Written by Christopher Kelly
June 20, 2018
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Josh: All right, welcome again to the Physicians for Ancestral Health podcast. On today's episode, we're going to be digging deep into the story of Tommy Wood who is also the president of PAH, recently crowned. We're going to hear Tommy's story of how he got to where he is and maybe also what his plans are for this organization. Tommy, can we get started by having you just tell us a bit about your background in science, medicine, school and so forth and also in how you spend your time these days?
Tommy: Yeah, absolutely. I am probably as traditionally trained as it is possible to be in science and medicine in terms of very old school approaches to those things, which is good and bad, but I did an undergraduate degree in Natural Sciences and Biochemistry at the University of Cambridge and then after that I did Graduate Entry Medical course at University of Oxford. The system in the UK is slightly different such that most kids go straight into medical school out of high school or secondary school, as we call it, so you go in at 18. It's a six-year course. That's where I was getting mixed up. It's usually a six-year course or a five-year course and then you go straight into being a doctor. It's not a post-graduate course like it is over in the US. However, there are some courses now, and it's an increasing number of them, where you do some kind of degree first then you do a four-year course to get into medicine. That's what I did. After I did that, I worked as a junior doctor in the UK for a couple of years so just entry-level stuff, equivalent of an internship year and a first-year residency.
At that point, this is where in the UK you have to specialize and you have to pick whatever area of medicine you're going to go into to continue your training. I actually couldn't really decide what I wanted to do and at the same time, I got an offer of a PhD over in Norway. So I moved to Norway to do a PhD in Basic Science in the lab so mainly working with a rat's model of perinatal asphyxia, hypoxic-ischemic encephalopathy, we call it, and it's basically a model where we generate both ischemia and hypoxia, as it sounds like, and you create essentially a one-sided or unilateral stroke in the rat. It's a model of what happens to babies if they have some degree of either chronic in-utero problems followed by an insult at birth or just a single acute event at birth, happens in just under 1% of babies, probably about 0.5% of babies, and trying to look at treatments for that. My PhD focused mainly on hypothermias treatment but then also some of the ways to investigate what happens to the physiology during an insult like that, so bit of neuroscience, bit of physiology.
Then I moved to the US to start post-doc period essentially, so I'm just wrapping that up now, continuing some of that work, so I'm now actually been developing models of premature brain injury and then also that same term, brain injury in ferret which is a very interesting model because they have a brain that's much more similar to the human brain compared to the rodent. On the side of that, I've slowly been more and more working with the adult population as, I guess, more of a health coach. I don't really act as their physician but, obviously, with a background that includes medicine, I can incorporate all of those parts of it, both the principles of science and medicine and then some of the coaching aspects that I learned through working with athletes, through some experiences researching more chronic disease treatment and etiology, and that's where I'll end up going very soon is actually working with clients mainly online, mainly remotely as more of a health-type coach to support them in a health journey, be that athletic performance or chronic disease treatment.
Josh: You got from Biochemistry to neonatal hypoxic-ischemic injury to coaching elite athletes. That's an unconventional path, so I imagine there were a few decision points along this journey, when you started out, going medical school and then pursuing the PhD and now where you are now. I would imagine you had maybe some different ideas at each of those junctures about where you were going with those things. Can you take us back to when you first started your medical training, where you thought that will lead and then how you got into the, not only the PhD, but how you ended up in a neonatal hypoxic-ischemic injury which is a fairly specific area.
Tommy: I always count myself as basically somebody who has been very lucky to have been offered really cool opportunity or just to go for something that has been put out there just because of like, oh, yeah, that sounds like fun or that sounds like a good idea. So far it has worked really well for me. Just being open to that stuff has led me down to this point. It actually goes a little bit earlier than that which is that as a kid and as a teenager, I was very uninterested in health. I ate poorly, and I wasn't interested in sport I was very bad at sport and just generally liked eating cookies and watching TV and then other things that teenagers like to do with their time. Then actually towards the end of school, high school, secondary school, I essentially started to think more about my health mainly because I got dumped and then I was sad, and every teenage boy thinks, well, if I go to the gym and I get myself a six-pack then my girlfriend will love me again. Obviously that's not true, but that is --
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Josh: That's the root of all [0:05:21] [Indiscernible].
Tommy: Yeah, this is exactly one of the root changes. Then I, like I said, got interested in health, working out, going to the gym, reading about nutrition, things like that, and my mom had actually always been very interested in nutrition and meditation and yoga and things like that. She's a bit of an old school hippie and actually, I recently was looking through her bookshelves back at her house, she lives in Iceland, reading these books from the '80s and early '90s. I'm just like, this is all the stuff that I talk about now that my mom was reading about 30 years ago.
Josh: Right, there's nothing new under the sun.
