Ep75 | Two Worldviews, One Exam Room with Dr. Ken Sharlin

If you work in healthcare, you already know this. Conflict is everywhere. In the OR, in labor and delivery, in committee meetings, between physicians, nurses, administrators, and teams that are all trying to do the right thing. But here's the problem. Most of us were never trained to handle conflict well. We learned procedures. We learned Diagnostics, but we didn't learn how to navigate the moments when 2 professionals strongly disagree. That's why I developed the SPARK framework. SPARK stands for stop, pause, ask, don't assume, reflect and respond, and create a path forward. It's a practical system designed specifically for high shakes healthcare environments. Through keynote talks, residency workshops, and Spark Masterclasses, I teach physicians, nurses, and healthcare teams how to turn destructive conflict into productive conversations that strengthen teams and improve care. If your hospital, residency program, or medical conference is looking for a speaker on conflict, Communication and leadership in healthcare. I'd love to work with you. You can learn more in the show notes because in medicine, conflict is inevitable, but handled well, it can make teams stronger. In every operating room. In every ward, in every clinic, and every team meeting, a silent battle brews. Conflict, negotiation, identity. Welcome to the Scalpel and Sword podcast, where I, Dr. Lee Sharma, physician and conflict analyst, explore the hidden negotiations beyond modern medicine. Let's trade burnout for boundaries and learn the art of healing with precision and power. Great. Hello, my peaceful warriors, and welcome to the Scalpel and Sword podcast. I'm your host, Dr. Lee Sharma, physician and conflict analyst. And there's a conflict happening in medicine right now that doesn't take place in an operating room, a boardroom, or even necessarily between 2 people. It's a conflict over how we understand illness itself. For much of modern medicine, we have been taught to identify disease, establish a diagnosis, And treat it using interventions supported by scientific evidence. And that approach has accomplished extraordinary things. But increasingly, patients and physicians are asking another set of questions. Why did this person become sick? What happened before the diagnosis? What roles might nutrition, sleep, stress, environment, metabolism, Inflammation, genetics, relationships, or behavior be playing? And instead of asking, what disease does this patient have? What happens when we also ask, why this patient? Why this disease? And why now? And that's part of the worldview of functional medicine. And depending on whom you ask, functional medicine represents either an important evolution in medical thinking Or a movement that sometimes gets ahead of the evidence. That disagreement has created something bigger than a scientific debate. It has also created a cultural conflict inside of medicine. And you all know what we do with conflict on this podcast. We don't run from it. We get curious. Welcome to The Scalpel and Sword. Today, I'm joined by somebody who occupies a fascinating and really unique position. And this particular thing we're talking about today. Dr. Ken Charlan is a board-certified neurologist who has practiced medicine for more than 25 years. He practices functional medicine and has built an approach to neurologic disease that incorporates conventional neurology, precision medicine, lifestyle interventions, and system-based thinking. He is also the host of the Healthy Brain Toolbox podcast. Ken, welcome to The Scalpel and Sword.

My pleasure. Thank you for having me.

So, you know, I think it would be kind of expected to start with what is functional medicine, but I want to start with a different question. How does functional medicine see the patient differently?

I think a big part of where functional medicine comes in, and I hope we can get to, I will say some discussion of where I think functional medicine needs to evolve or where this, let's call it a field of root cause medicine, is evolving. Because I started my journey in functional medicine around 2012 or so, give or take some years of not realizing what I was doing had a name, but I was sure that yes, nutrition and sleep and movement and stress and all those things play a role. But in the end, functional medicine is really an individualized, ideally personalized care of the patient in which we strive to understand the factors that contributed to why a person got sick. We sometimes call that antecedents and triggers. And then beyond the tipping point where that illness becomes apparent, What's keeping that person on their current trajectory? So it's not necessarily about treating the disease, although that, in my opinion, remains important. It's also about addressing the person who has the condition. And I think the most potent toolbox really when it comes to helping folks is being able to combine the two together.

