In this episode we discuss:
- What the healthcare debate isn’t covering
- Reason #1: Our genes and our modern environment are out of sync
- Reason #2: Our system is not designed for managing chronic disease
- Reason #3: Our care model does not prioritize spending on diet and lifestyle interventions
- We need a new model of healthcare
- We need a new model of training
- Introducing ADAPT Academy
- My book Unconventional Medicine will be published on November 7th — stay tuned for more updates.
- The special launch pricing period is now over, but you can still enroll in ADAPT Academy here.
Chris Kresser: I’m Chris Kresser and this is Revolution Health Radio.
Hey, everybody, Chris Kresser here with another episode of Revolution Health Radio. We just released an episode a few days back, as I’m sure you know. But I wanted to get this one out to you more quickly than normal for a couple of reasons, which will be evident at the end of the show. This will be also a little bit different in that I’m not going to answer a listener question; I’m just going to talk to you about a topic that I’m really interested in, and I hope you are as well.
What the Healthcare Debate Isn’t Covering
Unless you’ve been living under a rock for the past several months, you’ll know that healthcare has been a fevered debate between Republicans and Democrats over the last several months in the United States, and the debate has really revolved around whether we should keep the Affordable Care Act or whether we should get rid of that and possibly replace it with the Republicans’ proposed American Health Care Act, or AHCA. Just to be extra confusing, they named it something almost identical to the Affordable Care Act. The Democrats have argued that the Affordable Care Act—I think correctly—has insured a lot more people and led to some really important changes. Of course, the Republicans suggest that the Affordable Care Act has been a disaster, and it has actually increased premiums, and I’m sure you all know at least a little bit about the debate.
But the problem is, in all of this debate, neither politicians nor the media acknowledges the real reasons that healthcare is really doomed in this country, and if that sounds like an exaggeration, I don’t think it is, and I think you’ll agree, at least after we get through the rest of the show. At least in its current form, when I say it’s doomed, if we don’t make changes, the trajectory is not good, and that’s been acknowledged by both parties and by many different analyses that have been done on the healthcare system. For example, many of these have predicted that if we don’t make significant changes, the United States will be bankrupt by the year 2035, and that’s with our current system, not with some of the changes that were proposed. That’s what I want to talk about on this podcast.
What’s missing from the heathcare debate
I would argue that there are real reasons that healthcare is destined to fail, and they go much deeper than just the political reasons that have been debated in the media recently. The three reasons are:
- Number one, our modern diet and lifestyle are out of alignment with our genes and our biology.
- Number two, the biggest challenge we face today is not acute disease but chronic disease, and our medical paradigm is not well suited to tackle chronic disease.
- Number three is that our model for delivering care doesn’t support the interventions that would have the biggest impact on preventing and reversing chronic disease.
To use a metaphor, the typical solutions that are proposed for fixing healthcare are just like conventional medicine itself. They ignore the root cause and they focus on symptoms of the problem, whereas the unconventional approach that I’m going to pose in this podcast is more like a Functional Medicine solution. It identifies and addresses the underlying root causes of the problem so that lasting transformation can occur.
Reason #1: Our Genes and Our Modern Environment Are out of Sync
Let’s look a little more closely at each of these three problems. Number one, you’ll be already familiar with, if you’ve been listening to this podcast or reading my blog or others like it. There’s that profound mismatch between our genes, which are hardwired genetic programming, and our physiology and biology that came from that and the modern environment that we’re living in.
The evolutionary biologist Theodosius Dobzhansky once said, “Nothing in biology makes sense except in the light of evolution.” And what he meant was that all living organisms including human beings evolved in a specific environment, and our genes and our biology adapted over tens of thousands of generations to allow us to survive and thrive in that environment, but if that environment changes faster than our genes can adapt, a mismatch occurs, and it’s this mismatch that is the primary driver of the chronic disease epidemic. I’m not going to spend a lot of time on this one because I think you’re all nodding your head and you’re quite familiar with it. If you’re not, there are a lot of podcast episodes before this one. If you’re a new listener, my blog and my first book, The Paleo Cure, are all really good primers for this. But I want to spend a little bit more time on the second and third because I haven’t talked about these quite as much.