Tommy: There's nothing new under the sun. All the same stuff is still important. I think that's why Ancestral Health is so key. This has always been important. Now we just have the science to back it up, all that science to back it up. Anyway, then by the time I got to university, I was very much hyperfocused on performance, and I started what I thought was required for optimal health. I started rowing when I got to university, and I was always the guy who wouldn't go out drinking with everybody else, who would either be working for my degree or would be in bed sleeping or training essentially, and that makes me very uncool as an undergraduate, as I'm sure people know, but that was me.
Then over time, you become the person where people are like, oh, well, so maybe ask you questions about diet or ask you questions about supplements for sports performance or something like that. I was also very interested in looking into other ways to fuel yourself or other ways to train. Particularly in my second and third years, I started to coach rowing as well as being a rower myself, and I found things like CrossFit. CrossFit was just starting to take off back then. It was 2004, 2005, and through that, at least at the time, there were vegans, Paleo kind of sphere. Robb Wolf back then was associate to the CrossFit movement, read some of his stuff, read some of his books, and it made sense to me, some of that Paleo approach to stuff but essentially sat in the back of my mind. I'm still in my early 20s, I'm reading all the top nutrition information available like Men's Health and Men's Fitness magazines, therefore I think that the most important thing is to drink as many protein shakes and eat as many protein bars as I possibly can. That still doesn't quite jive in my head and takes some time for those things to develop.
When I got to medical school, again that stuff continued. I was doing more coaching, trying to figure out how to get athletes to perform better and doing various things with the people, all kinds of fitness levels and performance levels and goals. At the same time, I started to work on what I call a family project, and I mentioned it previously in our first episode, which is my mom got married to my now stepdad or at this point this was before they even got married. We started this family project looking at multiple sclerosis because my stepbrother was diagnosed with multiple sclerosis. My stepdad is a chemical engineer and what chemical engineers are very good at is problem solving, and he was of the opinion that the human body is just a system just like any system that's mass producing some kind of chemical or something, some kind of product that chemical engineers work with, so we basically read probably thousands of papers by this point and tried to build a big system of all the things that could feed into multiple sclerosis as a disease and then maybe find intervention points that you can then use to fix the disease.
All the stuff the fell out ended up looking like all of the stuff that I read previously in the Paleo-type sphere, so it might be problems with gluten or other aspects of a more modern diet, so moving to something that removed a lot of the things that maybe were common problems in the diet or common allergens in a very traditional Paleo diet. We even uncovered a lot of the factors that might go into something more like an autoimmune Paleo diet so where you're also removing things like nitrate and being stricter about certain legumes and beans and maybe some spices. That stuff started to come together and then finding out that actually a lot of other people were discovering this stuff at the same time but almost completely separate so, say, Terry Wahls who is big in that kind of sphere. She had multiple sclerosis, reversed her disease progression, almost essentially put her into complete remission, and she was actually an early member of PAH and associated with the society.
When multiple people are finding out the same things about the same disease but in completely different areas and investigating in different ways and they're coming up with the same answers, I think it's a really powerful way to show that you're essentially on the right track. A lot of those things that came out of that really aligned with what we were talking about Ancestral Health, so food is obviously a big factor but then also stress and movement and sleep and circadian biology and light are super important for multiple sclerosis. Latitude is a big risk factor and issues with low vitamin D, also an issue or a problem with autoimmune diseases and probably exposure to sunlight is an important factor there. All these things really started to come together in my mind and made sense that way.
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When I moved to Norway to do my PhD, I finally had some time to really sit down again and investigate some of this stuff, so we spend a lot more time reading papers on PubMed, maybe finding some time to listen to podcasts, I never really listened to podcasts before that point, and all of this stuff starts to crystallize. Then I figure, well, maybe I can start to send some of this stuff back out into the world, so I started a blog, started a podcast and through that, started to interact with people. Initially it's all about really basic stuff, talking about food, talking about sleep, talking about stress, talking about love and meaning, and all this stuff comes in waves and turns up, but I have these little blog posts where it popped up into my sphere and I talked about it a little bit a few years ago. So this is all the stuff that I think is really important and then as I learned more about that and could talk more about that, that made me realize that was what I really wanted to spend most of my time doing.
Then when it got to the point I was going to go back into the more traditional medical system, I [0:11:15] [Indiscernible] enough to be at a point where I had a girlfriend and a fiancee who was very supportive of me taking a nontraditional path because if you've done all this very traditional training in medicine and science, which I had up to that point, then leaving all of that behind and to go out in the world and talk about diet and sleep and things like that is just a little bit daunting, but luckily enough I met some like-minded people and become part of a company and part of a system that allows me to do that, and that's where I've ended up today. Each step has just been something that I essentially fell into and then the pieces started to come together.
