Breaking the Cycle of Chronic Disease: Functional Pharmacy and the Power of TPE | TPE Blueprint #14

Could the missing link in your health journey be hidden in your pharmacy's compounding lab? Pharmacist Dr. Steve Hoffert shares how a one on one approach blending personalized medication, lifestyle tweaks, and therapeutic plasma exchange can all help extinguish long standing inflammation and reboot your vitality. Let's dive into it with them.

Doctor Steve Hoffrey. We are going. I'm happy and grateful that you're here today. So can't wait to get into it. How are you doing?

Oh, doing great. Thanks for having me.

Yeah, man. And you just, you just actually did a podcast with Dr. Savage separately on your show. Shout out your podcast really fast and just tell me briefly what, what you got going on there.

Yeah, thanks a lot. I have my own podcast. It's called the Trusted Pharmacist the Truth about how the Body Works. I think there's just so much out there now in a million spaces between influencers and podcasters. But I figure pharmacy has a unique perspective between medical, pharmacy, pharmaceuticals. I have a wellness background working with patients, and so it's just kind of to put a different spin on things because there's just a lot to digest nowadays.

Well, that's. You kind of led me right into it, which is great. So I mean, because I know the podcast is newer, which is great. You obviously got something to say and that's why we brought you here too, is I think it's really cool you have this unique perspective of being a pharmacist. You know, having your, you know, I would love for you to describe the way you work and how you see things, because you're, you're about to start, maybe by the time this goes live, you are already offering therapeutic plasma exchange, TPE as a partner. So of MD lifespan and Dr. Savage. But I'd love to hear your perspective, I guess just like off the cuff without me feeding you too much. Just your, your thought of. Yeah. Being a pharmacist, kind of where things are, where you're seeing things with, in regards to toxins and personalized health care and whatnot.

Yeah. So, I mean, I'm a traditional trained pharmacist. I went to pharmacy school, learned about how the body works, learned about medications, learned how they interact, learned about disease states. And, you know, it's the same thing that medical providers are taught. It's. Everything is so siloed nowadays. And the fact that we're taught we have this condition, you take this drug and you do this one thing and this gets you well. But as I've gotten outta school. What frustrated me was, was one, I was just looked at somebody who put pills in bottle and obviously my knowledge is way beyond that. But then also too, it seems like that patient came in and took one prescription and then three months later they took two prescriptions and a year later they were on three prescriptions. And five years later they were on five, six, seven. And one drug caused another problem, caused another condition. And I just got to the point where I got really frustrated. I had a mentor who ended up with cancer and I saw what he was doing. He was in this wellness space, golly, 20 years ago, talking gluten free diets, back when nobody even knew what gluten was, talking fish oil, vitamin D, 20 something years ago. And it just made sense because I see what it did to his house, his health. I saw what it did to the patients we work with and got going down this road. I went to, started going into wellness conferences. And what was neat was to merge together the traditional allopathic medicine with the functional side and looking at taking like the things I learned in pharmacy school, but then applying a systems approach, going back to the biology and chemistry, all the stuff that we really hated when we were in school, but realizing that's really where it all starts, at the cellular level and then just taking that to really help patients. Because nowadays people are so complex and there's so many things going on and really more people are super frustrated because the doctor tells them one thing, their family member tells them something else, the podcast influencer tells them something, the social media says something and then they go on Dr. Google and it tells them something. So they just come in a train wreck. And I think it's, I feel like as a pharmacist when I'm there, it's kind of more of like a appointment. And it's like I try to take in everything. I don't want to be their doctor. Let me get that straight right off the bat. I tell people that all the time, but I try to take everything in, look at everything that they've been through and where they've done and then try to point them, look, this is if I was like step one, step two, step three to get you in the right direction, this is what I would do. I will say people have to be motivated to help themselves nowadays because a lot of these things we're going to talk about, people have to want to help themselves. Because if it's like, hey Steve, give me a pill because I want to feel better, like that's not What I.

