When Chris Kresser, M.S., L.Ac, was in his early twenties, he traveled the world surfing and learning to meditate. Along the way, he fell ill — and when he returned to the States he discovered that the conventional medical paradigm had little to offer when it came to treating complex, chronic illness. So he embarked on his own healing journey, studying acupuncture and Chinese medicine and learning about ancestral health. Today he is a globally recognized leader in the fields of functional and integrative medicine. In this podcast, he talks with Dr. Fitzgerald about being one of the first holistic practitioners to establish a solid online presence; why blogging and writing about functional, ancestral, and integrative approaches to health matter today more than ever; and how the current medical paradigm needs to be reinvented both to prevent and reverse chronic disease and to prevent the collapse of the entire healthcare system. His new book Unconventional Medicine is available now.
In this podcast, you’ll hear:
- Chris’s own healing journey and how he came to his career in functional medicine
- Why it’s critical for holistic and functional practitioners to have a solid online presence that includes blogging and writing
- How Chris launched his own career as one of the thought leaders in functional medicine
- How – and why — chronic disease rates have exploded in the last 30 years
- Ways to reinvent the current medical paradigm to better serve patients
- The importance of health coaches in solving the chronic disease crisis.
Chris Kresser M.S., L.Ac., is the CEO of Kresser Institute and the co-director of the California Center for Functional Medicine. He’s also the creator of ChrisKresser.com and is the New York Times best-selling author of The Paleo Cure. Chris was named one of the 100 most influential people in health and fitness by Greatist.com, and his blog is one of the top-ranked natural health websites in the world.
Chris Kresser Links:
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Dr. Kara Fitzgerald: Hi everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine—and today is no exception. I’m really excited about our next guest. He doesn’t need much of an introduction but let me jump in here and tell you about him. Chris Kresser is an MS LAc. He’s the CEO of Kresser Institute and the co-director of California Center for Functional Medicine. He’s also the creator of chriskresser.com, and is the New York Times bestselling author of The Paleo Cure. Chris was named one of the 100 most influential people in health and fitness by greatist.com and his blog is one of the top ranked natural health websites in the world. Chris, welcome to New Frontiers.
Chris Kresser: Kara, I’m happy to be here. It’s always a pleasure to speak with you.
Dr. Kara Fitzgerald: Yeah. Likewise. Likewise. I just had a lot of fun kind of designing our questions and I really appreciate who you’ve been in the functional medicine space and your commitment to excellence and just pushing this forward. How did you…
Chris Kresser: Well, thank you.
Dr. Kara Fitzgerald: Yeah. Absolutely. So, how did you get here? Talk about your background. I know you like many of us, actually myself included, kind of found this in seeking recovery from an illness…
Chris Kresser: Out of necessity.
Dr. Kara Fitzgerald: Yeah, that’s exactly right. Then you sort of found in this journey of yours, functional medicine. Just talk about how you got here.
Chris Kresser: Yeah. That saying, necessity is the mother of invention. It’s not that I invented functional medicine or anything remotely close to that but it sort of lead me to invent a path for myself that I wasn’t imagining before. I wasn’t one of those kids that always wanted to be in medicine when I grew up. That wasn’t on my list of things that I was going to be when I grew up and…
Dr. Kara Fitzgerald: What were you thinking about being? Just out of curiosity.
Chris Kresser: Well, no. I was one of those kids and I’m actually still this way as an adult. I have a broad range of interests and my interests change a lot. I can’t even remember. There were so many different things but, interestingly enough, doctor or medicine was not one of those things.
Then I was in my early 20’s and I was traveling around the world, kind of a one-year trip around the world, surfing mostly, studying massage and meditation. I got really sick in Indonesia and, very long story short, it lead to a decade long recovery process, and during that process I learned a lot. I learned number one that conventional medicine was poorly suited to deal with chronic, complex illness to put it kindly.
Every doctor I saw, their heart was in the right place and they were trying to help, but they just didn’t have the tools to help in a situation like that. I also learned that the way that I had always thought about medicine and healing was incomplete and that if I was going to get better, I would have to take matters into my own hands, which is what I did. So, then I eventually at the end of that process, people around me had seen what I’d gone through and they’d seen my recovery and started asking me questions about, “Hey, how did you do that? Can you give me some advice and pointers?”
Then I decided to go back and study Chinese medicine because that was the closest thing that I had encountered in my journey back to health to a more holistic framework in it. It drew me in because of that and, at that time, I didn’t know about functional medicine when I had first made the decision to go back and study Chinese medicine. I mean, this was way back in, like, 1999 or 2000. Functional medicine was around but definitely [not with] the level of awareness that it has today.