So this is really interesting because even before you realized it had a name, you already saw value in doing this. 24 years ago, you already said, you know, I want to know how my patient's sleeping. I want to know what their exercise is like. I want to know what their nutrition is because I believe that has an impact on the illness in front of me. So you were already kind of drilling down and answering these questions. So at what point did you really see benefit in formalizing What your thought process or what your suspicions already were in terms of this impact?

Well, in the early 2000s, I actually got interested in endurance athletics, cycling and running, and eventually bringing it all together into the triathlon and the good fortune of completing many races, including the Ironman triathlon a few times.

Congratulations. That's awesome.

Thank you. Not first place, but a good effort and a finisher, right?

Hey, crossing the finish line for an Ironman, that is first place in my book. So yeah, that's great.

Well, for those who are watching or listening, this is a 1-day race that covers 140.6 miles. It's 2.4 miles of swimming followed by a 112. mile bike ride, often through very beautiful scenic places. And then, well, getting on your feet and running or moving through the distance of a marathon, whatever your legs will let you do at that point in time. And I often tell folks that, you know, I'm not superhuman. I'm a reasonably good athlete, but nothing incredible. And for anyone who's ever followed that sport on NBC for years, and I don't know if they still do, featured a sort of a cut-down version, you know, compressed into 2 hours of the World Championship in Kona, Hawaii. And while they did feature the pros off and on, most of this story, and it really is a story, had to do with the heroes that weren't the pro athletes. And they might be someone who had a specific disease that they wanted to raise awareness about, Down syndrome or cerebral palsy or cancer or ALS. There's a famous athlete that crossed the finish line with ALS years ago. And I say that if you put your mind to it and you're realistic, you know, you do need a training plan. It's probably not a bad idea to have a coach and You know, a group that you can train with, cuz it's a lot of training. It can get lonely out there if you're training that many hours per day and hard to maintain. But the point is that really most people could actually do this. They might not be first place. They may come in at the strike of midnight, which is sort of the witching hour for the Ironman triathlon, but a great tradition. With the athletes that cross the line at midnight, but they can finish. And in order to finish this distance, this event, you know, it's more than just pure athleticism, as I've already implied. It's how are you sleeping? You know, the whole movement plan leading up to race day is a build toward that peak fitness. It most definitely is the nutrition you have to have. Your nutrition very dialed in. How many calories per hour? How much carbs? How much protein? And I could calculate that in my head on the run, cuz like anybody else, I had oops moments with nutrition and I'd go, okay, what am I gonna do now? It really requires that you understand the physiological stress on your body, right? Overtraining. can be a big problem. And understanding things like heart rate variability, which is not uncommonly used in functional medicine, has very much a place in training and endurance athletics. So I was seeing myself change, my body change. I was accomplishing things, and I was in this sort of typical vicious cycle of going to the clinic, making the diagnosis, Prescribing the appropriate drug, which might work for a little while, usually not forever. And then just the vicious cycle of drug after drug and watching my patients get worse and worse. And being this sort of nerd that I was with all the science behind triathlon, I was listening at the time to a podcaster and coach who still works in the space, although Doesn't identify as a triathlete anymore, but I was listening to the Ben Greenfield Podcast, and at the time he did focus on fitness and triathlon, and he was interviewing David Perlmutter, who's a neurologist, has since retired from clinical practice now several years ago, but is a very prolific writer, has written many books, and is somebody you see on those PBS specials next to Dan Amen and all those folks. And David's wonderful and an inspiration. At the time he was talking about his book called Grain Brain. And as I listened to this, and again, he's a neurologist, I'm thinking, wait a minute, this all makes sense. And I'm kind of doing a lot of this already and I see myself changing, but maybe I can bring this into the clinic and figure out how to apply some of these principles. So. He had been a board member at the Institute for Functional Medicine for many years. I don't know if he still is, but at any rate, he mentioned IFM and I looked it up and it was like, you know, the gates of heaven opening. I could hear the trumpets and the chorus in the background. I'm home. You know, I was about to quit medicine. I was so unhappy. My wife said, you need to go now. And the conference that was available was one of their advanced programs on hormones modules. And so I went and I went anyway. It was absolutely wonderful. It was different than any other conference I had ever been to. There was positive energy, there was joy, there was dancing. Since you don't go to neurology conferences and dance, they danced. Okay.

