A Consumer’s Guide to Integrative Medicine [transcript]

Written by Christopher Kelly

June 6, 2019

[0:00:00]

Christopher:    Well, Dr. Gerstmar, thank you so much for joining me this morning. It's a pleasure to have you back. I think this is the third time you've been on the NBT podcast.

Tim:    Yeah, I think this is number three. I appreciate it. Obviously, you find my conversation worth having. I'm glad I can share valuable insights with your audience. I appreciate you having me back on, Chris. Thanks so much.

Christopher:    Absolutely. I first became aware of your work at the Ancestral Health Symposium. I've been following you quite closely ever since because you're one of those ancestral doctors that I very much enjoy, both technical and you get the big picture too, which is not something you see very much of.

Tim:    That's something that I try really hard. This was kind of brought home to me. It's kind of my background. If we want to get into a little bit of that in a minute, we can. But what's really brought home for me, if people haven't followed my bio, they may not know, like a number of years ago, shortly after I graduated from medical school, my mom was diagnosed with stage 4 cancer. I was down helping her. We were at her oncologist meeting one day. The oncologist was outlining what we were going to do, what the treatments were going to be like, what was going to happen. Of course, for me, having been through medical school, I was like, "Oh, yeah, absolutely." I understood everything. It made sense. But I was watching my mom and she was nodding and smiling and everything looked good. The oncologist and great guy asked her, "Does that make sense? Do you understand what's going on?" She was like, "Oh, yeah, that's great."

    Then he left and literally we walked out into the hallway outside the treatment room, and she turned to me and said, "I don't understand a word of what the doctor just told me. I need you to tell me everything." My jaw like hit the floor and I was like, "Oh, my god. Patients could be doing this to me as well when I'm sitting with them." One of my missions became how can I explain things in ways that truly sink in for people that make sense, that they understand? One of the complaints we hear all the time from people coming from other doctor's offices is simply, "I didn't know what was going on. I didn't understand. Why am I taking these medications supplements? Why am I getting these lab tests done? What did it actually say?" all these pieces.

    I know your audience is super smart, really well-educated, Chris. But for a lot of "average" people out, they're just lost and they don't know what's going on. One of my missions became like how can we be clearer, how can we help people understand better? Because obviously, when they do, they're more engaged. When you're saying to someone they need to change their diet or they need to change their exercise routine or they need to take this medication or supplement or whatever the thing could be, if they go, "I know why I'm taking it. I know what the purpose is. I know what I'm supposed to be looking for." I understand they will make those changes. One of my missions has been clarity. I thank you for recognizing that. It means I have actually been somewhat successful in making that happen.

Christopher:    Absolutely. For listeners that don't know, Tim has written a new book. It's called The Clear Path to Health. Although I feel like there's a book within a book there and I think that book within the book might be called The Consumer's Guide to Integrated Medicine or perhaps The Consumer's Guide to Functional Medicine. I think you've done a really nice job of guiding people through that process of choosing a practitioner in a very unbiased way. I really enjoyed that. I feel like it should have had subsections called How to Avoid Four Integrative Medicine Rip-Offs, Six Costly Misconceptions About Integrative Medicine, Seven Mistakes to Avoid When Choosing Integrative Practitioners.

Tim:    Right. Well, hey, I really appreciate that. Obviously, you and I and most of your audience here are on the same page that whether you want to call it functional medicine or integrative medicine or alternative medicine or more natural medicine, whatever term you want to apply to it, that most of the time, it is the superior choice for people who really want to get healthy and stay healthy for a long time.

    Again, a lot of the people who approach us, they fall into a few different buckets. But one is people who are just sort of exploring it for the first time and that they really don't know what they don't know. There are some prudent questions like any field out there. Whether it's a carpenter or a carpet cleaner or like whatever, there are going to be really great, honest, ethical, high value providers, and there are going to be some shady people getting into it who really don't know what they're doing or just looking to make a fast buck on people.

    It breaks my heart to hear stories of people who are like, "Well, I went and saw this practitioner, that practitioner," or even some bigger names out in the field and they just didn't get value, they didn't get help, they didn't get what they wanted. One section of the book absolutely is about how do you know if you're considering integrative medicine in the bigger picture, what should it look like, what should you get, how do you know it's right for you and what are the questions that you need to be asking the provider to make sure that it is really a good fit and it's providing the value that you're looking for.

[0:05:08]

Christopher:    One of the mistakes I've made in the past when choosing a doctor is not understanding the scope of that doctor's practice and the type of problem that different doctors are good at solving. Can you talk about that?

Tim:    Yeah, well, absolutely. There are both sides. The conventional medical system has sort of recognized that there's way too much knowledge to know everything. The days when a doctor could know literally everything head to toe about every system, every issue, and every treatment that can help people. You can't. I mean, even super smart people like Tommy can't know everything about everything as much as we want to.

    The answer conventionally was to say, "Well, let's cut into pieces." You have a dermatologist looking at someone's skin. You have a gastroenterologist looking at their digestive system. You have a neurologist looking at their brain. Each of these people is going to make sure that they really know these different pieces. That's great in theory, but the problem is that often that care isn't integrated or put together properly. You have this very common situation where the left hand doesn't know what the right hand is doing. One doctor is prescribing a treatment or protocol, and another doctor is prescribing something that mismatches and doesn't work properly and so we get a lot of side effects and a lot of poor treatment, a lot of wasted time, a lot of wasted money, all those pieces. Rightly so, we go, "Hold on, that doesn't work very well. That's not what we need."

    Now, on the flipside, in the functional and integrative space, we know that it's important to know the pieces, but it's also important to zoom out and back up a little bit and that there are these kind of central levers that affect so much of what's going on in the body. My favorite is the digestive system. We know that the digestive system is sort of this interface where multiple different parts of the body, really almost everything interacts with or is interacted on by what's going on in the digestive system. Because the digestive system directly impacts the immune system, it impacts the brain and the neurologic system. It feeds into the hormonal system. It controls nutrient levels which affect everything really.