Then I got out of school and I started practicing. I was working as a solo practitioner and enjoying it a lot, but also started to see some of the limitations of that solo practice model and episodic model of care where we just see a patient once every three or four months for a half hour, an hour, and that’s it. I think most of the patients that I was seeing needed more support than that. So, that’s when I started to explore a more collaborative practice model. It’s also when I started to train other practitioners because I recognized that, although we’ve made a lot of progress in terms of functional medicine, awareness of it spreading, there’s still far more demand than there is supply. Patients who need that kind of care versus practitioners who are able to offer it. I know you feel the same way because you’re training people as well.
That was kind of the next natural evolution. Then, along the way, I’d written a book about taking back your own individual health using diet lifestyle and behavior change. Then as my awareness of this issue continued to expand, I just become more and more focused on: how can we roll these changes out to a broader swath of the population? How can we actually take them mainstream and how can we take back healthcare? Not just our individual health—and that was the genesis of my latest book on conventional medicine, which is really about taking back healthcare because I think what I realized is that you can’t really talk about individual health without talking about the context that, that happens in, which is our healthcare system.
Dr. Kara Fitzgerald: It’s amazing to me … I think a lot of us, especially jumping in at the time that you did, which, really, it mirrors my own journey. It’s a mission along with our own healing journey and that’s so woven in with everything that you’re doing. I just want to mention again Chris’ new book Unconventional Medicine. It’s just beautiful. It’s really well articulated and we’re going to dive into those concepts more in just a second. Funny Chris, you’re really modest. You’re talking about your journey but you really kind of blew up. I mean your book, I think this nutrition book that you’re sort of referencing extremely casually was a New York Times bestseller, The Paleo Cure and it was really huge. It catapulted you really kind of front and center. Talk about actualizing your vision. And so you’re out there, one of the people who’s cutting the edge.
I know there’s a responsibility that comes with that and I’ve appreciated seeing what you put out into the space. I appreciate your commitment to being evidence-based or evidence-informed, as I like to say it. I also obviously appreciate that you have an abrasive traditional ideas that come from Chinese medicine. I mean, I know you have this intention of growing things but you really took off. Did you anticipate that and what’s that been like?
Chris Kresser: No. Not at all. From the beginning, when I was in school still, I started my blog. At that time it was called The Healthy Skeptic.
Dr. Kara Fitzgerald: Oh, interesting. That kind of reflects your space now.
Chris Kresser: Yeah. That was the original concept was it’s healthy to be skeptical and we should be skeptical not only about conventional medicine but also even about our own sacred concepts. I was skeptical, frankly, about the traditional Chinese explanation of how acupuncture worked. I never really accepted that energy, radiance, and chi. I know this is sacrilege and will get me in a lot of trouble, but it’s just I went looking for other explanations that made more sense to me. I’m not saying that there isn’t a possibility that it’s true, it just didn’t resonate with me and I found another way of understanding how acupuncture worked. It was more in alignment with modern evidence and what resonated with me in a way that I could talk about it with my patients that I could get behind.
I started this blog, The Healthy Skeptic. I started writing about heart disease and the relationship between saturated fat and cholesterol in heart disease in particular because my grandfather had, had a heart attack and they gave him a triple or quadruple bypass at age 85, which was totally unnecessary. It basically killed him. He didn’t die right away but he just kind of withered away after that and the whole thing was based on a faulty paradigm.
So, I started writing about that. This is early days when people were like, blog? What’s a blog? A blog was kind of like a journal. That was the idea early on. It was like you just kind of write about what’s going on in your head and so that’s … I was doing this research and I’m a kinesthetic learner. I like to synthesize and write things down. I was doing that with my blog, no idea that anyone was reading it. I was shocked when somebody first left a comment on the blog. I was like, oh my, wow! Someone actually reading this and many, many times I was going to quit writing my blog because I just didn’t have any intention of building anything with it. It was a lot of work and whenever I would say that, my wife would say, “I think you should see this through. There’s probably something here.”
Thankfully I knew enough to listen to her. Then the blog kind of took off and then when the book came, that was really well received, which was great because it was a labor of love. I believed in what I was putting out there. I was glad that it could reach people and help them, which was the goal in the first place.
Dr. Kara Fitzgerald: Yeah. Yep. But it has put you forward and there’s a degree of responsibility that comes with that I think and maintaining continued integrity.
Chris Kresser: Yeah. I’ve always been conscious of that and wanted to embrace that in my work and have been aware that if we want functional medicine to become the default paradigm of medicine, which I firmly believe that it should be and will be—to the point where I think someday it won’t even be called functional medicine, it’ll just be medicine. It’ll just be how we practice medicine. If that’s going to happen, it has to happen within the context of [what] we’re operating in and there has to be some evidence to back it up and there should be. There is. There’s a ton of evidence to back it up.