Reason #2: Our System Is Not Designed for Managing Chronic Disease
Number two is that the biggest challenge we face is chronic disease, and our medical paradigm is not well suited for it. Conventional medicine is absolutely amazing for acute care—things like trauma injuries, emergencies, and also high-tech interventions. If I get hit by a bus, I definitely want to be taken to a hospital. There have been pretty fantastic advances in medicine that have turned what was previously limited to the realm of science fiction into reality. We’re starting to be able to restore sight to the blind. We attach limbs and even clone human stem cells. We definitely need oncology surgeons who can remove cancerous tumors and gastroenterologists who know how to do higher-tech procedures like performing a colonoscopy.
But I think we can all agree that the conventional medical model has been terrible for chronic disease and that’s now the biggest challenge we face, so consider the following statistics. One in two Americans now suffers from a chronic disease, and one in four has multiple chronic diseases. This isn’t just limited to adults anymore. The rate of chronic disease in kids has more than doubled between 1994 and 2006 alone. It went from 13 percent to 27 percent, so now that means a quarter of kids have chronic disease. That’s absolutely heartbreaking because if an adult gets a chronic disease at age 40 or 50, they might suffer with that for another 30 years or another 40 years if they’re lucky. But if a kid gets chronic disease at age 10 and achieves the average lifespan of 78 years in the United States, they’re going to be suffering from chronic disease for seven decades. That’s just shocking and completely unacceptable. Chronic disease is now responsible for seven of 10 deaths each year, and 86 percent of $3.2 trillion dollars that we spend on healthcare in the United States goes toward treating chronic disease. We’re in a completely different landscape now than we were when the conventional medical model evolved.
Back at the turn of the 20th century, the top three causes of death were all acute infectious diseases: typhoid, tuberculosis, and pneumonia. In the 1900s, you may have visited a doctor for an accident or an injury, a gallbladder attack, appendicitis, or maybe an infection, not because you had an autoimmune condition, allergies, and asthma. Treatment for those issues back in the 1900s was relatively simple. The doctor would remove the gallbladder or appendix, set a broken bone in a cast or give the patient medicine for an infection, especially once antibiotics were invented. There is a single problem usually, a single doctor, a single treatment, and then it was finished. But unlike these acute problems, chronic diseases are difficult to manage. They’re really expensive to treat and they usually last a lifetime. They don’t lend themselves to this one-problem, one-doctor, one-treatment model that worked so well in the past, or at least worked pretty well, that conventional medicine evolved out of. Today’s patient instead has multiple problems, she sees multiple doctors, and she requires multiple treatments that go on for years, if not indefinitely. We absolutely need a paradigm, a new medical paradigm, that’s better suited to address our primary challenge of chronic disease.
Reason #3: Our Care Model Does Not Prioritize Spending on Diet and Lifestyle Interventions
The third major problem is that our model for delivering healthcare does not support the most important interventions for preventing and reversing chronic disease. The interventions that we desperately need to address the chronic disease epidemic require investing far more resources in promoting health, which is just the opposite of what we’re doing today. I mentioned before that 86 percent of the $3.2 trillion dollars we spend on healthcare goes toward treating chronic disease. Guess how much we spend on public health measures that would educate people on diet or lifestyle behavior changes that could actually reverse chronic disease and prevent it in the first place? Three percent. You can see where our priorities are.
At one time back in the ’80s, perhaps when there was so much enthusiasm about sequencing the human genome, it seemed like genetics might hold the key to solving chronic disease. But recent studies have found, not surprisingly for you, probably, that 84 percent of the risk of chronic disease is not genetic, but environmental and behavioral. Our genes do play a role in determining which diseases we’re predisposed to developing, but the choices that we make about diet, physical activity, sleep stress management, and other lifestyle factors turn out to be far more important determinants of our health.