Josh: One thing I wanted to say, as far as the multiple sclerosis work that you did, what's really cool there is that you took a systems-based approach to try to understand it and basically, independently validated the fact that it's a disease of civilization. All these factors that you ended up isolating, we could always say, these are classic mismatches, so just point to the power of that is our initial framing device for understanding a lot of these illnesses and then digging deeper into the specific causes. It also says, when you look at something like that, and I remember that talk you gave, you look at all the variables involved there and you think, how on earth or why on earth will we ever think that some single intervention is ever going to work?
It has to be, if we're going to make an impact on a disease like that and most of the diseases we see now, it's going to have to be a multi-system-based, multi-barrier intervention and then the question becomes, well how do you research that because that's not what our current research system is set up to investigate. So we have two issues there. We're not even thinking about systems-based approaches and then we have to build a research infrastructure to actually investigate them if we want to move the needle on these sorts of things. I think it's a perfect example of why, as a neurologist, I haven't seen any breakthrough treatments at all from multiple sclerosis since I've been in practice despite all the advancements we've made in understanding the illness and understanding the nervous system. That whole talk you gave is a perfect illustration of why that is.
Tommy: Yeah, this is something that really frustrates me about science and medicine in general. First of all, if we're talking about the basic science of multiple sclerosis, the animal models that we investigate or that we use to investigate potential therapies for multiple sclerosis, they're just complete trash, I'm sorry. They're all --
Josh: Right, same pathology, totally different cause, yeah so you're not going to -- right.
Tommy: So you're never going to be able to figure out -- again, you're not going to be able to do true root cause and you're not going to be able to -- you might be able to do some symptom management but you're never going to be able to actually reverse what's going on in the disease. Then when it comes to the required therapies -- you're right, if you look at a map of multiple sclerosis and where the highest prevalence is, people will talk about the latitude, so more northern latitudes have a greater incidence, but in reality, you can immediately see it's a disease of civilization because it's only in the most Westernized populations and it's highest in those who have been doing for longest. It's by far higher in the US than pretty much anywhere else, so they just have to be linked. But then when you try and treat those or you want to create the gold standard, randomized clinical trial to then try and come up with a therapy, a multimodal therapy that includes stress management and sleep in circadian rhythm, sunlight exposure, maybe some nutritional supplements, maybe some changes to the diet, that's just never going to happen. Nobody is ever going to do that trial. It's completely impossible.
Terry Wahls is doing some small pilot studies which is great. All power to her for doing it because I know it's very difficult to get approval to do that. Something very similar is, say, Dr. Dale Bredesen's approach to Alzheimer's disease. He has a lot of very similar things, a similar approach, and I know that he has tried to run trials and organized trials, and particularly in Australia, I think they tried to organize a trial of his approach, and the IRB said, "You can't do this because you're changing too many things at the same time, and you won't know what worked, you won't know what did what, so you just can't do that." I'm really sorry, I'm wrestling with my dog right now because he's trying to climb my leg.
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Josh: He's training to win the Ancestral Physician Award, wrestling a dog on the interview.
Tommy: Yeah. I guess the problem is, if you're trying to think about doing this stuff in a traditional system and create the evidence that many people will demand, we're not going to be able to do it because it's always going to be a multimodal therapy and we're never going to be able to isolate the variables. Maybe we don't care about isolating the variables, but that just doesn't work in the traditional system.
Josh: Right, that's one of the big challenges is that we're not rejecting evidence-based medicine at all. We're just trying to keep it to this proper domain of application. It works for single variant conditions and investigating single variant interventions, but for most of the stuff that we're seeing now, it's not going to be the right research tool.
Tommy: Yeah, absolutely.
Josh: That's a challenge to figure out but, yeah, it's really important question. Hopefully and maybe we'll have better tools for figuring out how to do that. It's going to take a pretty big paradigm shift in understanding how we research these things.
Tommy: There are some places where patients are turning up to their doctor and saying, "I did this stuff and my disease got this much better," and then they're starting to at least create small pilot studies or things, so we may not be able to roll out the big randomized, controlled trial type thing but at least these pockets of interventions and evidence behind them are really starting to pop up which is really promising.
Josh: Yeah, I totally agree. So nowadays you're working at Nourish Balance Thrive. Can you tell us a little bit about what that particular kind of work involves, what an encounter with a client in that setting is like and the testing that you might do?
Tommy: Yeah, like I mentioned, it's a fully online coaching company. People work with us, generally they commit to working with us for a year. Sometimes that can be flexible, depending on the person, but we basically found that because if you're doing wholesale changes in somebody's life, that requires a lot of coaching, it requires a lot of support, it might require several testing and then changing interventions, so to get the possible outcome, it requires a commitment on both sides to really invest in that person and their health. That has worked very well for us. So somebody signs up, they will work with various people within the team, so you might speak to me, although usually that's slightly later on.