Do so well, that's.

Yeah.

How do you compete with that? Because like you mentioned Dr. Google. I mean now you have AI, so it's getting even crazier. Like what's your approach to. And obviously you can't make someone do anything, especially when it might be something completely new. It's like, well, why don't you just give me a drug for this? And it's like, well, no, that's. How do you, how do you work with someone and reframe things?

Well, I mean there are, there's two different type of patients. There are some people that come to that mindset. And I'll tell you right off the bat, in an initial interview, patient setting, we consult, we'll go over those things. It, it doesn't take very long to see if that's the person that came to me looking for that. I'll be very upfront and honest with them. I really sometimes feel like I'm more of like a motivator or like a health cheerleader or whatever you want to call it. Because, I mean, but a lot of times that people do come to see us think they're so bad off, I swear they'll almost do anything nowadays. And especially if like I can help point them to another healthcare provider that they can work with. And then we all three work together. And on the pharmacy world, it's called a triad. It's the patient, the pharmacist and the medical provider. If we can establish that relationship, that's when the magic happens and that's when I feel like we get the best success. But I will say those patients that come in, they're like, okay, I don't care what it is, just tell me what to do, I'm ready to get well. I feel like that's the most successful ones and really do extremely well in terms of getting to the other side of, of an illness.

That makes sense. Yeah. The most open minded, they're willing to be coachable, I guess. Right? Yeah. And that's probably a metaphor for life too. I, I'm curious as you say this. And yeah, I'm thinking of lifestyle changes. You know, those are some of the, the biggest things, right. Maybe things like supplements, like is there a change that you think every patient today that you think they should be making or at least thinking about? That's, that's kind of a blanket statement, but something you see.

Yeah, I mean, I'll be honest, I'm, I'm one. It all starts with food and diet. I mean, that's the One thing we do to our bodies every day, it's the one we, it's, believe it or not, our bodies are pretty adaptive. But if we change how we eat, what we do, our bodies really, what's crazy is the gut changes super fast and what the gut does is what the body does. And so I think that's important. So to me that's a no brainer. But from there, you know, it's controlling stress and trying to limit that as much as possible. I mean there's physical stress and emotional stress, but we all, it seems like we're all burning the candle at both ends nowadays, trying to make it so I mean that's part of it, but you have to address that because those are the two things that I've learned is if you eat a crappy diet and you have a lot of stress, you are going to have health issues. You're going to have inflammation and chronic disease and there's no way to, you can't run, you can't out supplement yourself from that and you can't outset out exercise yourself out of those two. You know, the other thing is the sleep, Sleep's important as far as that goes. Exercise, movement, that's the one thing I've seen especially as people get older, man, it's like once they lose their ability to move and it's just, their health is just, it's a crash course headed to nowhere. I mean, and that's, those are things that I think's important. And so, you know, it's working on all those little things like that, you know, and I think supplements do play a part. I, I watch my social media stuff. You'd be like, Steve, that's all you talk about, supplements. And I think, I think it's, these are all little pieces of the puzzle. There's not one magic bullet for all of this. But if you start plugging these holes, I think you'll ultimately find a solution that, that gets the body in the right place. Because that's the thing I've learned is if you put the body in the right place, it will heal itself. It's pretty amazing.

Yeah, I mean it's a great machine. And that's the thing is, you know, Dr. Savage is talking about all the time with toxins. You remove the toxins, things like mitochondria start functioning better. Your whole energy, you know, the engines in your body all goes upstream there and yeah, yeah, we, we, you kind of touched on, I think really quick inflammation and you know, how that affects the body. How do you how do you see that? Because I want to kind of start pivoting a little bit to how you look at toxins and ultimately what you're doing with now, therapeutic plasma exchange. How do you practice there?