It’s really tempting to think that we can just solve this problem by better educating people about the changes they need to make and that’s really kind of what the conventional approach has been. Let’s just have more articles about this and let’s just do more of what we’re already doing that isn’t working. Although as I said, we’re only spending 3 percent of our budget, so clearly it’s not as much of a priority as it needs to be. But the other issue is that it’s now well established that knowledge is not enough to support lasting behavior change. Most people know that eating poorly and not exercising, not getting enough sleep, and engaging in other unhealthy lifestyle habits isn’t good for them, but we continue to do those behaviors anyway, or we chase quick fixes that don’t last for more than a few weeks.
What about doctors? Could they be the ones that lead this charge? Well, we just don’t have enough of them to address the problem. Recent statistics suggest that we’ll have a shortage of 52,000 primary care physicians by the year 2025, so that’s less than 10 years away. But even if we didn’t have a shortage of doctors, most doctors simply don’t have the training or the time that’s necessary to support people in making really significant lasting behavioral changes.
We could start training doctors and other healthcare providers in this area, but that still wouldn’t solve the problem because our sick care system is not really set up to deliver this type of care. What do I mean by this? The average visit with the primary care provider in the United States lasts for just 10 to 12 minutes, with some newer doctors that are in residency today spending as little as eight minutes with patients. The average amount of time that a patient gets to speak before they’re interrupted in one of these appointments is 12 seconds. I think we agree again that it’s impossible to deliver high-quality care in eight to 12 minutes if a patient has multiple chronic health problems, is taking several medications, and then comes in presenting with new symptoms. These super, super short appointments leave really no time to dig into the important diet, lifestyle, and behavioral issues that are causing the patient’s symptoms. And when a provider has as many as 2,500 patients on their roster, it’s really difficult for them to develop the kind of relationship with their patients that would support those changes. Even in Functional Medicine, where we spend a lot more time with our patients, if I have a 30-minute appointment with a patient and I’m reviewing a bunch of labs and prescribing protocols based on those labs, unless I have nutritionists, health coaches, and nurse practitioners on staff, which fortunately we do because I see the need for this, there’s not going to be really much time left over to advise patients on these important changes. That’s the third issue. We just have a system that is not designed to deliver the kind of care that we need to prevent and reverse chronic disease.
We Need a New Model of Healthcare
What are we going to do about it? Well, I would propose that we need a new model of healthcare that addresses these three root causes of our current system’s “terminal illness,” if you will. If we don’t do an intervention that really gets at these underlying causes, healthcare as we know it will die. I suggest such a model in my upcoming book, which is called Unconventional Medicine, and it’s going to be published on November 17th. I’ll be sharing more about it in the weeks to come, but I’m really super excited about the book because my purpose is to end chronic disease, and I think this book, and the model it proposes, has the potential for a really big impact there.
Those three elements of this new healthcare model are:
- Number one, realigning our genes with our environment using our ancestral diet and lifestyle. As you’ll see with each of these elements, each of them addresses one of the core problems that we’ve talked about.
- The second element is addressing the root cause of disease and shifting to a truly patient-centered care model with Functional Medicine.
- Number three is a collaborative practice model to support patients and make changes that can actually prevent and reverse disease and promote health rather than just managing disease after it occurs. This collaborative model puts licensed providers like medical doctors, chiropractors, naturopathic physicians, acupuncturists, etc., together with allied providers like health coaches and nutritionists so we can provide a much more comprehensive, multilayered, and higher level of care.
The first thing is establishing what this new model of healthcare is that actually gives us a chance of fixing healthcare once and for all.
