Dr. Gary Kaplan On How To Be Mentally and Physically Healthy For Life - I Love Marketing With Joe Polish And Dean Jackson - Episode #169

Hello, this is Joe Polish and I'm here with Dean Jackson. And we just got done doing a fantastic recording, an interview with Dr. Gary Kaplan on the subject of his new book, Total Solving the Mystery of Chronic Pain and Depression. And we asked him some really great questions. He had some really powerful insights and things that would be really, really valuable to your health and to your life and to the reduction or elimination of pain. And during the episode we actually had some popping because we were doing the interview over the phone. And so I want to ask you to overlook any of that as much as you can because the content is incredible and valuable and we really hope you find it useful. So join me and Dean Jackson interviewing Dr. Gary Kaplan.

Hey everybody, it's Dean Jackson and Joe Polish here.

And today we're going to interview a friend of ours, but also an extremely smart doctor by the name of Dr. Gary Kaplan. And this is a departure from our normal business interviews, but this is a really important subject that I think is going to have a lot of impact on our listeners and people in your lives that you can probably learn a lot from. So let me give you a quick bio of who Gary is and then we'll get into some questions. Gary Kaplan do. He's the founder and the Medical director of the Kaplan center for Integrative Medicine and the author of a book, Total Recovery. He's a pioneer and leader in the field of Integrative Medicine. Dr. Kaplan is one of only 19 physicians in the country to be board certified in both family medicine and pain medicine. He's also board certified in medical acupuncture and is certified by the American College for Advancement in Medicine in the practice of helation therapy. Dr. Kaplan is a clinical Associate professor of Family Medicine at Georgetown University School of Medicine and serves on the Advisory Committee to Health and Human Services for chronic fatigue syndrome. Dr. Kaplan created the Kaplan center to offer patients suffering with chronic pain and illness a more effective model of medical care. And his website is kaplanclinic.com with a k k a p l a n clinic.com and his book Total Recovery is available and you're probably going to want to get it after you listen to us talk to Gary.

So first off, Gary, how are you? I'm quite good, Joe, thank you for that generous introduction.

Absolutely. It's great to be with you. And here we have a, we have a history too. I mean, Dean, I'll let you, you know, speak to yours. But I mean, I remember my good friend Richard Rossi who introduced us. We actually went on a vacation together. In 2009 on a National Geographic boat to Galapagos for 10 days. So we spent a good deal of time together and that was kind of awesome and fascinating at the same time. So you've been doing a lot of stuff since then, Gary?

We've been doing a few things since then, but that was truly an extraordinary trip. We had the pleasure of my father and my wife and my son on that trip. And I don't know if you recall Matt, but Matt had managed to have the place so wired that I walked by the communications center at one point and he was on the phone and I'm sit going at $100 an hour or a minute that you're talking to the land, who are you talking to? And the guys on the boat had all chipped in to give them their time on the phone. So he was talking to his girlfriend for free every day.

Oh, that is hysterical.

That's awesome.

And I remember that trip. I actually went literally that month. I also went to Vietnam and I went for over 20 days without a phone or computer. I literally was completely disconnected. And one of those rare moments now in modern life how people do that, which has a lot to say to probably even what we're going to talk about, which is one of the things in your video I saw about your book is what you really do is help people just recovering from suffering and the whole subject of suffering. And I think that technological connected sort of world we live in, there's a lot of manifestations of pain in different ways than probably a hundred years ago. And you certainly are a world leading expert in all of this. So I'd like to just kind of get into it and for people, what did I didn't say about you for those people who did not know you, you know, how would you describe who you are and basically the mission of, you know, the Kaplan Clinic and your Kaplan center that is and your work and what you do and all that.

Well, what we're trying to do, we've been doing over the last 30 years is come up with a better model of medical care. The medical system is in crisis. We're now down to 8 minute appointments for the average physician visit. People don't have a chance to tell their stories. And telling the stories is an incredibly important part of being able to truly understand how people got sick and why they're staying sick and why they're not getting better. And so being able to create a model in which time is available to hear the story. So my average, my first appointments are somewhere between an hour and a half to two hours. And follow up appointments, we don't have anything less than a half hour. Most of them are about 45 minutes. Because I need that much time to actually listen to what people have to say, get their full stories, and then be able to figure out a treatment plan. And plus, there's a lot we do in that time. So we're trained in manual medicine in osteopathic, and so we'll do manual therapy on many of our patients. We may do acupuncture on many of our patients. We do medication management and we do a lot of counseling. And the thing you talked about, suffering is extremely important because pain may not be optional, but suffering is. And that's a rather startling concept to many people, is that, you know, I have people living with some really difficult medical problems, but they're living with them and still fully engaged in life limitations, but engaged in life to the fullest success that they can be, as opposed to people who actually sometimes don't have as much going on medically, but their suffering is so severe that they cannot function day to day. So this business of suffering as an option is one of the things that we address with people early on and the other thing that we've now looked at. And this whole thing is turned on its head because I've been doing pain medicine pretty much my entire career. We used to think of pain as a disease, and pain actually isn't a disease, it's a symptom. And it turns out that we were seeing lots of people not only coming in with pain, but also the suffering component, which is manifesting as depression and anxiety. And we were getting very. It was very difficult to quite understand why these things were always occurring together. We were saying, well, yeah, we're in pain. Of course you're depressed, of course you're anxious. You can't get done what you want to get done. But it turns out that the answer to that is far more complex and also gives us much more insight into how we can potentially help people fully recover. And the answer to the question is that really what we're looking at in chronic pain is, and with things like anxiety and depression and post traumatic stress syndrome, it's really an inflammatory process in the brain and that these are symptoms of the inflammation going on in the brain. And that if we suddenly turn this thing around and quit tracing after the symptoms and start going after the causes, we have a much higher probability of success. And to give you an idea of how abysmal our treatments are, if you look at just for depression alone, 40% of people we treat have no recovery whatsoever from depression. From our interventions, the medications are effective in only about a third of the cases. If you add cognitive behavioral therapy or some other therapy, you get another 20, 30%, maybe, but that's only a partial response. And so we're leaving better than half the people suffering with depression and anxiety disorders. And if you're looking at the numbers you're talking about, depression alone is 18 million people a year. Add in the anxiety disorders, you're talking about 52 million people. There's a lot of people out there suffering. If you look at chronic pain, you're looking at over 100 million people. Over a third of the people in this country report suffering with chronic pain. That is pain several times a week. That's interfering with their activities of daily living.