I talk about this in my book, a lot of people say, “Oh, there’s no evidence for functional medicine.” I say, “What do you mean?” They say, “Well when you go to PubMed and you search for functional medicine, nothing comes up.” I’m like, “Well, that’s not actually how it works. Functional medicine’s a paradigm. It’s a different way of looking at things. If you go to PubMed and you search for irritable bowel syndrome and SIBO, you’ll find a whole bunch of studies that show a correlation between SIBO and irritable bowel syndrome and that’s functional medicine. That’s because it’s showing an underlying cause of a problem that in Western medicine is usually just dealt with by prescribing drugs that suppress the symptoms but nowhere in those studies will you see the term functional medicine. You have to know what you’re looking for and you have to understand that functional medicine is a lens or paradigm that we’re using and it’s not an entity in its own right that you can find a textbook or studies on.” I think that’s the message that we have to continue to get out there.
Dr. Kara Fitzgerald: A couple of things and then we’ll continue in this conversation. But I just wanted to say that I love the quote that Mark Hyman put in the foreword of your book from 1871 Dr. Wade and that’s when functional medicine was coined. Actually 1870, published in The Lancet, which is still a premiere journal.
Okay, so before we jump into talking about where we are now and how we can change the paradigm. I was cracking up when you gave your blogging story because mine is somewhat equally obscure. I mean, I was confident that my mom was reading because I would get grammatical corrections and I just really appreciated that. I put all my friends on my list, so they were receiving my blogs early on. But yeah, it was radio silent. But because I just enjoyed doing it, it was an important part of my world and I continued to. I mean, I just wanted to ask you around new practitioners coming into this space and using blogging or social media, I just wanted to grab it while it’s hot. Any advice to them? Should they be doing it? I mean, what should they do?
Chris Kresser: I think it’s really important for any practitioner these days to have a solid online platform for a number of reasons. But the first is that really medicine and healthcare is about relationship above all else. The best way to create a vibrant and healthy practice that is sustainable over the long term is to build relationships with people. That’s how someone is going to consider coming to see you as a practitioner. I mean, just think about it yourself, how do you pick a healthcare provider? You usually don’t just open the yellow pages, nobody opens the yellow pages anymore. But go on Google and search for doctor in your area. You ask around. You ask or if you’re trying to find a therapist or a massage therapist or somebody like that, you’re not generally just going to pick them from a Facebook ad in your newsfeed. You’re going to ask around or what I’m saying is what you’re probably going to do is you’re going to say, “Oh, I’ve been reading this blog for the last two years and I’ve learned a ton and it’s helped me tremendously. Now, I’m a little stuck and I feel like I’ve gone as far as I can go on my own. I’m going to go become this person’s patient.” That’s exactly how it worked for me.
When I graduated from school and first had my license, I sent out an email saying that my practice was open. It was nearly full within a few months. That’s simply because I had spent many, many months, actually two years prior to that, delivering really valuable free content that helped people. When they thought of someone they might want to see as a practitioner it was just natural and organic for them to think of me. I’d never paid a dollar to advertise in my entire career because of that. I think that’s really in this day and age, especially when we’re so overwhelmed with information and media and advertising and re-targeting and all this stuff. I’m not saying that there isn’t a role for that but I think just creating a relationship with people where you’re helping them in delivering value. That’s the best way to do it.
Dr. Kara Fitzgerald: And in a consistent way and continuing the walk even when you feel like there’s echo, echo. Nobody’s out there because people are as you demonstrated. You hung in there for a really long time. I don’t think in this day, one would need to be blogging two years to fill their practice. I think it would happen much sooner but-
Chris Kresser: Yeah. I was early.
Dr. Kara Fitzgerald: Yeah, you were really early.
Chris Kresser: There’s good and bad that came with that. But, yeah.
Dr. Kara Fitzgerald: I know the whole layout of how blogs looked back then. It was pretty crude but good story. Okay so circling back to Unconventional Medicine, your book. We’re in a serious quagmire of dysfunction with regard to healthcare in the US and globally. How did we get here? Just talk about really this chronic disease pandemic?
Chris Kresser: Yeah. I mean I think we’re facing an existential crisis. It’s interesting that the Department of Defense, Robb Wolf, who’s a friend and colleague, has met with him a few times. He told me that they are approaching chronic disease as an existential threat to the United States equivalent to a missile attack and I think that’s actually appropriate. I mean one in two Americans now has a chronic disease. One in four have multiple chronic diseases. Almost 30% of kids now have a chronic disease, which is absolutely heartbreaking. Today is the first generation of kids that’s expected to live shorter lifespans than their parents. I mean that is absolutely not the right direction to be headed. A lifespan’s been continually increasing for as long as we’ve been measuring it and now it’s going back in the other direction for the first time.