We have a couple of health coaches who are brilliant and one of them, Megan, who does most of our coachings, she has a Master's Degree in Nutritional Science. She just published a great paper on ketogenic diet in mice which if you follow the ketogenic diet world, was cited by everybody, and was in a very highly respected journal, really good work, and now she's coaching our clients. She's amazing and everybody loves working with her. It's that kind of high level of person that we're trying to make available to coach people because, like I said previously, a lot of our clients are people who do a lot of research. They understand a lot about this stuff already. Often they're coming to us with research that they've read that we haven't read and we're learning a lot as we go, in both directions, which is great.
Then our other coach, Clay, he's actually a client of ours who basically loved what we did so much, he retrained as a health coach so he could do this stuff full time. Somebody would work with those guys first, and health coaches, being continuous touch points for clients even online, I think that's going to be a big thing as we move forward because there are just not enough doctors to do all the coaching that's necessary and neither do doctors need to do that coaching because there doesn't need to be a medical intervention. So we definitely take advantage of that.
From there, people would do some testing, so we do blood testing. We used to do a pretty large panel of blood test, nothing really exotic but everything, covering metabolic health, some hormone testing, thyroid, sex hormones, all that standard stuff, CBC with differential, comprehensive metabolic panel with liver function, kidney function, basic lipids, iron studies, some nutrients, zinc, copper, iron studies. Now actually we're transitioning over to something that we built called the Blood Chemistry Calculator. This is a little bit of an aside but basically, Chris who is the CEO of the company, he's a software engineer by training and in collaboration with another doctor called Bryan Walsh, we've basically created something that allows us to use only very basic markers that almost anybody can get anywhere in the world.
Then we've created some optimal reference ranges based on disease outcomes in the literature, so it's not just a normal range which is the mean plus or minus two standard deviations of the people who took the test, which most people nowadays, if you look outside and you realize what the normal range of a person is, if you're trying to achieve good health, you'd obviously don't want to be normal. You want to be different from normal, we'll put it that way, so created those things and then from there, Chris got some machine learning algorithm some to predict a lot of the stuff that we used to test. Because if you have enough data, basically the algorithms can see patterns in even very basic lab tests and then predict the other stuff you're going to see, say like low testosterone or high fasting insulin or elevated CRP or maybe some nutrient deficiencies like B12 or folate or something like that.
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That allows us to track more frequently because you can do a very cheap and quick blood test and run in through the calculator and track how it sees issues over time or you can then predict some other stuff that maybe we weren't testing regularly but now that we can predict it, we can do other interventions so we could broaden what we can do but it requires less initial data to do that, and I think that's pretty cool. So we've now had that on our blood testing because we can do so much more in terms of predictive analysis. At the same time we'll do some urine testing, so we do urinary hormones, something called the DUTCH test, an organic acids test which looks at various intermediates of metabolism. These are newer tests.
If you look at how they use the information you get , it's certainly something that not everybody would be familiar with, but if you dig down into the research, you'll see that all of these urinary metabolites are very closely linked to what is going on metabolically. So while you might not focus on one particular marker and say this is something that you really need to worry about because there's less data on these markers compared to, say, blood tests, you can certainly fit them into a bigger picture of what might be going on. I think that data is really useful particularly for building patterns and then tracking things over time.
Then all of the people that come to us have some kind of gut issue, and GI symptoms in athletes which is our main population, it's super, super common. Up to 90% of runners, say long distance runners, have some degree of gut problems, particularly, the longer the distance and the more intense, the worse those problems are. We often have issues that we see and we tend to use stool test to look at that. I don't think we're at the point yet where we can say these exacts things are exactly what you want in your gut. We don't really know which
We don't really know which bacteria, as part of the microbiota, are essential for healthy gut. Maybe that will never be the case. It ought to be different things for different people because the microbiota certainly helps you adapt based on your physiology. There are some bacteria that can cause symptoms in a sedentary population but which are actually maybe beneficial to performance or metabolism in the athlete. So it's super interesting and we'll continue to learn more about that, but we can at least pinpoint common pathogens. We might often pick up a parasite. We might see giardia or cryptosporidium, or maybe we'll see a huge preponderance iniside endotoxin producing bacteria. E. coli really enjoys a very inflamed gut environment. There are some really nice, basic research looking at that. We can find those things and help treat those.
