I happened to go to a medical meeting early on in my career, this would have been in the in the '70s, the middle 1970s, and there was a gastroenterologist from Santa Barbara speaking in a kind of a breakout session, and he was talking about stools, and it wasn't just talking about stool testing based on looking at fecal fat for pancreatic insufficiency, he was saying, you know, the stool is a great device to, or sample, to test all sorts of things about how your body is working. And I thought, really?

It's just like a waste product, right?

Exactly, like a dumping ground, who wants to deal with stools? But he went on in very good detail about all the things that are in store that you could learn about, interrogate the function of the person. So I went back and I thought, wow, that's interesting. I wonder if anyone was really, if there's any history in this. And lo and behold, it didn't take me long to find the 1902 winner of the Nobel Prize in Medicine and Physiology, Ilya Mechnikov. 1902, yeah. Yeah, who took on the role when Louis Pasteur had died as the director of the Pasteur Institute.

He was no slouch.

No, exactly. And he wrote this book that I found, it was translated from the French into the English called the Prolongation of Life, which I'm very proud of in my book collection, an original edition of this book. And in that, as I read it, from the scientists who discovered the innate immune system, by the way, he's credited, that's how he's remembered. It was our ancient original immune system. Precisely. So I read this book and in it he's talking about the installation by Enema of Lactobacillus bulgaricus to re-inoculate the bowel, to treat all these chronic diseases that were, he felt amenable by just getting the gut flora to be properly regenerated. And I thought, man, now this is really strange. And then I found out, lo and behold, that there was a tradition in medicine called naturopathic medicine that had been talking about that concept for some time. And the more I dug into this and the more I historically evaluated it, and then I started looking at the literature, said, this is really something here. I think that we ought to spend a bit more time. So that those are the- this is.

Before anybody knew the word probiotics, right?

It was really in the dawning of the age age of probiotics. So this would have been like the middle 70s.

I mean that whole era of the gut back in the early 1900s led to some crazy practices, right? They were doing colectomies, taking out people's colons to treat all sorts of diseases. It was sort of the right idea, but the wrong practice.

That's right, exactly. Exactly.

And now, you know, we are seeing an era where we're here at the annual Functional Medicine Conference where we see top scientists from Harvard talking about doing fecal transplants for not just C. Diff or infections, but for all sorts of diseases, whether it's obesity or autism or autoimmune disease. And so this whole field of the gut has been central to functional medicine. And I know for me, it's been the doorway to help so many people. It's always where I start with people, whether it's they have allergies or autoimmune disease or headaches or joint pain, whatever it is, if you start with the gut and help them restore their gut, so many things get better that you don't even have to treat a lot of things.

Yeah, I think that you have taught very, very eloquently and made it accessible to so many people the construct that there are certain places where our body interfaces with the outside world. And those places where our body interfaces with the outside world, there are antennae sitting on the surface of those cells that are interfaced with the outside world. So you think of the nose, you think of the lungs, you think of the skin, you think of the oral mucosa, barriers, you think of the gut. These are the places where the body is interfacing directly with the outside world. And then how is it picking up that that information and how is it translating into internal function? That concept is a hugely frame shifting concept that you never learned in medical school. It was all about how things break down and what do you name them? And now we're saying, no, hold on just a minute. The reason they break down and we give them names called diseases is because upstream these interrelationships between the outside world and these receptors on the inside world, our body, are starting to get a message of be on guard, do battle, something hostile is coming and our body is well designed to be able to do that and then it becomes an innocent bystander to our own reaction to it, which we call disease.

Yeah, I mean, it's really stunning when you think about how many, literally thousands and thousands, maybe hundreds of thousands of patients have been helped through your work and just highlighting these concepts decades before they're starting to catch on in the mainstream. And they're still so marginalized. They're still so peripheral. You know, I'm in a major academic center, and, you know, even though there's people there who are studying the microbiome, it hasn't translated into any clinical practice. you know, functional medicine for all its faults has been brave in actually introducing simple ideas that have low risk but potential benefit and seeing amazing results. And I think that's why we're seeing a million people a year searching for functional medicine doctors on our website. That's a professional website. It's not even a consumer website. And they go there and they try to find doctors. Or we have 3000 people on our waiting list at Cleveland Clinic because people are really hungry for a different way of thinking, even if they don't know what it's called. they want to get to the root cause of it.

Absolutely. So let me use another example. It's one that you and I have mused over and see the extraordinary value in understanding, and that's mitochondrial function, the energy power.

We were going to get there. I was going to get there. Let's do that.

Oh, so in 1990- Other than the.

Gut, that's my favorite topic.

In 1996 was the first time that I think we started talking about mitochondria and its relationship to chronic illness in our functional medicine training programs. And that was fairly early because prior to that, the role of mitochondria in medicine was principally associated with inborn errors of mitochondria.

And these are these little things in your cells that take oxygen and food and burn them and create energy.

That's really the powerhouse of the cell. Precisely. And the cells of the body that are most actively involved in doing work have the highest number of mitochondria. Like the heart, 75% of the volume of a heart cell, a cardiocyte, is occupied by these energy powerhouses because the heart is having to work 24/7. seven.

