I’m really excited to have James Maskell from Functional Forum and Revive Primary Care. He’s also the director of the Evolution of Medicine Summit just coming up that I’m participating in. I asked James to come on this show so we could chat about functional medicine and the future of medicine in general, because there are some really big and exciting changes happening in the world of medicine and functional medicine in particular, and James has his hands in a lot of different pots in this field.
In this episode, we cover:
2:32 The Evolution of Medicine Summit
9:13 Scalability of Functional Medicine
12:46 The Role of Technology in Functional Medicine
22:46 Dr. Palevsky’s Theory of Viruses
Jordan Reasoner: Hi, and welcome to the Revolution Health Radio show, brought to you by ChrisKresser.com. Steve is out today at a meditation retreat, and I’m your guest host Jordan Reasoner, from SCDlifestyle.com. With me is integrative medical practitioner, healthy skeptic, and New York Times bestselling author, Chris Kresser. But before we dive into this week’s show, I wanted to let you know, if you haven’t been over to ChrisKresser.com, you’ll notice on the front page, Chris is again giving away his 9-Steps to Perfect Health eBook. This eBook was taken off the market for a while and Chris has re-released it. It’s a 63-page eBook, and in it you’ll find the nine steps that Chris has been talking about for perfect health for quite a bit of time. Now, Steve and Chris have recorded a number of podcasts on these steps, but if you want to get the greater detail—including specific steps to take back your health, right now—head over to ChrisKresser.com. Put your name and email in the box and you’ll get instant access to your free eBook.
Chris, I’m really excited today, because we have a special guest with us, and I want to just let you guys take it away.
Chris Kresser: Hey, everybody. Chris Kresser here. I’m really excited to have James Maskell from Functional Forum and Revive Primary Care. He’s also the director of the Evolution of Medicine Summit just coming up that I’m participating in. I asked James to come on this show so we could chat about functional medicine and the future of medicine in general, because there are some really big and exciting changes happening in the world of medicine and functional medicine in particular, and James has his hands in a lot of different pots in this field. He runs something called the Functional Forum, which is where functional medicine practitioners meet in New York—I think they’ll be meeting at some other places soon—to talk about these topics. James will tell us a little bit more about the Evolution of Medicine Summit that’s coming up. So welcome, James. Happy to have you.
James Maskell: Thanks so much, Chris. Great to be here with you.
Chris Kresser: Why don’t we talk a little bit about what this summit is and why you put it together in the first place. And then we can talk a little bit about functional medicine in general and go from there.
The Evolution of Medicine Summit
James Maskell: Absolutely. Well, the concept with the Evolution of Medicine Summit was that I saw so many ways in which medicine was evolving. You know, medicine is evolving to treat the kind of diseases that we have, the current epidemics. So it’s having to sort of evolve and adapt to deal with that. There are also really cool evolutionary concepts within medicine and health that I know you’re really big on. And that’s why I had to have you come in and speak. You know, obviously, I know you’re big on the microbiome, and our evolution with microbes has certainly been something that people are interested in, obviously evolutionary nutrition and then Paleo concepts. We are really excited to have your talk as the keynote for the Paleo day on the summit. And then there’s also this evolution with regards to technology as well, health technology and the interaction. You’re right there in San Francisco, the Silicon Valley Revolution, which I really feel is a synergistic force to the work that we are all doing in integrative and functional medicine. I just saw all of these things coming together. They’re literally coming together in the first week of September. There’s the iPhone, the new iWatch is going to launch then. We have the Cleveland Clinic announcement with Functional Forum. We have the Brain and Gut Journal coming up. So all of these things are happening in the first week of September. It’s just been really congruent to put together a summit of the finest minds and try and share some of these messages as quickly and as effectively as possible.
Chris Kresser: So what kind of response are you getting? I mean, it sounds like, just from the little bit that I’ve heard, that this is really happening at a big level, with The Huffington Post support. You know, this is getting beyond the typical kind of blog tour that a lot of these summits do. So what’s been the response in the more mainstream world to the whole concept of functional medicine and doing a summit on this topic?