A lot of it is maybe somebody needs to go to their physician and get triple therapy for H. pylori just to get rid of it which is fine, but sometimes it has to do with what you're eating or the stress that you're exposing yourself to because that can also affect gut function as well. So all of the principles that we talk about in terms of Ancestral Health, both the diet and then the environment that you put yourself in the environment you construct, all of that becomes important in constructing long-term health. We direct where people should focus based on the testing. The idea is to build somebody who is as robust as possible to prevent them getting sick again in the future. That's the whole role. Eventually somebody out there working with us for a year or so, they learn all the tools, all the things they need for themselves to certainly make themselves robust and healthy. Then they go off into the world, and they will hopefully stay like that for a long period of time.
Josh: Yeah, very cool. You guys are on the cutting edge in a lot of different ways with the machine learning and health optimization events, lab testing and just in general, you're working in this area that's kind of no man's land in the world of medicine where you can think of disease or human health as existing on a continuum from optimum health all the way to disease, any particular disease, you're going to have this long process going from a healthy system to a diseased system with many points along the way. You have damage to the regulatory capacity that finally breaks and that's when we see disease in our system. We're just picking up in that point in time and we're very limited because of that, in what we can do.
Probably I would guess that a majority of people who are coming to you as clients, if they were to walk into their doctor's office, symptomatic or not, and have testing done. They will be told they were perfectly normal and sent them on their way. Yet you guys are obviously identifying all sorts of areas that are in need of intervention and that pay off in big ways. Are there things that you would think of in the work that you guys do, that you would see as directly applicable to the daily physician practice? Were you picking up warning signs that most people in convention medicine are missing and could potentially intervene on much earlier and potentially prevent something catastrophic to the world.
Tommy: Absolutely, and I think so much of it comes down to the subjective quality of life, and I don't think most physicians have the time or the capacity to really think about that. Because what happens when quality of life changes, that happens well before the blood chemistry looks really terrible or where symptoms of a really dangerous disease have accrued to the point where fasting blood sugar is over 200 or something like that and you have overt diabetes, but there's a huge amount that you can tell from subjective quality of life and people who have looked at it have shown how predictive it is of long-term health.
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The things that we see, which generally people are told by their physician, "Your blood test looked normal. There's nothing we can do. You're not sick so at this point I can't really intervene in any way." Lack of sex drive is a huge one. So many people come to us and they're like, "My penis doesn't work anymore. I'm 40 years old, and I do all this training. I'm supposed to be super healthy, but when I hope that something happens down there, nothing happens." I think that's a huge canary in the coal mine.
Then we talked about various digestive symptoms and having diarrhea or constipation really frequently is not -- or gas and bloating that's really uncomfortable, very frequently, that shouldn't be the case. That is not normal yet we've normalized that somehow. Then problems with sleep, people turning up and saying they're tired all day and they can't sleep at night. Again, we have end-of-pipe solutions for those things. Viagra does work for the guy with ED, but you haven't solved the problem, whatever the problem was to start with. You can take Ambien or whatever to help you fall asleep but that, again, hasn't fixed whatever the problem was. Then we're reinforcing those issues and they may even come around to bite us even worse further down the line.
If you pick up that stuff really early then you can really halt whatever disease process is starting to happen well before it becomes something that's going to be much harder to treat. Again, it's always going to come back to these same things. I talk about athletes a lot because we work a lot with athletes but what principles already used to help somebody hopefully reverse or at least halt disease progression in multiple sclerosis is exactly the same stuff I'd use in an athlete to build a robust body that can tolerate the training and adapt the training and get better and faster over time. The same dietary principles, the same sleep principles, the same stress management principles, how much and what somebody needs to do at a given period of time is going to be different. What it takes to make a healthy human hasn't changed, and it's always the same.
Whatever you can do in terms of, like you said on the first podcast, whatever you can do in terms of small wins, even if you're somebody who is still within a more traditional healthcare system, working in a more traditional healthcare system, anything you can do to help nudge people in that direction, you may then never have to see them again, and that's going to be great for everybody.
Josh: Yeah, I think one of the values that advanced lab testing has and lab testing in general is it's motivating for people in some cases. Just seeing a number that's out of range or off, it can sometimes spark someone to want to make a change in behavior. For the standard blood test or chemistry that someone may be getting, are there certain markers, whether it's fasting glucose or hemoglobin A1C or things along those lines where people might be told or found are within range, but you guys might have different idea about and that could, potentially, for even someone, regular clinical setting, be used as a means of sparking someone's motivation or willingness to change in certain areas.
Tommy: Yes, absolutely, and I think you mentioned some of the really important ones. Fasting blood glucose is incredibly important. You can see a nice U-shaped curve of fasting blood glucose and just something like all-cause mortality. So if your blood glucose is in the range of essentially 80 to 90 milligrams per deciliter, beyond that or even lower may be worse and then higher, obviously you're going to be worse. For blood glucose, this will start to be picked up, so I think 120 is the cut-of, the of pre-diabetes, but as soon as you start to get about 110, things really start to look bad really quickly. So that's a really nice metric. Post-pranial glucose is a really good one too so if you're continuously shooting up above 150, I think the cut-offs then become 180 or 200, but if you're regularly going up above 150, that's really going to tell you have some issues there.