So it really-- the brain too.

The brain, that's right. Thank you, another good example. So when I started to teach this construct at first, I think it seemed very esoteric and very kind of to a lot of people like, whoa, this guy's way out there in left field. But then I used a clinical example, which was for me really the kind of entree point into this understanding of the importance of mitochondrial function and health. And this was a gentleman that we had seen actually when I was the lab director at a medical clinic in Seattle, Washington, actually in Bellevue. who had come in with very, very severe fatigue and muscle pain of unknown origin that had come on kind of suddenly for no expected reason. And he had been through many, many different types of studies and didn't have a good diagnosis, but it was clearly obvious that he had this unremitting fatigue and this muscle pain. So ultimately the way we started looking at it, I thought, well, maybe we ought to take a look at his mitochondria. So we did a biopsy and looked at his ragged red cells and his mitochondria's muscle, and lo and behold, It turned out that he had not all of his mitochondria, but a great percentage of them were suffering from a mitochondrial injury that we could detect by looking at mitochondrial DNA. And it wasn't an inborn error of mitochondria. It was something that required a defect. It was something that he didn't get from his parents. It's something that it seemed like it happened. So then we asked him, was there anything that you can recall in your timeline that was associated that could have happened was the onset of these symptoms. And he was tracing back, sometimes it's hard to remember, and he said, oh geez, I do remember that I was driving through the Sacramento Valley in my convertible car. And they were spraying. And they were spraying, and they were spraying all, and the wind was blowing it over the road, and I was exposed.

The Central Valley, which is a big farm area in California.

For a couple of hours I was driving in this with these crop dusters, and the air was filled with the fumes. And now that doesn't prove it, but it was at least circumstantial that maybe there's an ideological origin of this problem. So we then started to do what you would do if you had an inborn error of mitochondrial injury. And we said, let's give a lot of those nutrients that are necessary to promote proper mitochondrial function. N-acetyl cysteine, carnitine, coenzyme Q10, a family of omega-3 fatty acids. and lo and behold, his function started to improve. So, this was like an empirical test of a hypothesis. And once we got that aha, we said, well, hold it. Now we start to look at, maybe there are all sorts of these acquired mitochondrial opathies that we're unaware of. So, that's how these concepts started developing.

Well, thank God for that, because it's actually how I got sick was through a toxin, it was mercury, and living in China, and it created massive mitochondrial injury, which led to severe muscle pain, severe fatigue, complete brain shutdown, because your brain is dependent on it. I had elevated muscle enzymes, CPK, which turns out I did my genome and I have a particular gene variation that makes me more likely to have problems with the muscle enzyme CPK. And that was a mitochondrial injury and I had fasciculations, my muscles were twitching, I had just all these symptoms of mitochondrial dysfunction, like my energy just just battery was just on low, like when your iPhone's like, you know, about one percent battery, it's kind of how I felt. And it was through understanding that and actually getting rid of the mercury and giving myself mitochondrial support, which I still do to this day, had profound effects. And I had a patient who was a 19 year old young man in college who came down with this severe muscle pain and, and what we call, you know, rhabdomyolysis with, which is where the muscle breaks down. And he had very, very high levels of CBK, not like mine, where 600. He had like six thousand, ten thousand. And I'm like, listen, I don't, you know, he went to the geneticist, he went to all these experts, he went to everywhere. No one could help him. I said, listen, what Dr. Bland taught me was that through first principles, if we, even if we don't know what's going on, if we just try to help use the principles of biology to restore function, to just give him the support for his mitochondria, maybe it'll help. I don't know. He couldn't walk up a hill without severe pain. He couldn't really exercise at all. He was tired all the time. So I gave him fairly high doses of the things you mentioned, coenzyme Q10, I gave him D-ribose, I gave him carnitine, I gave him an acetyl cysteine, omega-3 fats, magnesium, potassium, aspartate, all sorts of ingredients that are the fuel to help these chemical reactions. And he's completely recovered. Now, if he takes these things, he's completely functional. He can exercise, he can go to the gym. And I think, you know, this is really one of the principles that I think was the origin of functional medicine was Linus Pauling's paper, Orthomolecular Psychiatry, which was published in Science Magazine in 1969, which laid out the concept that you could use nutrients to help push chemical reactions in the body. that may be dysfunctional because of various factors, genetics or lifestyle or insults or chemicals or toxins, and they actually get the body to work better. And that's really the principles of functional medicine, which is not to treat a disease, but to restore function and to take away the things that impair function. And when you do that, disease just sort of goes away as a side effect. I don't actually treat disease anymore. I just. I mean, like, it's interesting to know what they have, and it's sort of.

A guy, like a signpost, but it's not the end of the story.

Story.