Yeah, I mean, inflammation is the driver of chronic disease. And I mean, if. If I've said that one time in the last couple years, I've said it a hundred times in the last couple years. It just. The more and more we're learning, if you go to the root cause of pretty much every medical condition that's out there nowadays, from when we learned it in pharmacy school to the umpteen new autoimmune condition that comes out this week, it's. It's inflammation, and it's that inflammation that makes everything dysfunctional from the immune system and all the things that go wrong. And it's just all of those things I mentioned, a bad diet drives inflammation. Chronic stress drives inflammation. Not exercising drives inflammation, not sleeping drives inflammation. And it's all of those things. And then the other aspect of it is if you put the body in the wrong place and you have bad genes, it's those bad genes are like the weak links, and that's where the flips, the switches start to get flipped. That causes these problems that drive problems. And that's the thing is it's like. And on the wellness space, I think that's what's important, is if you go to a traditional doctor, you're going to get diagnosed with blood pressure or cholesterol issues and autoimmune condition. But the neat thing is, I think with a functional approach is we actually look at a lot of inflammation markers so we can see that function. Fires burning. So then as a good clinician, it's to go figure out where is that fire at so we can put the fire out versus just saying, well, you know, you've got blood pressure, which is probably driven by inflammation. Let's give you a blood pressure medicine. Because that doesn't take care of the inflammation. All it does is put the band aid on it. And I think that's where, like, the inflammation part is. You've got to find where it's at and take care of it.

Can you break down what inflammation markers are? And like, just so we understand a little bit more, because that's something I don't really. I don't really get too much.

Yeah, not a problem at all. To me, like, the number one, there's a lot of different markers that indicate inflammation. Like, my favorite is something. Something called hscrp, which is a Marker of inflammation. It's an inflammatory protein that the liver produces when it's inflamed. And, and if you keep it underneath one, like that's a good side. You don't have a fire burning somewhere. If you start getting like in that 1 to 3 range, you need to go look. But sometimes you'll check people and they'll be like 8, 10, 12, and like you gotta, you got a dumpster fire going somewhere and we've gotta find out what it is and we'll talk about. Toxins can be one of those things that's driving it. Underlying infections, chronic stress, I mean, you, you name it as far as that goes. And like you said, it's, it's when inflammation is there, things get dysfunctional. The immune system, you mentioned mitochondria. Like, I mean, that's the powerhouse of the cell. I mean, what person do I not see nowadays that comes to my pharmacy and says, oh gosh, I'm tired, run down and I'm fatigued? Well, it all goes back to mitochondria. I mean, if those aren't functioning properly, and I hate to say it, I mean, inflammation is just like the blanket you throw, you know, that smothers you. I mean it, it, they just can't function properly. And that's the part where we have to go after that. But I like that there's other markers that are kind of indirect markers of inflammation. Things like uric acid is something else that's kind of gotten popular to check. There's some other things we can check, like mitochondrial dysfunction, actually checking things. Something called a reverse T3, which is a marker of like your antithyroid. So your body makes an active form of thyroid and like a gas and a break sometimes if that's elevated, that can indicate that. So those are just some of the more common things. But I really like looking at those things because that can tell us do we have a problem or do we not have a problem? And that makes it a little easier to go after the issues.

After this whole journey. What I really learned here is like there are a lot of health conscious people. I think I'm considering myself one as well. But no, there's a lot of things, no matter what you do, how much you pay attention to it, how much you avoided, and sometimes it just got in. And I think TPE give me a good opportunity to restore my body again.

That's interesting. So that's, yeah, I learned something new there. How do you help kind of locate it within the body? Like you said, you know, liver like that could stand out. But it like, based on these markers, are you able to actually kind of identify where in the body this is really firing up.