Then you add to that the social and economic consequences. We have some estimates suggesting that the US will be completely insolvent or bankrupt by 2035 if healthcare expenditures continue at their current pace. Some estimates suggest that we could be spending almost $50 trillion on treating chronic disease by the year 2050, which isn’t very far off and, just to put that in perspective, that’s equivalent to the GDP of the six largest economies in the world. I mean, this is a big deal. I don’t think people actually get how big of a deal this is. That’s threatening the very fabric of our country and its survival. It’s threatening the health of future generations. I’m sure you’ve seen the studies on the decline in sperm count in men and how alarming that is. It could literally even be threatening our survival as a species.
Dr. Kara Fitzgerald: Listen. Chris, why don’t we get it? Why are we numb to this massive proof that you just put out?
Chris Kresser: I don’t know. I think part of it is we’re the frogs in the boiling water. On the one hand, it’s happened extremely quickly. I mean, just I think 12 or 13% of kids had chronic disease in 1994 and that statistic of almost 30% that was back in 2010, I think. I don’t have a more recent statistic. I’m sure it’s higher. That’s just 16 years. Almost doubling of chronic disease in kids.
On the one hand, it’s happened fast but on the other hand, it’s slow enough that it’s not like a meteor just came down and hit the planet, which everybody would notice. No one’s going to miss that but it’s happened slowly enough that we all kind of know someone with chronic disease, if we don’t have one ourselves, and because of that I think we’ve come to accept it as normal. It’s just the way things are. We all know that people get chronic disease and have it. It’s not that alarming but there’s a really big difference between what’s common and what’s normal. It’s common for people now to have chronic disease, but that doesn’t mean it’s normal.
We learned that by studying traditional cultures that are still living their typical lifestyle and eating their typical diet and we find that oh, wait, they don’t actually have all these … They don’t get heart disease or certainly not at the rates that we get it. They don’t have obesity. They don’t have diabetes. They don’t have autoimmune disease. They don’t get Dementia, Alzheimer’s. Okay. What’s going on here? Why is that? Maybe we should investigate that.
Dr. Kara Fitzgerald: It’s powerful. It’s difficult to actually get when we talk in trillions or that we’re going to bankrupt. These are big, important, necessary concepts. I was lecturing on hypertension and I put the trillions of dollars that hypertension costs normally and I just wrote out all the zeros to give a visual and there’s a full page. It’s a whole…
Chris Kresser: …mind-blogging number that we can’t even get our head around. This simple concepts like our government might not be able to pay for roads and schools and basic defense and any other services than healthcare. That kind of brings it home a little bit. If you’re a parent thinking that your kid might not live as long of a lifespan as you. I mean, as a parent myself, that’s pretty gut wrenching. That just feels wrong, especially given all of our progress technologically and in other ways. That’s where we are. In terms of your question of about how we got here, that’s a little more involved. But in short, the reason that we’re here is our medical paradigm … Well, there are three reasons.
Number one, there’s a huge mismatch between our modern environment and what our genes and our biology are hardwired for. The easiest way to think about this is all organisms are evolved in a particular environment and when they live in that environment they thrive and if you take them out of that environment and drop them into a totally foreign environment, they’re not going to do well. If you think of bacteria that thrive very deep in the ocean, your hydrothermal vents, are among the few organisms that don’t require sunlight to survive then you take them and you put them in a shallow tide pool, that bacteria is just going to die. It won’t even survive.
Or if you take a cat, which is naturally a carnivore in nature and you feed them kibble, which has grain and a bunch of other stuff that the cat’s digestive track is not designed for then they’re not going to thrive. They’ll survive but they’re not going to thrive. If you take a human being that evolved in an environment where they ate primarily meat and fish, fruits and vegetables, nuts and seeds and some starchy plants, no process and refined food, they didn’t sit for long periods, they’re physically active throughout the day, they lived in sync with the natural rhythms of light and dark and then close knit tribal and social groups and then you air drop them into New York City where they’re eating pizza and drinking beer…
Dr. Kara Fitzgerald: Sitting in an office.
Chris Kresser: Sitting in an office for eight hours and then riding the subway home and sitting on the couch and binging on Netflix at night and have the phone next to their bed and it’s beeping and flashing all night and emitting light that interferes with our circadian rhythms. We live in isolated, alienated social arrangements. I mean, that’s a 180-degree difference from the environment that we evolved in. It shouldn’t be surprising to us that we’re suffering from this epidemic of chronic disease because we were totally mismatched, our genes and our biology are totally mismatched with our modern environment.
Dr. Kara Fitzgerald: That’s actually a really nice analogy. That hits it home really clearly.
Chris Kresser: That’s number one. Number two is that our medical paradigm is not well suited to tackle chronic disease. This is one that, when most people hear it, they’re like, ‘oh yeah that makes perfect sense.’ But we don’t think about it. Our medical paradigm, conventional medicine, really evolved in the 1800’s and early 1900’s. At the time, the primary challenge that we were facing were acute problems —like acute infectious disease, typhoid, tuberculosis, pneumonia — were the top three causes of death in 1900. People would also go to the doctor for gallbladder attack or appendicitis or a broken arm or an injury they had at work and the treatment was pretty simple. It didn’t always work but it was straightforward. One problem, one doctor, one treatment, that was it.