    For me, when we back up and we can say, "Okay, there are key levers that are going to impact almost everything that's going on." You'll see that. You go to an integrative doctor or functional medicine site and you see these giant lists. We can help with diabetes and baldness and bunions on your feet and fertility and back pain. You're just like, "Okay. Wait a second. What's going on here?" In a good way, we know that by addressing these fundamental central pieces, high level levers, we can pull and we can have effects. A lot of people come to us and skin isn't their primary concern. For some people with psoriasis or eczema, it is. But for some people with other issues, it's not their primary concern. We work on their digestion and we work on other issues, and then they come back and go, "Oh, my gosh, my skin is so much better." Well, sure because at a higher level, we've addressed systems that feed into other issues that are going on.

    But the negative, of course, is that, again, it's not possible to know everything about everything. There are a lot of providers, in my opinion, in the functional and integrative space who bite off a bigger chunk that they think they can handle that they can't always deal with. That's one of the things I appreciated about you, Chris, is you knew where your area of expertise was in working with athletes and other high-performing individuals and you tailored the work that you were doing and the care that you are providing to help optimize those people. You knew that dealing with your "average" 40-year-old mom of two kids who has no athletic aspirations and is trying to get through the day and maybe they're dealing with these other issues, it's not that you can't help them, but that's not your sweet spot and not where you're really equipped to work with them.

    All that to say is you can't help everyone. As much as you want to help everyone, you don't have the expertise, you don't have the fundamentals, and you don't have the infrastructure to deal with that. Increasingly, for me, it's been clear that while we don't want to cut people apart and ignore other aspects of them, that's one of the bad things about the conventional system, we also need to respect where our knowledge base lies and the people that we can most help. One of my questions to people is really like if your doctor claims they can help anybody with anything, I would be cautious of that doctor. They're right on one level by addressing fundamentals. Cleaning up diet, one classic example, can help with so many different issues that people have going on, but they may not have the expertise to deal with what's going on for you.

[0:10:12]

Christopher:    I think that hits mistakes number two, three, four, five, six and seven. But the one I was thinking of was not understanding the types of problem that different types of doctors are good at solving. I'd walk into my general practitioner's office, and he would run a blood test and the results come back. Apparently, he knew how to read that result.

    There was one number that I saw that I thought was interesting, which was hemoglobin, and I knew that was a key determinant of my exercise performance. My thought was, "Oh, well this guy can read this test and he could probably help me improve this number." But what I didn't realize was that it's not the type of problem that he's used to solving, like he's got a waiting room full of sick people.

    My hemoglobin is not as simple as just one number. It's a chronic multivariate problem with many moving parts, and that's not the type of problem that doctors that accept insurance typically are good at solving. There's a difference between a multivariate problem that's been going on for a long time, a chronic problem, and an acute single variable problem. Like I just crashed my mountain bike and my hand is pointing in the wrong direction. That's going to make a big difference in the type of doctor that you choose.

Tim:    Oh, absolutely, a hundred percent. I mean, for most of history in humanity's time on this planet, acute problems like were the problem. Injury and disease were basically the two biggest roadblocks or hurdles facing most people. For the most part, if you could avoid getting injured and avoid getting sick, you're pretty much set and things are in pretty good shape. That's the beautiful thing about viewing things through an ancestral lens and again big picture concept.

    Once I understood the ancestral health paradigm, it helped me understand health and disease in a whole different way. As you know, being part of the Ancestral Health Symposium, I think that's one of the huge pieces that conventional medicine is missing to make sense of things for people. But certainly, acute problems like, how do we best describe them, broken bones and injuries and kind of your significant life-threatening issues. If you go into kidney failure, that's something that has to be dealt with right away. If you have a heart attack, you're either going to make it or you're not going to make it from those.

    While they can be extremely serious, and we're very grateful this is where modern conventional medicine is the best there's ever been as far as dealing with these acute issues and concerns, they're relatively simple, relatively. It doesn't mean it's easy by any stretch of the imagination, but it's relatively straightforward. This is the issue. Now, can we deploy a fix to deal with it? Can we reopen up blocked blood vessels? Can we prevent some of this damage? Can we rehab and deal with some of this damage?

    But chronic problems are a whole another ball of wax, and this is where we see the great failure of the conventional system. One example, I had a guy with diabetes come and talked to me last week. His doctor has said, "Yeah, diet has some impact on diabetes. You should try to eat healthier in general and you should get some exercise. But diabetes is a chronic progressive disease. Meaning it's just going to get worse over time and you're just going to need to take more and more medications to deal with it." That doesn't sit very well with me. I have to think there's more that can be done. It was like, are you kidding me? Diabetes, again, not to belie how serious it can be and the consequences for people. But in general, diabetes is easy -- Let me make sure I say that right.

Christopher:    Yeah, if it's the type 2 diabetes.

Tim:    Right. Diabetes is hard. It requires changes which are difficult. I don't want to, in any way, diminish that for people. It's a challenging disease or dysfunction to have and it's challenging to deal with. But in general, for most people, it's really simple. You change the diet. You work on the lifestyle patterns. Assuming there's not other big confounding issues going on for people, the vast majority of people with diabetes are going to be much better. This is a chronic problem that when we try to apply acute measures for, we've got to drive down the blood sugar, we've got to stabilized blood pressure, we've got to do this and that, results in really substandard care for people.

    I'm kind of going off on a tangent here, Chris. I hope we're moving in a good direction for people. I kind of answered your question. I'm not so sure that I did.

Christopher:    No, I think you did. Tim, one of the things you talked about in the book is the difference between principles, strategies and tactics. I think you illustrated your point very nicely with Gina's story. Can you tell us about Gina?