Yeah.

So I was like, okay, I'm sold. This is it. And I'm not even a dancer, by the way. But yeah, so it was great. And then I went and continued my education, made sure to connect with other thought leaders, Terry Wahls, Dale Bredesen, et cetera. And I've been doing this now for quite a few years. It took this sort of personal transformation and thinking about things and Realizing that there had to be another way.

There's so much that I want to talk about what you just said. First of all, congratulations on completing Ironmans. I am also an endurance athlete. I run ultras. So we have to be careful because this could totally turn into an endurance sports podcast very quickly because I can tell how passionate you are about it. And I'm very passionate about the sport as well. So I love how you talk about the idea of being an endurance athlete, making you Really build an awareness about these very specific things in training, and I think I'm like you. I realized really quickly I've been running for 25 years, but I didn't start running ultras until about three years ago. And there is a big difference between hopping up and running a 15 miles or running a 5K or a 10K versus going out. I'm going to run 30 miles today. That's very different, and it requires a very different level of attention. And I think. As you're talking, one of the things that occurs to me is there is a difference between muscling through an illness. I'm going to pop these drugs until I get better versus I really want to drill down and understand why my body is doing what it's doing. And that means, like you said, I need to know how many carbs I need for every 30 minutes. I need at least 8 hours of sleep. I need to know how much hydration I get, because if I'm going to ask my body to recover and do these things, I can't just muscle through. And I think that's one of the big aha moments for me as an endurance athlete is what you're talking about is it makes you pay attention to the little things. You have to, or else you will never get it done. But I love how that was a bridge for you in opening your eyes to the value in functional medicine, that having that experience of intentionality made you dig deeper. And then you were able to draw a line between let my curiosity Take me to this place. Now I want to be in a community. I want to be in a group of people who are doing this and actually join other people who are moving the needle in this way. But there's something else that you said that I really have to shine a light on, which is the fact that when you went to the functional medicine clinic, people were happy, that you saw joy, that you saw people who were dancing. And that is something that is sorely lacking right now in traditional medicine is. The concept of having joy in the clinical space and what we do is something that doesn't exist. And that's, I think, a very important thing is that the people who are doing this really feel like they're practicing in such a way that they're discovering the real essence of why they went into medicine in the first place, where I think that may have gotten lost in more traditional models. And you definitely sound like you found that in functional medicine. So I guess your perspective is such a powerful perspective, but it's not one that a lot of people have. So why do so many conventional doctors misunderstand, or maybe I don't want to say look down on, but maybe don't think that functional medicine is as valid as traditional Western practice?

We could speculate for sure. And I'm sure there are multiple reasons. It's very unfortunate. You know, we're fed narratives throughout our lives. There are all kinds of narratives that we tell ourselves about our world, about our existence, about what we know or what we don't know. And that's in medicine, but it's of course outside of medicine as well. That's really how our brains work. We gravitate towards story. And I think, you know, providers have been fed lots of stories. I wouldn't say it's a massive conspiracy, but the reality is if you're sick and you're put on a drug, then potentially You're a customer for life to the pharmaceutical companies and they sponsor meetings. You know, if I go to an update in neurology, which I've sort of vowed to never do again, because really it's just like, this is the next drug and this is the next drug and this is the next. I'm done with that. Like I can read about drugs and I don't need to go to a conference to hear all that. I wanna hear of people getting into the science and the systems biology and all that. So I do think that's part of it. We get caught in a trap of debt. We're taught that we have to work for, you know, there are fewer and fewer, it seems, independent hang-a-shingle type physicians. I hope it's changing. I think direct primary care is really an important revolution. So maybe the pendulum is going to swing in the opposite direction. We certainly had an explosion of those practitioners, but it's still a very small percentage. Of the overall practicing population of providers. But I think when you work in corporate medicine, it's fee-for-service. And if you're behind the scenes, you look at the business of medicine, and to be clear, part of it is a business. Like, I own my own clinic. I have to pay my employees. I have to pay my landlord. I mean, there's just no two ways about it. I have to pay my insurance. So You know, I have to earn money. And when I bill an insurance carrier and they pay me 20 cents on the dollar, but my landlord says, no, if the rent is $6,000, it's $6,000. It's not 20 cents on the dollar. I've got a real conflict. And so that's why you see these, you know, what I call wham, bam, thank you, ma'am visits, right? Mm-hmm. 5 minutes in and out. Doctor didn't examine me, didn't answer my questions. These are good people. People who go into medicine, I think in general, are good people. They're caring people. They're empathetic. They're very smart. They work very hard. And I think that unfortunately we get jaded very quickly. There's other things we could talk about, like keeping up with the literature. I think you said something earlier that I felt resonated with me a lot. I always send my staff little texts when An article comes out and I say, see, we were doing this 5 years ago. Like we knew this. Functional medicine providers were talking about gut permeability when I was in training. And that's when Fasano published his article in New England Journal of Medicine. And yet there are too many doctors that still debate whether gut permeability is, quote, real. Come on. Read the literature. This is a major driver of disease, and why aren't we paying attention to this? So there's always that aspect of it as well. People think that food plays no role, all kinds of stuff, and it's just from narratives and biases, and I don't really read, and who's my community, and things like that. So unfortunately, those same providers usually very bitter and jaded by the system. So we need to have them listening to. Your podcast and show them a better way.