James Maskell: Well, there’s a reason why I didn’t call it the Functional Medicine Summit, because, I just feel like that is something that’s still arriving, as far the time. But I think everyone really sort of—you know, the cool thing is that people resonate with the concept for different reasons. And, we’ve been on The Huffington Post. We did a whole series of segments on there as part of Arianna Huffington’s Thrive segment. It really fits in with a lot of different areas. So yeah, the response has been great. Bigger medical organizations like George Washington and TEDMED, have all been interested in what we’re doing, because I think people are realizing this is the future of chronic disease management. The Cleveland Clinic announcement about their huge, big functional medicine center, is sort of like a watershed moment in medicine, where it’s saying, “Okay, big conservative organizations also see that this is the future of chronic disease management.” So it seems like the right thing at the right time, and I’m really excited. We came up with the idea for doing this in February and we set the time then. We had no idea that all of this would sort of come together at the same time. But, I’ve learned to just trust the universe and just be happy that things are moving in this direction and other forces are supporting this work.
Chris Kresser: Yeah, that’s pretty amazing. I talked with Mark Hyman a little bit about the Cleveland Clinic Functional Medicine Program. And just for the listeners, what this is—and James, you might know a little bit more about it than I do—but just from what Mark said, the Cleveland Clinic, for those who don’t know, is a major institution in the field of medical research and pioneering new treatments and approaches to disease from the more mainstream perspective. They basically invited Mark Hyman to create a functional medicine group within the Cleveland Clinic that is funded and actively looking for strategies. Basically, how to scale functional medicine and make it more viable within the healthcare model that we have. And that is a really much-needed step because, as I’m sure all the listeners know, right now in functional medicine, everything is paid for out of pocket. Insurance doesn’t cover it. That really limits the number of people who will be able to take advantage of it. So getting some mainstream recognition like this for functional medicine is a huge step in terms of making it more accessible and available to the majority of people out there.
James Maskell: Yeah, absolutely. And it’s cool as well. So in this summit, we have a doctor track as well as a patient track. And in the doctor track, we’re actually talking about some of the ways that this is actually being delivered. And there are ways to deliver functional medicine on insurance. We’re featuring the group visit model in one of the doctor-specific tracks. That’s been very successful at bringing people together, developing a community around groups of people with the same disease. They want accountability. They want support. They want to hear from other people that have the same issues as them. So that’s working and that’s going to be included in the functional center at Cleveland Clinic. And then also health coaches. They’re looking at using different providers together, so you can have higher-cost and lower-cost providers working together. So it’s really exciting. I feel like once we get more and more organizations doing it that are credible, people will work out how to get this done on insurance and how to do this at a bigger scale. The first thing is just the clinical acceptance that’s been a long time coming.
Chris Kresser: Mm-hmm. So let’s talk a little, since we’re on the topic, let’s talk a little bit more about scalability. We’re actually, you mentioned combining higher-cost services with lower-cost services or personnel for implementation. I’m expanding my own clinic now and we’re getting ready. I’ve hired an intern here that I’m training, and we’re going to be hiring, probably in the future, some nurse practitioners and physician assistants that can help to implement some of the treatment protocols that I’m designing and researching. We’re using technology now a lot more efficiently with electronic health records, and handouts and documents that can be delivered through that on specific health conditions that patients have. So rather than spending time clinically to talk them through these things, we can give them a handout or even direct them to a video or webinar to watch, which is a lot more time-efficient for me, and cost-efficient for them, because they’re not paying me to just tell them something that they could learn by watching a video or a webinar. So what’s your take on how functional medicine will scale and become available? And what role does technology play in that?
Scalability of Functional Medicine
James Maskell: Yeah. Well, obviously, you have, some of the ideas you talked about there are perfect I think. I just wrote a blog for The ZocDoc Blog about why doctors should curate their patient education. And curating resources is much more efficient than just telling people stuff. You don’t need people to do that, you just need to use the resources that are available. And so actually, one of the ways that we designed this summit was that it would be almost like the perfect thing for a doctor to curate for their patient—because there is a patient track. It’s going to basically teach the patient how to be a great patient and how to look after the four major modifiable causes of chronic disease: diet and stress, toxicity, immunity, and the microbiome. These are all things that patients have the majority of control over. This is not medicine that’s done to you. And so, we were just—so that’s part of the track in the doctor track. I think the curation of patient education can take a lot of the time out of the appointments, because you see one of the biggest things about functional medicine is that it takes a lot of time to do it, because you have to listen and so forth. So that’s one of the things. But like you said, technology can play a key role. And we have doctors in the summit that are talking about how they’re using technology even in poorer, rural areas of the country, where they’re building community-orientated practices that serve a blue-collar type of patient, and it’s working. And if it could work in rural Indiana, it can work anywhere. And that’s really exciting. You know, our vision for this, Chris, is just a nationwide network of remarkable community-orientated functional practices. In the same ways you saw the natural response to Walmart was farmers’ markets—you know, going directly to the farmer and having that direct interaction—I think the natural reaction to big medicine is these small micropractices that deliver exceptional value to patients in local areas into the community.
