What's Broken In Western Medicine & How To Fix It: Unconventional Medicine With Chris Kresser

Hey, what's up? It's Ben Greenfield. I've got my friend Chris Kresser on the show today. Chris is. He's just pissed at Western medicine. Just absolutely pissed at Western medicine. No, I'm just kidding. He's. He's a good guy. He wrote a book, though, about what's broken in Western medicine and how to fix it. It's called Unconventional Medicine.

I was able to.

I was able to harness him for this podcast. I don't know why. I just made him sound like a horse or something else one would harness. He's not a barnyard animal. He's actually a pretty smart dude. I need to quit digging myself into a hole now and tell you a couple of things in this episode of the Ben Greenfield Fitness Show.

If you understand the basic concept of evolutionary biology, it's that all organisms are adapted to survive and thrive in a particular environment. And if you change that environment faster than the organism can adapt, there's going to be a problem. Functional medicine is the new model that is specifically designed to prevent and reverse chronic disease, and it does that by addressing the root cause of these diseases instead of just suppressing symptoms. So to use an example, he's an.

Expert in human performance and nutrition, voted America's top personal trainer, and one of the globe's most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance. He is Ben Greenfield. Power, speed, mobility, balance, whatever it is for you, that's the natural movement. Get out there. When you look at all the studies done, studies that have shown the greatest efficacy, all the information you need in one place right here, right now on the Ben Greenfield Film Fitness Podcast. Hey, folks, it's Ben Greenfield. And I have on the call today the author of a relatively new book. It's called Unconventional Medicine. Unconventional Medicine. Join the revolution to reinvent health care, reverse chronic disease, and create a practice that. That you love. His name, and you may have heard of him before because he kind of gets around in the functional medicine circles. His name is Chris Kresser, and he was actually named one of the 100 most influential people in health and fitness. His blog is amazing. He has a podcast as well. He puts out some of what I consider to be the best, most informed information, especially when it comes to functional medicine. In this particular book, he's done a really good job really wrapping all that information up into almost like this treatise on how you can combine functional medicine and an ancestral diet and lifestyle and what he calls a collaborative practice model. To create this system for patients and for practitioners and to break all the crap that's wrong in modern medicine. So, Chris, welcome to the show, man.

Ben, it's a pleasure to be with you.

Yeah, and I was actually thinking about you the other day. I. I found, like, some kind of nasty, like, it looks like ringworm, maybe athlete's foot on the bottom of my foot. So I've been smearing oil of oregano on it. But I know you have kind of like this history with parasites or some kind of, like a worm infection that got you started with all this in the first place. Is that true?

Yeah. I spent some time in my mid-20s. I spent about a year traveling around the world, and I was in Indonesia surfing, which was the main purpose of that Trav. And I got what I later learned, much, much later learned, was three. Two parasite infections, one amoeba and two parasites all at once.

Was that just from the water?

So there were. This was in a tiny little village on the island of Sumbawa, and, you know, locals there didn't have a lot of understanding about, you know, sanitation. And there was a pool of stagnant water where cows were kind of milling around and defecating right near the river mouth that went out to the surf, you know, to where the surf spot was. And unbeknownst to the few of us that were staying there in the village and surfing, the locals had dug a trench that drained that stagnant water into the river mouth and then it carried it out into the river. Yeah.

You were surfing in a giant cow toilet.

Yeah, pretty.

Wow.

So I, you know, I'd been pretty careful not to, you know, drink or eat anything that I shouldn't while I was there. But even despite that caution, you know, I couldn't escape it.

Wow. So this sounds very similar to what I experienced when I used to do this race over in Thailand called the Laguna Phuket Triathlon. It was this amazing race, like decades of history, and all these famous triathletes would come race it. But the swim, after swimming in the beautiful Andaman Sea, you cross the sand, and then you jump into a lagoon, and you swim across this lagoon. And I would always get sick a few days after the race. And once I came back with all these, you know, all these crazy critters in my gut, similar to what happened to you. And I found out after about five years that the lagoon that we swim across, 500 meter swim across the lagoon, and is kind of the main lagoon that all of the resorts dump their sewage into. So we were just basically swimming through tourist sewage. Same thing?

Yeah, pretty much.

So that's what got you into functional medicine, was it was cow poop?

Yeah, yeah. I mean, at that time, I was not considering a career in medicine. And even, you know, for a few years after that, I still wasn't. I was just concerned with getting my health back. But it turned out that conventional medicine was not very helpful in that process.

What did you try conventionally when you say it wasn't effective?