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I'm really glad you said that because I agree with you on that, that so much of, I think, the questions with regards to functional medicine and being able to get down to root causes is a time pressure, a systemic pressure, is it's really hard for physicians who are Trying to, I'm trying to see this many patients in this period of time, that to be able to sit down and even ask those questions is hard. But also too, I think that we are on some level, I want to say a victim because that sounds like we have no agency and we do, but sometimes it's easier to just say, well, I'm just going to give the drug. I'm just going to write the prescription because it's hard. It's hard to actually sit there and spend that time to do it. And I think that is one of the things that. People talk about with functional medicine is that there is a time factor that's involved to sitting down and asking the patient these questions. But I would actually flip that script. I'm like, if you actually do the math of the patient who comes in with this problem and you ask them, what went on in the last week and a half? What did you eat? What did you sleep? Did you travel? Did something stressful happen? And then they tell you, yeah, I'm really scared because this happened to my best friend and now I'm worried this is going to happen to me. And so I haven't been Sleeping, and I haven't been drinking my water, and I did not eat what I normally. Okay, so now we're actually getting down to something that's really important to the story. And what I've done when I do that is maybe it took me another five or ten minutes to do that in my clinic visit, but maybe it saved the patient coming back for another two more visits that weren't needed because I actually got down to the root problem. And I think that's one of those shifts that we need to make in medical practice that we think we don't have time. But actually we can't afford to not take the time. Is that one of the things that may be standing in the way of people seeing the value in functional medicine?

I think time is part of it, but I think as physicians, we're also not really trained as communicators and coaches. We're used to saying, you know, you have high blood pressure. I'm going to write you a prescription, make sure you take it every day. Take with a little water on an empty stomach. I'm just making this up. And I'll see you in 3 months. That's not how functional medicine actually works. And I sometimes say we are really masters of human behavior informed by science, if you will, that behavior is a big part of functional medicine and understanding the behavioral models that look at why people change and what motivates them. And using language that resonates deeply, usually at an emotional level, less intellectually, because that's really how we make decisions emotionally, to ultimately guide people and support them. And in fact, elicit decisions that to the patient feel like it's my decision, right? It's my choice to do this. As opposed to go home and do this, because for those of us who raise children, how often do our kids respond to those sort of marching orders? That's not their idea.

Of course.

So I think there are complexities there. Frankly, I don't think functional medicine is for everyone. The framework absolutely is, the concepts are, but is everyone ready for the approach? No. And as you pointed out, it's also time-consuming, which is wonderful. It means we're spending the time with our patients. But that means for the most part, functional medicine practitioners don't accept insurance. And that's even a hard pill to swallow for a lot of folks who are under the impression that somehow insurance saves them money, which it really doesn't. But that's another discussion.