[0:15:07]

Tim:    Yeah. Well, Gina, like a lot of people, had been suffering from chronic issues for a while. Again, this is a really common story that we hear. People get sick and Gina had had some serious digestive issues. They were really almost keeping her house bound. She lost a lot of weight. She was feeling really terrible. She saw her MD because that's what you do. You're sick and you go to the doctor and that's normal. They had worked her up and checked things out. Good news, bad news, they came back and said, "Well, the good news is there's nothing really wrong with you."

    Of course, the bad news is people all the time are like, "Listen, I feel terrible. There is something really wrong with me." It's a good thing you don't have colon cancer, you don't have inflammatory bowel disease, or you don't have some of these issues. But, of course, it doesn't mean nothing is wrong with you. It simply means that the doctors, the conventional workup did not find anything going on with you. It's totally natural and normal where your local medical doctor doesn't work out, you turn to Dr. Google and you start looking, researching and trying to understand better what's going on for you.

    The internet is a wonderful place. But honestly, it's like trying to drink from a fire hose. There's like so many different books and blogs and podcasts and videos and websites, and most of them are telling you very different things. One says, "Well, if you have this issue, you should be eating this way." Another says, "No, that's completely wrong. You should be eating this way or you should be taking this supplement," or "No, no, you should be taking that supplement."

    A lot of people just end up with their head spinning and they're just not sure what to do, or they try a few different things. Earlier in our discussion, they seek out a doctor, but they don't really know what to ask or how to make sure that this doctor or these providers are really the right fit to help that person with what's going on for them. In order to better make sense of this, we have to understand these three levels. We have principles, we have strategies and we have tactics. You can think about it. Tactics are the nuts and bolts. "You should take two of these and call me in the morning or you should cut this out from your diet for 30 days or you should do this particular exercise regimen and this percentage of heart rate and blah, blah, blah," like the granular details. That's kind of where we focus on. It's normal and natural. "I have a stomachache. What should I take for that? Well, this website or doctor or so-and-so says that I should take 500 milligrams of this, that or the other thing." That feels good because it's very concrete and it's very easy to implement that.

    But the big issue here is context. What might be the right diet, the right lifestyle, the right supplements, the right tests, the right treatments for one person who has IBS? Maybe the complete wrong match for another people with the same diagnosis of irritable bowel syndrome, and so when we're down on this very granular level of tactics, we don't have any real ability to discriminate what is the context and what are the right things to use to get that person those results. We can step up to a level of strategies which is a bigger picture. It's not so detailed, but it's saying, "Look, if we want to deal with dysbiosis or messed-up bacteria in the gut, that's more of a strategy of dealing with that."

    Now, tactically, we can do that through prescription antibiotics. We can do that through dietary changes. We can do that through the use of herbal medicines. There's a zillion and one different ways to deal with dysbiosis. But on a strategy level, we know we want to deal with it. Then we can step up again to a yet higher level of principles which says, look, tactics change all the time. That was one of the challenging things for me in writing the book was this book was trying to decide how much tactically to get into this. People like it when you say, "You should take X probiotic, Y pills for Z number of days to deal with this." There's value to that. But tactics are constantly changing. Well, today, brand ABC probiotic may be the best one that's out there on the market, the most effective. The fact is tomorrow, there may be a better option.

    For me, my piece was, look, if we can clear the confusion and we can orient people in the right direction by stepping back from tactics to strategies and then even higher level principles to make sense to orient someone and help them understand the context of their situation. Then if you start from a principles-based level, again, instead of starting at the bottom, if we start at the top and then we come down to strategies, when we say, okay, look, the goal is to, again, let's say deal with dysbiosis in the gut, we can understand that whether you want to take oil of oregano or berberine or nystatin or whatever it is doesn't really matter so much as are we aligned with correct principles and strategies to deal with those issues.

[0:20:09]

    The book for me was in large part laying out the principles and strategies and, therefore, the tactics that derive from it from having worked with people for over a decade now and seen a lot of what actually does work for people and what by and large for most people is going to be a complete waste of their time, their money and their energy. That's one of the big pieces that I wanted to get across with this book.

Christopher:    That's very useful. I think people listening will recognize this from other areas perhaps of their professional life. Certainly, as a programmer, that resonates with me. You go to university to learn those higher-level principles and strategies and programming with Python is just a tactic. If you understand those higher order things, then you can switch out the programming language and it not be that much of a big deal. But it's very easy to get lost in the weeds on Stack Overflow.

Tim:    Right. Well, totally.

Christopher:    I mean, the programmers will have laughed because they'll recognize the Stack Overflow website. Everyone else would be wondering what the hell I'm talking about. But, of course, you do a Google search like the best diet for IBS, you're going to find a lot of information on that. Tell me, what did you do for Gina?

Tim:    Again, why I hesitate for one second is I'm happy to discuss what we did for Gina, but also, remember context. Someone else with chronic digestive issues who's dealing with a lot of pain and discomfort, who's loss a lot of weight, who isn't feeling good. They may say, "Great. I'm going to copy exactly what you did for Gina and it's going to get me exactly the same results that it got for Gina." The point is no, it may not. It may be incredibly helpful. It may be 80% of what you need, but it might actually be the wrong fit for someone.

    If you will, let me just tell you about a different patient really quickly. I had a lady come in and she had strange kind of autoimmune symptoms. We couldn't quite tell if it was multiple sclerosis or what else. She didn't have a firm diagnosis. She'd had a lot of work up, but she was suffering from a lot of issues. One of our go-to diets that we found incredibly helpful for many people is the autoimmune Paleo diet for autoimmune issues. A lot of people find a lot of benefit from doing the diet. But we worked with her for a while implementing the autoimmune diet. We could not get good results from her. Unfortunately, she is one of our failures. Eventually while we got some positive results and she saw some improvement, things just were not moving along like she wanted to. She left us. She sought out another provider.