Yeah, I think you said it so eloquently. It's not only not the end of the story, it's the beginning of the story, right? Because it's not what you call they have, it's how they got there that's important. And that's the whole nature of what we have learned about the importance of functional medicine. It's the journey, not the destination. And you can alter the journey to the destination by asking the right questions. If you don't know the question to ask, you can never get the answers you and functional medicine teaches us how to ask a different set of questions than that which we were trained in medicine to ask. And by the way, those questions that we are now asking in functional medicine will be the questions that doctors of the future will be learning to ask. But we're the front edge of that changing paradigm. Well, we're seeing it because now these.

Concepts are creeping into academia and we're seeing, you know, I just saw a lecture from a guy from Washington University in St. Louis, which is one of the top most conservative medical institutions, and he's talking about the gut and he's talking about using various nutrients and things to support function. And I think that's the difference. Functional medicine asks, you know, how do we restore function? And medicine asks, how do we treat dysfunction? And that's a very different question. That's exactly right. And in a sense, medicine is the science of disease, whereas functional medicine is the science of health.

That's exactly right. So let's go back to the gut for a half a second.

So this way- My favorite topic. They used to call me Dr. See Every Poop. at Canyon Ranch. That's beautiful.

So let's talk about this week, a colleague who is at UCLA, Elaine Chow, S-H-A-I-O, just published a paper on the COVID of what is reputed to be probably the most prestigious basic science journal in biology called Cell. That's the name of the journal. And this cover article is revolutionary. I mean, it's a showstopper. in which she has found in two very highly respected animal models of seizure disorders and epilepsy, that there are two microbiome members of the community of the thousand or so different kinds of bugs that live in our gut that are directly associated with seizure management in the brain. And she has done such a great detective work, I won't give too much kind of detail here, but let's just say her detective work has been able to find out exactly the molecular process by which the gut bacteria, these two bacteria, can communicate with the brain in such a way as to manage seizure disorders. Now, if you were to have said that just in passing 10 years ago to someone that, by the way, that your gut might have some impact on seizures, you would have been saying, you need a proof frontal lobotomy or something. But now, the science is absolutely irrefutable. It is so powerful. So the things that we have been, as you mentioned, describing, maybe without all the precision that we need, now are opening up with these new tools to be absolutely proven correct.

It's like you had that coloring book that was going to connect the dots and then color in. We had all that, but we didn't have the color yet. And now we're getting the color filled in on the picture. it's powerful. And the mitochondria thing is such a big deal because, you know, we talk about ketogenic diets, for example, and the brain, maybe there's some effect on the gut bacteria, but there's also the effect of mitochondria and ketogenic diets, which are ways of rejuvenating the original sort of, sort of ways in which we actually produce energy, which is this low-grade ketosis.

That we had as hunter-gatherers that we had to be in a lot of the time. So you just said it because it turns out that her work See, this shows you how the functional medicine model works. That her work has shown that these specific two bacteria that are friendly in the gut, if they're there in the right percentage, influence then the influence of the ketogenic diet to modulate brain chemistry in such a way as to reduce seizures. So their presence is necessary for the ketogenic diet to really work. So it's all part of a large system and that's the way that we think, right? We're always in- It's all systems. And that's why for us, for you and I, it is so frustrating when we hear, like, let's say a woman patient comes in and she has osteoporosis and athalosclerosis and she has arthritis, rheumatoid arthritis. So he has three different medical conditions with three different diagnoses seen by three different subspecialists with three different sets of medications.

And then you ask, well, why does.

She have- Pill for every ill. That's right. And then we ask the question, why does that woman have those three conditions?

We say, well, it's just the bad luck of the draw.

Comorbidity, meaning they just happen to randomly be associated that's exactly right. That's the way we rationalize it in medicine, comorbidity. When now, as we know from functional medicine, they share a common lineage of their origin. And it's highly probable based on certain dysfunctions, if you treat the dysfunctions, you're.

Treating all three of those conditions. Well, that's it. You know, I think that's the challenge. You know, we are so specialized and we don't understand across our specialty what matters. And I couldn't choose a specialty, which is why I went into family medicine. I'm like, how could you treat a part? It's all one thing, right? and you often don't have to treat each thing individually, you just treat the system and the problems go away. Like this one patient that's coming to mind who I saw at Cleveland Clinic recently who had psoriatic arthritis, which is a terrible disease. She was on a drug that cost, you know, $50,000 to $80,000 a year. It still wasn't helping her. A little bit relief of pain, but not much. She still had all the skin lesions. She had irritable bowel, bloating, she had reflux, she had migraines, she had depression, she was overweight, had pre-diabetes, had insomnia, anxiety. This one was like a 48 year old executive business coach and was just struggling. And she was on medications for depression. She was on medications for reflux. She was on medications for erectile dysfunction. She was on medications for migraines. She was on medication for, she was like on everything. And I'm like, just listen to her story. And I'm like, wait a minute. You know, these are all inflammatory problems. And if we don't deal with the cause of inflammation, we can take, you know, all these drugs to shut off inflammation or deal with the symptoms and not really deal with the problem. So I said, well, let's just start with your gut. Let's just put you on an anti-inflammatory diet. We'll get rid of inflammatory foods like gluten and dairy and sugar and processed food. We'll give you whole foods. We'll give you some things to reset your gut. I treated her with. With bacterial overgrowth treatments and an antibiotic that's not absorbed in any fungal because of all the. Any drugs she's taking, the steroids. And I gave her some support, like vitamin D and fish oil and curcumin, not a lot of stuff. And six weeks later, she comes back. she's not because I told her to, but she got off all her medication. She was completely symptom free. She lost 20 pounds, and she felt great. And it wasn't that she needed all these different Specialists to give me these different drugs. She needs someone to understand how to reset her system. And by just working on the gut, she recovered. It was pretty. It was pretty amazing. We see these stories over and over again, and people go, well, this is just an anecdote, or it's, you know, maybe it's spontaneous remission, or it's whatever, but. After 20 plus years of doing this, and you've heard thousands of stories from thousands of practitioners over the whole globe, this is real and it's not going away and it's actually starting to infiltrate into medicine, which is pretty exciting.