But when you fast forward to today, seven out of the ten top causes of death are chronic conditions rather than acute problems and, unlike acute problems, chronic conditions are complex. They’re difficult to manage. They often last for a lifetime and they require a totally different approach so that one doctor, one treatment, one problem paradigm that conventional medicine came out of is really great if you get hit by a bus or my wife cut her finger yesterday and we were happy to be able to take her to the urgent care and get stitches.
After she finished, I was like this is an appropriate use of conventional medicine. It’s great. I’m super happy for that. I don’t want to take her to acupuncture at that point or to a functional medicine office. But it’s really actually not the best paradigm when someone has gas or bloating and diarrhea or constipation and skin breakouts and they have difficulty sleeping or maybe they’re having trouble conceiving or any number of other chronic problems that are what the vast majority of people are dealing with today and that medical paradigm that we ended up with is just not the right one. It’s the wrong tool for the job.
Then I think the third reason is that the way that we deliver care is totally mismatched from what we need and so the average time that a primary care doctor spends with a patient is now 8 to 10 minutes. If you imagine someone who comes into the doctor and they’ve got all the things that I just mentioned going on. Then they’ve also started to have some new symptoms of brain fog and difficulty concentrating, there’s barely enough time in that visit for the patient to communicate what the symptoms are much less for the doctor to ask them any meaningful questions about them to talk about their diet, behavior, or lifestyle and other changes that could be made that might address those problems. There’s just enough time maybe to figure out what drug, medication could be used to address those symptoms and write that prescription and hurry the patient out the door before the next one comes in.
That’s the model of care that’s sort of based on the paradigm of conventional medicine, so we not only need to shift the paradigm, we also need to shift how care is delivered because those 8 to 10-minute visits are not going to be enough when we’re talking to patients about their diet, lifestyle, and behavior. When we’re using functional medicine, testing to try to get to the root of their problem and then prescribing treatment protocols based on those results. That’s kind of how I see how we got here and what needs to change.
Dr. Kara Fitzgerald: Yeah. Right. Then we’ll layer into that 8-minute visit. Often I think there are really pricey referrals to specialists and extremely expensive workups that still don’t yield the solution because ultimately in the conventional model they’re dealing with the tool kit that’s inadequate even with the level of sophisticated workups that people can receive.
Chris Kresser: Yeah…
Dr. Kara Fitzgerald: Go ahead. Yeah.
Chris Kresser: I was going to say the other problem with that is we have specialists and there’s definitely a role for specialists in certain situations. But the downside of having a doctor for every different part of your body, and no network for those people to collaborate and communicate in a meaningful way, is that it really ends up reinforcing this kind of reductionist view of the body as just a collection of separate parts that are not connected in any way.
The example I’ve often used is you take a patient whose got brain fog, they’ve got skin breakouts, they’ve got GI symptoms, they’ve got difficulty sleeping, and they’ve got muscle aches and fatigue. That person could go to a primary care doctor. They get referred to a gastroenterologist. They get referred to a dermatologist. They might get referred to a psychiatrist and they’ll get treatment from all those different people. But what if that person is just gluten intolerant? And that single food intolerance is causing all those other symptoms. Nobody’s looking for that and all those different people will have different … The dermatologist will give some cream. The gastroenterologist will give some medication. The psychiatrist will give an antidepressant or the primary care provider might give something but nobody is actually tying all those things together. That’s where, of course, functional medicine can play such a game-changing role.
Dr. Kara Fitzgerald: Yes. It’s really, it’s very heartbreaking when patients end up finally finding us. Thank God they do but to hear their journey. It can be like PTSD to just listen, witness that journey.
Chris Kresser: Totally. I’ve got a story for you that you’ll appreciate. I’m sure you have plenty of others just like it. My nurse practitioner and I were seeing a patient this week and she came in and we hadn’t seen her in a while. She’d kind of fallen off the map, which sometimes happens. She came back and was like, “Yeah, I was having some GI problems and I just decided to go to my gastroenterologist and see what they said. They did some testing and they found that my gallbladder was not functioning optimally and she gave me a referral and I want you to go see this person. I went home and called up the number and when they answered the phone they said, “Okay, when would you like to come in and have the surgery?” She said, “Surgery? What do you mean?” They’re like, ‘We’re taking out your gallbladder. This is the doctor that takes out your gallbladder.'”