Yeah. I love how you're talking about That this idea of functional medicine that we're actually drilling down to these may not be a model that's for everybody. That part of having this model coexist within a system is really important because it gives patients more agency and choice if they are actually seeking that out. But there is an important part in that patient has to be very invested in that relationship with their functional medicine physician, because a lot of it is, this is what I do for sleep. This is how I eat. This is how I exercise. This is what my behavior's like. This is what my mental health has been like in the last month and a half. And all of these are playing into my health status and my disease processes right now. And so there's a lot of effort that comes in from both sides, from the practitioner and from the patient. And so it feels like you have to have that relationship even more intact than what you would expect to have this be beneficial.

I agree. And I mean, let's be honest, just like anything else, there are good doctors or bad doctors or good functional medicine doctors are quite frankly bad functional medicine doctors. It's very easy to fall back into the trap of disease treatment, right? Again, for folks listening, I think it's very important to understand what is the underlying condition that you're dealing with. If somebody has Alzheimer's or Parkinson's or MS, in my world, I have to know that. Mm-hmm. Right. And I have to embrace that in addition to those personalized approaches. But the reality is I also see a lot of what I call allopathicizing functional medicine, where people get diagnosed, you don't really have MS, you have Lyme disease, and then they're treating Lyme disease. I think that's a real problem. And I think that's part of the sometimes bad reputation that functional medicine invites. I'll be the first to say that Lyme disease is a big problem, especially in the Northeast and northern Midwest of the country. I'm in Southwest Missouri. I have seen the occasional case of Lyme disease, but a lot of it, you know, if you have to have a special test, I'm going to put it, a special test that no one else knows about, that only the company that makes it does this test, and they will tell you that technically you don't meet criteria, but for our special criteria, come on. Like we have to join the scientists. And there's a whole reason and why I think there's traction on this sort of thing. And I think it has a lot to do with basic human psychology and narrative and what we're really willing to hear. And something that I call the diagnosis narrative, which has to do with When you come to the doctor or provider and you're sick and you go into this sacred space and they're wearing the white coat and you're sitting on the exam table and all that, and then they say, well, this is my synthesis. This is what's going on. And you hear that and your brain goes, okay, that makes sense. Now I understand. Now you're stepping across the threshold From diagnosis to a therapeutic relationship. And too often, especially for those in this functional medicine space, there's a lot of folks that I see, I'm sure you do, with very complex multi-system sort of presentations, but no clear diagnosis. And they've seen, you know, 10 other providers and then they say, well, it's because they didn't do the right test. And you actually have Lyme disease. And they go, oh wow, light bulb moment. Now I'm ready. Now I'm ready for the therapeutic journey. So I probably stepped on a few people's feet over this. And well, I'm not sorry because I've too many years of doing this. I feel like I've earned a little bit of a voice in the industry. And again, I think Lyme disease is very serious. I think we have to recognize that. In addition to primary, secondary, and tertiary Lyme or neuroborreliosis, there is a post-Lyme syndrome. It's very much the same from, I'll use the term pathophysiology or what drives it, as long COVID, as chronic fatigue. And that to me is a much more fascinating discussion that really has to do with understanding us as sort of complex Multi, you know, system vessel and, you know, chronic inflammation and all that. And working through the factors that you get exposed to this thing and you just have this tipping point and your body can't recover. And I don't think we should be calling that Lyme disease, but that's a whole other, you know, I call it limbic system distress, but maybe too complicated for a lot of folks.