Well, Mark, I think that what you've just stated is the reason that we're all in this field and so excited to be part of this emerging frontier of how we're going to beat back the rising tide of chronic illness. Let me, if I can, give attribution to my colleagues that I shared for 10 years, the Functional Medicine Clinical Research Center, which I oversaw in Washington State. We had a full medical staff there. We saw about 4,000 patient visits a year, but it was all on different kinds of clinical protocols doing studies. One of those patients, which directly speaks to what you just described, was a patient that will forever be indelible etched in my mind as to what we're doing. medical doctors that was involved in the studies came into my office one morning, 8 o'clock, and he walked in very brusquely through the paper, the local newspaper, the Tokai News Tribune down on my desk and he said, We gotta help this woman. And I thought, Wow, what are you talking about? And he said, Look at this. And I looked at the front page of the paper and here is a photograph of a pair of hands, outreach, filled with pills. And you could only see up to the woman's neck. You couldn't see her face, but you could see that she was holding these pills. It went into this description of this woman who had this unusual autoimmune disease called erythromyalgia, which is very infrequent, but it's a problem in which her feet and hands would get red hot so much that she couldn't wear shoes, she couldn't stand up, and the skin would peel like you being severely sunburned. And she was showing the pills that she was on being treated by the top of rheumatology.

And it didn't help.

And she wasn't symptom free. And so he said, we got to help this woman. I said, well, you know, we don't really know much about this condition. I mean, this is pretty severe. And he said, Jeff, we know a lot about where these come from, just like Dr. Hyman was telling us a moment ago. And I said, well, what do you think? Do you think we should put her in the trial? Oh, yes, we should give her the opportunity. I'm gonna call her up if you don't mind, and we'll ask her if she wants to be involved in the study. And I said, okay, I checked with our lawyer to see if this was gonna be okay. And so we got her permission with obviously, signing off with her rheumatologist that this was going to be a lifestyle intervention, so he didn't feel it was too serious. Well, what happened, if I can go through this quickly, the end of the story, that when she started, she had three wishes. And those wishes were, this is her desire for outcome. Number one is that she could stand at her kitchen counter to prepare a meal for her children, which she had not done.

Not a very high bar.

The second bar was that she could go to the garden, because she hadn't been out of her house for a year and plant her garden in the spring. That was the second. was that she'd go with her kids and walk in the mall, the shopping mall. Well, you know, for most of us, those seem like really kind of simple things, but for her they were huge. So over the course of the next six months, you know, first of all, she was saying, my word, you know, I can stand up now for the first time and to prepare a meal. Then the second thing was, gee whiz, I can actually go out now in the spring because we saw her first in November, so then come April she could actually go out and plant her garden. then the key was here she comes in with her children. And I could always see when she and her husband drove up because they parked right in front of my office. And at first she could barely walk to the office and now she's getting out of the car, but she has her kids with her. And she comes in and she wants to show us the shoes that her children bought her to walk the mall.

I got the children.

Yeah, it was unbelievable. Then, now this is the key. And this was the moment that's indelibly etched in my mind. so, you know, by this time she was completely off all this medication. It was weaning herself away from all these drugs. And so then she was kind of graduated and left and, you know, finished the study. And so we wondered how she'd done. And about into the summer, so that would have been another four or five months later, she comes back for a visit, not as a patient or part of the study, but just to revisit us. And she's carrying a wrapped gift that looks like some kind of a painting or something.

Yeah.

And she says, I'd like to really see Dr. Jack and Dr. Minnick and because I want to give them a gift. And so in she comes, they unwrap it, and it's a photograph of her at the top of Mount Si.

I've seen that picture, which is the.

Big mountain outside of Seattle that is a walking trail. Quite, it's about a 2500 foot elevation rise over about two miles. So pretty steep trail. And here she is on this beautiful summer day overlooking Seattle, holding up this big sign that says, Thank you, Dr. Jack and Deanna. Now, to me, these are the stories, right?

Yeah.

That drive us.