    By the way, I do recommend it. You need to both give the people in the plan that you're working with time. One of the mistakes we see people make is shiny object syndrome and lack of patience where they're just like, "Well, this sounds interesting. I'm going to do this." Then it's like, "Oh, this looks interesting. I've been doing this for four days now and I'm not seeing miraculous results so I'm going to jump over and do something different." Please, no offense meant to anybody who's suffering. I know you want results and you want to feel better now, and I totally get that. At the same time, we say, "Look, if you're not willing to commit to a plan, whatever it is, for a minimum of three months, you can't truly judge whether there's real effectiveness in doing that plan or not."

    Having said that, doing the same thing over and over again and expecting to get different results from the same thing is also insanity. There does come a time and a place where you've given something a good solid try and you've really worked it, you've really tried it. If it's not working for you and your provider doesn't have other options, or it is time to seek somebody else out, look in a different place for more answers. As always, there's a context and a balance here. Humans like absolutes. It's either black or it's white. The reality in health, just as in most of life, is there are a few black and white things, but a lot of it is shades of gray. There's a time to stick with it and push through things, and there's a time to frankly give up and move on and try something different.

    This patient left us and I heard back from them. I try to stay in touch with everyone even if they leave us to understand, okay, what did I miss? What we found for this person, she found that essentially almost a raw vegan diet provided tremendous benefits in terms of her symptom and what was going on for her. While generally I don't recommend raw vegan diets for people because I don't think it's the right match for most people, for her it brought outstanding benefits. It just goes to show there is no one singular therapy or option that is going to be the right fit for everyone.

[0:24:53]

    With Gina, first and foremost, we did a thorough and comprehensive workup. You know, Chris, there are ways to interpret blood that can give us a lot more data, again, speaking of hemoglobin and many other things, than most conventional doctors can extract. Just plug a here for your blood chemistry calculator, I found it really helpful and useful as a way to get more data out of blood work. But then there are other tests. Again, we found for her that when we looked at her gut bacteria and what was going on, it was severely imbalanced.

    The one treatment by all the other providers that she had seen had been to tackle that dysbiosis and deal with it. We also worked and coached her through dietary changes and other lifestyle changes. Again, one of the mistakes that we see commonly, when people understand that food affects them, they tend to fixate on food. That well, if I'm better from having eliminated or changed my diet but symptoms remain, then it always must be something about my diet.

    Listen, sometimes it's true. Sometimes you're still eating something that's still problematic and still an issue. But what we found is a lot of times, especially someone who's given dietary changes a really solid go, is that it's not diet. It's other things, like their sleep or their stress levels or their mindset and attitude. Some people may be rolling their eyes at that, but we've seen all of those factors be keys in unlocking what's going on for people. People don't get better until they sleep well. People don't get better until they manage their stress or their mindset or beliefs around some of what's going on for them. All of these factors play in.

    We worked with Gina on all these different factors. The good news is we took her from a place of overwhelm and anxiety. Because I don't know what to do and the internet is telling me all these different things. One set of doctors is saying one thing and another is saying something else. We were able to calm all that down and work with her over a period of time and get her better again. I'm happy to say Gina is like a happy healthy person these days. We stay in touch to make sure everything is good. But she's great and she went from basically being debilitated by what's going on to, again, living a happy healthy life again.

Christopher:    That's great. Congratulations.

Tim:    Yeah, thank you. We live for these days when we see someone and we take them from a place of almost nonfunctionality, and then to be able to give them their life back and restore them. All credit goes to Gina as well because you've got to make these changes.

Christopher:    It's hard, very hard.

Tim:    One of the big things. I mean, just straight up, that functional and integrative medicine requires a lot of active participation on the part of the patient. I was seeing a young man yesterday. He's considering coming to work with us. He has ulcerative colitis, autoimmune disease of the digestion, lots of diarrhea and bleeding. He'd been hospitalized for complications at one point. We just sat down to have a frank discussion of "Look, you're going to have to change your diet. You're going to have to do these things. You're going to have to make some changes." It's not just sort of life is normal, and I go in and I get an injection once a week, once a month, once a quarter and then go on and live my life. That's not how this works and that's not for everybody. I understand that. All credit to all the people out there, your listeners and everybody else who are making these positive changes in what's going on in their life.

Christopher:    Simon likes to point out to me. Simon is our performance psychologist, Tim, if you don't know him. But he's been on the podcast several times before, including recently with an interview with David Bailey that I thought was very good. But yeah, as Simon likes to point out, most people are not like me. My now wife said to me at the time, "Oh, I think you should do this also, I mean, Paleo thing." I was like, "Okay. When do we start?" Like, "Tomorrow morning." "Great. I'm in." Most people don't think like that. They have ambivalence and they have reasons to not do it and they procrastinate. Yeah, it's really hard.

Tim:    It is really hard. That's why one of the missing pieces, one of the sections of the book talks about health coaches and the value of having health coaches. I know coaches are something that's familiar to athletes out there and it's a part of the work that you do with people. But it's something new to most of the medical profession as a whole. When I first heard about health coaches three or four years ago now, it was a no-brainer to me how valuable they were going to be in our work

    One of the complaints we get and we hear all the time from other doctors is "Okay, they gave me a list of stuff to do and they said, 'Good luck and we'll see you in three, four, six months from now. Let us know how it's going.'" There are a segment of superstars, those people who are just like, "Give me a list and I'll get it all done." But the vast majority of us out there, we really need more support. We need more coaching. We need a little bit of hand holding. We need some guidance. We need some troubleshooting. We need people to help us over the rough spots. Since being involved with health coaching in my own work with people, we've seen results just skyrocket.

[0:30:02]

Christopher:    That's right.