So, so you're like headed down the toxin train in a minute because you're funneling in. Because what happens is, is when, is when somebody has inflammation, you're right, you test it. I say let's figure out what's going wrong. So what we do, we take those patients and we say, hey, let's start eating an anti inflammatory diet. Let's take and let's eliminate the foods that trigger inflammation. Sometimes we may even start with an elimination diet. We can work some of these foods back in slowly and see if the inflammation goes up. The next thing is we start working on stress. If somebody, you know, burns a candle at both ends, it doesn't take time. We start working on things like meditation, yoga, breath work, those things. We can monitor cortisol. We can actually look is somebody's cortisol off the chart? Because if it is long term, it's going to cause dysregulation because high cortisol is, causes blood sugar issues. It destroys the gut, it chews up your muscle. I mean it's just horribly bad for you. So we just start plugging holes. We, somebody says, hey, I don't have good sleep. We fix their sleep, we make sure they're getting good rest, hormones. That's the other thing is, you know, hormone replacement has kind of gotten back in the swing of things for women, especially in the last couple of years. Some of the studies that kind of put a bad light or a dark shadow on hormones, we begin to learn like that was all wrong patient, wrong drug, wrong dose, it was given the wrong way. And we're finding out if we balance hormones that can reduce inflammation. So it's fixing all these things. And then if those don't start to work, then we've got to start doing a little deeper testing. We've got to start looking for markers of infections, we've got to start looking for heavy metals, we've got to start looking for toxins. Because if, if something's got to be driving this inflammation and you've got to get, you know, you can have like a gut dysbiosis, which is an inordinate amount of bad bacteria in the gut. So we've got to find where these things are. If you fix the basic things and nothing doesn't get better, we've got to start looking at these kind of other things to make sure, like the other thing we're seeing a lot is Lyme's disease and stuff like that that are just driving this inflammation.

That makes sense. Okay. So it's basically. Yeah. Peel back the layers bit by bit, starting with, obviously, the food and the things that, like, sleep, the things that we're probably able to control a lot easier. Right? More or less. And then peel back with more tests and tests. Now. Yeah. I'm curious. Toxins, you know, because you said I was leading down the path to toxins. So when does, like, a toxin test come into play in that. That whole chain of events there?

All right, so the way I see it is. And this is my understanding, too, because I'm kind of. I know way more about toxins now than I did six months ago. But what I'm learning, it's like I get like the light bulb goes on because it makes good sense. So what I see with toxins, it's the 80, 20 rule. We've got 80 of our patients. We're going to do all the basic things I talked about, and they're going to get well, and they're gonna be like, man, this is the best I've ever felt. Thanks so much for your help. We move on with life, and life is good. But it's these 20% that they do all these things right. They eat better, they sleep, they reduce stress, they exercise, they move. We balance hormones, we fix all the things we know to fix. And they're like, I don't feel any better. Matter of fact, I may be even worse. I've gotten worse since I went on this journey because these things take time. We'll work with patients for six months to a year, and you're asking a lot of a patient. They're making changes. They're cutting stuff out of their diet they like. And they're like, you haven't got me any better. Like, what's going wrong? That's when I think it comes into. Or. The other thing is, you've been down this journey and you've been doing it, and you're on eight or nine medications, and your doctor says, there's nothing else I can do. You know, I'm sorry. I think that that's. That's the patient that screams, you need to do a toxin test. The other thing that I would say is, is for somebody who.

Is maybe newer, down the road, younger, never had a health issue. Nothing's happened. But all of a sudden, like, man, I've started noticing I've just got a lot of brain fog. Like, I can't concentrate. I can't focus. I think that's another person. I think the other thing that I run into, especially in the world that I live in, doing patient interviews, is what I like to ask, what does somebody do for a living? Because I've ran into some really unique patients. Like, I had a female patient the other day that's just got all these medical conditions, and she's got inflammation off the chart, and we got to look at and ask her, what do you do? She goes, well, believe it or not, I work at a feed store. And she talked about all these chemicals and stuff that she's on. She lives on a farm that's next to this big ranch or this farming community, and she's got well water. And I just think about all the possibilities she has of potential toxins, not counting all the stuff that's like plastics in our foods and all this other stuff. It's just like, I had a gentleman the other day having issues with testosterone and inflammation, and come to find out he's a welder and he's breathed all these fumes of chemicals. Been doing it for, like, 30, 40 years. Like, sometimes it's just like, it almost like, slaps you in the face. Like, duh. Like, you know, you've got to go look and see what's going on.