One third, one third.

So this is an epidemic that is truly getting away from us. And our means of addressing it has been highly ineffective to date, since the leading causes of disability tend to be pain problems. And depression is one of the top causes of disability for people between the ages of 15 and 65. So these two conditions are taking a horrendous toll on our population. And they affect not only the people that are suffering with the conditions directly, but they affect their families, they affect their ability to work. There's massive economic consequences to this as well as personal consequences to this. So it's a big problem, and we're not doing a good job of addressing it now.

You know, Dean, do you want to. I've got so many questions for him.

But I want to. Well, we were.

I mean, it's just. We had dinner in New York with Richard Rossi and Brian Kurtz, and you were sharing a lot of these stuff, the link between our neurosystem and the actual pain. And I've been fascinated by it since.

We talked about it.

That's why I'm really looking forward to hearing how it all works and the solutions that you've come up with.

So what have you found to be the cause of chronic pain in most people? What's the link found between mental disorders and chronic pain? Because you write about that in the book Total Recovery.

So the first thing to understand is that most of these things that we're looking at are symptoms, and they're symptoms of inflammation in the central nervous system, and that the inflammation is mediated by a small cell, an immune cell in the central nervous system called the microglia. And once you get to that point, you can then turn around and say, okay, what is it that causes the microglia to create an inflammatory response? Now, microglia are extremely important in the central nervous system. You need them in order to initiate a repair process. Early on, when the developing brain, you need them to make sure that the neuronal pathways stay straight, otherwise they get tangled in one another. And so the microglia help make sure that the neuronal pathways form appropriately. So everything's working. As opposed to lots of short circuits in the adult brain, the microglia address trauma to the brain. So anytime that you have death of neurons, anytime that you have an infectious assault, the microglia move into an inflammatory mode, the purpose of which is to wall off the area of damage, to clean up the neurons that have been damaged, or in some cases, to eliminate and kill any bacteria or viruses that have entered the system. And then they start secreting another set of chemicals that call in the repair process. And. And then they're supposed to go quietly back to their resting state, where they're monitoring the system. The problem comes in is when either the salts are ongoing and thus the microglia stay in a chronically upregulated state, or when the assaults have been cumulative, such that the microglia remain upregulated even though the assaults are no longer occurring. And the real problem on top of all of this is that this condition is neurodegenerative, meaning that the longer it goes on, the more brain cell you're losing and the harder it is for the brain to repair. Because while young brains have a phenomenal amount of plasticity in terms of repair, older brains do not repair as well. They still repair, but they do not repair as completely as younger brains do.

Interesting.

Well, so one of the things to keep in mind about this, what we've discovered with this, is that, for one, since there's these cumulative assaults that occur, one of the things that you want to do is start paying attention early on. So you want to prevent yourself from getting into these situations. Best way to tell you about this is kind of some stories. So let me tell you about one young woman that we saw. She was 17 years old. She had gotten kicked in the knee when she was 15. And as a consequence of that, she was playing soccer. And as a consequence of that, the knee swelled and developed what's called a complex regional pain syndrome, which is a horrific pain problem, where you have pain not just for the knee sitting there, but you have a condition called allodynia. And allodynia means that things that normally shouldn't cause pain do cause pain. So for Instance, gentle stroking of the extremity with your hand or a light touch would cause excruciating pain for her. An air breeze over her knee would cause excruciating pain. And the pain got progressively worse over time, despite a great deal of treatment. So much so that she ended up with pain throughout her entire body. And multiple trips to the er, multiple hospitalizations. She was seen at Hopkins, she was seen up at Boston Children's, and finally she was seen over at Children's Hospital in Philadelphia, where they take these kids and they need them before the age of 16 because they need the plasticity in the brain. They take these kids and they put them through an incredibly grueling physical therapy process, the purpose of which is to reset the neuronal receptors so that the pain receptors quiet down. She went through this program for about six weeks and the end result of which was dramatic reduction in her pain. But she still had headaches and she still was quite fatigued. She came back to this area, went to school, and was getting increasingly debilitated as things were starting to ramp back up on her. And that was the point at which we had a chance to see her. So she came to see me. And one of the things I did with her is we stepped back and we said, well, wait a minute, wait a minute. Why does a 15 year old kid get kicked in the knee and develop this horrific pain problem? Right? I mean, plenty of people get kicked in the knee. I've been kicked in the knee and I walked away from it, right? A couple of days later, you're fine. Well, in her case. So we said, okay, what is it that set the nervous system up? And in her case, as we took a longer history and we quit focusing on the event, but looked more at her history, what we found was when she was 11 years old, she had actually had a case of Lyme disease. When she was 12, she had a case of Lyme disease. And when she was 11, she had been bitten by a poisonous spider. All of these things had been treated and they thought resolved. In her case, it turns out that genetically, she didn't have the genes necessary to make the enzymes to process toxins as a result of the tick bite. So the Lyme disease was in fact fixed on her, but the toxins that had come into her system from the spider bite and from the Lyme disease had not been addressed. And when we addressed that component of the issue, we were able to completely resolve her headaches and her fatigue. And this was early on in our understanding of this stuff. And she gave us kind of a gift about four months later, after we shipped her off to college, where she got bit by another poisonous spider. Now, I don't know about you, but I've never been bitten by a poisonous spider child. It's just like attracting these things. But everything came back. All of the symptoms, all of the pain, the headaches, the fatigue came back. And we treated her again for the toxicity issue, and everything went away. And we saw her a couple of years ago. She's subsequently gotten married, she has a child, and life is quite good. So it's about taking a bigger picture, stepping back, and getting a better understanding of the whole process of what's going on with someone and not just. Yeah, go ahead.

I was gonna say, I've been wondering since you were sharing that story with me in New York, and I've been wondering since you said that, and since you said These numbers of 100 million people reporting suffering with chronic pain, I was wondering about this idea of. Is that it's all a cumulative effect of building up in our system. Is there anything that. That we can do to test for or to identify if we're at kind of the tipping point to knock it out before somebody kicks you in the knee, and it manifests as this chronic suffering and pain?