She was kind of shocked that there was no conversation about it. It was just, “Here’s the referral to the surgeon.” Your gallbladder’s not working quite right. It’s inflamed. The treatment for that is to remove it. I’ll give it to them. That’s efficient. That is definitely an efficient way of dealing with gallbladder inflammation. Your gallbladder will no longer be inflamed if you don’t have one anymore. But wow, that was kind of like sometimes I feel like it’s changing. I see a lot of positive signs of changes but then every now and then something like that happens and I’m like okay, we still need to be talking about this.
Dr. Kara Fitzgerald: Yes. Absolutely. Yeah. Yeah. Okay. Let’s move over. There are, there’s plenty of really heartbreaking stories around and we absolutely do. We can swim in our pond and it’s very amazing. The water is quite warm here and it’s very satisfying and exciting, but there’s much to do in the greater paradigm. You talk about that in your book. You give three reasons around reinventing healthcare and how we can actually prevent and reverse chronic disease. Talk about the solution.
Chris Kresser: The solution flows from the problem. I gave three reasons that conventional medicine has failed to address chronic disease. Not surprising you’ll recognize the three solutions. The first one is to bring our diet, lifestyle and behavior more in alignment with what our genes and our biology have adopted to. That means nutrient dense whole foods, anti-inflammatory diet instead of highly processed and refined foods. The top six foods in the American diet today by calories are grain-based desserts, bread, sugar sweetened beverages, alcohol, pizza, and fried chicken dishes like chicken nuggets.
Dr. Kara Fitzgerald: Really?
Chris Kresser: Yeah. If you base it by calories consumed, those are the top six foods in the American diet. If you contrast that with the foods that we historically eat — some combination of meat and fish, fruits and vegetables, nuts and seeds, and some starchy plants — you can see the dramatic difference. Just realigning our diet but not just our diet how we exercise, how we sleep, how we manage our stress, social support, pleasure, play, all of these things that make us human and it doesn’t mean that we need to go back to living in a cave and wearing a loincloth. It just means there’s some simple steps we can take in all of these areas to bring our diet and behavior and lifestyle back into alignment. That’s number one and that’s really what my first book was about.
Number two is to shift to a new medical paradigm. Functional medicine is what we call it now, but as I said I think it will just be called medicine in the future. The primary difference there of course is that instead of just putting band-aids on symptoms by using drugs or surgery in the case of removing the gallbladder, we actually orient towards identifying and addressing the underlying cause or problem.
If a patient comes in and they’ve got so called “IBS,” I’m doing air quotes because I don’t think that’s a really useful diagnosis instead of just saying, “Okay. We’re going to give you Imodium. You have diarrhea, we’ll give you a laxative. If you have constipation, we’ll give you an anti-spasmodic for the pain and maybe an anti-depressant.” We say, “Huh, okay. Your bowel is irritable. Why is it irritable?” Maybe we’ll do some stool testing to look for hidden infections or dysbiosis. Maybe we’ll do SIBO breath test to look for bacterial overgrowth in the small intestine or organic acids urine test to also look for signs of dysbiosis or fungal overgrowth. Maybe we’ll also do some blood testing to look for deficiencies or excess of nutrients. Maybe we’ll do heavy metal testing because we know that heavy metals can interfere with gut health and maybe we’ll evaluate your nervous system, your HPA access because we know that the gut is a big bundle of nerves basically, and chronic stress and cortisol issues too much, too little, not the right timing of production can also really impact gut health.”
As you can see, that’s a fundamentally different approach and it’s one that leads to much longer lasting and better results. Then the third step is how we deliver care because that was the third problem. It’s not enough. I think we all know to have an 8 to 10 minute visit with a patient, there’s very little that can happen there. We need longer appointment times, which are typical in functional medicine. But not just that we also need to utilize providers like nurse practitioners and physician assistants and nurses and registered dieticians and nutritionists and health coaches to provide a whole another layer of support that currently is not offered. Where imagine, this is an example I gave in my book:
Imagine someone who had prediabetes went into the doctor and they said right now what would happen is generally nothing. They don’t typically prescribe drugs to prediabetics. They might give them some vague advice about eating healthier and exercising more before they’re shuffled out the door.
But imagine if they came in and the doctor said, “Good news, we caught this early and there’s excellent prognosis when we catch it early like this and chance of reversing it so you not only don’t have prediabetes anymore but you never develop it or full-fledged type 2 diabetes.” Here’s how we’re going to do that. We’re going to set you up with a health coach and they’re going to really work with you intensively on changing your diet. They’re going to come to your house and do a pantry clean out. They’re going to go shopping with you. They’re going to give your recipes and meal plans and you’re going to check in with them on a weekly basis until you really feel like you’ve got this down and you’re able to implement these changes because we know that just telling you to do it in a vague way is not going to work for 99.9% of the people.