So that's. That's fair. I mean, but it's. So, yeah, when you're living it, you're just living your life and you don't know any better, you know, and. And until hopefully they listen to this podcast or yours or who, you know, and then finally realize, oh, maybe I should go check that. I should go think about the environment around me. You know, Dr. Savage, he says what your. Your home is, I think he said, 500 times more toxic inside your home just because of all the various things that are, you know, that are not being filtered and. Or you're consuming, you know, water that's just filled with all sorts of fun stuff. Not fun. Yeah. Yeah, it's. It's. It's a wild world. So I guess I'm curious how. How you. Yeah. With tpe, we'll just say that at this time, this goes live, you'll have started rolling it out. But, like, what brought you to the point to offer that at your pharmacy? And how does it work, I guess, within the flow of. Of how you work with your patients? I'm just curious how you're, like, integrating that in there.

Yeah. So what got me down this road is I've got a friend and mentor, Pam Smith. Which I. At some point, if you've never met her, she's good friends with Dr. Savage.

And I just interviewed her yesterday and I've had her on my other show. Yeah, she's awesome.

Yeah, Pam is awesome. So. So Pam, at event, she came down to speak to our providers, and she calls me aside and says, steve, we got to talk. And when Pam says, we got to talk, you set and stop what you're doing. And you listen to what Pam has to say. Because Pam is so knowledgeable and is an expert in what she's been doing for so many years. And she's like, there's something coming out that we did in the emergency room many years ago that we're calling their plasma exchange. But we're taking it to a new level. We've got pr, so what we do is we take plasma exchange, which is accepted, been FDA approved for years, to, to remove things from the body, but we take wellness medicine and merge the two together so that we get the benefit of removing toxins, but then we put back the nutrition, the vitamins, the supplements, and do all of these things and further remove the risk of toxins. And I'm going to tell you, she says, steve, I have never seen anything like this. And she got there and she proceeded to tell me stories with her patients on how before they couldn't take hormones, and now they can take hormones. How. I guess they've. They can find out how they can remove so many toxins from ladies who are pregnant to help make sure that before they get pregnant, to make sure they have healthier babies. And no offense, when Pam come to me is like, this is a game changer for me. Like, this is going to change medicine. I'm like, all right, enough said. What's. What do you need from me? She goes, well, we need, we need, we need you to bring it into your pharmacy. She goes, you know, you're, you're. You're already a healthcare destination. You've already got a good following. You already do great work at your pharmacy. You do compounding and traditional, and you do wellness, but this is one more tool that you can bring, and your patients need that. And I'm like, pam, you're right. Because like, I, I can tell you there are these ladies that are so toxic with all these things that we try to give them hormones, and that's where our compounder comes in. So there are some commercially available bioidentical hormones that a patient can get that doesn't have to be compounding, but as a compounder. We get asked for all the oddball things. So for instance, you'll have a lady who wants to take bioidentical progesterone, which is something the body made. It's essential to help with anxiety, mood, sleep. It's anti inflammatory, protects the brain. It has so many benefits. But we get ladies that are so toxic, sometimes we try to give them a, a, a dose that's traditionally what you should take. They get sick and nauseated, it makes them feel a million times worse. So we'll get asked, can you make a lower dose? Can you make a lower dose? So we keep going down and down to the point like you really can't make it any smaller and they still can't tolerate it. Well, that's where this, that's where this TPE comes in, is we remove the toxins and now that lady who couldn't take hormones because they, they, they battled for the same receptor site. Now that progesterone can sit on that receptor like it's supposed to not compete with this toxin and the, and she gets all the benefit. And that's the kind of stuff that I really feel like opens the door what TPE can do. I'm excited to actually roll it out to my providers. It's one more thing. I mean, I feel like it's compounders. We already provide really personalized medications that is tailored for each patient. But this is one more thing that they can send their patient in to help make sure that we kind of clean them up and then send them back to them so that the provider can have success. Because trust me, doing this functional medicine stuff gets a little frustrating sometimes. Especially when you do all the things right and people don't get well.