It's true. And you know, when you hear pushback from people, you just go, well, I mean, it's just, this is what breaks my heart. I mean, I just know we have not the perfect solution for everybody, for everything, but I know that we have a way of thinking about things that that can get people better in ways that most of modern medicine just doesn't. We're great at acute stuff, but we're not really good at thinking about this chronic disease stuff. And your book, the Disease Delusion, was really, I think, an important book. And it really needs to be read by everybody in medicine and in healthcare and policy and pretty much anybody with a body. And the reason is that it maps out a sort of a reimagining of the body from the perspective the science today as opposed to the science 100 years ago, which is what medicine is based on. And in your voluminous reading and your serving of all the world's literature in these different areas, you've helped us to put together a map of what's actually happening in the body. And we call that in functional medicine the matrix. And it's what we use to actually assess patients, which looks at their environment and their genetics and their lifestyle and how that interacts with these basic systems in the body that are all connected. And I wonder if we take a minute to talk about some of these fundamental physiologic processes. Now, we've grouped them into seven, but they could be five, it could be eight, it could be nine. It depends how we cut and slice and dice it, but they're all really relevant. And if you understand those, you don't really need to know that much about anything else. I mean, I hate to say it, but like, people say, well, do you treat X or, you know, rethromyelitis? Well, I don't know. I've never seen that before, but. based on these principles, you can treat these patients even if you don't know what's going on because you're working on seeing where the imbalances are. So this woman had inflammation. Well, you can start on working on that. So tell us about how you came up with these basic concepts and how they're put together and how we can sort of learn a little bit more about what these seven physiologic systems are. Yeah, thank you.

And of course, you were part of this development of this model. Yeah, I thought it was all set when I got involved with this.

I'm like, wait a minute, nobody knows what they're doing.

We better figure this out. Yeah. so I think this is a great example of the development of human knowledge in collaboration. So my wife was very prescient in 1989 and she said to me, Jeff, you've been traveling a lot all around the world. You keep coming home telling me about all these extraordinary people you meet in different disciplines that are making these major discoveries in healthcare and in biological sciences. And then you come and you complain about the fact that we're not doing all these things that we should do in healthcare, we should be appropriating and translating these things into practice to reduce the burden of disease and you have this big frustration. So why don't you stop the frustration.

And- Stop whining and do something, exactly.

Why don't we sponsor a meeting and invite some of these people that you've been talking about to come in and sit down with a whiteboard discussion about what if and get away from the concepts of reimbursement and licensure and all those things. Just talk about what would healthcare be if you were to really idealize its evolution. so we did that in 1989 in Vancouver Island, British Columbia, and Victoria. Had a marvelous meeting about 35 to 40 of my colleagues came in for those discussions and then it was so successful we said well let's do it again in the next year, 1990. And in 1990 at the end of the second day, that night I had this vision or dream or whatever you want to call it saying I think what we're really talking about is improving function as precedent to that of disease. And so maybe we ought to call this functional medicine. So I came back and I tested that concept the next morning and people thought, well, yeah, maybe so, but that term has a little bit of negative connotation. But maybe if you're looking forward to what it could be, maybe it'll be redefined. So let's give it a whirl. So that was 1990, the Institute for Functional Medicine was started in 1991. And then we sat down with this insider group of which you were early on, one of our insider group, And we said, how would we cluster all this information that's being developed into functional piles? In other words, so we started off with all these articles and all these studies and everybody brought their own favorite studies, hundreds and hundreds of different research papers, and we started to organize them manually into piles.

Wow.

And it was really kind of a fun process. So we had a room that was filled with piles. And we said, well, hold up, that's too many piles. Can we consolidate these into where they aggregate, where they group? aggregating saying, well, this paper is really like that one over there. And so we, you know, we did a, you could probably do this artificial intelligence today a lot more, but we did it manually. And eventually we ended up, believe it or not, with seven piles. And those are the seven core physiological.

Processes that we started to work on.

That was the process, basically.

Lots of piles, yeah. And, you know, and it turns out that, you know, these ideas that you taught us about inflammation, the gut, mitochondria, toxins, hormones, you know, structural systems, membranes, interfaces, these are all these seminal ideas that now are sort of, we're peeling back the veil in science and going, now we're really understanding these things. You've got like Dr. Alessio Fasano, who is also on the doctor's pharmacy and was talking about this idea of leaky gut and these membrane and barriers that break down and the discovery of the scientific mechanisms behind it. And we kind of knew what was happening. There were shadows, but now we actually can see things in full relief and it's pretty amazing.

And think about what you just said there, the power in that sentence that we have now understood, starting to understand, I don't want to say complete understanding, but we're starting to understand that this outside world, the things that we eat that come from the soils and the environment from which nature nurtures, have an inborn communication connection to our body's receptor systems that signals through every DNA molecule that creates our function. Now that is a paradigm shifting concept, that we're connected into the soil, into the air, into the water, into the sun in ways that are directly tied to these biological processes that we call intracellular signal transduction for which we are involved matrices not disconnected from the world, but an integrated part of the network of the world into our biology.