Well, I mean, the first thing I did, I came back and I saw a doctor. Actually, I continued traveling for six more months after that because initially, while I was there, I took some antibiotics that a friend there had in his medical kit, and I got better from the acute phase. But then as I traveled for the next six months, I just started to get worse and worse. So I came back home a little early, earlier than I had planned. And I went to a few doctors, and they said, oh, you probably had a parasite. Nobody did any testing. They just said, you probably had a parasite take these antibiotics, took the antibiotics, got a little bit better while I was on them. But shortly after I stopped, I got worse. One very, very long story later, had seen probably 20 different doctors by then, had had lots of testing, which initially was all negative, but later revealed the parasites, and then eventually did get rid of the parasites. But the treatment is one of those cases where the treatment can be worse than the disease. So what I had to do to get rid of the parasites wrecked my gut, which then led to other symptoms and problems that it took me probably almost a decade to fully recover from. And all the doctors I saw were genuine. They wanted to help me, but they just didn't really have the tools to deal with a complex, chronic, and somewhat mysterious illness. They had been trained to use drugs to deal with mostly acute problems or to suppress symptoms that, you know, from chronic problems. Not to really get to the root cause of what was causing my issue and do that kind of investigation that's necessary to, you know, figure that out. And of course, that's. That's what functional medicine is really about.

What'd you eventually do to wipe out the parasite? What'd you say? A parasite, an amoeba. And there was something else, right?

Two parasites and an amoeba. I mean, amoeba is a parasite, too, but slightly different. So is Giardia, Blastocystis hominis, and then E. Histolytic Entamoeba histolytica, which is the amoeba. So I took a ton of Antibiotics and antiparasitic drugs. But then I also took a lot of herbs. Sometimes with organisms like that, herbs will be enough on their own and sometimes you need antibiotics as well. So I had to take several courses. And like I said, that just really torpedoed my gut health. Way back at this time we didn't know as much as we do now about the importance of the beneficial gut bacteria. So I was much more cavalier and I wasn't, you know, I wasn't a health professional at that point either. So I was more cavalier than I would be now certainly about taking that stuff. But that led to a pretty, pretty much a decimation of my gut flora which as we know now affects virtually every system of the body. And so I developed a lot of other symptoms like fatigue and muscle pain and joint pain and pretty severe insomnia, inability to get a restorative sleep. And it just kind of wreaked havoc on me. But there's opportunity in every challenge, right? So as I became more and more interested in recovering and taking my health into my own hands and realized that I was going to have to do that if I wanted to get well because no one was coming to save me. And the conventional medical establishment was just again not set up for this kind of problem. It's fantastic if you break your leg or need your gallbladder removed or something like that, but it's not really set up for this kind of issue. And so that's, that's what led me down the path that I took.

Interesting. Yeah, there, there was actually a documentary I was watching this morning. I, I doubt you went this far. I don't know if you saw this. It's, it's called a grueling and grotesque biohacking experiment where this guy Josiah Zayner off to put a link in the show notes by the way, if you guys are listening in, Shownotes are gonna be@BenGreenfieldFitness.com Kresser today that's just Chris's last name. K R E S s E R BenGreenfieldFitness.com Kresser Anyways, this, this synthetic biology research scientist at NASA and this documentary just came out, he did his own recolonization of his body with this ecosystem of microorganisms to fix this lifetime of gastrointestinal problems he'd been having. And it was apparently successful but it's actually a very interesting documentary. Is basically like a self imposed poop transplant more or less. But it sounds like you didn't quite go that route. But you.

Well, actually I did have a fecal transplant. Several. Yeah, I mean, so I tried some pretty wacky stuff. I mean, I'm maybe not quite the biohacker that you are, Ben, but by necessity I have tried some stuff. Like way before it was, I think I did my first fecal transplant at least. Let's see, this would have been probably 15 years ago.

Wow, you're like one of the OGs of poop transplants.

One of the OGs. It was not a thing at all. I actually flew to Australia to Sydney, to the center for Digestive Disease there, which is run by Tom Borody, who was on the Nobel Prize winning team that discovered that H. Pylori bacterium was the cause of ulcers. He was also the person who really pioneered the modern version of fecal transplants. The Chinese have been doing them. In ancient Chinese medicine. They were done, but he pioneered the modern version. So I did that. I also, I think was food transplants.

Were done in ancient Chinese medicine.

They were, wow. Yep. Yeah, they're discussed in ancient Chinese medical tests. They were a lot lower tech at that point. Yeah. But yeah, this has been around. It's a treatment that's been around for a long time. I also was probably one of the first people that did pig whipworm therapy, which is where you swallow Trichura suisse, which is a nematode that's aimed at restoring normal immune function. So this is based on the hygiene hypothesis.