Then other things that are super easy to check, I think are really good warning signs are hemoglobin and RDW, red cell distribution width. Hemoglobin, people probably understand but as soon as your hemoglobin starts to go below, say, 14 as a male or 13 as a female, again, you're just trying to see all-cause mortality increase and that could be because of anemia because of iron deficiency or folate or B12 deficiency or anemia is a chronic disease, any of those are going to contribute to that.
The other side of that is the RDW, and RDW is one of the most predictive things of all-cause mortality. It's actually really amazing that as that starts to creep up, so above 13% or 12.5 or 13%, your hazard ratio for all-cause mortality really starts to drop off so by the time you get to like 16 or 17%, you have a five to eight times risk of dying. So that stuff really seems to drop off. Again, what that's related to is related to nutrient deficiencies, chronic inflammation or blood dyscrasias which people are probably going to be able to pick up by looking at the other parts of their differential. Just things like that are going to give you a really quick way to look at what might be going on. We do have tighter ranges for ferritin. We have very different ranges for cholesterol, total cholesterol and LDL cholesterol, particularly as people get older. Basically the higher it is, the longer you live. It's completely different. It's completely different from what --
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Josh: Blasphemy.
Tommy: -- from what we're traditionally told. There's this great study, the HUNT 2 study in Norway where they basically looked at a whole population and measured -- they only did total cholesterol, sadly, and they looked at all-cause mortality which I think is, when we're hyperfocused on something like cardiovascular disease, we don't realize that you might be able to decrease somebody's risk of cardiovascular disease maybe because they died of something else first rather than because they're actually healthy overall. So in the HUNT 2 study, if you're a woman, and again these are women of Scandinavian descent, basically the higher your cholesterol, the longer you live. There's no maximum. That curve keeps on going down in terms of mortality versus total cholesterol, so it's just nice things like that.
If you really dig into the research here, it will come out slightly differently. I guess if you cover those things, some of the tighter ranges on the CBC and then some of that lipid stuff and then triglyceride/HDL ratio is a really nice thing to look at, again pretty much, the lower, the better although if your triglycerides are very low, maybe then you have some kind of autoimmune disease that seems to increase at the same time. So it's always a U-shaped curve rather than lower or higher is better, but those kinds of things can really guide you very well and it's stuff that pretty much anybody will have access to.
Josh: In your opinion, for the lipid panel, as far as what is predictive of heart disease, what do you guys look at?
Tommy: Yeah, the most important stuff I think is triglycerides and triglycerides/HDL ratio. You can transform that somehow.There's the Atherogenic Index of Plasma which was basically log transformed calculation of those two things, so it's very similar. Study just came out that showed if you had low triglycerides so, say, 100 or 90, no matter what your cholesterol was, you had very low risk of heart disease. Similar things have come up with insulin. If you look at the Montreal Heart study that showed if your fasting insulin ratio was low, I think their cut-off was 12, I'd like to see it lower than that, so if your fasting insulin was below 12, no matter what your LDL particle was, you had very low risk of heart disease.
Those other things, things that suggest hypoinsulinemia or insulin-resistance, high fasting insulin, high triglyceride/HDL ratio, those are the things that are then going to predict issues with, say, other aspects of your lipid panel. If they look good, in general, and again this is going to change as people go on different dietary patterns and things like that, but in general, on a population level, that seems to be most predictive.
Josh: Would you say then that the primary value of the triglyceride/HDL and its predictive value for heart disease is because it tracks well or is a surrogate for insulin resistance?
Tommy: Exactly, although that seems to work best in Caucasian populations, so Asian and African populations, it doesn't seem to attract as closely, but that's tracking with insulin-resistance as measured by euglycemic hyperinsulinemic clamp, and that's the gold standard of measuring insulin-resistance. I'm going to have to say that I have real issues with that test because how well your body responds to being basically stuffed full of supraphysiological amounts of glucose isn't necessarily the best metric of what is true metabolic health and it's all predicated on the hypothesis that the main role of insulin is to stuff glucose into cells which actually, it isn't very good. It does other stuff before it starts stuffing glucose into cells.
So when we're talking about insulin resistance, the way we measure it, the gold standard for the way we measure it isn't necessarily the best way to do that because it's based on the assumption on the functions of insulin which isn't correct. That's maybe why it doesn't track as well in those other populations. However, in those populations, things like the triglyceride/HDL ratio are still very predictive of long-term cardiovascular disease risks.