Tim:    The vast majority of people out there, they just need more support and guidance to go through the process. If you're someone out there and you've struggled with making these changes, please don't think, "Well, I'm a failure. Something is wrong with me." That's normal. To all of you out there who were just like someone gives me a list and tomorrow I'm on autoimmune Paleo and it's all good, hey, congratulations, you're a stud. But recognize that that's just not the reality for most people out there. Most people are going to need more support than conventional doctor's offices offer them. That can be one reason you haven't gotten the results that you're looking for.

Christopher:    Do you think health coaches, they have like a PR problem, don't they?

Tim:    They do.

Christopher:    I mean, you can probably testify to this. It's really hard to convince somebody that they need a health coach. I start to wonder whether maybe we should call them something else like health advisor or health consultant or maybe just someone who only does health coaching. That role needs to go away. Suddenly now your personal trainer becomes your health advisor or your health consultant. Do you see what I mean? It's like you kind of break that role up and kind of embed it in other things.

Tim:    Well, totally. I mean, I was shocked. For me, it was a no-brainer. When I saw health coaches, I'm like, "Oh, my God, this is going to revolutionize medicine and my practice in particular." I brought a health coach on board and I started lining up patients to go and see them. I thought everyone would nod and smile and go, "Of course, this makes perfect sense." I was utterly floored when a lot of people were like, "Yeah. No, thanks. No, not interested. Don't need that. Don't want that."

    What I've seen is mostly it is. It's a PR thing. People don't understand what they do, why they do it, and the value they're going to receive from it. Overwhelmingly, when people actually see our coach and work with people, they go, "Oh, I get it now. I see the value. I understand how this is going to help me and how this is moving me forward so much faster than if I didn't have a health coach involved."

    I agree. I'm not quite sure. I think its early adoption is going to be part of it. I think we've got some big names in the integrative field that are pushing for health coaches. I think a lot is experience. But I certainly think names may be a piece as well that people just don't know what they do and the value that they were going to get from it.

Christopher:    This problem isn't specific to you. I've just been thinking about behavioral economics. I did Simon Marshall's training course. I'll link to that in the show notes. It's absolutely fantastic. It's behavioral economics with respect to health coaching. One of the books that Simon recommends is Nudge. It's not a new book, but it's a very good one. I'll link to that in the show notes too. One of the things they talk about is how hard it is to make a decision when the decision is completely disconnected from what you will receive as the result of that decision.

    A good example is you order from a menu in a restaurant and then it gets even worse. Like imagine you're in a foreign country and you can't even read the menu. The disconnect between what you're going to choose and what will arrive on the table is so far. It's like forget about it. If you trust the chef, which you do because you're in his restaurant, like stipulate your dietary requirements. Like, "Oh, I can't have gluten or I can't have meat or whatever," and then just let the chef do his thing or her thing. Let's bring out the food. I wonder whether we could do the same thing or you could do the same thing with your practice where it's not an option. If you want to work with me, then this is my team and these are the services they provide, and this is what you can expect when they arrive. You don't give people the option to work with the coach or not.

Tim:    Well, yeah. Listen, I mean no offense, but we honestly have been moving in that direction purely as well because of the results we see. I have people who come and work with me and they say, "I really don't need a coach. I really can do it all by myself." We've experimented with different ways of letting people do that. Again, there are a few people out there. They really are superstars.

    I can think of one person I was working with. She has rheumatoid arthritis. I'm like, "Autoimmune Paleo diet." She was just like, "Great." I'm like, "We should see the coach because they'll help walk you through it, get everything set up for you, build meal plans, do all the rest of the stuff so that it is ten times easier to implement it." This particular patient was like, "Nope, I got it." I'm like, "I highly advise not doing that." I've seen failure after failure after failure. She was like, "Nope, I got it." I'm like, "Okay." She was one of those studs who just knocked it out of the park. Yeah, that particular patient.

    But overwhelmingly nine times out of ten, I see the people who refuse coaching, they get worse results. It takes longer. They end up spending more money, more time, more energy and more frustration by not engaging with health coaches. More and more, we've come to a place where we really don't want to work with people who won't work with a health coach because it's frustration for everyone. We want you to come in and get better as fast as it's humanly possible. You want to come in and get better as fast as humanly possible. That's one of the issues.

[0:35:22]

    Now, one other way, I don't know if your audience would find this valuable, Chris. But one of those same options is the dichotomy or the split between using prescription medicines and not using prescription medicines. A lot of people out there, they see the failures and the faults of the conventional system. They see the fact that most prescription drugs are aimed to be taken basically forever, and most prescription drugs aren't really treating the root causes of what's going on.

    Metformin can be a great drug. It can be very helpful in diabetes. It won't even get into the life extension and the other possibilities for it, but just solely is a diabetes drug. But, of course, it doesn't deal with the underlying dysfunctions of diet and lifestyle and other issues that are going on. They go, "I don't want to take prescription medicines." There are a lot of providers out there who will bang the drum about how evil prescription drugs are and it's all bad, bad, bad. I just do not agree with that.

    Prescription drugs are, in my mind, we can imagine a toolbox in front of us. If you're going to build a deck in your yard, you want a toolbox with the right tools so that you can build that deck. If you have to dig a big post hole to sink it in and all you have is a tiny little trowel, can you get the job done? Sure, eventually, but it's a lot harder than if you have a big shovel or even like a backhoe that can come down and scoop out the holes that you need or all these other pieces. We have tools in front of us.

    A lot of prescription drugs are very powerful tools. I often say many of them are like a chainsaw. A chainsaw is a really powerful tool that in the right context is incredibly helpful. If a tree is going to fall down on your house, could you get out a hammer and hammer the tree down? Well, maybe, if you really like worked at it forever and ever. Or you could get out a chainsaw and you could carefully and properly cut down that tree quickly, relatively quickly and relatively easily without that damage.