How do you swallow it? It's like in a capsule or is this like.

No, it's in a vial.

Oh, wow.

So worm therapy is based on the hygiene hypothesis or the old friends hypothesis, which recognized is that for the vast majority of human history we co evolved with nematodes like whipworm or hookworm. And these have a tuning and modulatory effect on our immune systems. Modern sanitation, which has led to some spectacular benefits, dramatic reduction in infectious, acute infectious disease being the main one, has had some downsides in that it's lessened our exposure to these organisms that we've harbored for most of our evolutionary history. And a lot of scientists and researchers think that it's at least partly to blame for the dramatic increase in autoimmune diseases and other conditions. There are actually lots of peer reviewed published studies that have investigated, well, what if we reinoculate ourselves with these organisms, you know, whipworm and hookworm and others. And they've looked at it for Ms. And inflammatory bowel disease and a number of other autoimmune conditions. And at one point I thought that I had developed inflammatory bowel disease as a result of these parasite infections. And so I swallowed some pig whip worms and I even went down to Mexico and inoculated myself with Nector americanus, which is a human hookworm. So I've been around the block, I've done a few things that are outside the box.

Do you think that in terms of this inoculation or in terms of kind of restoring some of these old friends to our gut, that we need to go to those type of extremes like pig wickworms and fecal transplants, or do we just need to get out more? And this is relevant to me because I was telling you before we started recording, I just did an obstacle course race yesterday, right? And I was covered in dirt and mud and left tracks all through the airport. As I was walking through the Sacramento airport, you know, just leaving mud behind me. I was kind of guilty that I just destroyed their floor with dirt. But I was reading in Outside magazine about Amelia Boone, who's one of my friends and also an obstacle course racer, and they tested her gut. And when you look at her gut, even compared to a lot of these other athletes who might be like a snowboarder or basketball player, somebody who's not out in the dirt quite as much, she had an extremely high level of these, these soil based microorganisms kind of rolling around in her gut. And, you know, I'm curious, you know, for, for people who think that, you know, unconventional medicine is all pig whip worms and fecal transplants, if there's, there's other methods that you've found to restore these old friends.

Yeah, yeah. Functional medicine is absolutely not those methods that I just mentioned. Those are sort of the last resort, functional medicine. And really, even stepping back before you even get to functional medicine, I would say just implementing an ancestral diet and lifestyle is the first step when you have any kind of chronic health problem. And that means bringing our diet, behavior and lifestyle back into alignment with what our genes and our biology are hardwired and adapted for over thousands of generations of human evolution. And no, I know you've talked a lot about this diet. We're talking about real, whole, nutrient dense foods rather than processed and refined foods that make up most calories that Americans eat today. But it's not just diet. It's also sleep, sleeping in a cold, dark room and making sure we're getting enough of it. It's physical activity, making sure we're moving and not just getting enough exercise, but we're not sitting for too long.

And 180 minutes, I think, is now kind of the approximate recommendation. If you look at a lot of these comparisons to tribes, you see like around 180 minutes, which is a chunk of time to be active during the day.

Absolutely. And then what you're saying too, like spending time outdoors. We evolved in an outdoor environment, we, believe it or not, did not evolve in houses and offices and cars. We started, we lived outside, slept outside, and we were in close contact as a result with soil and soil based bacteria. We consume milligram quantities of soil based bacteria in the form of dirt that was still on the food that we ate and also dirt in water that we drank. Soil and water we drank. That doesn't mean that just going out and eating dirt is necessarily the solution here or even that you have to spend time in the dirt. But the idea is that we want to bring our lifestyle back into more alignment with what it has typically been. Because if you understand the basic concept of evolutionary biology, it's that all organisms are adapted to survive and thrive in a particular environment. And if you change that environment faster than the organism can adapt, there's going to be a problem. It's like if you, there are certain types of bacteria that can survive without exposure to light very deep in hydrothermal vents in the ocean, and if you took one of those bacteria and you dropped it into a shallow tide pool, it would die immediately because it wouldn't have a chance to adapt to those new conditions. Now, the shift that happened for us wasn't immediate. It happened over several generations, but on a relative timescale, it's not nearly enough for us to adapt to this new modern environment that we're living in. I think getting outside, spending more time outside, being more physically active, eating more nutrient dense food, those are all the starting places. And it's only in extreme cases like mine where you'd even need to consider those kinds of interventions. They're not, I'd say less than 0.1% even of my patients who are pretty complex need to, you know, go down that road.