Here’s the good news, your insurance program covers this health coach visit because they recognize that even though they have to spend a little bit of money up front on the health coaching at the cost of $14,000 a year of treating a Type 2 diabetic patient, they’re going to potentially save hundreds of thousands of dollars over your lifetime if they prevent you from having diabetes in the first person. Then we’re going to set you up with a physical trainer at a gym and we have a partnership with them so your insurance company is going to cover that as well and they’re going to get you on an exercise routine and make sure you’re doing it safely and effectively. You’ll stick with that for … That’s what it could look like and that’s what it will look like because it has to. There’s no other way to reverse chronic disease and there’s no reason that it can’t look like that. Everything that I just mentioned is completely feasible financially and logistically. The only thing that’s stopping it from happening is us, our will to make it happen.
Dr. Kara Fitzgerald: That’s the next obvious question. How do we get from why we failed and how we can succeed? What’s the bridge?
Chris Kresser: Well, that’s a really good question. Of course, there are different ways of looking at it. I can give you the glass half full way and the glass half empty way. I think the glass half full way is that we continue to spread the word. Books like mine, clinics like yours, teaching programs like yours, institute for functional medicine, my training organization. Everyday, I hear from doctors who they know that the conventional model is not right for chronic disease. They want to do something different but they’re not sure how to make the transition. We need more training programs for doctors and other healthcare practitioners who want to take this leap.
We need more blogs, more podcasts, more books to get this word out. It’s already changing. It’s changed dramatically in the last few years and we also need to re-educate patients because I think patients have been trained over many decades to become passive recipients of medication. That’s kind of the idea in many people’s minds of what medicine is. Medicine equals medication. That really has become the default belief system and that’s obviously not going to work. It’s not just practitioners that need to be re-educated, it’s patients that need to be re-educated.
Then you start to look at pockets of success like Mark Hyman’s Center for Functional Medicine at Cleveland Clinic. Iora Health, which is a primary care organization that is reversing Type 2 diabetes with health coaching. On a smaller scale, clinics like ours, which are implementing this new model of functional medicine and collaborative care. It just takes more of these small pockets of success becoming bigger pockets starting to touch each other. We’re doing a pilot program with the Berkeley Fire Department right now.
Dr. Kara Fitzgerald: Oh, that’s great.
Chris Kresser: Which has been amazing and more and more of these things happen. More proofs of concept. More and more people start to pay attention and that’s how the change occurs. That’s the glass half full and the one that I’m still rooting for. I wouldn’t have written my book if I didn’t believe it was possible.
The glass half empty is our current healthcare system basically implodes, which I think by all accounts is not far off. It becomes increasingly apparent that it’s unsustainable, that there is no way of paying. A lot of the debate around healthcare recently is centered around insurance but we have to remember that health insurance is not healthcare and that there is no way … I don’t care if government is paying, corporations or individuals, there’s no way of financing the care of chronic disease even at the current prevalence of chronic disease. But if it continues to increase at the rate that it’s been going, it’s hopeless. There’s no possibility of paying for that. It will bankrupt any system that we create. The message I try to get across in my book is the only way that we can right the ship is to prevent and reverse chronic disease. It’s not more insurance. That’s not going to work. We have to actually prevent and reverse chronic disease.
The glass half empty is that we don’t get that message across soon enough and the healthcare system implodes and we have to start from scratch. The good news is I think we’ll get to this new system that I’m talking about one way or the other but the implosion way is going to be a lot more painful and lead to a lot more suffering. I’m really hoping that we can be proactive in taking those steps.
Dr. Kara Fitzgerald: I want to just mention a point that you reiterate in your book over and over again. I think it’s incredibly important that individuals listening to this podcast and clinicians hear this. You say, “If not now, when? If not you, who?” Me, today, what am I doing? You today. The people that come and see us and then I’m just thinking about your commitment years ago to continuing to get your blog out and just doing it and doing it. Sometimes we don’t think that it’s possible but if not us, who?
Chris Kresser: Exactly. Yeah. That saying. That story actually comes from an old zen Buddhist story. It just really touches me and moves me and it’s why I get up in the morning. Jump out of bed every day. Are there times where I would just like to go be a coconut farmer in Nicaragua and surf all day every day? Absolutely. There’s no question about that.
But it’s so clear to me that this is what I’m here for and this is the impact that I can make. It’s also clear to me that none of us can do it alone and the more people join this revolution to reinvent healthcare, the more successful we’re going to be. We need everybody. Not just practitioners. Not just patients. I had a patient who came last week and he works in finance. He’s so excited about this that he is actually creating a fund to launch new functional medicine clinics. That’s his contribution. He doesn’t want to become a doctor. He doesn’t want to go back to school. He wants to use his expertise and background to support this movement. That’s exactly the kind of participation that we need from all different people, all different walks of life.
Dr. Kara Fitzgerald: It doesn’t necessarily have to be that massive.
Chris Kresser: No.