    Now, it doesn't mean a chainsaw is something you want to play with. Certainly, you can cut off your own leg with it if you're not careful. A host of prescription drugs are like that chainsaw. They have a specific use. They're very good at that use and they have to be used properly and carefully. My thing again, one of the questions to ask, everyone has to find the right place, but we want to neither say all drugs are bad or that only drugs are good. Again, we want a nuanced context-dependent situation. We'll use drugs for people when it makes sense. We also know that in a lot of situations, the drugs are not necessary. It's finding that balance.

Christopher:    I do like chainsaws. I've recently discovered that. I just bought myself a Husqvarna XP 550 and it's endless fun. I highly recommend it. Speaking of chainsaws, what are the drugs that you've found to be really useful in your practice? Did you use any drugs with Gina? Can you give us another example? Can you make that concrete and give an example where it was appropriate to use the chainsaw?

Tim:    Again, let's talk about a really common one again on a tactical level. Again, understanding here whether we want to use drugs or not use drugs is often a tactical question. For example, I can think of many patients where we're faced with two common ones. We're either faced with a SIBO situation, small intestinal bacterial overgrowth. Conventionally, we can use rifaximin or Xifaxan to treat that. Or more alternatively, we can use a whole host of different herbal compounds or various things for it. I've definitely seen patients where rifaximin is the better choice.

    In other words, it works better. They get better results from it. They have less issues from it. It clearly is a superior choice. I've also seen patients where rifaximin has done very little to nothing for those people. Again, tactically, oil of oregano or a whole host of different other herbal compounds work incredibly better for that person. Or yeast is another example. I've had patients where they have a yeast dysbiosis. Something, a prescription drug like nystatin or Diflucan works incredibly well for that person. Whereas others, it does very, very little for them. Again, it's choosing the right tool for the right person.

[0:39:56]

    Or for example, someone with diabetes. In the short term, we might want to get them on metformin or another diabetes drug. Or we might even want to escalate all the way to using insulin for that person in the short term to bring their blood sugars down, protect their system, give their pancreas a bit of a rest while we work on changing diet and lifestyle for that person, addressing underlying dysfunctions, and then we either need less of or no longer need that medication for a person.

    There's a lot of instances where medications can have their place. Some people, they really should. The right tool and the person really needs them. While diabetes is not my specialty, because it's so common out there, I've ended up seeing a good deal of it. One type of diabetes in particular that's very underdiagnosed, it's not common, but it is an autoimmune disease called LADA.

Christopher:    Yeah. I thought I had that once. That was the shiny new object. You listen to it in a podcast, you think, "Oh, that sounds nice. I think I'll try that." I ran the TID antibodies and all of that and like, "No, you've just got incredibly low fasting insulin."

Tim:    LADA, latent autoimmune diabetes of the adult is what that word means. Another way to think of it is slow type 1 diabetes. Classic type 1 diabetes is a very fast onset. Typically in a matter of weeks or months at the most. Someone goes from normal to being very sick and having issues. But LADA happens typically very slowly over the course of often years for people. They'll often present looking kind of like a type 2 diabetic. Blood sugar is creeping up. They're making some changes, and that works for a little while. But then the underlying autoimmune disease continues to chug along for that person, and things get worse and worse. Then eventually, they end up getting properly tested. They find, like you said, their insulin levels are very low. Their GAD antibodies come back positive. This is what we see going on.

    I was working with a woman with LADA and some other issues going on. We put her on a low dose of basal insulin. That's the insulin you take at night typically or in the morning if you need it, not around meals. That was incredibly helpful while we worked on dietary changes and we did other things. She's doing much, much better, very happy. Everything is going really well for her. But she's in a place where we're not sure, but it's unlikely that she's going to be able to come off that insulin.

    Now, if we've done our job and gotten the results we want, we'd like to see no further progression. She's not needing more insulin. She's not having to take more. But she's in a place where if she goes, "Well, I don't like medications and I don't want to be on insulin and I'm just going to go off," there's a chance that very high likelihood that she's going to run abnormal blood sugars which will lead to long-term consequences down the road for her.

    Again, doing our best to get out of black and white thinking. If our goal is quality and quantity of life, people want to live a long, healthy, happy life, they want to take Robb Wolf's criteria, they want to feel good, they want to look good, they want to perform well in their day-to-day lives, the question is what do we need to do to get there? Again, I think integrative medicine, functional medicine is the greatest tool to get there and getting out of the tactical level where we're saying, "Well, should it be this insulin or that insulin?" It's important but it matters less than understanding the strategies that we're implementing, and then those strategies are coming out of principles of what health and disease look like.

Christopher:    You reminded me that one of our previous podcast guests, Dr. Mark Cucuzzella, who I'm sure you know, is also LADA, type 1.5 they sometimes call it. I don't think he's taking any drugs. I would have to double-check on that. I'll look that up and find out and put in the show notes. I'm pretty sure he's managing to manage that with a very low carbohydrate diet. Of course, he's incredibly active too amongst other things.

Tim:    Listen, again, there is no absolute. If he's able to fully manage and, again, he looks good, he feels good, he performs well, his lab tests look great, he's not putting himself at risk or harm for future damage by not taking insulin, more power to the guy. That's awesome. Awesome. But again, not everyone is going to be able to do that.

    I want to make sure that we talk about the two dark sides. The dark side of conventional medicine is fear and lack of control. The gentleman who came to see me yesterday with ulcerative colitis, he said, "They basically said the only thing I can do is take this medication. What I eat, what I do, what I take, everything else, it doesn't matter. It's just take this medicine and if you don't take it, you're going to have to have surgery and have your colon taken out. That's it." There's a lot of fear there. There's total lack of control. There's nothing I can do other than go to the doctor and take these medicines.