And that's truly an excellent question. And one of the things we're increasingly focusing on is how do we stop people from getting to this tipping point where they go into this disastrous downward spiral? And the answer is, yeah, part of it is starting to pay attention. So we put up with a lot of things. It's astonishing to me when I listen to people getting their headaches. I was in excellent health until four years ago. All right, no problems whatsoever. I was exercising, I was doing great, and then X happened. Well, okay, that's fine, except when you start pushing back in the history and you get more information. One guy in particular I'm thinking of. Oh, yeah, I had. I've had some problems with depression. I had two suicide attempts, but, you know, that's under good control now. And I was a car accident, and I've had some whiplash injuries. And. Well, that's under control now. And, yeah, my gut's constantly. You know, I've got problems with indigestion, and I have irregular bowel habits. And, no, I haven't been sleeping for about 20 years. Because as you start to get all of that information in, you realize that this guy has been an accident waiting to happen for most of his life. In his particular case, what we go Back to his childhood where life was not happy. We know that high stress kills neurons. Even if you're not getting direct trauma in terms of concussions and head injuries, but rather if you live in an environment of extremely high stress, we know that that kills off neurons. If you're killing off neurons, you're turning on the immune system to start dealing with the inflammatory and you start an inflammatory process. So very early on he's dealing with an inflamed brain and it was a function of a series of things thereafter and that continue to add to the problems, inclusive of that irritable bowel syndrome, which I don't know the stats off the top of my head, but we have a huge number of people living with indigestion. We pop over the counter acid blockers like candy. We take non steroidal anti inflammatory medications, Advil, Motrin and the like like their candy. And by the way, constant use of those medications, the Advils, Motrin, the non steroidal anti inflammatories, 75% of people will develop ulcerations in their small intestine with chronic use of those medications. That's using them two or three times a week.

Wow. I'm always amazed at the TV ads for all those indigestion or things that heartburn that you see. They don't talk about it as you need to change your habit. It's like, you know, go ahead and eat the chili and the chicken wings and whatever else, just pop this pill, you're okay.

We're crazy. You know what, you said it right.

There, Gary, we're crazy. I mean there's a cultural, just sheer massive volumes of nonsense. And you know, part of, you know, part of. I think, I don't know if this will bring the best analogy, but interviews like this are hopefully to give people a mental enema from all of the crap that is constantly fed into to the way to deal with your health and with your challenges and how you feel. Because for the most part I think it just dramatically just exasperates already pre existing issues and problems and the attempt of much of the medical industry, the drug companies and everything. I mean they're there to sell. It's not about prevention, it's about sick treatment and it perpetuates the problem. And you're obviously digging in a much deeper well than most people in what you're discovering because even the subtitle of your book, how we get sick, why we stay sick, how can we recover. So there's a lot to this this is an onion that has many layers.

That's exactly correct. And getting back to Dean's question about, okay, how do we prevent this? The first answer to the question is we listen to ourselves, we listen to our bodies, and we spend so much time, as you were pointing out, Joe, covering up the symptoms. So if you've got heartburn, God forbid you should change your diet. What you do is you pop an antacid. If you've got muscle aches or pains, rather than pay attention to what you're doing and modify your exercise approach, you start taking Motrin and then that starts snowballing and creating lots of other problems. And so it's a failure to be attentive to ourselves that ultimately results in a lot of these problems. This is a cumulative issue that eventually breaks through in many people in terms of chronic pain, depression, anxiety, and post traumatic stress syndrome. It can be prevented if we stop and take a look first, take an inventory. Okay, where are we at today? What symptoms do I have today? How do I sleep? How much champion am I needing to take a week in order to get to bed? And by the way, taking Ambien or Lunesta or any of the sleeping pills on a regular basis, that is using those as little as once a week actually has an all cause mortality, that is death from all reasons, that shortens your life by about five years.

Wow. We both said wow at the same time. I was just going to say, would.

Melatonin fit in that same category?

No, melatonin does not fit in that same category. And melatonin then becomes a very interesting supplement because melatonin can also be used to address reflux. At three to nine milligrams a night, melatonin will help with reflux as well as help with sleep. There are much better ways.

Yeah.

Since we're on that subject, because there's a question I was going to ask you anyways. What do you recommend for people who have sleep disorders or problems focusing?

So the sleep disorder is also a very big deal. First off, one of the things that sets off inflammation in the brain is loss of oxygen to the brain. Hypoxia. One of the ways, and the most common ways that hypoxia occurs is through sleep apnea. We estimate that somewhere around 5% of the population has sleep apnea, of which only 15% have been diagnosed. So that one of the things is if you're getting lots of sleep and you're not refreshed when you get up in the morning and you're finding yourself sleepy, during the day, and people tell you that you snore enough to knock the roof off a house. Then you have to be checked for sleep apnea. You need to go to your doctor and check that that's literally where you stop breathing because of obstruction during the middle of the night. You can do it multiple times and you're denying oxygen to your brain. That alone, undiagnosed, untreated, will take a decade off your life. It causes hypertension, it causes diabetes. And the overwhelming majority of people with this condition are not diagnosed and doctors aren't asking the questions. So you need to educate yourself about sleep apnea. If your problem is falling asleep, the question becomes, when did it start? And you really have to get into the particulars of what's going on for somebody. So is it pain keeping you awake? Is your mind running keeping you awake? What is it that's causing the problem? Or is it just very bad sleep habits? Meaning I go to bed somewhere between 9pm and 4am in the morning because I got too much to do. And that also creates inflammation in the brain. So getting proper sleep, hygiene, getting to bed on a regular basis, getting seven to eight hours of sleep a night, is all crucial in order to maintain your health. And we think we can get away with five hours of sleep. You know, studies show that if you're operating on five hours of sleep consistently, your performance is equivalent to that of being drunk.

Wow.

So imagine going into work every day drunk.

Right. It's kind of like dealing with Dean Jackson in a lot of ways. If people would just realize that, that should be more than enough evidence to show that sleeping is critical and make it a. Yeah, thank you. Sorry, Dean, I just. I had to. How good is this?