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We Need a New Model of Training
The other thing we need to do of course is train an army of practitioners in this new approach. It’s not enough to just articulate the model. We have to train people in it so we have a whole bunch of practitioners that are ready to implement this approach in the real world. I’m sure you know there are many training programs out there for practitioners who want to study both conventional and non-conventional approaches to healthcare, including some of our own at Kresser Institute, which I’ll talk about briefly, but there are several issues with the currently available training programs for practitioners:
- Number one, most of the courses are time-consuming and not cheap, which can really limit their accessibility.
- Number two, many of the courses that are available don’t embrace an ancestral health perspective, which I think is crucial, and I imagine many of you listening to this agree. They are based more on a low-fat, plant-based type of diet.
- Number three, there’s no central community right now where practitioners and students who are interested in both Functional Medicine and an ancestral perspective can gather and support each other, network, talk, inspire each other, give each other ideas, etc.
- Number four, we don’t have enough of these allied providers like health coaches and nutritionists who are trained in a systematic framework that includes all three of the solutions to the problem—the elements of the model that I proposed just now.
- Number five, how training is often delivered doesn’t reflect the current evidence on how we learn. Most Functional Medicine, and conventional medicine training, for that matter, is based on the firehose model, where we just overwhelm you with information, sometimes in a weekend seminar format from Friday to Sunday or sitting in a chair for eight hours a day and looking at 800 slides pass by you. There are numerous studies that show retention with this kind of model is horrific. Most people get through that weekend and they might take away two or three pearls from the entire weekend and that’s it. When they get back to their practice on Monday morning, most of it’s just going to be gone, never to be retained at all.
The other issue that’s related is that a lot of the training that’s available is really didactic and more focused on answering the question “Why?” Why should we do this? Why is there a connection between these issues, let’s say, diet, lifestyle, or toxins in chronic disease, without enough emphasis on practical application? Or how—how do you actually put this stuff into practice in your clinic?
As many of you know, I launched Kresser Institute last year to train practitioners in Functional Medicine with an ancestral approach, and the first program we launched was a 12-month practitioner training program that covered Functional Medicine, the ancestral health approach, and practice management, primarily for licensed clinicians.
It addressed a couple of the issues that I mentioned above, which was that many trainings are lacking in ancestral perspective and they’re based on a firehose model of information. But it didn’t address some of the other issues, like training requiring a long-term commitment and not being cheap and not having a central community.
Next year we’re launching a health coach training program that will hopefully address the shortage of coaches and nutritionists that are trained in this systematic three-part framework that I’m proposing as a solution to the chronic disease epidemic, but still the other issues I mentioned remain.
Introducing ADAPT Academy
I wanted to create a new training platform to address these issues, a place where you could find a cutting-edge affordable Functional Medicine training that’s available in a really accessible way. I wanted to offer training that doesn’t cost an arm and a leg and doesn’t require commitment of several months or longer.
We call this the ADAPT Academy, and it’s unique in that it delivers training in a format that just fits into your daily life. Some lessons are as brief as 10 to 15 minutes, 20 minutes, and some are as long as two hours. Depending on how much time you have in a given day, you can do something that fits your schedule. It’s constantly updated with new research, new lessons, new seminars, and new courses every single week. Again, you don’t have to wait three months until your next Functional Medicine seminar. You can be training without leaving your house on a daily basis. I want it to be extremely affordable. That was probably one of the key reasons I created this because so much training is not. Right now during the early registration period, which ends this Friday, August 25th, you can get it for as little as $29 a month, and then even after the registration period ends, it’s still going to be very affordable, $39 or $49 dollars a month, depending on whether you pay monthly or annually. [Note: the early registration period has now ended.]
Last, but not least, I wanted the ADAPT Academy to address that one problem where there’s no central community, where practitioners and students that are interested in all these areas can gather together. As I go and travel around the world and speak to people in different countries and different states in the United States, I constantly hear this. I hear things like, “Oh, I’m so passionate about these topics but no one in my family or my town or my medical practice is interested, and I’m just met with blank stares, and I’m just so hungry to connect with other people who are on this path.” I hear that. I mean, I felt isolated even myself, especially in the early days, when I didn’t know that many other people who were practicing this way. I can say that I have a monthly group that I meet in a local Functional Medicine group, and those are such a big support. Just having a group of colleagues that you can bounce ideas off of and learn from and share with is crucial to our learning process as individuals and as practitioners.