Yeah. One that I'd also throw in, there would be like hefty doses of natural electromagnetic radiation. I mean, that's another big one. Would be sun exposure.

Huge. Yeah, yeah.

Infrared, visible light, you know, UV radiation, a lot of that stuff that the people just don't get. You cannot replace that with a vitamin D capsule, in my opinion. Absolutely. You know, people talk a lot about, you know, like you mentioned sleep and circadian rhythm and the microbiome and getting exposed to Proper amounts of germ and physical activity. But I don't know why people still seem to shun the sun. Even when I go to these ancestral medicine conferences or health events, people sit inside so much, it's crazy.

And it's really. I think part of it is that for so many years, we were taught that any exposure to sunlight was harmful. Right. And so you get this situation where even when people do go outside, they're wearing like a huge straw hat and sunglasses and they're slouching in sunscreen, even if they're going to step out of the door for one minute. But not just from evolutionary perspective, but actual modern research has shown that that's really problematic, that we do need some exposure to sunlight to optimize our health. And it's a Goldilocks thing. We don't want too much. So much that we can increase the risk of skin cancer, but we want enough. And it's not just about vitamin D, as you pointed out, man, it's sun exposure increases the production of nitric oxide, which is an important vasodilator. So it will reduce the risk of high blood pressure, which is the number one contributor to heart disease, which is still the number one cause of death. It has powerful effects on the immune system, and it also, of course, has powerful effects on mood. So, so many reasons that sun exposure is important.

Yeah, yeah. Including opioids. You know, you could even argue that part of the opioid epidemic could be blamed partially on lack of sunlight because you get a huge beta endorphin release, you know, once you get out in the sunshine. So, yeah, peoplepeople don't put enough emphasis on it, in my opinion. But I wanna backpedal what you were talking about when it comes to genes and how our genetic code is hardwired for this specific environment. And you say that our environment, you know, kinda changed pretty dramatically over the past several thousand years, you know, faster than our gen evolve. Do you think we could make an argument that at some point the human genetic code will evolve to deal with, let's say, wi fi, heavy metals, toxins, et cetera? When it comes to the human body, is it smart enough to be able to evolve, to keep up with some of these things that you say are causing chronic disease?

That's a really great question. And the truthful answer is we don't know. But I'm skeptical. I'm skeptical, for example, that our genes could change such that we can somehow extract the nutrients that we require from big gulps and chicken nuggets. And pizza. And I'm also skeptical that we can figure out a way to transform the toxins that we'd be exposed to through things like mercury and cadmium and arsenic and thallium, which is the most toxic, toxic heavy metal that we know of, and somehow learn to deal with that in such a way that we're not impacted by it at all, possibly over a very long period of time. But my concern is, will we have that opportunity? Will we get there without some really harmful effects? It is true that over the last 10,000 years, about 10% of our genome has shown evidence of recent selection. And there have been some changes in some populations and people that, for example, have made them more able to process the starches and grains and legumes. We know of studies of Japanese people who live on islands who have evolved genetic and epigenetic changes that allow them to process the certain fibers that are in seaweed, that they're indigestible for most other people, but that they are able to digest. And that has involved changes not only in their genes and epigenome, but in their microbial epigenome that then it gets passed on to their. To future generations. So there are some, certainly some changes that have occurred over the past 10,000 years, but 90% of our genes are still the same as they were when we were hunter gatherers 30,000 years ago. So that just gives you some idea of the timeframe we're talking about.

Yeah, yeah. And I guess the other thing is a lot of times it seems like these chronic diseases seem to spark even though they're occurring earlier. A lot of times they strike people later in life when the impetus for genetic adaptations kind of goes down a little bit.

Exactly.

As your fertility decreases. So it's far less likely that we're really enabled at the time that a chronic disease from a lot of these modern assailants would strike to be able to produce genetic adaptations. Just because the body doesn't change its genes as much as you age.

No, now that is very true. Some people might point out that in the future, and there's debate about how soon or far away this is, evolution will not be driven by natural selection anymore. It will be driven by human choice via things like CRISPR, Cas9 gene editing. But that's a whole other conversation. There's a whole other set of risks that comes with that, with humans being in control of our own evolution. And I have some real concerns with that as well. But. But we certainly live in interesting times, let's put it that way.

There's another tribe that you talk about. I don't know how you pronounce this. The Simone.

Simone.

Simone. Your pronunciation sounds far more French than mine, Simon.