And for our teenagers, we're particularly crazy because we think that they can get by on 6, 7 hours of sleep a night. They cannot. Studies demonstrate that they need nine and a half hours of sleep a night. And so they're running around sleep deprived and exhausted all the time. We start our schools way too early because we've got to have bus schedules that allow for middle school and high school and grammar school. And we don't take into account the science that tells us that our teenagers cannot function at 7 o' clock in the morning. Their circadian rhythms are such that they actually go to bed a little bit later. And they need nine and a half hours of sleep every night. We don't let them get that. This is where our society, our way of living and the pace that we live at begins to make us Sick and we don't properly address that.

And with electronics and everything. I remember Brian Tracy came to my office about a month and a half ago, and he used this, this term screenagers over teenagers, because of some tests saying that the average teenager can spend up to like 11 hours a day staring at a screen, be it a phone, a computer, an iPad, a tablet. And they're constantly swiping. And from just what that is doing to the human brain is so new in terms of civilization. But it's like, what are your. The reason I bring this up, and I do want to come back to what we were talking about earlier, earlier about inflammation in our brains and all that. I just wanted to ask you about addiction and how much do you know or have studied about how a lot of these things relate to just compulsive, unmanageable, addictive behavior, Chemicals or just behavior in general. Gambling, sex, Internet, workaholism. I mean, how much is that tied into just the compulsivity that you know? Because I believe addiction is a brain disease. I don't know what your thoughts are on it, but it's just fascinating to me.

I believe you're correct. I believe addiction is a brain disease. In fact, we're finding that some of the things we're doing. One of the things that we found was that binge drinkers in adolescents cause inflammation in their brain that can last as long as a decade after they stop drinking. So this is long term, ongoing damage, this business of compulsive behaviors. The computer screen. We are almost never separated from our computers in one form or another. Our iPhones sit next to the bed at night, or the iPad sits next to the bed at night. And we're constantly on these things first thing in the morning and last thing in the day. And one of the things that our brains haven't caught up, evolved enough to really handle the. The input of information coming in on these devices. And we know that if you're on these devices and we tell people for sleep, everything electronic off for an hour before bedtime. Because the screens tend to entrain your brain to a higher wave function that prevents you from getting to sleep. It'll keep you attentive, keep you alert. And so all electronics off for an hour before sleep. There's a whole. The other thing about the compulsions, many of them are coping mechanisms to deal with the stress of life. And so we're coming home and we're taking a drink. We're in Colorado smoking a weed. But people are doing things because they haven't got enough time. And so they're constantly trying to manage stress. And they sometimes manage stress in very dysfunctional and damaging ways. So that also becomes part of the problem. The whole business of addiction in and of itself, it is an inflammatory process in the brain. And we're finding that some of the newer anti inflammatory medications may in fact be effective for dealing with that inflammation. But let's stop for a second and talk about what inflammation is. So inflammation is different things in different parts of the body. So if you have an allergy, your nose runs, your eyes itch, that's caused by histamine release as a result of an antibody response to things like pollen and other environmental stimuli. If you have an infection on your leg, that infection is caused by a bacteria and the redness and swelling that occur in that area are caused by white cells that move into that area. And you need different things to address different types of inflammation. So in the leg with the infection, you might use an antibiotic. For the allergies you would use an antihistamine. But in the brain it's a different type of inflammation, the inflammation mediated by the microglia. And for that kind of inflammation you need to utilize either medications such as low dose naltrexone, there's doxycycline, seems to be effective in some cases of inflammation post stroke. And we're looking at a whole new set of medications that may in fact down regulate the microglia and reduce the inflammatory process. But ginkgo also looks like it's effective in reducing inflammation in the brain. That's a supplement that you can take. Ginseng may also reduce inflammation in the central nervous system, another type of supplement that you can take. So acupuncture is neuroregenerative and so acupuncture can be effective in terms of repairing the brain. So. And meditation, meditation is also brilliant in terms of reducing inflammation in the brain and causing regeneration of brain cells. It actually builds resilience into the system. And so giving people a whole bunch of tools that allow them to take charge of their life in a productive manner, as opposed to one where you're ignoring all of the symptoms and complaints and you're just trying to cover them.

Up with these kind of things. With these, like the brain inflammation that you're talking about, would they show up in your like C reactive protein numbers or would they, how would you, how.

Would you know that you have that? So the struggle right now, and that's, you know, an excellent question, and one we're trying to figure out the struggle right now is what are the biomarkers, what are the things that we can look at? And some suggestions have been that for instance, in chronic, especially chronic depression, non responsive to therapies, certain inflammatory markers like C reactive protein, like fibrinogen may be elevated in these people and may give us an idea of who's going to respond and who isn't. But the reality of the matter is we haven't got the biomarkers, the blood tests that we really need to tell us about the inflammation. If we reduce spinal tap, we can measure the inflammatory factors in the cerebral spinal fluid, but most people are not willing to have that done, especially on a regular basis. So we're stuck and we haven't been able to do it. And one of the things that we've been looking at is whether or not looking at the types of bacteria and the distribution of the bacteria in our gut might actually give us some insight as to specifically what types of diseases people have and tell us more about the inflammatory process. So that gets into a whole thing called fecal transplant and the gut microbiome. I don't know how much you want to go into that. Right.

Well, I'm just curious about the, whether, you know, it was something that would show up as a normal type of inflammation. But you're saying it's not, not as easy to identify. Is it something that would be kind of like the best to, you know, things like, like jinko and like ginseng and the things you were talking about? Was it, is it one of the things that is best to, since it's so prevalent, assume that you have it and do the things that are going to help it anyway.

So here's what you're looking for. If signs of inflammation, chronic inflammation, the central nervous system is basically moodiness, depression, anxiety disorders, all of those are signs that there's potential inflammation. Problems with sleep, sleep disturbances, problems with your gut where you've got irritable bowel syndrome, problems with pain on a recurring basis, problems with sleep, all of those things tell us that there is an inflammatory process probably going on in the central nervous system. Now the causes of that can be many, but it begins to tell you that something is wrong. And there are things and many of our low enough grade that you put up with them day to day until things bubble over the top. And I'm telling you, you can't put up with them day to day. It's too dangerous because eventually there will be long term consequences for this. And the older you are when those Consequences show up the harder it is for us to repair this process. So we want to build resilience into the system. So supplements that can be useful in this kind of stuff. We want to make sure your vitamin D levels are appropriate. And that should be somewhere between, I believe, 50 to 80 nanograms per milliliter. You want to make sure that you're getting adequate omega 3s. You know that omega 3s, the fatty acids, are essential for brain repair. And so taking about a gram and a half of Omega 3s a day can be very beneficial. It also looks like taking things like probiotics can be very beneficial to you because we've seen increased endurance and strength in people who are taking probiotics on a regular basis. Probiotics. The best way to get probiotics is through foods and eating. These are mostly fermented foods, but we don't eat a lot of that stuff in our diet. And so taking a good probiotic that's got at least 25 billion colony forming units live, that means they need to be refrigerated a day, can be helpful in terms of both toning down the inflammation in your body and in keeping you healthy.