Yeah, I gotta unpack that because that was deep. So what Dr. Bland is saying, and I've been his official translator for 20 years, is that we are constantly in communication with everything, with the sun, water, the air, the earth, with environmental toxins, with our food, which is the biggest thing that we deal with every day. So this is really information science. Biology has turned into information science and understanding how do we interact with all the information that's around us and in us and all the microbes in us, all the food we eat, and that this is far more relevant than trying to just categorize people into groups around diseases and find the right drug for it. And once we understand that this complete dynamic crosstalk of information is actually driving all the things we see, then we have a whole new way of like not only thinking about it, but treating people from these first principles and seeing extraordinary results when and we never imagined possible. I remember, I saw someone with autism, I don't know what to do with autism, I'm not trained in autism, but I just said, well, let's just get these things in balance and people started to recover. And with Alzheimer's who came in who was sitting in a corner drooling and depressed and demented and turned out he had severe mercury poisoning. We just looked, well, let's look at the things that are out of balance. Let's look at, he had insulin resistance. He had methylation issues around folate and B12. mercury. He had a lot of gut issues and bacterial overgrowth and leaky gut and inflammation. I said, well, let's just calm all these things down. I don't know what's going to happen. And he recovered. And I'm like, this is extraordinary. And I. I was able to do that based on using these Concepts that are out there in the science, but that no one's using and using the lens of functional medicine, the things that you've helped us know and understand and really just getting people to sort of do those simple things that make profound difference. So it's changing the information. and that food is information, everything is information, exercise information, sleep is information, food is information, thoughts are information, and these are all communicating with every cell and every system in your body every second. And when you understand that, then it's enormously empowering because then you can do something about it.

Precisely. So once again, you've triggered a memory in my mind I wanted to share real quickly, and that is My father, who was a life of the mind kind of guy, he was an aerospace engineer and a lot of my intellectual curiosity was really fueled by my father. He was a very good father, was engaged with me as a child a lot. And unfortunately, as he started to get older into his 70s, he started to get some cognitive problems. So much that basically he moved to a separate bedroom because he didn't want to keep my mother awake and he was very restless at night and he was starting to get cognitively detached and my mom was very worried about him and become pretty much a full-time caregiver. And this very strong capable man started to become very dependent. And so he was down to one last thing that he loved doing that he could still do, which was to, with great, great difficulty, work on his computer. But it'd become a real labor. It would take him a long time to do a simple task on the computer, but he's still holding on to that. And my mom was greatly distressed by this whole, I mean, we all were. but she was living with him all the time. So I came down, they were living in a home down in Northern California, and I was visiting him periodically, and I came down and I said, you, know, I wonder if my father, your husband, is not somehow suffering from some kind of a metabolic defect that's really exacerbating his dementia.

So your mother said, this.

I said this to my mother. I said this to my mother. And I said, so let's do have his doctor. He had this MD, PhD internist in the local area as his physician. Let's ask him to measure homocysteine and methylmalonic acid in his blood. These are two metabolites that I know. B12 and folate. That's exactly right. And, and, and so my mom said.

Okay, write those down. By the way, Jeff, most doctors just check blood levels of B12 and folate.

Not these other markers which tell you.

About the function of the B12.

Thank you. Very good. So my mom took my little note to the doctor and then she called me up and she said, well, I talked to the doctor, but he doesn't know about these. Now he has a PhD in hematology. Now that's, and I thought, really? He doesn't know about these? And she says, well, he might know about them, but he's never ordered them as a test. And he doesn't sure, he's not sure that Medicare covers that. And I said, okay, let's deal with the Medicare thing first. I'll pay for them. and let's then deal with the second thing, if he doesn't know about them, ask him and I will send him some articles. So she says, comes back to next, she says, well I've talked to him and he does say that he knows about them a little bit and if you'll pay for them he will order them, but he'd like to know more. He would like some articles. Well you never asked Jeff Bland for articles. And this is back in the days of the fax machine. So I burnt out his fax machine. I sent him all the- His nurse came in in the morning and they were all on the floor, he had all these papers so basically, hopefully he got interested enough and then the data came back and lo and behold he had very high homocysteine and methylmalonic acid both. So, as you said, the functional B12 and folate deficiency. But he didn't know exactly what to do. And I said, Mom, you needed to have him tell you how to train you to get injections of B12. and so, oh, I think you better talk to him. So I had this conversation with him and he was a very amenable, very good guy in receiving my thoughts. And so he trained my mother and he got on a high oral folate and he's daily IM intermuscular injections. So I would call every day and I'd say, well, how's dad doing? Well, I don't really see much change. Yeah, that's too bad. So about a, I think it was about 10 days went by and then one morning call and my mother was in hysterics. and she was just hardly even able to talk. She was crying and carrying on. I thought, oh my word, we've had a huge crisis down there. And I'm thinking, you know, maybe I did something here that was bad. And then I said, Calm down, mom, calm down. What's going on? Is it really bad? Is it really bad? She says, no, no, it's not bad. It's unbelievably good. She said, this morning for the first time, as I was in bed this morning, your father walked in fully dressed, standing up and said, Let's go on a picnic today.