Simone. There's an accent on the E and it took me a while to figure that one out.

Yeah. And you talk about how they have this lifestyle that's very ancestral. Sun exposure and dirt exposure and physical activity all day long and. But, you know, one of the issues, of course, when it comes to prevention of chronic disease is that's all good and well for them, but we're inside, right? Like I'm inside talking to you right now on my computer. And yesterday was great. I was on the sunshine and I was rolling through the mud and I was lifting heavy stuff and I was walking, you know, back and forth through the grass and the mud in the parking lot to this race I was at. But, you know, now today I'll be spending probably eight hours inside. So what type of things you do with your patients to get them to hack their environment to be able to emulate a little bit more of this hunter, gatherer, gardener esque existence like the Simone tribe has?

Yeah, it's a great question. So, of course it depends on people's circumstances. You know, someone who works inside of an office building and doesn't have a lot of control over their schedule is going to have fewer options than someone who works from home, for example, and has complete control over their time. But let's start with the person who works in an office and has little control over their schedule. Even there. There are things that can be done that can when, especially when you add them all up, they can make a significant impact. One would be to either walk or ride bike to work, if that's possible, because that gets you some outdoor exposure right there and it gets you some physical activity. You could take walking meetings and suggest that your colleague, you go outside and walk around and talk instead of sitting in the conference room, you could go outside and eat your lunch on a park bench instead of eating it at your desk inside of your office. If you can't walk or ride your bike to work, you could still, if you take your car or public transport, you could park two miles away from work or a mile away from work and then walk a mile there and walk a mile back.

I hadn't thought of that one before.

It's really helpful. Or you could take public transport and get off two stops away or one stop away and get some physical activity that way. Even within those limited circumstances, there's still quite a few things that you can do during the workday. For example, I recently got a combination where I have an office where I see patients, I have a home office, and I also have an office at WeWork, which is a shared communal office space. At my home office, I have a treadmill desk. And, you know, where I can walk on the treadmill while I'm typing and working. And I can stand and I can sit.

Well, I gotta back it up just a second. I don't want to derail you, but do you find yourself able to successfully type when you're walking?

I can, actually. I learned to do that when I wrote my first book. And I walked about. I tracked and figured out that I walked about 2,000 miles in the course of writing my book.

Were your arms. So not to go too deep into specifics, but were your arms, like kind of extended and resting on a standing desk or how did you manage that?

So it requires a keyboard tray. That's very important. And it has to be zero tilt. So it's. My keyboard tray is not completely flat. The back of it tilts down, and that creates a natural angle between my upper and lower arms and my hands so that they can hang. My arms can hang loosely from my shoulders, just as they would if I was standing. And then I can rest my wrists on a keyboard. Rest on the keyboard tray. So it definitely requires a focus in terms of how to set it up ergonomically to make it comfortable. But then at my WeWork office, I couldn't do that because the treadmill is loud and it could bother other people. So I found a under desk elliptical machine. So it's a little mini elliptical thing. You put it on the floor under your desk. And so I can pedal the elliptical while I'm in a seated position working. So I'm still able to get some activity while I'm sitting at the desk.

You can just grab those on Amazon, right?

Oh, yeah, they're on Amazon, Yeah. And Dan Pardee told me that, according to what he's seen in the research, that the elliptical is even better for cognitive function than walking on the treadmill. And I found that. That I haven't seen as big of a difference between them myself, but I think they're both great. There are a lot of little things that you can do even if you are working inside to get more time outside to be more physically active. And any one of those changes on their own might not be that big of a deal, but when you put them all together, it makes a really, really big impact.

Interesting. Yeah. A lot of these things people just don't think about because they hear that they need to hang, pull up bar in the door of their office or put the kettlebell next to their cubicle. And to some people who are just getting started with management of chronic disease through adaptation to a more ancestral lifestyle, that seems exhausting or intimidating or even embarrassing to be swinging a kettlebell when you're at your office. But you can, I mean, getting off at the bus stop, that's one bus stop away from your office, or parking a mile away and walking, that makes sense. And it also kind of forces you into this corner where you, you finish work and you just have to frickin walk to your car or stick out your thumb.

No, no, getting an Uber for one block to your four blocks to your car, that's cheating. But you know, like the under desk elliptical is great too, because you can be pedaling that thing and nobody would really even know, right.

The mild BO you might have at lunch. So I want to dive into a few more practical things when it comes to changing the face of healthcare. I know your time is limited today, so I want to be sure that we get a chance to tackle some of this stuff. So first of all, something fascinating I noted was I saw you mention that the Cleveland Clinic opened this center for functional medicine to use some of the techniques that you talk about in the book. And they already have a six month wait list. In your opinion, and why is that? What is it that they're doing that would make that approach so popular?