Chris Kresser: Yeah, that’s really exciting to me. I think another frontier is lab testing. I mean, that’s one of the, as a practitioner, that’s one of the things that troubles me the most, is how expensive these labs are. And in a lot of cases, the insurance isn’t covering them because they don’t deem them to be medically necessary, which just makes me want to pull my hair out, because of course, you know, if we do these labs and we identify the underlying problems initially, we’re potentially heading off tens of thousands of dollars, if not more, in medical costs to the insurance company later on down the line. So I guess it just depends on how you define medically necessary, but that’s a whole different discussion. Some of these labs can be hundreds or even thousands of dollars. So I know there are some pretty exciting, new movements out there to make this lab testing more affordable financially. And then some of the tech tools that are becoming available, like the Quantified Self Revolution, that could really help in terms of not only gathering the necessary data, but organizing it and then presenting it back to the clinician in a way that makes sense and makes it easy for the clinician to track progress. So I know this is an area of interest for both us, James. Maybe you could talk a little bit about some of them, the more exciting technologies that you’ve seen, and that people have talked about in the summit.
The Role of Technology in Functional Medicine
James Maskell: Yeah. So we have a couple of people speaking about tech. Specifically, Stephanie Tilenius, she’s written a lot for Forbes. And she’s high up at one of the biggest VC companies in Silicon Valley. She really spoke about a number of the things that you’ve spoken about there, wearables. I don’t know if you’ve seen in the US Open now, they have all the ball boys wearing the wearables, so that’s really expanding the interest. Dr. Robin Berzin, who was with me on The Huffington Post the other day talking about tech. She’s really talking about it from a patient’s perspective. I think, I’m sure you’ve seen this, Chris, but I think just for men; men need different incentives to take care of themselves. Women are generally better at it. They are generally better at taking care of themselves and feeling problems before they come up and get serious. Whereas men tend to wait until the very last moment, until there’s literally no other option apart from going to the doctor’s office. And so I think what’s really cool is that, for men, obviously we’re going to have these touch points. Medicine’s going to have these touch points to be able to catch things before they get really bad. And then on the other side of it, you have things that I find, that I’m quite competitive. I want to get competitive with my friend who’s in Iceland and who has a Fitbit, and he’s doing 120,000 steps a week, and he’s challenging me to do it, and we’re going back and forth. There’s some of the gamification aspect. There’s this really cool app called GymPact, which I’ve been following since I saw them at South by Southwest. And in that, you sort of put money, you bet on yourself to do your run, or to go to the gym, or to eat the right food. You bet on it. And everyone puts all their money in and the people that do what they say they’re going to do get paid out by the people that don’t. And so if it was going to give you $5 or $10 to actually go to the gym, there’s extra incentive that might be the next thing that gets the next generation of men to really be proactive with their health. What I think is cool and interesting is that at the moment, there’s a lot of apps that are being made by healthy 30-year-olds for other healthy 30-year-olds, which is probably not going to solve medicine’s biggest problems right now, but at least there’s starting to be iteration. And the most exciting thing is that once the iWatch comes out, in the same way that you saw the iPhone, the biggest apps—things like Instagram and Snapchat—where people are innovating on top of a hardware platform for software, just think about all of those people out there that are going to want to build apps for the iWatch. And what you actually have is the concentrated intention of way more people around the world looking for ways to engage people in being healthy. And that is exciting by itself.
Chris Kresser: I think that’s like the biggest change we’re going to see, is the nature of this device will change people’s awareness of health, and that’s incredible to think about. There are so many people who are interested in tech that aren’t necessarily that interested in health. But due to their interest in tech, they’re going to become interested in health, just because that’s going to be one of the main implementations of the iWatch. And as you said, there’s going to be such a big community of people developing software. And what we notice and pay attention to is what we can change. If we’re not aware of something, we can’t change it. And that, to me, is the most exciting factor of this new technology. It’s really going to dramatically increase people’s awareness of things—like how many steps they’re taking, and what kind of food they’re eating, and if they’re tracking that, and their heart rate, and how their heart rate variability might correlate to what type of exercise they should be doing that day. And it’s not just about those kind of specific things that they’re becoming aware of. It’s that focusing even on a few specific things like that is inevitably going to expand their awareness around all aspects of their health. So I think it can really be a revolutionary impact. And I know, as a clinician too, I’m really looking forward to having additional ways that I can both support my patients, by referring them to apps and things that can make implementing some of the recommendations that I give them easier and more practical. But if I need to collect data for something, some of these devices are going to make that a lot easier and they’re going to be able to send it back to me in a way that’s very actionable for me as a clinician. It’s a pretty exciting time to be involved in medicine and particularly the evolution of medicine.