Okay. First of all, I do really think it's cool how you talk about when you see these people with these very complex multi-system processes and they're coming to see you and you have done this for such a long time. And this may be one of the biggest strengths for functional medicine as you're talking about it, is the idea that you're not just looking at a symptom or one organ system, but you're looking at an entire picture. And when I teach clinical diagnosis to medical students, I teach them about illness scripts, which I'm sure you're familiar with. But the idea that when you look at a patient and they have all these things going on, that you're able to sort of put that picture together. And when you see that picture enough times, you actually, okay, I already know what this patient has. And you're already doing this with Lyme disease because you've seen it enough now that when the patient walks in with this collection of symptoms, you already know what this is. You're going to order the test to confirm your diagnosis. But you already know what you're looking at. And so one of the strengths of functional medicine, which I think is something that Western medicine is trying to get better at, I think New England Journal is running this. There's actually Clinical Diagnosis Foundation that is teaching this as well. They have a wonderful program called TeachDX, which I have done, where they're actually teaching clinicians how to teach this process to other medical students and residents. But being able to put this picture together, this illness script together. But when you see that picture, you can't unsee it. The first time you see it and you go, this is X, you can't unsee it. And then every time after that you see it, it gets reinforced. And that to me is one of the greatest things about what you do, not just as a clinician, but as a functional medicine practitioner. You put a picture together and when you show the patient based on this picture, this is what I think you have. That's not just the patient crossing over a diagnostic threshold into therapeutics. That's a patient that's built trust in you and in the system. You have actually, in so many ways, caused that patient to buy into what the system can give them, how they can benefit from, not just in terms of illness, but in terms of wellness. That's a huge gift you're giving somebody just by exercising that gift that you have. In recognizing that illness script.

Right. And I think functional medicine historically, you know, has worked well in general, and it's worked largely on the premise of creating resilience and creating wellness by eliminating factors that may or may not directly contribute to the diagnosis, but certainly contribute to a lack of what I'd call homeostasis, where we really focus on something, as you know, called systems biology and how these various systems that govern how the body actually works get disrupted by everything from, you know, heavy metals and methylation issues and lack of mitochondrial cofactors and hormone disruption and sort of a domino effect where an imbalance in one area ultimately affects another area. However, I do think that we need to evolve functional medicine. We are in the age of precision medicine. And as you teach, it's kind of an expression about an association does not necessarily mean causality, right?

Right.

With precision medicine and biomarkers, we have a much greater opportunity to bring in, to take the literature. What do we know about, again, I'm a neurologist. So it might be a little different if you're a gastroenterologist, cardiologist. What do we know about what are the factors that cause MS or ALS or Parkinson's and Alzheimer's? Can we actually, if we say, well, mitochondrial dysfunction is a major driver of Parkinson's disease, we have tools to test mitochondrial function, right? Mm-hmm. So it's less of a sort of a nonspecific template of I'll create health and that crowds out disease. That's sort of the older way. The newer way is we still need to do that, but now we can bring in some of those tools of precision medicine and actually ask the questions of what does the science tell us? Can we test that? Can we correct that as part of the overall plan?

That's huge because I think the ability to move from sort of this global picture into something that's that Drill down. That's a really cool way to give patients data to act upon. I think that's one of the biggest things about it. But you're giving them data to act upon it, not necessarily just targeting one disease. It's something that's much more proactive. I think that's one of the greatest things about what you're doing. And that leads me to my next question: Do you think? that functional medicine and Western medicine can coexist in such a way that they can become maybe not even cohabitative, but maybe even complementary?

Well, I do. I mean, they coexist now. Of course, there's lots of functional medicine providers. And more broadly, whether or not they call themselves functional medicine, people do see chiropractors and naturopaths and acupuncture, LACs, and so forth. There's a true hunger for this, I think. And too often there's— in my clinic, my patients know that I am more open, more integrative, more holistic, for lack of a better term. So they'll tell me, oh, you know, I'm seeing my chiropractor. And I'm like, cool, tell me what you guys are doing. But a lot of times I think that also happens behind the provider's back. And what we really need to do is form these partnerships because let's face it, I mean, I'm 62 and if in reality someone said, I'm going to teach you a whole new way of practicing medicine and it's going to completely change the way you do things, I might say, I am too old for this. I've already spent X amount of money on medical school and training and dragged my family through this. I know what you're saying is important, but. It's not enough for me to make a big change. On the other hand, if we can, and I'll just use one example, I'm not promoting this in any way, but Mark Hyman, who's an investor in Function Health, sends an email to me and says, give your patients access to this lab panel. It's reasonably okay lab panel, and you can add on to it if you want. The basic ones, I'm like, $399, and then if you're the patient, they have physicians who are licensed in different states so they can talk with you about your results. Unfortunately, the providers, like if I'm not a function health provider, I can't get their reports, which is a problem. I can't simply order that lab panel because it's pretty cheap, and for what you get, it's actually a pretty good deal. But the more we work on integrating this into a single cooperative space in which a team of providers, and by the way, that includes health coaches that I think are critical to this equation, then we're going to really raise the care of our patients. And I think it will resonate with traditional practicing physicians because there's this thing called value-based care. And if they can get better outcomes for their patient, wait a minute, fine. Improve your reimbursement. It'll just make you happier, make you run your clinic a little smooth, more smoothly. And it's a win-win all the way around. So I do think there are models out there that are attempting to do this. We have a bit of a ways to go, but it's happening.