Josh: Gotcha. So some of the testing that you guys do, do is probably more familiar to folks who are in the realm of functional or integrative medicine. You've obviously been immersed in that world as well for a good bit of time and has integrated that and did what you do. A lot of that stuff would feel foreign to a conventional MD and maybe somewhat skeptical or suspicious because of that. Are there certain things that you think that the typical traditionally trained doctor might misunderstand about the world of functional or integrative medicine?
Tommy: I think the problem is that it has become sort of us and them thing and everybody wants to keep a hold of their own area.
Josh: Territory.
Tommy: Yeah, exactly, and as we do more advanced testing, the fact that we have access to these and many physicians may not because they won't be paid for by insurance, there's always going to be skepticism, and I completely understand that. That's often why we focus on blood testing because that's something that everybody can understand. But as research comes out that supports the use of these markers, as we start to understand more about metabolomics, we may want to call it because that's essentially what a lot of it is, I think a lot of this stuff will become more mainstream. The problem is testing tends to be the remit of, say, other types of healthcare practitioners. In the UK or in Europe, it's essentially doctors. That's what there is. Maybe there's a few chiropractors and osteopaths but they do different things.
[0:35:02]
In the US, there's this huge scope of people from naturopathic doctors, to all kinds of different functional nutritionists and nutritional therapists and acupuncturists and all those kind of people, and they have access to this kind of testing and they're doing that. Then an MD is saying, "Well, hang on a second, you're starting to do the kind of stuff that looks a lot like the kind of stuff that I do yet you don't have the education that I do. Therefore this kind of stuff you're doing clearly can't be validated." I think in some scenarios, that is perfectly valid but, equally, I think that there's -- this stuff is coming out in some of the labs that we work with. They provide a huge amount of information on their validation and all of the techniques they use are actually behind well-validated clinical tests. They're just creating them so that they're a product that somebody else can order and use. So the technology is certainly sound, a lot of the data are very well validated, it's just not something that many physicians have had access to.
Then like I said, if it's other types of healthcare practitioners who are using this, which a traditional physician can be quite skeptical of, that's always going to create some friction there. Hopefully some of this stuff is starting to feed in and people are certainly starting to understand more about metabolomics or the importance of gut health and the gut microbiome has become a very sexy thing even in traditional medicine and traditional science. So this stuff is changing and it's coming together, but I think for a period of time, there's still going to be a bit of us and them picture. I've thrown myself out there and I certainly hope that because I have a more traditional background, I can help integrate those worlds because I can show I feel like I have a reasonably good idea of how both sides feel about that kind of stuff.
Josh: Yeah, I definitely think that type of integration is necessary. That's a lot of what our organization is about. In some ways I think the barrier is artificial. The functional medicine practitioners are, in large part, trying to serve the needs that we talked about before where you have this continuum between optimum health and disease where there's progression of dysfunction, and the current conventional medical system really doesn't address that, so you have the need to figure out how to identify that before it's too late.
You also have, like you mentioned, quality of life issues aren't really addressed in the same way or addressed at all, and you have a huge need for people who want to figure out quality of life issues and address those. That's fine if that's not necessarily the space that conventional medicine wants to inhabit though, certainly, having an awareness of it is important and not really any reason to be skeptical of it. There's a bias towards thinking that anything that's outside of the mainstream is nonscientific but that's certainly not true.
But by the same token, the more we can integrate the tools and techniques of Western medicine and science into those particular areas, they'll be the more robust. They'll be better at solving these particular problems. So I'm all about trying to break down that barrier and really just find out what's true because we're not going to solve the problems that we face right now without answering those kinds of questions.
Tommy: Yeah, there are certain aspects of functional or intuitive or alternative medicine that's certainly completely wrong and not science-based. I think that dilutes some of the message, and that's a problem that we'll continue to deal with. But as more traditional medicine probably could take care to realize is that obviously there's something that patients want that they're not getting from their traditional doctor or their physician, whatever that is, they go to seek elsewhere. So even if the answers they get aren't always great, there's obviously an unmet need there. That's why some of these other healthcare providers then start to provide that in whatever capacity that is and just realizing that that need is there, maybe that will help people to branch out into some of these other stuff.
Josh: Right. So we've covered your background. You have a PhD and now you're recently appointed that president of Physicians for Ancestral Health. I think all that's left is for you to get knighted, right?
Tommy: Well, I have met the Queen.
Josh: Yeah, I was wondering if you [0:39:00] [Indiscernible] in there.