Oh, I bet that's probably the worst because you're just like, I'm dealing with you. I'm not dealing with a whole bunch of a group of people. It's an individual. And that's why, I mean it just, it seems like it's like a perfect partnership. What you're doing with MD lifespan to bring TPE in your clinic is you're already a provider, a one on one type provider, very customized. I feel like the trends are going a lot more personalized with medicine anyway with the fact that there's so much better data through testing, it's more widely available. You do have, you have the Google and the AIs where you can search up things, but I'm not, not condoning that. But people do it anyway. Yeah, any, any thoughts I guess on where that will go in the future, I'm just kind of curious about like personalized medicine. And you know, TPE is just one of the treatments, but I mean, there's so many other cool ways to now support people at an individual level.

Yeah, I mean, the, the way I see it, and this is important, removing the toxins is like the start of the process. When I started doing functional medicine probably 15 years ago, it was taught the first thing you've got to do is you got to clean, you got to fix the gut, and you got to address stress and then we go from there. But what I'm kind of learning is, is because we're getting so many sick patients that are so toxic, it really starts us, we need to start doing tpe, clean that up, then fix the gut, then reduce stress, and we'll have better success. Because there's a lot of these things, if you do them in the wrong order, you're not going to see the full benefit of what you're looking for. So I do feel like TPE is that one thing. And then that's the part where I feel like, well, some of the newer therapies that we use on the compound side, things like low dose naltrexone, which modulates the immune system that gets out of, bat out of whack during inflammation, actually has the ability to work better. One of the big things right now we're compounding a lot of is something called methylene blue. Methylene blue is another thing that works to help the mitochondria. If you've got a sluggish mitochondria with fatigue, tiredness and all that stuff, it actually can circumvent a dysfunctional mitochondria and allow it to better produce energy. It also is good for like brain fog, memory cognition issues, which parlays onto TPE because it's been shown to do the new thing. I think the other thing that's coming down the road in terms of things to supplement this is doing things like nad. Those are just some things that I see moving down the road that if you tpe, clean the body up, then do some of these other things, it's like a stack benefit and it's like one plus one equals three equals six. And then you kind of get benefit from there. But that's kind of where I see this being able to take this wellness and longevity space a little farther down the road.

I love it. Yeah. And that's similar to some of the studies that I've seen as well. It's like clean the blood you clean all the, all the crap out basically and you allow all this other stuff in to help really supplement and bring you up. So this is really cool. Steve, let's shout out again your podcast and the best place for folks to follow you.

Yeah, for sure. Yeah. So all our social media channels, it's Magnolia Pharmacy. I've got a lot of those on TikTok, Instagram, Facebook and all those good places. You also can find Magnolia Pharmacy on YouTube and that's where you also can watch or you can listen to on like Apple or Spotify. Apple Podcasts, the trusted pharmacist podcast. Like you said, it's new, but it's really been kind of fun to get to start giving a pharmacist perspective. I don't feel like there's a lot of medical providers in this world, but there's not a lot of pharmacists that do wellness. So I thought, hey, let's kind of see how this goes. But yeah, if you will have to share and follow us and, and, and that message, like I said, you'll see a lot of TPE stuff on there in the coming weeks to months. That's for sure.

Right on. And find the Dr. Pam Smith interview you did. I, I watched it. It was great. And yeah, that's on your YouTube channel is where I saw it, but I'm sure Spotify works too. Very cool, Steve. Appreciate you, man. And we'll talk again. You taught me a lot, so I'm hoping everybody else got the same.

Awesome. Thanks, Joe. You have a wonderful day.