That is brilliant. And I'm so glad you said that because I think this is one of the things where, when we talk about worldviews, people having different ideas about what the practice of medicine looks like, one of One of the things that we always have to remember anytime, and this is any conflict anywhere, but specifically with our topic we're talking about right now, is that you always start from the common ground. You start from the place where you're together. And if you can start from that place where you're together, everything else has a better shot of being aligned. And if you're talking about alignment, not only for the care of the patient, this is how we're going to get the optimal care for the patient. If you have and I have, and we work together. But we also have this goal of keeping physicians' practices financially healthy. We also know that's a thing too, which is where value-based care is becoming such a big model. So when you're talking about not only can we actually keep the patient healthier, maybe we can make our system healthier, but we can be financially more survivable. That's where you're going to get a lot of people maybe who did not see functional medicine as something that was beneficial or valid. That's where you're going to get a lot of people to buy into it.

Yeah. I mean, I interviewed David Katz, who's, I think, his credentials with Yale Medical School, and he was involved in their preventative medicine program and very prolific and really quite brilliant. And he sort of stumbled into this company that he created it, but I mean, it consumed him after a while that he had to step away from academics and all that just to run the company, but it's focused solely on bringing the principles of anti-inflammatory nutrition into the routine medical clinic by offloading some of those responsibilities that the doctor would say, I don't have time for this. I'm not trained in nutrition. Mm-hmm. Right. But how can we actually do it in a way that becomes a win for everyone? And he has won. Method to do that.

That's so cool. I think this idea that we can actually have other people, and I think it is true. I think it's hard for physicians to look beyond the idea that they're supposed to be doing all of it. I think it's really hard for us to say, you know, it takes a village. It really does. You have 10 minutes in the room with a patient to talk about all these things. And I'll just throw out irritable bladder syndrome is something that I see a lot. And a big part of irritable bladder syndrome coaching is nutrition. And so I have what, 4 minutes after I've talked with a patient about, I have suspicion this is what you have, and we're going to talk about a low acid diet and I outline it and I write it down, but then that's it. If I actually had somebody else who could call the patient several days later, it's like, hey, how's it going following a low acid diet? And then the patient has a chance. Oh yeah, let's reinforce that. Oh, I did this. I drank this. I ate this. And you actually have a coach who can say, okay. That's a really good improvement. Could we try this next time? Could you do this when you're in this situation again? Maybe you could swap to this because this has less acid. I think those are the kinds of things that we don't really realize how important it is. And especially if we're trying to get the patient to as healthy and well state as possible, that we need help to do that. We can't do it by ourselves.

Yeah, no question about it. And it's about learning the language that resonates with people. I learned early on in experimenting with all that one of the most non-resonating phrases is to talk about a healthy diet. The term, for me at least, that was my experience, that the minute I used the word healthy, it triggers a defensive response and everybody feels they eat healthy. If you talk about an anti-inflammatory diet, If you talk about nutrient density, you know, not just calories, but quality, if you will, that starts to improve the conversation and raise the curiosity a bit. Agreed. And then we're faced with what I call fad diets that may have some basis. Most of these diets are really tools and not lifestyles. There's a place for ketosis, but most of us shouldn't be in ketosis all the time. I truly do not understand carnivore diets, but hey, there are some people that really subscribe to that. But I think a lot of it has to do with you're not eating the other stuff. Yes. And I understand modifications of that more recent, relatively more recently, allow some Plant-based food in there. By the way, that's a whole class of micronutrients, right? That's a problem, especially when it comes to the brain. Phytonutrients like flavonoids and polyphenols have been found to be highly neuroprotective. So, you know, you're not going to get that in a bloody steak.