Oh my God.

And for the next six years, my father was at his computer doing everything he wanted fully functional from that one simple insight. Now I'm telling you, those are irreversible learning curves. So when people tell me there is nothing to this, they're gonna have a hard sell with me.

Yeah, no, absolutely. It's so powerful and it's not always that simple, but sometimes it is. I had a woman who was a very, you know, accomplished woman who was on the board of many big companies and a leader in a community. And she came to me about 75 years old, and she's the same thing. She was depressed. She had cognitive impairment. They diagnosed with pre-dementia she was on her way down. So I checked the homocysteine and methylnolic acid, same thing. And they were elevated. So I gave her B12 shots and folate and high doses in the right forms, and she completely recovered. And then about I never kind of heard from her after that. And then 10 years later, I got a call from her and I'm like, she was like 85 and I'm like, I thought maybe something's wrong or maybe I saw her my schedule. I'm like, well, maybe she's declining and needs some more help. And she's like, well, Dr. Hyman, I'm going trekking in Bhutan and I want.

To know what I need to do to prepare for my trip.

And I'm like, okay, I think we're on the other side now. Yeah, so not all stories are that. cut and dried, but it's pretty extraordinary when you begin to understand the body in this new way. I mean, I say it all the time, but I think what you've done is you're sort of like the Galileo of medicine. You sort of presented us a new paradigm that seems so much heretical to our point of view that it's been so marginalized. But now I think people are just recognizing that what we're doing isn't working, that we can't get to where we want to get to using the same kind of thinking. That's like Einstein said. we're in this place where this is a magic moment where we're invited into the center of healthcare, you know, whether it's conversations in Washington with Food is Medicine caucuses and Congress, can you imagine that now? Or whether it's, you know, Cleveland Clinic where we're researching Food is Medicine or functional medicine to other institutions bringing this on, it's happening globally in China and South America and South Africa and UK. I mean, there's just this burgeoning interest in this field, which was so marginal. And I had to say, Jeff, your commitment to this and your dedication and your tireless travel, I mean, I can't imagine traveling to 50 countries, millions of miles. You must be like a more than a diamond. You must be like a, I don't know, whatever that is, traveler. And that kind of dedication, that tireless sort of beating the drum year after year, day after day, is just amazing to me. without that, I don't think all of us would be doing this. You really have birthed this whole field.

Well, that's very gracious. I think that there is energy and a universal truth. I always say it's like a leak in your window. It may take some time for the water to find its entry point, but eventually it will. Truth will out in the end. So, if it wasn't me, it would be you or others that would find and do this. I can say one thing though, just as a social parenthetical comment. Yes, there was a lot of travel and I think back and I was laughing last night as we were having dinner together about the fact that there were times where I would leave my university position on a Friday, go out and do a Saturday-Sunday, all day long, Saturday-All-Day-Long-Sunday, eight hours each day, 16 hours meaning lecture with doctors on this concept, get back in the plane and come back to work on Monday and did that for 40 weekends a year. and that went on for many, many years, more than a decade.

And I was at many of those seminars. Yes.

And so I now have adult children. I now have 49, 46 and 36 year old sons and their families. And so we've had many kind of now adult conversations about what that meant. And my kids who are all affected by this activity because clearly they grew up with it. It was part of their childhood and growing up. As they've now become middle-aged, as my oldest son reminds me at 49, he's becoming middle-aged, he says, Dad, at times as a child, I really would have liked my father around more. And it would have, because we really loved you and we would have liked you to participate with us more. But now as I look back, what you left the family with was a sense of where we were going as a culture and how we're connected to it in a very powerful way that we're sending on to our children now and to my grandchildren. And so I think nothing comes free of charge, right? Everything has a price and you have to kind of evaluate what's the price for the value in any activity. And as I look back, yeah, there are certain things that I personally might want to reapportion some of my time allocation, but on the main, having friends and colleagues like you and watching what's happening and having the conversations you and I have shared here at this meeting with 1,500 docs who are all coming up to you and me and telling me that we helped transform their life and that of their patients and they saved all these lives. And I mean every moment we say, okay, what is a purposeful living? What is it all about? It's some kind of a balance of all these things. You can't sacrifice one totally for another, but a purposeful life is finding ways to serve not only your family, but the world at large and best that you can bring your talents to it. So, that's true.

You've lived a life of service. It's really true. which is rare and precious and the gift you've given is just extraordinary. So for you, Jeff, every day you run around, you do all these things. How do you stay healthy and sharp and good? What are your non-negotiables? What are the things that you just have to do to stay who you are?