Dr. Kara Fitzgerald: He’s in finance. It’s the micro movements; posting on Twitter or getting your word out as a clinician or as a patient. Participating in being the stone, the pebble in the water that causes the ripple. I had a patient really early on back when being gluten-free was oh my gosh-
Chris Kresser: Revolutionary.
Dr. Kara Fitzgerald: Yeah. Exactly. He was the best. Actually, I still work with him. I’ve been working with him longer than anyone and I love it. I love it. I was in a tertiary care pain center in New Haven, Connecticut and he was on literally 19 medications including Oxycodone, Fentanyl, just it was an incredible cocktail of toxic medications. Now he’s not on anything and he’s just such an awesome individual, so inspiring. But he would hang out in the grocery store and educate anybody who came into his stare.
Chris Kresser: He would listen. Yeah. Yeah.
Dr. Kara Fitzgerald: I just love it. I love it.
Chris Kresser: Yeah, I mean it’s as simple … I’ve had people come into my practitioner training program. We always ask where did they learn about Kresser Institute. For me, at least a surprising number of doctors heard about me from their patients and their patient brought them a book or printed out a blog post or something like that. Yeah, I see your point. Don’t underestimate the impact you can have by just a very what might seem like a small step. It can have big repercussions because in that situation a patient gives a blog post or a book to the doctor. The doctor goes and gets trained in functional medicine and then goes on to treat 5,000 patients in her lifetime. This unbelievable impact from that seemingly small action.
Dr. Kara Fitzgerald: Yes. That’s exactly right. One individual’s restoration of health in this paradigm it does not stop with that individual. I don’t care how shy or quiet you might be. That transformation, just the physical change it has an impact on people around us. It’s an amazing thing. I just wanted to comment too again knowing that a lot of clinicians listen to this podcast. I spent some time actually my entire team and I worked really closely to design our vision and our mission and our guiding principles and that created our direction. It actually A, let us see what we’re doing, which was amazing and very empowering but really create who and what we are. Once that was done, it was a good exercise for us and once that was written down, we see it manifesting like it has taken on a life and movement of its own. That piece for clinicians moving into this paradigm, I would just encourage you to do. It’s powerful work.
Chris Kresser: Absolutely. It’s never too late to start. We have practitioners that are in their 60’s in the ADAPT training program and this one woman, her enthusiasm is so infectious. She was totally burned out and just ready to quit and thinking about retirement and I got an email from her a few months ago. She’s like, “I can’t ever imagine retiring, I’m so excited about my work in a way that I’ve never been. Why would I ever stop doing this?” That just brought tears to my eyes because it’s just such an incredible gift to give to yourself and of course to give to your patients as a practitioner to believe and be that passionate about your work.
Dr. Kara Fitzgerald: Absolutely. Folks, I will have the links to everything that Chris has mentioned and I’ll make sure we get the name of his new book Unconventional Medicine up there and site and a link over to his ADAPT program. Your next steps should you be inspired to go there, links will be on the show notes. So, Chris just in our final minute I wanted to just ping you on anything new in your space. This is a kind of a little bit off topic but is there any new research that’s standing out for you? Any new…
Chris Kresser: Yeah I mean, I think we’ve touched on this a little bit a couple of times throughout the interview but I’m really focused right now on health coaching. I think that’s been a big missing piece in the delivery of care for all the reasons I said before. Most of my time right now is going to launching our health coach training program through…
Dr. Kara Fitzgerald: Ah.
Chris Kresser: For the first two and a half years, we’ve been training mostly licensed clinicians like MD, DO, ND, chiropractor, acupuncturist, nurse practitioner, physician assistant, et cetera and that’s awesome and we’re continuing to do that. That’s still a major focus of perseverance too. In June of this year, we’re actually launching the ADAPT health coach training program. I’m super excited about that because we’re trying to create an ecosystem now where we have licensed clinicians that are working side-by-side with health coaches that share the same framework and foundational approach. I think there’s just an incredible power that can come from that kind of synergy. I’m really jazzed about that.
Dr. Kara Fitzgerald: Wow. That is really cool. It’s needed and I’m sure that you’ll do a fabulous training for the folks going into your program.
Chris Kresser: Thank you. I’m looking forward to it.
Dr. Kara Fitzgerald: Yeah. Absolutely. Well, Chris it was really great to get to chat with you today on New Frontiers. Thank you so much for joining me.
Chris Kresser: Likewise. It was such a pleasure to be with you again and thank you so much for all the fantastic work that you continue to do and it’s great just to know that we’re all out there supporting each other and making this happen. It’s an exciting time to be in this field and I’ve really enjoyed getting to know you and continue to collaborate with you.
Dr. Kara Fitzgerald: Yes. Absolutely. Absolutely. Okay.
Chris Kresser: All right. Take care.
Dr. Kara Fitzgerald: Thanks.