James Maskell: Absolutely. The evolutionary concepts were one of the big reasons why I wanted you to be in there, Chris, because I know you do the Paleo, which is evolutionary in itself. But also, one of the things that you talk about is how the Paleo diet is something that has needed to change and evolve, and how we’ve evolved to go beyond what our ancestors ate. I don’t know, maybe for your listeners, they might be interested to just get a snapshot of that. Because that’s one of the cool things in nutrition that I think that you bring together, is a very sensible approach to eating. I thought that was one of the highlights for the nutrition part of the summit.
Chris Kresser: Yeah, sure. I’m sure a lot of my listeners know this about me, but for those people who are new to this especially, I think Paleo—and I’ve said this before—is a fantastic starting place, but it’s not a destination. What I mean by that, is we know that Paleo foods are safe and well tolerated for most of us because we’ve eaten them for such a long period of time. And by we, I mean human beings. And they’re the least likely to cause problems, allergies, food intolerances, and issues like that, because human beings have been consuming them for thousands of generations. But that doesn’t mean that we absolutely need to restrict our diet to those foods, because even though we’re largely the same genetically as we were 10,000 years ago, there have been significant changes. In fact, as much as 10% of our genome shows evidence of recent selection. And the pace of genetic change today is occurring at a rate 100 times faster than the average over 6 million years of hominid evolution. So we’re similar to our Paleolithic ancestors, but we’re different in some important ways. And those differences actually do affect our tolerance of certain agricultural foods, like full-fat and fermented dairy products, even legumes and grains, some of the newly introduced foods like alcohol and chocolate and coffee. These are all foods that modern research actually suggests can be beneficial when they are well tolerated, but I call them gray-area foods because our tolerance of them really depends on the individual. So for one person who is casein intolerant or intolerant to some of the proteins in dairy, eating any dairy is going to be problematic. But for someone who has no problem with casein or lactose, the sugar in dairy, all of the research on full-fat dairy suggests that it’s beneficial and may reduce the risk of cardiovascular and metabolic disease, and even obesity. So those are just a few examples of how our diet has changed. And I think as a healthcare practitioner, my focus is always on the science—what the science shows, and what I see in the clinic in my work with patients. And I’m generally kind of allergic to extremely rigid, dogmatic approaches, especially when they’re not flexible enough to evolve and adapt with what the changing science tells us. So that was one of the big focuses of my talk at the summit.
James Maskell: Yeah, absolutely, it was great. You know, we have a whole day based on the evolution of nutrition. It includes you and Terry Wahls, talking about the nutrition side. But we also have Food Babe in there because she’s not really in the Paleo world, but I think a big part of the evolution of nutrition is to really get active and find out what’s in the food. And I really commend her. I think she’s playing a big role in sort of holding some of these food companies accountable. And I think activism is an important part of making sure that we do have good options in the future. So she’s included on that day. And then Darryl Edwards, who does his Primal Play. He’s just a great guy, another English guy. He’s going to be talking about the evolution of exercise. I had an opportunity to do one of his Primal Play sessions in Central Park. And I can tell you, I was hurting the next day and the day after, in places that I didn’t realize I had muscles.
Chris Kresser: Yeah, that’s great. The summit, it seems there’s so many great speakers, so many good topics. I love that there’s a doctor practitioner track. And I really encourage anyone who’s listening to this to check it out, because there’s a wealth of information there. It’s really representative of what the future of medicine is going to be. And there’s a lot of really practical, actionable information that you can use right now to improve your health. So if you want to check it out, go to ChrisKresser.com/evomed. That’s E-V-O-M-E-D, ChrisKresser.com/evomed. And you can register for free for this summit. You can watch all the talks for free, which is about as good as it gets. And, yeah, go over there and sign up, and they’ll send you the schedule.
Dr. Palevsky’s Theory of Viruses
James Maskell: Cool. I’d love to leave your listeners with something just to get them thinking, Chris, before the summit comes up. Because we did have one talk that I think is going to really change people’s thoughts on a lot of things. You know, a lot of it is great information, but I know that you’re passionate about the biome, the microbiome, and our understanding of germs. But if you don’t mind, I’d love to just share one concept that was shared that I think that you’ll really like. I’d love to get your comment on it.