Well, I think the first thing that probably stands up for all of us that have survived, in my case probably more than now six million miles of air travel over the years, is to remember that you have a responsibility to yourself to be the best you can be for the rest of the world. And it's not a sprint, it's a distance run. I've seen many of my colleagues that I've been with over the last 40 years that saw more of a sprint and they're no longer participating because they burned out. And for me, it's always been the long run because I knew that-- the ultra-marathoner. That's right. you know, you overdo at times because you have to do certain things and then you have to find balance. Let me give you a good example of that in my life. So, and I have a good partner that reminds me of this, she's very good about putting the stops on and reminding me. So I would really have been forcing hard like we all do to get some things done, probably overextended to say the least. And then one day I came home and she said, well, you know, here are your bags, we're packed and we're heading out. I said, well, no, we can't. I've already taken care of your schedule. And so, you know, she recognized that that really had to, and it had to be unplugged from cell phones and it had to be unplugged from computers and email and we were going away. And so that became kind of a pattern of our living in the 30 plus years that I've been married with her, in which, for instance, on our 60th birthdays that we share the same year of birth, We made the decision that we were going to take the whole summer off. Now, taking the whole summer off when you still had all the responsibilities that I had seemed impossible, but then I had a whole year to plan. So I basically decided to bring in people to help me to take over a lot of my responsibilities. And we took three months and traveled to Alaska in our boat together with our animals and we flew in the kids, flew them out. But most of the time we were just the two of us together in the most romantic environment, just seeing nothing other than animals and blue sky. for us for three months and that then empowers you to be best in the long distance. So I think that's where I would start is finding the right balance points and recognizing that it's not a sprint, it's a distance run. Secondly, then once you've got that kind of rhythm, then what are you going to do? You're going to make certain things about your diet and about your exercise program and about your sense of responsibility to yourself as very high priorities and as you said, non-negotiables. so yes, there's always going to be a little bit of a slop around the edges and certain things that, you know, you might say, I don't want to do that you'll do periodically, but in the main, you should stick by certain rules. And for me, they're rules that you've been talking about so eloquently for quite a while, you know, the sugar reduction, the management of calories, the using things that are close to the earth, the Michael Pollan way of eating, the regular activity, even if I can't get a full dress to exercise, you know, exercise in it's at least walking an hour a day, having a dog, which becomes your universal little trainer. And my, my dog is very special in my life. I have a golden retriever that, you know, we, we run together in the woods. And so all of those things are part of becoming a rhythm. It's, it's your, you wouldn't do anything else because it is your behavior.

And I think you, it's building those habits of life that just are sustaining. Exactly. You can go sprinting, but you have to know how to reset and recharge.

Yeah.

And it's all about, like, understanding, you know, how does your body work? You're a biological organism, you know, and I like my nephew, for example, he's sort of disconnected from his own body, his own environment, because he's focused on his devices and his computers and his video games. And it's like he's not in the world of being an animal, which is we all are, whether we like it or not. That's right.

Well, and I think that's the other, thank you for saying that, because we are all unique, right, in our needs. So in my case, I know that I have a family history, my father's side of diabetes and my My grandmother, his mother, was one of the first people and first generation to get insulin for her diabetes. And then my father had type 2 diabetes. And so I have to recognize that that's a factor. So I follow very closely my biometrics and I'm always making sure I'm on the right side of the curve. And if I look like I'm straining, I can pull myself back. And so I think it's individualizing to your own unique strengths and weaknesses is very important.

Yeah, that's good advice for all of us. So last question, if you were king for a day and you could change anything in the world of health, healthcare, food policy, to make the world a better place, what would it be?

I would have a woman president.

Okay.

And I would bring the feminine into healthcare. The reason I'm saying that is that I think the command and control model that males generally like, 'cause they like widgets and gadgets and devices has been really, really great for technological development. And I would never say it's not been good for society and cultural evolution. But we're at a time that we need some new skills and some new ways of managing information, new ways of communicating, cooperating. We need less doing and more being. And I think that that's why the feminine might be a really important part of our future. So that's how I see it.

It's time. I think that's a great thought to leave on, which is understanding things in a different way than are very controlling and like you said, command and control view. It's awesome. Well, Jeff, thank you for being on the Doctor's Pharmacy and sharing your life and your wisdom and your intelligence with us and especially thank you for me because without you, I wouldn't be able to do what I do. I wouldn't understand the things that I understand and I'm just a good translator and I really appreciate all the work you've done to help the field, help us, help so many millions of people, and nobody really has any deep understanding, I think, other than a few of us in this field of the contributions you've made. I just want to honor you for that.

Well, Mark, thank you, and I would say that it goes reciprocally. In the absence of a translation to practice and to really delivering this in a way that could serve people, it's just intellectual cocktail talk. And so you are my voice to the universe of making this really real. So thank you. It's a brotherhood that we will always share.

Thanks, Jeff. And so you've been listening to the Doctor's Pharmacy, Dr. Jeffrey Bland. If you've enjoyed this podcast, please leave a comment, leave a review, and share with your friends and family on Facebook and Twitter and social media, and subscribe to the podcast on iTunes and anywhere else you listen to your podcast. We'll see you next time on the Doctor's Pharmacy, a place for conversations that matter. Don't forget, there's a way to listen completely ad-free. With Hyman Plus on Apple Podcasts, you can enjoy every episode without any breaks. Just open Apple Podcasts and tap Try Free to start your seven-day free trial.