There you go. What do you think of that, Dean?

There you go. I was about to say the same thing.

Well, it's interesting because, Gary, you probably know this. I put a real heavy emphasis on eating whole foods, eating very clean. I got trained in transcendental meditation last year, and I've been doing it most days, twice a day. Sometimes I only do it once. But I never in a million years thought that I could fit, you know, two sessions of 20 minutes twice a day of meditation into my life. But I realized that when I do those things, just like when I work out and exercise, which I do almost daily, my life just functions better. I feel better, my body functions better, my brain functions better. And for me, who's had, you know, whatever, I mean, there's many people on the planet that have horrendous, you know, lives. You know, I had a pretty traumatic sort of, you know, childhood. I mean, it wasn't very fun. And there was a lot of stuff that left a lot of residuals and things that has led to addiction and anxiety and things. So for me, learning about this stuff, even doing interviews like this, is not only for our listeners, but it's also for my own life. It's just constantly trying to get better because going through life suffering is horrible, but people do it, and it's just a matter of dealing with it, minimizing it and figuring out what to do and how to do it. There's so many things that people would get gigantic benefits from if we could just sell them on these benefits. And more than anything too, it's not just in educating people about things, but it's doing a sales job on people of like, hey, here's how you do it. You talk about the girl earlier that got kicked in the knee. She had. You talk about this. She had seen many, many different doctors and got many misdiagnoses. And that becomes a very frustrating sort of experience because people then don't trust anybody. After a point. You're going to experts, you're in pain, things are not working, and then they're telling you to do this, do this, do this, and it's not working. And then you get to the point where you lose hope and hope heals. And the problem is if you lose hope, you're in a really bad place.

You are absolutely correct, Joe. There is nothing worse than taking hope away from somebody. You always have to have some level of optimism, some belief that you can recover. And it's that belief. Recovery is a lot of different things to a lot of different people, but it's about being able at the basic level to re engage in your life and to connect with loved ones, to be able to participate with your family and to find some meaningful type of work that you can do where you're contributing, where you're actually, you have some sense of self value. And that becomes extremely important in this process of helping people heal. We have to help them understand that there's much they can do in life even though they may not be able to do everything they were doing previously. That's the beginning of the end of suffering.

Yeah.

Interesting.

So, you know, can you explain the concept of symptoms versus disease just so it's real clear about what the difference is?

Sure. So guy comes into the emergency room one day when I was back when I was a student. He's got excruciating shoulder pain. He can't move his left arm. And we take a look at him and he's a bit ash in color and he's sweating. And we take a listen to his heart and it's skipping a few beats. So we throw an EKG on him and it turns out that he's in the middle of a heart attack. We treat the heart attack and the pain in the left shoulder goes away. So the pain in the left shoulder was a symptom of the underlying disease, which in his case was a heart attack. Had we treated that symptom, he would have died. Wow. Okay, so this is what we're doing with pain and this is what we're doing with depression. We're treating them as symptoms and we are missing the underlying cause. And failure to identify the underlying cause is what's leaving these people sick and setting them up for the next illness. So even if you get them a little bit better, even if you get them partially improved so that they're re engaging, they will fall down again because the setup is there and the brain's still inflamed. And just to give you an idea of the spectrum of things you have to go look at for the inflammation, there are infectious processes, which include Lyme disease and the co infections from Lyme. There are autoimmune processes, such as celiac disease, but also non autoimmune processes with other food intolerances, such as just gluten intolerance, which affects about 6% of the population. I had a woman recently who had severe panic attacks and anxiety disorder and chronic migraine headaches. And she had been to the psychiatrist and the psychiatrist, you go to the psychiatrist making up a story. She comes from kind of the ideal family, really had a great life, and he's trying to make up some story as to why she's having these panic attacks and anxiety about, well, how are your conflicts with your mother? You're having conflicts, none of which were true. It turned out that the question he should have been asking her is what was she eating before she had these panic attacks? And what was she eating before she had the migraines? And the answer in her case was wheat gluten. She had gluten intolerance. Not true. Celiac disease, we got that out of her diet. We cleaned up a few other things on her and addressed the magnesium deficiency and all of that stuff went away. So you have to understand, by understanding microglial physiology, you can understand what questions to ask and where to go look. And when you do that, you end up with a whole bunch of answers that you didn't have before. And now you're treating the cause and, and not the symptom. That makes sense. That makes.

Yeah, that does make sense. And it appears that seems to be the process that most people go through. You said something really critical in the very beginning, when we first started, about the time you spend with your patients and when doctors offices are just churning people through. I think you said they spend like eight minutes or whatever with somebody. It just. I mean, how on earth is something that needs proper Care and nurturing going to get ever handled, if that is the existing model. And the fact that you're bringing a level of compassion and empathy and understanding to these people and really getting to the root, which is the case. It is about getting to the root. And so there's so much, you know, misdiagnosis that is, that is being done. I mean, I had a tremendous amount of chronic pain in my back, neck, shoulders, knees. You know, I've never had a deep discussion with you about this, but for, you know, the last couple of years, I had, you know, showing an mri, a torn meniscus in my right knee. And I've had, you know, prp, prolotherapy, stem cell injections, acupuncture, all kinds of different treatment, three different doctors that said you got to have surgery. And last week I'm doing squats with 185 pounds on a knee that's supposedly being told I need to have surgery on. And what I realized is that I had a lot of the pain go away by studying TMS, which first talked about by Dr. John Sarno. And it's completely transformed my life. But I realized my life repressed emotions were doing more to cause my pain than some sort of structural abnormality that I had many doctors tell me that was wrong with me and it just wasn't accurate. It wasn't right at all. And I'm not going to get into a whole discussion on that. And you certainly identify and talk about how much the mental faculties go. But I have a real issue with how much crap is being taught to people. And a lot of these doctors, they're not. I don't think it's their intention to do this. I mean, a lot of it's just. I don't know if it's the system. I'm not sure how to even think about it. So I want to ask you, I mean, how do you think about it? How would you recommend to people out there? How do they interact with doctors? How do you even know?