[0:45:01]

    Now, on the flipside, we have, again, whatever you'd like to call it, functional, integrative, natural, whatever medicine which turns around and says, listen, actually, you have a lot of control. Your diet. Your lifestyle. Lots of other factors you can take into your own hands. You can have a competent, well-trained professional to help guide and support you through this process. There's a lot you can do.

    The dark side of that is guilt. If I have LADA, if I have autoimmunity, it's my fault. If I hadn't have eaten this way, if I hadn't taken these antibiotics, if I hadn't done this, that or the other thing, it's on me. Or if I'm not able to completely go off my insulin, there's something wrong with me and it's my fault. I just want to say, look, there's a balance here as in everything. There are the things that come back to the serenity prayer. Whether you're religious or not, the basic concept behind it, the things that I can control, I should. The things that I cannot control, I shouldn't because it makes me crazy. And then the wisdom to discern those things that are under my control and those things that aren't.

    To everyone out there, be gentle with yourself. We're hard chargers. We like to get stuff done. But also understand we're also human. We have all these foibles. We have all these issues and weaknesses. Some of us need a kick in the ass to get going and get moving. Others of us, we need a hug basically. It's okay and do the best as you can. You cannot control everything.

Christopher:    I think I have a non-religious version of that. Develop the courage to solve the problems that can be solved, the serenity to accept the problems that can't be solved, and the wisdom to know the difference. How about that?

Tim:    There you go.

Christopher:    I believe that's Russ Harris from his excellent book, The Happiness Trap. Highly recommended as well.

    Talk about the problems that can't be healed. I found your writing on this to be particularly insightful. In particular, it's almost a natural extension of that. There are the people whose illness becomes their identity. Can you talk about that?

Tim:    Yeah. I mean both of those, again, are issues. To segue off of what we just said, again, the positive of a functional integrative approach is the understanding that a lot of what's going on for someone can be healed. People like Gina thought she was doomed with her digestive issues. She was never going to recover. There was nothing that could be done for her. The fact is that it can be. I've seen people with ulcerative colitis, again, an autoimmune disease of the digestion, they've taken it into their hands, they've made the steps and made the changes they need to, and I've seen them go back and have a follow-up colonoscopy and the doctor goes, "If I didn't know, if I wasn't the one who had diagnosed you with ulcerative colitis, I would never know that you had it because your colon looks beautiful." You don't hear many people saying your colon looks beautiful, but gastroenterologists will tell you that, that your colon looks beautiful. It looks normal and healthy and everything looks great. Having said that, not everything can be healed. We don't like that. That's like nails on a chalkboard to me to hear that.

    My job is to help people, to restore quality and quantity of life to people, to help people heal. Often, we can do that. But we can't always get full healing and some things just can't be healed. Now, I hope that as our understanding deepens, as our technology increases, I hope more and more things, the seemingly unhealable things today, if someone is listening to this podcast 5, 10, 50 years from now, you'll be able to look back and go, "Oh, yeah, remember when we couldn't heal those things?" I truly and deeply hope that's the case.

    Again, this can fall on either side. I'm getting to your question here, Chris. But we see people, they've seen a massive improvement in their well-being and their quality of life and their symptoms and maybe 5%, 10%, 20% kind of remains. It's sort of that area of diminishing returns. At some point, we need to ask ourselves are we satisfied with where we're at? Is it really worth putting in increasing amounts of time, money and energy to try and get those last percentages?

    Now, I know a lot of your athletes are like, "Hell, yeah, it's worth the effort to do that." But we have to ask there does come a point where good enough is good enough and some issues and conditions can't be healed or the damage that's happened. Listen, some people with rheumatoid arthritis have suffered so much damage to joints that it's extremely unlikely that that joint will ever fully recover and get range of motion back. Again, we have to be gentle with ourselves both as providers and as people to understand that full and complete and total healing is not always possible for people.

[0:49:53]

    On the flipside, your other question was it's part of human nature. Humans were innately incredibly adaptive creatures. That's incredible. That's how we live on every continent, in basically every ecological niche on the planet we're involved with. But that adaptation comes at a cost in that we normalize things. I'm sure Simon has told you, again, there's no shame or blame here, but there are secondary benefits.

    One example I share in the book was a lovely person, but they had been suffering from a variety of issues for so long that their family life came to revolve around helping that person and dealing with those issues. Her husband took off work and came home and took her around to doctor's appointments. Her kids were all involved in helping mom. Again, beautiful, noble, but so much of it became the whole family's life was revolved around that illness and the attention that the patient got from that illness.

    Then as things began to improve and get better for her, suddenly the husband was like, "Awesome. We've got medical bills and we've got other stuff going on. I'm going to spend more time at work and I'm going to spend time doing these other things." The kids were like, "Great. Mom doesn't need us so much. We can go to more of our own things." Again, I can't emphasize this enough. I don't want to put any blame on the person. But what we found was suddenly the diet changes that had been going so well suddenly weren't sticking. The treatments that had been so effective suddenly weren't working as well.

    It's normal and natural that when we start losing these things, this time and attention and these other things that were so valuable, we can start to sabotage ourselves. Again, not always consciously. Humans need to maintain our sense of identity. Again, one of the many reasons people lose weight and then gain it back again, you'll see some people say like, "I don't know how to be a thin person. I've been fat my whole life. That's how I relate to people. That's how I go out and do things."

Christopher:    It's who I am.

Tim:    That's who I am. Part of the healing process for chronically ill people, especially if it's been going on for more than a few years and especially if it has majorly impacted a person's life the way they work or don't work, their interactions with friends and family, part of healing is forging a new identity for themselves. That sometimes can be harder than making diet changes. That can be harder than spending money on tests and supplements and medications and treatments.

    Again, we need to be gentle with ourselves, but we need to recognize that sometimes part of the healing process is becoming a new person. We talk about healing isn't just like, "I'm just going to fix it. I'm going to put a new alternator in my car." It really is a journey and a process where we fundamentally become a different person than we were before.