Tommy: Actually this is a completely random story. So my PhD supervisor, she actually won a prize from the Queen as part of a group with the University of Bristol for the work they did basically saving babies' lives. When she got the prize, she got to go and meet the Queen at Buckingham Palace, so she got to take one trainee with her which ended up being me which I was very happy about. So I got all dressed up and I went. The Queen comes around and meets all the different people. I think it was like ten groups from ten different universities in the UK that has won this prize. She comes around and there's this brilliant picture from the row of photographers. If you imagine the photographers behind me and my boss and were standing next to each other and the Queen is in front of us, so you can see the back of our heads and then the Queen's face between the two of us, between the two of our heads. You see a picture of the Queen, she's talking to my boss, and she's very happy and smiling. The next picture is the Queen talking to me and she's just deadpan, looks like she wishes she wasn't there. I don't know what I said, but clearly something upset her. So maybe that knighthood just isn't going to happen because --
Josh: Might be an uphill battle.
Tommy: Yeah, well I think I'll be okay with it.
[0:40:01]
Josh: It would give me great pleasure if by the end of your tenure, we would refer to you as Sir Tommy Wood.
Tommy: I've got a few years left, haven't I?
Josh: Yeah. So is there anything else you want to share with the audience before we wrap this one up?
Tommy: No, I don't so. Hopefully that was a useful tour of the stuff that I do and the way I think about things. I'm always really interested to hear from other people, and especially with this podcast here, from other physicians and maybe they can tell us why they've been frustrated with either the system they're working in or maybe frustrated with the messages on Ancestral Health. I've often heard people say that the ways that people talk about Ancestral Health or Paleo or stuff like that, it's like, "It doesn't quite make sense to me. It doesn't quite jive with me. I just don't really quite get it." Or they've got some misconception about how those things maybe work, how we think that they work, and really interested to hear from those people because I really want to try and better create a message that people understand and can see why that's important as part of modern medicine.
People who disagree with me are some of my favorite people because then I get to learn something. So again, if you're listening to this and somebody sent you this podcast and you think, oh, my God, this guy is full of shit, please let me know and then maybe I can figure out what it is that we're doing wrong and what it is we could explain better. So that's what I'm hoping, we can expand the conversation and get more people talking about this stuff.
Josh: Yeah, I think that actually, to some degree, that open-mindedness and willingness to be open to other ideas and being proven wrong, it's baked into the ethos of Ancestral Health. The movement as a whole has, no pun intended, evolved quite a bit --
Tommy: Yeah, absolutely.
Josh: -- over the past several years from where it started, way more rapidly than most fields, part of that fueled by the Internet and its ability to spread information quickly but also because the culture has been to try to seek truth first wherever possible. That's not always easy but I think that's part of the whole movement and it's definitely part of our organization that we all want to learn and we're okay with being wrong, as painful as it can be sometimes.
Tommy: As long as things were you get told you're wrong and your amygdala goes, oh, this is the worst feeling ever and then your dorsolateral prefrontal cortex says, hang on a second, this is actually okay, maybe we can learn from this. We can go from there.
Josh: If you think about the most exciting times in your life, it's actually when you've had some mind-blowing new concept or idea that totally reversed something you thought was true. So it's actually really fun to be wrong, but you have to bypass the amygdala to get there.
Tommy: Yeah.
Josh: Where can people find more about you and learn more about the work you're doing in the Elite Performance Program?
Tommy: So the best place is to go to nourishbalancethrive.com. There, we have links to all those things, so the calculator that I mentioned if people are interested in that. We also have a tool to help people see if there's any potential issues underlying again using a machine learning algorithm, looking just at subjective questionnaire responses. That's freely available. I think that's interesting. I also have an email list where I'd send some of the research behind the kind of stuff that we do out. I think it's kind of nice. Then obviously the ancestraldoctors.org website for Physicians for Ancestral Health so that people can directly make contact with us about the work of the society and getting us the [0:43:16] [Indiscernible] separately as well so, yeah, definitely check that stuff out.
Josh: Great. Yeah, I would encourage people too to go to the Nourish Balance Thrive site and sign up for the highlights email, not because you put me in a couple of them but --
Tommy: Yeah, I think you've been in three or four of them [0:43:29] [Indiscernible].
Josh: -- but they're actually really great. There's chock-full of information in it. I'm sure everybody knows the general quality of email newsletters, so these are one of the few that I will read the moment I get it and read the whole thing so definitely worth it so go sign up for that. I think I speak for everybody in the organization when I say that we're looking forward to your tenure over the next couple of years as president and to see where the organization goes under the reign of Dr. Wood.
Tommy: Well, I will be heavily relying on other people in the society to do this. I certainly don't see myself as the boss, just hopefully provide some ideas and help guide stuff, but I'm very excited too. I think we have the ability to really get things going in the next couple of years, so I'm excited to see what happens.
Josh: Absolutely. All right, thanks for taking the time today, Tommy.
Tommy: Thank you.
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