I’m really excited about the ADAPT Academy. It is geared primarily toward current and future practitioners like MDs or DOs, acupuncturists, naturopaths, nurse practitioners, physician assistants, etc., students in those programs, people considering entering those programs, as well as current and future allied health professionals like nutritionists, dietitians, health coaches, physical therapists, occupational therapists, physical trainers, etc.—anyone who is working with people in a health capacity.
As many of you know, the yearlong ADAPT clinician training program has been limited mostly to licensed providers, but I wanted this ADAPT Academy to be more accessible to a greater number of people who are interested in this kind of approach. We’ve already got 100 practitioners enrolled and training together. There is a lot of activity in the forum networking going on supporting each other. I hope you can join us and take the next step on your journey, whatever that may be, if you’re a practitioner or an aspiring practitioner. You can go to kresserinstitute.com/academy to learn more.
I really hope to see you in the academy. I’ll be coming back to you with more information about my upcoming book, Unconventional Medicine. I’m so passionate about these topics right now because, as you saw with all of the recent debate about healthcare, we desperately need a solution to this problem, and the ones that are being proposed are absolutely inadequate. I’m so excited to talk to you more about all of these things and thanks for listening.
Next time we’ll be back with a listener question as usual, but thanks for going down this path with me today, and I will talk to you next time. Take care everybody.
That’s the end of this episode of Revolution Health Radio. If you appreciate the show and want to help me create a healthier and happier world, please head over to iTunes and leave us a review. They really do make a difference. If you’d like to ask a question for me to answer in a future episode, you can do that at chriskresser.com/podcastquestion. You can also leave a suggestion for someone you would like me to interview there.
If you’re on social media, you can follow me at twitter.com/chriskresser or facebook.com/chriskresserlac. I post a lot of articles and research that I do throughout the week there that never makes it to the blog or podcast, so it’s a great way to stay abreast of the latest developments. Thanks so much for listening. I’ll talk to you next time.
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Hidden pricing is a very sore point in the marketplace, not that even Time Magazine wrote a series on the Charge Master. Even with accurate pricing, the average citizen is still buying a pig in a poke in medical services! You need to count the success of the treatment as well as the price.
An even better idea is to give the doctor a chunk of money for care of their patients and then require the doctor to pay for the treatment every year. This will result in the doctors fiscal interests being in selecting the most effective and least costly avenue of treatment! We would have to have standards that insist they treat patients or be fined or have their license challenged, but this arrangement aligns patients interests in having health as opposed to more treatment with those fiscal interests of the doctor and medical marketplace.
As you so articulated in this article, medicine needs to be collaborative, not just with the patient but across all medical disciplines. That is the basis of functional medicine. But insurance policies, in violation of the ACA, will not cover alternative health care. Try getting them to cover chiropractic, let alone naturopathic, traditional Chinese medicine, or even just acupuncture. Medicare is worse since there is no mandate for it to cover alternative health care when that would probably reduce Medicare costs dramatically! The insurance companies just ignore the ACA rules. Pharma does not want to have to compete with alternative practice, so it has a stranglehold on what Congress decides, leading to what Medicare will cover. This makes it very difficult to recommend Bernie Sanders’ bill to provide Medicare for all. The only way that will work is if it also requires alternative medicine to be covered as well.
Interesting how on ‘The Doctors’ (CBS) show this morning, Dr. Travis Stork (an ER doctor), in his ‘Drs. Prescription’ speech at the end of the show, told us to demand less of the medications, doctors to prescribe less medication and start to address symptoms differently. Unfortunately the show is very reluctant to recommend many successful alternative health care practices. Out of ignorance of the research, they often denigrate some medical suggestions. I know, I could tell they had not kept up with the research because it does not fit their “philosophy” or paradigm.