Christopher:    Well, I think that's a really good place to wrap up, even though we didn't even get into any of the very specific steps that you lay out in the book. This is the book that I wish I had when I was in that doctor's office asking if he could put [0:53:14] [Indiscernible] on my hemoglobin. There wasn't a book like that that could act as my instruction manual for recovering my health. I pieced it together and I'm still piecing it together.

    That's one of the things you talked about in the book is that it's not a destination, it's a journey and you're constantly learning. Yeah, I would encourage people to not think that they've now heard this book because they've listened to this interview to go get yourself a copy of it. I'll link to it in the show notes.

    Tim, I believe you've got a special offer for my listeners.

Tim:    I do. There are actually two things I'd like to offer people. We are actually making the e-book copy of the book free, absolutely 100% free for a limited time. If you're hearing this anytime between Monday, June 3rd and Friday, June 7th, you can go over to Amazon and get a copy of the e-book, the Kindle book absolutely for free. Please, if you're listening between Monday, June 3rd and Friday, June 7th, head on over to Amazon, grab a copy of the book, take a look at it and tell any family or friends that you think might benefit from it to go and grab it for free.

    But our second offer here for you, because Chris and the audience here, you guys listening are so awesome, I'd like to make five copies of the physical book, the paperback edition of the book. I'd like to raffle them off for free to Chris's audience. Chris, why don't you tell your audience what to do if they'd like to be entered into the raffle to get a free copy of the book?

[0:54:54]

Christopher:    Well, I think the easiest thing is for you to just shoot an email to support@nourishbalancethrive.com and we'll take care of you, or just get in touch with me any way that you can think of. If you poke around in the show notes, you'll find there's a comment section there or if you're on the forum. Do whatever you need to do. I realize that most people when they're listening to a podcast, they're doing what they should be doing. They're walking the dog. They're in the gym. They're driving their car. They're not necessarily in a position to do something on a computer.

    I'll email people within that window to make sure they hear about it. If you're not on my email list, then please come to the front page of my website and consider getting on our email list so you find out about these things in a timely fashion. I'll also try and turn this podcast around really quickly. Hopefully you're hearing this by the time that window before us expires. But yeah, to shoot an email to support@nourishbalancethrive.com, and we'll take care of you.

Tim:    Awesome, yeah. Happy to raffle off some books for you guys for listening. I want to thank you so much. Again, if you take one thing away from this, let's distill it down to two points. The first is that context always matters. What you read has worked for someone else. It's a good starting place to consider what type of treatment or option is right for you. But just because it worked for someone else does not guarantee that it will work for you. If that person was a 20-year-old CrossFit athlete and you're a 60-year-old postmenopausal woman dealing with diabetes, very different situations. Obviously, that's a really big example. But again, just because it worked for someone else doesn't guarantee it's the right choice for you. If you try it and it doesn't work, it's not because you're a failure. It could be that it's not right. Context always matters.

    The second is remember, if you're feeling confused and overwhelmed, you're probably down at the tactics level of the situation. The first thing to do is always to back up and get up into the strategies or up back into the principles and make sure that those pieces are solid. If the situation is just way too overwhelming, you're feeling way too lost, you really know that you need some guidance and support, some accountability to get this done, then seek out a good practitioner to help you make that happen. If you pick up the book, we have appendices at the end that lists out the 11 questions that you should be asking any integrative functional practitioner to find out if they're really the right fit for you. Pick up the book, take a look at it and use it.

Christopher:    I appreciate that you've done such a standup job of coaching people on how to choose an integrative doctor. But let me ask you this. I think you know what question is coming. Do you have any room in your practice? Are you writing this book because you've got a two-year waiting list and so the book is all you can offer people at the moment?

Tim:    Thankfully and I'm grateful to be able to say no, that we do actually have room right now. The good news is we've helped a lot of people get better and I'm incredibly proud of that fact. The other side benefit means that we do have room open to work with people. If you or a loved one is dealing with, again, our specialty, if you're dealing with autoimmunity, you're dealing with digestive issues or you're dealing with both of those things at the same time, let's have a chat. We only work with people that we are confident we can help. We don't want your time, your energy or your money if we're not confident that we can help you. If you want to give us a call, it's 425-202-7849. Or drop us an email at info@aspirenaturalhealth.com. We'll arrange the time to just have a chat. See if we're the right fit to work together. If we are, we'll talk about next steps and what that might look like. If we are not the right fit for you, we will help you find the right fit for you. We're very excited, looking forward to helping, making our little dent in the universe that we each can make.

Christopher:    That is an exciting offer. I would be super excited if I came and spoke to you and you said that we were a good fit. Having heard you to say that and how genuine you are, I'd be like, "Oh, that's super good news. If he's taking my credit card number, that means he could fix my problem, which is a very good sign."

Tim:    Yeah. Well, again, a lot of people, this comes back to our earlier discussion, they bite off more than they can chew. They step outside their area of expertise. Often, then that leaves people dangling and frustrated. They don't have coaches. They don't have the support that people need to get better.

    Same way, we all go through our health journey. This has been a journey of understanding how can we best support people, how can we best get them living their healthiest, happiest life possible, and so we continue to work on it. But I am 100% committed that we don't take people on if we're not confident we can help them. Frankly, we get a lot of calls that we do turn away because we're not the right fit. We turn them on to other practitioners and other people who are the right fit who can help them get those results that they're looking for.

Christopher:    Tim, you do excellent work. Thank you so much. I very much appreciate you.

Tim:    I really appreciate having you on, Chris. Please, once again, if it's between Monday, June 3rd and Friday June 7th, head on over to Amazon. You can search for me, Dr. Tim Gerstmar. Search for the book title The Clear Path to Health. Please pick it up and make good use.

Christopher:    Thank you.

Tim:    Thank you.

[1:00:13]    End of Audio

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