So your points are really excellent. And we have a very broken system. The problem is people go for where they're rewarded, right? And so in medicine under the insurance system, you're penalized for spending time with people and you're rewarded for doing procedures on people. So they'll pay you $875 to do a selective nerve root block, which takes about 15, 20 minutes, but they'll pay $125 if you spend an hour with somebody talking to them. This is the inherent problem. So insurance has Thoroughly corrupted the system. And frankly, we have to do massive insurance reform if we're ever going to get this fixed. The other part of the problem is we are now training a new generation of physicians to be employees. And I think that this is a pending disaster. So that we have managed to train them to the insurance model. We've managed to train them to. Now, you got five minutes to see the patient, and you only look at the labs. You don't need to really spend any time looking at the patient, and you move on. And they spend so much time looking at their computer screen and doing. In family medicine, the studies are showing the doctor's spending far more time looking at the computer screen for the electronic medical record than they are looking at the patient. This is a disaster.

That's really interesting. I mean, everything you just said, too. I guess the advantage for people listening to this and getting your book is it will give you a different way on how to handle and interact with your health and pain and suffering. Because certainly going into a broken system, you could get caught up in it and you could be totally lost. And unfortunately, it's so big, it's so large. I mean, to count on that is kind of rolling the dice in so many until you actually do come across one of the types of doctors or people that can assist you. So obviously doing, again, an interview like this, me and Dean are always trying to take as much valuable people and knowledge and insights and share it with people so they can make better, more informed decisions and have their life be as beautiful as their life can be. But it seems to me that you have to take this under your control. If you were not a doctor, Gary, you didn't know this. What would you do? Do just knowing what you know, but say you weren't a medical doctor, I mean, what would you advise to the average person out there to give them the most advantages, you know, from this point forward with having to be as healthy as humanly possible? Because certainly a lot of this requires for some people massive lifestyle changes. Others just they need to have education. I mean, what would you kind of recommend or some steps?

So one of the things, and the purpose of writing the book was to kind of step over the medical profession, which was becoming ossified in its thinking, and get directly to people and say, look, we have to think about these things differently, and we have to approach this problem differently, otherwise we're not going to do anything except leave a path of suffering and phenomenal expense behind us. So one of the things that what we've Created is a timeline that, that you can download free from our website. And that timeline is the beginning of organizing your thoughts in terms of, okay, when have you had major illnesses or events in your life and seeing if they relate to each other. So did you have a period of particularly traumatic stress? Did you have a period of severe loss? Have you had periods of being particularly sick? And when did those events occur? But we also put in the good birth of children, weddings, that kind of stuff. And as you put those on the timeline, it begins to give you a sense of how your health has evolved or devolved over time. And you can start to pinpoint the things and understand how they all connect. So utilizing that timeline to just sit there and go, okay, yeah, this is the big thing that happened when I get sick, but how was that before this? And be honest, in terms of going on from birth, as you point out what happened in childhood, did you have a difficult childhood or was it more idealized and life was safe? And that's the big thing is, was it safe? Were you safe? And are there times in your life where you haven't been safe? Because those are the things that cause the biggest stress. The other thing I would say is knowing what we know today is meditation needs to be part of everybody's life. I would plan somewhere between 10 to 10 minutes to 30 minutes a day of doing meditation every single day. Exercise also helps down regulate the microgliation and improves neuroplasticity. Exercise needs to be part of everything we're doing. These are all things we know about. And then diet. Diet is the big thing that we keep wanting to work around. But the fact of the matter is we eat way too many grains and we also don't listen to ourselves. So we don't realize when we're sensitive to different foods. I have people start off with a diet of rice, fish, chicken, fresh fruits and vegetables. That eliminates soy milk and milk products, all nuts and gluten. And see how you do on that for a month. Stick to that diet for one month and then see how you're feeling. And when you eat different foods, notice if you start to feel sluggish or if you feel congested, because that doesn't eliminate everything you're allergic to, because corn, for instance, is still on that list. And you may find, I had one woman who found out she was vegetarian, found out she was allergic to blueberries. So you've got to listen to your body and listen to what's going on. But the basics still remain. The basics. Exercise, proper sleep, Getting seven, eight hours a night of sleep and being on a regular schedule and meditation on a regular basis, exercise on a regular basis. All of these things are neuroregenerative. And begin the healing process. And if we're not doing those things, we're actually tearing ourselves down.

No, that's such great advice. And I mean, even the simple comment, you said, listen to your body. I think so many people are so out of touch with the signals. I mean, all of these pains, all of these symptoms, many of these things are just your life's way of trying to say, hey, will you please pay attention to me? There's something going on here. And people will do so many things and consume so many drugs and behaviors to numb it and to avoid it. And it just gets worse and worse and worse and worse.

Worse.

And people wake up in a spiral that they feel incapable of getting out of. I also want to mention one thing, too. I was given this definition of intimacy years ago, and you talked about safety. And I actually have this as a note on my phone. I share it with people once in a while. And this seems like a good place. The definition of intimacy is a mutual exploration of a shared safe place. Abuse anything that destroys the safe place. Addictions, what we do to make ourselves feel good about ourselves when we don't have a safe place. And I thought that was pretty. Yeah, pretty profound because there, if you don't mentally feel safe, you're going to try to escape from that fear and what that can do to a person and how that can become such a domino effect. And certainly you write about that and you talk about that and you're great at telling about people's stories. And I wanted to ask you about this because I don't think most doctors would say it. Why are people's stories about why they got sick crucial to the recovery? Because I think everyone should go to your timeline. It's Kap. I want to give out the website again. It's Kaplan K A P l a n clinic.com and do that. But why are people's stories about why they got sick so crucial to the recovery in the future?