So not at all. So before we close, I just wanted to just, we won't say rapid fire, but we'll just go through some questions really So what do you think is one thing that conventional medicine gets right?

Well, I think the diagnostic methodology is extremely important. I don't want to dismiss the importance of understanding what is this disease that they're dealing with standing right in front of me.

What do you think is one thing that conventional medicine gets wrong about functional medicine?

I think we're a pretty smart bunch of people. I've met some absolutely brilliant, extremely well-credentialed functional medicine providers, and that tells me that we're not stumbling into this because we've got nothing else to do. We've come to deeply believe that this is really a tool that is necessary in helping other people achieve resilience and a deeper understanding of why they're sick and what their journey, this first journey, can ultimately mean and be seen and be heard. To be clear, I meet people, maybe you, Lee, I don't know your exact educational credentials and publication history, but Harvard Medical School and, you know, practice at MGH and functional medicine. It's not an accident. One of my mentors for years, and he's rest in peace as it were, Norm Shealy started his career as a neurosurgeon and, you know, eventually became one of the fathers of holistic medicine and kind of raised an awareness of energy as medicine. And he was kind of an out-there guy, but he was very brilliant and certainly prolific. And so don't underestimate functional medicine providers and how they've found their way to this place.

That is awesome. And that to me probably is the biggest thing. And anytime you wanna break down a worldview, anytime you wanna build collaboration, I think the biggest thing that you do is you reach across the aisle and you look at the person as, I love your journey, I respect your journey, and you and I really do agree on what we're trying to get to. And I think once you get to that place, the people that benefit from that primarily are going to be the patients. But secondarily, of course, it's going to be the clinicians. I want to see everybody dance when they go to their conventions. I don't want to just see the functional medicine docs do it. I want to see all the doctors dance when they go to their meetings. That would be probably one of the greatest things I could ever witness.

Hope and joy are critical. And we have this entire culture built around, again, in my world, but So many other specialties, if you will, say, well, once you have the diagnosis, that's it. You have to learn to live with it and learn to die with it. We have a real problem, right?

Yeah.

Alzheimer's disease. I can't tell you how many cases that I have in my clinic and piles of test results where objectively this person no longer meets criteria for Alzheimer's And yet a tagline of the Alzheimer's Association was the only brain disease for which there is no cure. Come on, come on. Now we're not going to fix grandma who's been in the nursing home and is end stage and et cetera. But if you're having early changes, you do need to see someone. You do need to, who knows what they're doing, because there is help and the literature supports it. supports this. Well-scrutinized, well-peer-reviewed literature supports the idea that cognitive function and those amyloid proteins and all that can be altered by things like diet and exercise and sleep and so forth.

That is awesome. Ken, if people wanted to reach out to you, if they had questions about your clinic and about your functional medicine practice, What's the best way for them to find you? I

encourage people to just start with my clinic website, which is functionalmedicine.doctor. So it's not .com, it's .doctor spelled out. I do have a website that's drkensharlan.com, more of a, I call it a vanity website, that's speaking and books and so forth. We have a YouTube channel, the podcast called the Healthy Brain Toolbox. And my book that's available on most of those platforms, also Amazon as well. I have a couple of books, hopefully a third in the near future. We'll see.

Well, I tell you, we'll put all those in the show notes, but Ken, we would love for you to come back and after the next book drops so we could talk about the new book.

It would be my pleasure.

Awesome. Ken, thank you so much for being here today. This has been a really cool conversation. I've learned a lot and I think our listeners have learned a lot too. So I appreciate it.

Thank you for having me.

For all of our peaceful warriors who have joined us today on the Scalpel and Sword podcast, thank you so much for being here. If this podcast resonated with you, share it with a friend, share it with a colleague, and until next time, be at peace.

Every episode is an invitation to speak, to negotiate, to choose peace. I'm Dr. Lee Sharma. Join the dialogue by subscribing to Scalpel and Sword. Until next time, peaceful warriors, may your choices be sharp and your voice be even sharper. This podcast is a reflection of lived experience and research in conflict resolution. The Scalpel and Sword is not intended as medical or legal guidance. For personal matters, please consult a qualified professional.