Dr. Stork did not mention they should try to cure their patients, despite the evidence from actual clinical trials which give us experimental evidence for various cures. There is often a better track record for the “cure” research than the typical “observational” research that many MDs depend upon as “evidence” when it is NOT good evidence for their recommendations at all, but it happens to fit their paradigm.
Chris, Thank you for putting these thoughts in writing. I personally, have been verbalizing this very message for years now. We truly do need to address the root causes of disease and not just the band-aid (ignorant) approach. I have a son with chronic disease and i have not been able to go near conventional doctors with him. They just have no clue. I am confident that my son will recover but it is unbelievably expensive to pay for everything out of pocket. We also need to treat health insurance more like a blend of car insurance/life insurance – where you can’t just get anything you want but also have to prove that you’re not engaging in risky behaviors.
I have had the privilege of assisting in the facilitation of a Harvard research study that is looking into promoting wellness programs in the workplace and if they do, in fact, create healthier, happier, more productive, and “less prone to absenteeism employees”. Even with the Dietary Guidelines as the standard, though they fall short, we’re bound to do better by monetarily incentivizing the population to participate in wellness programs where they’re encouraged to get better sleep, more movement, less sugar, manage stress and add more whole foods in the diet. This study could potentially influence health care policy in the right direction.
There is of course another economic angle to this: healthcare policy is effectively decided by the lobby from incredibly rich pharma companies. They exist to make shareholders rich, not to make the population more healthy.
As a result they are more interested in patients who take their over-priced drugs for many years than in patients who get cured by changing their lifestyle.
Can someone recommend a functional medicine expert in Virgina to eradicate H.pylori by natural means?
Look on yelp “doctors to you” gets very good ratings. There is also an Integrative group, Inovo. But its rating is not great.
What really does well is freshly juice organic cabbage juice and it tastes not bad and it works.
Here is Chris’s post on gastric upset, a little more than yo may want. He does get to h. pylori; the is a controversy that it is not the root problem and Chris goes into getting your gut in shape but it would be ok to simply try the juice. https://chriskresser.com/get-rid-of-heartburn-and-gerd-forever-in-three-simple-steps/
BUT you really need to gt to the root case and get on a good diet. Chris has a 30 day Paleo reset diet that I teach and coach. I teach you how to be your own advocate.
BTW I am an affiliate of The Kresser Adapt Institute. I am a teacher, not a doc but we can get you hooked up with some great docs via phone and teach you how to be your own advocate. Each of us is very unique and need to learn to try thing. Natural health is great as things are non–toxic and short lasing.
Try the juice. Depending on your diet you may need more. Feel free to contact me.
Best wishes, Nancy Peden
Basically the marketplace for medicine is dysfunctional and inverted from what patients need. Doctors get paid for supplying treatment. What patients need is health, not treatment. As a result there are all the fiscal rewards for having mildly sick patients in treatment that need to come in regularly and no fiscal reward for use of vitamins or creating actual health. As a result we get every possible prescription treatment, but no increase in lifespan or quality of life. Any free market enthusiast looking at what we get for what we pay would accept the health plans of many other countries as better than what we have.
Completely agree with your first 3 items. But, you need to add a forth items that includes basic economics. The basic economics of incentives says that if I go to purchase a service and up front ask “How much does that cost”, and they say, “Well, we have no of knowing, but after we negotiate with your payer (aka, the insurer) behind closed doors, we will be sure to send you a bill in the mail two weeks from now.”, the basic market function of price discovery would be dysfunctional or retroactive at best. Aka, “I’m not going back there again.” Thus, until we start requiring that health care service charges be clearly posted and we stop letting insurance companies collude behind closed doors, prices will simply keep increasing 10+% per year until the system collapses. We have no incentive to shop for better care at lower cost. It’s a system of broke incentives. Why is my car mechanic so good at providing cost estimates? Because they have to be or they don’t get paid.