First off, the act of listening to someone and being heard is profoundly healing in and of itself. I can't tell you how many times patients have thanked me and told me that I'm the first physician to actually sit down and listen to them and take the time to do so. Because we create time, space. It's not a function of genius. It's a function of. We understand the importance of people Being seen and heard. And it's only when you create that space that you can begin to understand how the person got to you in the first place and how their disease has evolved in their system so that they are struggling and why they are struggling. So, for instance, another woman came to see me when she was 18 years old. She was 30 when I saw her. She was 18 years old. She was involved in a car accident, and from there, she developed fibromyalgia, which is this generalized pain syndrome. And car accidents are frequently attributed as the cause of that. But my question was, okay, what was the setup? And in the process of talking with her and getting more of her story, what I found was that she was raped when she was 12 years old, and she had never told anybody about that before. And it was a function of having the time to sit and listen. And she had post traumatic stress syndrome around this, not specifically because she was raped, but because she broke down in tears, and she's shaking and reliving the experience as she's starting to tell me about this. If you don't have that information, you don't know what you're treating. You don't know how you can begin to help somebody. And so you need to take the time to listen and understand what's been important to somebody. Where are the big events in their life? Because big events in some people's lives are not in others. And so understand who that person is that you're working with, what their life has been like, let you understand how they ended up where they are today.

Yeah. Yeah.

That's awesome.

So now you've been treating patients for 30 years, and so I want to ask you a couple questions. Some you've already covered, but based on that experience, what have you found to be the most effective ways for people to deal with and recover from chronic pain? Anything that you've not mentioned, I'd like to hear your response to that.

So the first thing is get the history, because you have to know what it is you're treating. Again. I saw one this morning. This poor woman woke up one day, four years ago, an excruciating abdominal pain. And she has been through several surgeries, hysterectomy. She's been scoped from one end to the other by the gastroenterologist. They've done a couple of laparotomies on her. They took out her gallbladder, and they haven't been able to find out where the hell this pain is coming from. No one bothered to back up and say, okay, well, wait A minute. What innervates, what makes the system work? And I found that she's got a herniated disc in the mid thoracic spine, and that's what's creating the problem. I blocked it, and virtually all of her pain went away. But it's a function of listening and saying, well, wait a minute, how did we get here? What is it that causes the pain? You have to get the triggers for the pain and what typifies it and whatnot. So that history is so important that how people tell it is so crucial, because you can't treat anything until you know what it is you're treating. And in her case, she's been treated for a lot of things that didn't do any good whatsoever because they missed the diagnosis, because they didn't spend enough time. They're looking at the belly because that's what hurts, as opposed to stepping back and saying, wait, we're not finding anything in the belly. What about, what else could it be? And so you have to listen. So history first, history second, history third, and find out what the diagnosis is. And then once you've got a diagnosis, then you can begin to treat and begin to get people better. And diagnoses is a lot of different ones. And so you've got to. It's by the individual. This is a very individualized medicine. This is not cookie cutter. You cannot simply say, okay, it hurts. Here we do this. You have to sit and listen and individualize the treatment approach to the person sitting in front of you. And then frequently there are layers to it. And so you have to be comprehensive in your approach, and you also have to be functional in your approach. Meaning that, yeah, it was great that you took a look at the. The intestinal tract, but you never looked at how the intestinal tract was functioning. So you missed that there was significant bacterial overgrowth. There was particularly one species of Clostridium difficile that can create psychoses in people when it overgrows by producing an organic acid called hphpa. So if you look at it from a functional standpoint and do the right testing, you can come up with another set of answers. But again, you need to sit and listen to the person to begin with and get the full history to begin to understand where to start looking.

Right.

Okay, now that's great. So are there any situations under which people cannot recover from pain? And if so, how can people avoid getting into those sort of situations?

Yeah, that's a superb question. And unfortunately, the answer to that question is yes. So we get back to pain may not be optional, but suffering is. So there are circumstances in which there's just too much damage done that we're not going to be able to eliminate the pain problem. And so then we become how do we work around that, control it to the best of our ability and get you as functional as possible. So, yes, there are situations where we can't fix it. It's too broken. That having been said, an example, and maybe you'll get a chance to meet her actually, when we're in. In California, a dear friend of mine from medical school was involved in a car accident in which she ended up paraplegic. And she, after a year of rehab, went back to medical school and finished, graduated. And she has had excruciating pain pretty much ever since the accident. And yet she has gone on to complete medical school, complete her residency. She went with a fellow on the Hill because she was getting fed up with the way the insurance system was treating her. She went back to school and got a law degree, and she's just made a full professor in neurology at ucla. And she's truly remarkable, one of the real heroes in my life. I have so much admiration for her because she doesn't suffer. She's clear what she's got in terms of her limitations. She's got to deal with this pain, but she still engages fully in life as fully as she possibly can, despite many obstacles that she's had to overcome. So, yeah, you may be stuck with the pain, but that doesn't mean you can't have a life in a very productive and a very useful life.

Right. You know, even my buddy Dave Kekich, who's been paralyzed from the chest down for over 35 years, I mean, he was the pinnacle of health when he got a spinal cord injury. And, you know, I mean, it was, of course, devastating for him at the time. And I've done many interviews with him.

He.

He's been a dear friend for over 20 years. He's actually speaking at my Genius Network event, which is going to be really cool. But he ended up really building just an amazing life and learning how to not only function and still work out every day. I always think of when I'm thinking I can't take time for exercise. Well, my friend Dave Kekich, other than a period of time where his mother was dying, where he missed about four or five days of exercising, this guy has consistently exercised almost every day for over 35 years, paralyzed from the chest down. And he just makes. He does the best he can with what he's got. And he's also really developed just great mental abilities. And he's now in his 70s and. Yeah, just amazing. So people like that are. Are incredibly inspirational when you see it, and it's another way of sharing that hope. So I guess one of the last questions I'll ask you and then, Dean, if there's anything you'd like to ask Gary, before we wrap up here and then tell people what the next steps are to take what we've talked about and go deep with it is all the years that you've been practicing and you've been helping people. Gary, what's the most interesting discovery or idea that you've ever heard or come up with?

Heard and working on the thing that I think the next 10 years in medicine. Medicine are going to completely blow us away in terms of what we're going.

To be able to do.