Yeah, well, most chronic disease is now the biggest health challenge we face by far. Seven of 10 deaths are due to chronic disease. One in two Americans has one. One in four has more than one. And this is the problem of our age. That wasn't the case 100 years ago. 100 years ago, the biggest problem was acute infectious disease. People were still dying of typhoid, tuberculosis, pneumonia, pneumonia. They were dying of appendicitis and other acute challenges. But today we're in a really different place. And the problem is that our medical model evolved during that time when acute challenges were the biggest issue. And it was set up to deal with those acute problems. But it's not set up to deal with the chronic challenges that we're facing that most people are struggling with. Things like diet, type 2 diabetes and obesity, and irritable bowel syndrome and autoimmune disease. These are the problems of today. But our medical model is still built to address the problems of yesterday, or rather of the last century. Functional medicine is the new model that is specifically designed to prevent and reverse chronic disease. And, and it does that by addressing the root cause of these diseases instead of just suppressing symptoms. So to use an example, irritable bowel syndrome is now the second leading cause of people missing work. It's really epidemic behind the common cold. And yet the treatments in conventional medicine are all based on suppressing symptoms. So if the patient has diarrhea, they'll get Imodium or something like that, stop the diarrhea. They might get an analgesic for the pain or an antispasmodic for the gas or the bloating. None of these treatments, although they can help relieve the symptoms, which is welcome, none of them actually do anything to address the cause of problems. And so these patients end up having to take these drugs for the rest of their lives. And these drugs often have side effects that then require other drugs and so on.

And that's, that's crazy. I didn't know that irritable bowel syndrome was such a huge reason that people stay from work. That's, that's interesting also because when I worked as a personal trainer and I was drinking, you know, like five ABB bodybuilding protein shakes per day and a couple of protein bars andand had these, you know, I mean, if anybody who's an exerciser knows protein farts and also knows the irritable bowel syndrome you get from a typical, you know, healthy gym diet, I would, I would have to literally schedule in my personal training sessions to be 50 minute long personal training sessions to give me 10 minute long breaks to go and use the restroom in between clients and just like get rid of all the bloating and the gas and literally just go in the bathroom and, and, and fart because of my diet. And it wasn't until I fixed my diet and I personally adopted kind of a, you know, Weston, a price ish approach, and it, it fixed almost all of that. But, you know, it comes full circle to what, what you're outlining is that, you know, rather than me getting on some type of a drug or a pharmaceutical to control that, what I did was I changed my diet and it fixed everything, you know, and that's a very simple functional approach. But I think a lot of people don't really understand yet what it looks like when you work with a functional medicine practitioner. Like, let's say somebody wanted to come and see you. Like, let's say I had irritable bowel syndrome like that and I were to come and see you like, how does it work? How is it different if we were to compare and contrast it to what would happen if I were to go in and see, you know, my local MD.

Well. So I was just describing mostly what it would look like if you went crmd. You'd get these various medications to address the various symptoms, but there would be no investigation into why your bowel was irritable in the first place. And because there's no investigation into why, there can be no addressing the real causes. And it's not like we don't know what those causes can be. If you look in the scientific literature, there are thousands of studies exploring the connection between a disrupted gut microbiome and ibs, or small intestinal bacterial overgrowth, or SIBO and ibs, or parasite infections and ibs, or changes to the gut brain axis, HPA axis like high cortisol or low cortisol, or alternating cortisol, inappropriate cortisol rhythm during the day, and ibs. There's many, many known causes of IBS that we can test for and then treat if they're present. And that's exactly what we do in functional medicine. So a patient would come to me and we would do stool testing and breath testing for things like SIBO and disrupted gut microbiome and parasites. We would test their HPA axis, look at their cortisol production. We would look for nutrient deficiencies, we would test for food intolerances, we would assess their diet, of course. And then with all that information, we would create a customized plan for them that would probably include a particular dietary approach. It would include some antimicrobials if they had SIBO or a kind of gut infection like H. Pylori. And they would include some behavior and lifestyle changes to address their HPA axis or so called adrenal fatigue. I'm using air quotes. And then maybe some supplements to do that as well. And so then the patient actually has the chance to fully recover from this problem. Like much in the way that you changed your diet and were able to address these symptoms, a patient could change their diet, they get rid of their sibo, they smooth out their cortisol production, and guess what? They don't have IBS anymore. Instead of taking a handful of medications for the next 30 or 40 years, they literally don't have this condition anymore. So that's the promise of functional medicine now.