Chris Kresser: Sure.
James Maskell: Dr. Larry Palevsky is speaking, and he’s speaking on the pediatrics day. He’s an awesome doctor. He was lecturing about the microbiome five years ago, before the human microbiome came out. And so I asked him, he spoke at my Functional Forum, and he brought up some concepts that were new, and I was sitting next to storied integrative medicine doctors who were just sort of blown away. And his thought is this: We all know now that 99% of our bacteria and fungus and viruses and so forth are mutually beneficial, and they help us, and they help with metabolism and digestion and immunity. That’s our sort of main understanding. So I asked him, “Dr. Palevsky, what are we going to learn next? What are we really going to understand next about the microbiome that we don’t understand now?” And he basically—you have to listen to it on the summit, but he basically says this—“We have trillions of non-redundant viruses in our chromosomes, in our DNA. So these are trillions of viruses that we’ve evolved with over time.” And so his question is, “When you get a viral illness, how many more viruses have to come into the body for you to get a viral illness? 10? 20? 100?” I mean, when you look at the numbers compared to what’s actually in our chromosomes and in our DNA, the numbers just don’t add up. His thought is, and his concept is, that these viruses, there’s different transmission mechanisms. His thought is that the next understanding that we’re going to have of the microbiome, the next level of understanding is going to be that the body and these viruses work together to be able to return the body to homeostasis. So when you get to a point where the body is just so stressed and there’s too many toxins and things for it to deal with, and it can’t get back to homeostasis by itself, it communes with viruses to be able to instigate what we think of as a viral illness, to be able to get the patient to just slow down, so that we can get back to homeostasis. And it made such an impression on me because I had a friend last year who got viral pneumonia. And what was happening before viral pneumonia? She was working for three months on a project about 15 hours a day. And suddenly, it finished and she did great with it, and then she was sick for a month with viral pneumonia. So what, pneumonia just came along and attacked at that moment? Obviously, not. So I’d love to get your thoughts on that. Because when he shared that, I was like, “This seems so obvious.” And I’m really excited to think what our understanding is going to be like when we start to appreciate that our evolution with viruses is a big part of our evolution, and that there may be a lot more to it than thinking a virus is just something that comes from outside all the time.
Chris Kresser: Yeah. And necessarily, things that are harmful, because without the co-evolution with viruses, we wouldn’t be who we are genetically.
James Maskell: Absolutely.
Chris Kresser: So it’s really fascinating. And I think the interesting thing about all this to me, James, is that you can understand that as the complexity of all of these interactions increases, paradoxically, things get simpler and simpler.
James Maskell: Yeah.
Chris Kresser: It keeps directing our attention back to the simple things. So in the example that you used, you know, we can bend over backwards trying to figure out how to address a certain pathogen or what combination of factors led to something happening. But really, we know that taking care of our immune system means eating good food, managing our stress, getting plenty of sleep, and then the body really takes care of the rest. But it’s when we go off the rails and stray from those fundamental factors that things really go haywire. It’s like we have the capacity for health in our bodies at all times, and we have the capacity for disease in our bodies at all times. Our role is how we create circumstances for health or disease to emerge from that incredibly complex interaction of factors that’s happening in our body at all times. And I don’t mean that we’re not going to find out, you know, develop new, incredible, advanced therapies that can be helpful in more complex situations. But even that won’t detract from the simplicity of it when it comes right down to it.
James Maskell: Absolutely. And Dr. Palevsky, when he spoke at the Functional Forum in March, the conclusion of everything—even though he was going into areas that have not been looked on before—is just what you said: epigenetics take care of these factors. It’s certainly another look at whether injecting viruses into tissue, you know, there’s another potential problematic mechanism there. But certainly, the overall view was that it’s epigenetics. We already know what helps to turn on the right genes and keep us healthy.
Chris Kresser: Exactly. Well, with that, we’ll leave you. And again, it’s ChrisKresser.com/evomed, E-V-O-M-E-D. James, thanks so much for coming on the show. And thanks for putting this together. I think it’s really important. And I’m excited to see what the response is going to be.
James Maskell: Cool. Thanks, Chris. Great to be with you. And yeah, appreciate having the opportunity to speak to all of your tribe. Keep on trucking, you’re doing great work. And I look forward to more collaboration in the future.
Chris Kresser: Likewise. Take care.