And I think one of the particularly exciting areas is with gene manipulation. And one of the ways that we may be able to do gene manipulation, I alluded to earlier was this business of the gut microbiome, looking at the genetic content of the bacteria and identifying all the types and different types of bacteria in the gut. And we've been looking at people with fecal transplants where we actually take healthy stool and give them to people who are sick. In our practice, we have two patients who have Crohn's disease who have gone into remission, doing that off all medications. And in the literature, there's cases where a guy with Parkinson's disease went into remission after a fecal transplant. A woman with Ms. Went into remission after a fecal transplant. So I think we've got a lot of research to do on this, but I think it holds huge promise. And indeed, leaving. When I leave your conference on Friday, I'm flying to Chicago to go to the Fecal Transplant conference in Chicago to meet with a bunch of colleagues who are involved in doing that. I think fecal transplants may revolutionize the way we treat a huge number of diseases. And we're beginning to understand this information flow that goes back and forth between the brain and the gut. And it may be possible that we'll identify the biomarker we were talking about earlier may be in the gut microbiome that we'll be able to see different bacterial genetic patterns in the gut according to people with diabetes, people have heart disease, or people who have depression. And that when we replace that DNA, which is about 90% of the DNA sitting in your body, that changes a whole bunch of signaling processes in you and may, in fact, be able to turn off the inflammatory processes in the body and allow your body to kind of reboot. We're not there yet. We still have a lot of work to do. But it is something that's coming and something which will certainly be worked out in the next five to 10 years at the most.

Fascinating. Dean, any questions you have, we could do this for another couple hours, but I know we got to wrap up here, but I do want to give people some recommendations and ask Gary any final things to do, but anything that's on your mind. Well, let me ask you this. A big part of your book has to do with inflammation. On the back of your book, you have, you have a testimonial from Mark Hyman, who is one of the smartest guys I know and a good friend, written a bunch of New York Times bestsellers, and I've interviewed him quite a few times. And he says with cutting edge science and clinical expertise, Gary Kaplan has identified the source of inflammation that keeps patients in an endless cycle of pain and depression. He offers profound insight into the way of our life experiences have a cumulative effect on our health. I highly recommend this book to anyone who has suffered without relief and wants a deeper insight on how our bodies actually work. So when people get your book Total Recovery, what will they get out of it? What will they learn? Because I obviously want people to that have listened to this and found it valuable to obviously take the next step, which would be go deep with your knowledge and get a copy of your book. So what will they get out of it?

Of the book? They're going to get a different sense of how to put their life in perspective and take a history which is more meaningful in terms of understanding how they got sick and why they're staying sick or how they may get sick if they don't address these issues. So it provides them with a different frame of reference, which is total person medicine, which is about integrative medicine, and it's about conventional medicine. And so I hesitate to use the word integrative because it's suggestive. It's a different type of medicine. This is an evolutionary step in medicine. This is a medicine which is far more conclusive, that reunites mind and body, that looks at people not just a structural but also a functional standpoint and begins to put all the pieces back together. And so what I'm hoping that they'll be able to do in reading the book is take a new look at themselves, see themselves in some of these stories and begin to understand what it is that made them sick or potentially is going to make them sick if they don't change it and do better. The other thing is at the end of the book we give a couple of really practical and direct things that people can be doing in order to take care of their health and address these issues. Wonderful.

And so if not only to get the book Total Recovery, but if people want to work directly with you or with your clinic, how do they do that?

Well, they can call the clinic and we have a staff of four physicians and three physical therapists. And that's the other thing is we do a team approach in the way we handle patients because no one person can embody all the expertise necessary. So one of the other take home messages from the book is this business of how do you organize a team? How do you create your team of physicians where you've got potentially an acupuncturist or you're working with someone who understands the muscle skeletal system and a physical therapist. And you also have a physician and potentially a therapist who also integrates into all of this process as well, creating teams of people in order to address everything that's necessary. And a nutritionist. So that's one of the other take homes of that. As far as working with us, we're delighted to see anybody. I have two ways in which I work with people. I'm available on a consultative basis where I'll see people twice. The first visit is for an hour and a half to two hours. The second visit is a follow up after we've ordered labs and so we lay out a treatment program for them. They can then take that treatment program home and institute it in their own neighborhood. Or we also have an ability for people to come in and do intensive treatment programs here for a week to two weeks and have them back repetitively if necessary over the course of the year. I also have a small group of patients that I work with on an ongoing basis past that two visits. So after the first two visits, you either continue to work directly with me or you can work with somebody else in the practice or your own practitioner at home. Or if you want to work directly with me, then I have a membership practice in which I'm available to a small number of people for ongoing treatment and consultation.

Sounds like you're changing the way medicine is being practiced because it's something that you don't get the opportunity to spend this kind of time with somebody. You know, like you're saying eight minutes is typically what people have. So that's the important thing, isn't it? Is to find your own team, to build your own team so that you can really take control of that.

Absolutely correct, Ian. You need not only build your own team, but you also need somebody who's going to listen to you. So if you go to your physician, the physician says, well, you know, your headaches aren't related to your gut. Walk out at one point or another.

These pills. Yeah, take these pills and call me tomorrow.

Yeah, Right. I want people to understand that it is all related, that it's all critically important to look at all of it and not look at it piecemeal, because it's the piecemeal approach that is killing us. And we've got to look at the whole person. But now it's not just a matter of a nice idea to go look at the whole person. It's a physiologic imperative. The physiology is telling us that if we don't treat these things in a comprehensive manner, if we don't individualize our approach to patient care, we will not be successful in helping these people.

Yeah.

Awesome.

Amazing.

Well, thank you, Gary.

So I want to Total Recovery is the book. Dr. Gary Kaplan. K A P L A N. Go get this book. And if you would like to do the timeline that Gary talked about, go to kaplanclinic.com and there's also videos there. There's more information about Gary. And I hope that everyone found this useful. It's K A P L A N C L I n I c.com kaplan clinic.com so, any famous last words, Dr. Kaplan?

Jess, thank you very much for the opportunity to do the interview and talk with you guys. And I'm very much looking forward to seeing you in California.

Awesome. Thank you so much.

See you in a couple of weeks.

And to all our listeners, please share this interview with anyone that you know would probably be well served to hear it. And I can't imagine everyone does not have one or many people in their lives that could probably benefit from hearing this. So please share the message. That's how we help people become better versions of themselves and reduce a lot of suffering, because that's. That's really what we want to do here.

So thank you.

Thanks, guys.