Isn't this expensive as hell though? I mean, that's. I'm gonna totally play devil's advocate. I've heard people even just to see you have to pay a lot of money compared to going to see like a, you know, an allopathic physician or getting things covered by insurance? I mean, how is it scalable financially to take that approach that would allow you to spend, you know, an hour rather than 10 minutes with a patient or to do all these tests, or to dig as deeply as you need to dig for this type of approach to work?

Yeah, there are lots of ways to answer that question. First of all, let me just acknowledge that it is too expensive right now for if it's, you know, if a patient is paying out of pocket, it's going to be severely limited in terms of who can access it. So there's no question about that. However, we have to remember that our current medical model is heavily subsidized. So it's a question of what we would like to subsidize. So imagine a situation where you go to the doctor and you get your blood sugar tested and it's a little bit high right now. What will typically happen is they'll say your blood sugar is. They might not even say anything. That's often the case. But if they do say anything at all, it might be like your blood sugar's a little high. Make sure to eat better and exercise more. Okay, next. Because that's literally all there's time for in a 10 minute appointment. And they don't have any medications that they give when blood sugar is just high, normal. They wait until you have diabetes to prescribe these medications. So then that patient will go back maybe five years later and they will have diabetes. They will get the medication prescribed and their insurance will cover that. But what if, and we know that that patient, it costs about $14,000 a year to treat to the healthcare system, not to the individual patient, but to the healthcare system to treat that patient with type 2 diabetes. And that patient could go on, you know, let's say they're diagnosed at age 40 and they die when they're 80. That's a cost of over half a million dollars to the healthcare system to treat that single patient for type 2 diabetes. So these enormous, they're just not seen by the patient. That patient's paying the $30 copay for that patient's whole life. But imagine a different scenario where that patient goes in when they're 35 and they have the high normal blood sugar. But instead of doing nothing, the doctor says, hey, well, we know that this will progress in five years to type 2 diabetes. That's what the statistics show us. But we're not going to Let that happen. So we're going to set you up with a health coach who is going to get you on a good nutrient dense, anti inflammatory diet because we know that just telling you to eat better is not going to work. Information is not enough. So we need to actually support you in this change. So we're going to set you up with this health coach. We're also going to set you up with a personal trainer at a gym that we have a partnership with because we know that increasing your physical activity is going to help you keep the weight off as you lose it with the diet and it's going to also reduce inflammation and make you healthier all the way around. And good news is your insurance company, in their infinite wisdom, they know that it could cost them a half million dollars to treat you if they let this progress. So they're going to spend just a couple thousand dollars upfront on this health coach and personal trainer. And they know that they're going to save a half a million dollars over your lifetime if they prevent this disease from happening. So there's absolutely nothing, there's no financial or logistical reason that that could not happen. We couldn't have a functional medicine, diet, lifestyle behavior change based medical model other than the political will to make that change and of course, the deeply vested financial interests of the pharmaceutical companies that do not want that to happen.

Yeah, that's a big one. It's one of those deals where you have to get the insurance companies on board, isn't it?

Yeah, and that's actually starting to happen. It's a little slower out here on the west coast where we have more choices. But on my own podcast in the next couple weeks, I'm actually sitting down with the CEO of a hospital in Connecticut and also someone who's a manager of one of the insurance companies in that state. And they are going to talk about how they're essentially moving more toward a functional medicine based model for this exact reason. They recognize that our current system is not sustainable, not only for patients, but also for providers. And insurance companies like data, they see the writing on the wall. The cost of chronic disease is going to bankrupt them. And so they're shifting the burden and the responsibility of care to the provider, meaning the provider is going to have to be accountable for the results that they get or don't get. And as that shift happens, providers are going to start looking for more effective models of care. And that's really what's already happening there. So, yes, we're not there yet. We've got a Long ways to go and it's going to be patchy and not happen at the same pace in every place. But I think we're going to get there one way or the other. Either the hard way, where the model that we have now collapses and has to be replaced, which I hope does not happen, or we're going to get there the easier way, which will be that we take, take more progressive, proactive steps like this. This group in Connecticut is doing.

Yeah, one of the things I've been looking into recently has been this concept of sharing medical bills. I was looking at a company called Medishare, for example, which shares medical costs between members and that's a religious one where members are, you know, it's church based, they're praying for each other and then also sharing medical costs. What do you think? Do you think models like that are scalable?

I think we're going to see a lot of different efforts to approach this and that the solution is not going to come from one place. I don't think it's going to be only bottom up, although I think bottom up efforts, grassroots efforts for change are going to be very effective and necessary. I don't think it's going to be only top down coming from a mandate from the federal government or a change that is initiated and, and then trickle down from the top. I think it's going to come from the public sector, the private sector, from public private partnerships, from new models of insurance, from new models of health care where health coaches play a much bigger role because we recognize that diet, lifestyle and behavior change is the most important step we can take to prevent and reverse disease. Again, like I was saying, imagine if you, you go to your doctor but you end up actually doing most of the work with the health coach or a physician assistant or nurse practitioner before you even see the doctor. Because what's the point if we know what the most effective interventions are and Dr. Isn't necessarily the best person to work with on those things? You could have many health coaches for every one doctor and we could get a lot further in most cases, cases of these chronic conditions.

Interesting. You know, I know you take a deeper dive into this in the book. And again, for those of you listening in everything Chris and I talk about, I'll put@BenGreenfieldFitness.com Kresser But I just wanted to throw a couple of rapid fire questions your way as we get close to the end here. Chris. One is smartphone apps, ways we can interact with physicians using websites or apps or technology or even Artificial intelligence. Have you looked into that at all? Are there any particular resources or apps that you use or endorse?

There are a number of efforts there. Nothing that's really impressed me enough to recommend. I am a believer in using technology to augment the kinds of in person and video interactions that I still believe are necessary and studies show are necessary to support behavior change. So, for example, there was a lot of enthusiasm about behavior change apps initially. What they found was that if you use the app on its own without any interaction with another human being, it's not very effective. But if you use the app in conjunction with interaction with the human being, it is effective. So I think we need to kind of go back to the drawing board and redesign some of those apps with that in mind.

Yeah. One that I was looking at was this human diagnosis project that uses AI. Scientific American did a big study on it or a big article on it last year. I haven't explored it that much, but it looks super interesting to be able to crowdsource use AI to help to diagnose or treat a patient prior to them actually needing to go see a physician.

Absolutely. I think AI is going to play a huge role in that regard. A more specific example would be understanding things like the microbiome and the genome and the epigenome. Those are so vastly complex that I actually don't think that human intelligence is going to be able to make sense of it. I think we're going to need artificial intelligence to identify meaningful patterns and then help us to come up with ways of intervening based on those patterns. That's not very far away. There are already some startups that are based on that, like Viome with the microbiome. Again, I think we're not quite there yet, but certainly in the next five to 10 years, we're going to be seeing big changes in that area.

Last question. If people wanted to work with somebody like you, but aren't able to get to Berkeley to work with you, is there a particular medical practitioner directory that you like?

Yeah, there are two. So I train practitioners in my approach in the ADAPT framework. So at kresserinstitute.com, there is a directory of practitioners that I've trained and that have gone through the steps that are required to be listed there.

Meaning those people actually know how to give pig whipworm fecal transplants effectively? No, to calculate surfers.

The basics. The basics. And we just started in 2016, so we're relatively new, but we've trained about 400 practitioners around the world. And then there's the Institute for Functional Medicine. Our IFM is Functional Medicine Training Group that's been around for about 25 years. And they have a directory at ifm, so those are two places you can find someone.

But Kresser Institute is yours.

Yeah.

Smart man. You're cloning yourself.

I like it.

I need to do something like that. But the Greenfield Institute doesn't sound quite as good. Yeah, yeah. It'd be how to lift a kettlebell with a training mask on while standing on a vibration platform.

Caked in mud.

Exactly. Caked in mud. Well, Chris, thanks so much for coming on the show and sharing this stuff with us. This book is good. I don't think that it's just for doctors. I think it' great handbook for patients, too. I loved it. And I'm obviously not a doctor, so I would highly recommend, if you have any interest in medicine, chronic disease, and changing the face of healthcare, that you grab this one. It's called Unconventional Medicine. I'll put a link to it along with everything else that Chris and I talked about. I'll throw a few goodies in, like that article in Outside about Amelia Boone and that gut biohacker documentary. I talked about plenty more along with the Kresser institute over@BenGreenfieldFitness.com Kresser Chris, thanks for coming on the show today, man.

Thank you, Ben. Really appreciate it. Take care.

All right, you too. All right, folks, I'm Ben Greenfield along with Chris Kresser signing out from BenGreenfieldFitness.com have an amazing week. You've been listening to the Ben Greenfield Fitness podcast. Go to BenGreenfieldFitness.com for even more cutting edge fitness and performance advice.

SA.