Functional Medicine’s Role in the Pandemic Era with Amy Mack and Dr. Patrick Hanaway

This is an exciting year for us in functional medicine, with the Institute of Functional Medicine (IFM) celebrating its 30-year anniversary alongside its Annual International Conference (AIC) on resilience in functional medicine. My guests in this podcast, Dr. Patrick Hanaway MD and Amy Mack CEO of IFM, join me to discuss how functional medicine is addressing the triple pandemic of COVID-19, racism, and economic crisis. Dr. Hanaway is a board-certified family physician, senior advisor to Amy Mack at IFM, and a founding medical director at the Cleveland Clinic Center for Functional Medicine. Amy Mack spent the last three decades in mission and service-oriented organizations and is now helping lead the IFM through uncomfortable territory as they not only offer evidence-based education but take action on the most pressing issues we are currently facing within our communities and healthcare. This is a powerful conversation with an important call to action, so stay tuned to learn more about the COVID-19 tools IFM has created for practitioners and patients as well as highlights on IFM’s upcoming AIC. Settle in, this is a good one and sneak peak at the exciting schedule for AIC! As always, thanks for listening, and I so appreciate any comments, reviews, and ratings wherever you listen to New Frontiers. ~DrKF

Functional Medicine’s Role in the Pandemic Era with Dr. Patrick Hanaway and Amy Mack

How is functional medicine working to address not only the COVID-19 pandemic, but also the pandemics of racism and an economic crisis? In this episode of New Frontiers, Dr. Hanaway and Amy Mack discuss the unique role of the functional medicine paradigm in today’s pandemic era, including the Institute of Functional Medicine’s (IFM) resources on dietary and lifestyle interventions, supplements, testing and vaccine data and how this approach supports practitioner and patient resilience. Join us to learn more about IFM’s upcoming Annual International Conference and how functional medicine is paving the way for an approach to healthcare that is accessible, inclusive, and can change the trajectory of future generations yet to come.

In this episode of New Frontiers, learn about:

Dr. Kara Fitzgerald: Hi, everybody and welcome to a New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine and of course, today is no exception. I’m always excited about our guests. Actually, we’re closing in on almost 100 podcasts. I’ve been doing this since 2015. I’m always excited about the human beings that join me in conversation. So today we have Amy Mack and we’ve got Dr. Patrick Hanaway. I want to give you their backgrounds and then I’ll give you the topic.

Amy, as you probably know, is the CEO of the Institute for Functional Medicine. She started with us as COO and has now really moved beautifully into the role of CEO. And I think she’s guiding IFM in a powerful and important way. We really need you right now, Amy. So she spent the last 30 years in mission and service-oriented organizations focusing on empowering individuals and community to drive systems change. Before joining IFM, she was the executive director at Europe Puget Sound in Seattle and CEO for two Big Brothers Big Sister Affiliates. She graduated with a BS in biology from Indiana University and an MSES-MPA from Indiana University School of Public and Environmental Affairs.

Dr. Patrick Hanaway, of course you are familiar with him at the IFM for years. He’s a board-certified family physician trained at Washington University and past president of the American Board of Integrative Holistic Medicine. He currently serves as the senior advisor to the CEO, to Amy at IFM. And he was previously the CMO at Genova Diagnostics and chief medical education officer at IFM. He was the founding medical director at Cleveland Clinic Center for Functional Medicine. He also served as the research director and currently serves as the as a research collaborator. Dr. Hanaway’s focus is to leverage his skillset to transform medical practice through education. Patrick and Amy, welcome to New Frontiers.

Amy Mack: Thank you-

Dr. Patrick Hanaway: Thank you so much for sharing.

Amy Mack: … I’m so glad to be here.

Dr. Kara Fitzgerald: So today, folks, we’re going to just dig in to where IFM is right now in terms of the mission of moving forward the COVID conversation and the training in the medical space. We’re also going to look at changing the functional medicine paradigm in terms of delivery, like a holistic delivery to meet everyone’s needs. So moving outside, moving through racial disparities, and embracing them and just really expanding the paradigm. I think this year’s AIC, which we’re going to reference a handful of times is doing both of these.

I’m going to start our conversation with Patrick, and then I will talk to Amy. So Patrick, you and I podcasted a handful of months ago. Actually, it was one of the most powerful podcasts I’ve done. I loved it where you shared your personal health journey over the past few years. And so we’ll link to that in the show notes, if people want to exclusively focus on it, but tell us just a little bit about that and how you’ve cultivated resilience in your own life and how that’s impacted you and how has it impacted you as a clinician?

Dr. Patrick Hanaway: Well, thank you, Kara. It was and is a powerful influence in my life. So I’ve had a lot of opportunities in functional medicine to be able to learn and grow and help people learning in those aspects on a personal level of like working with insulin resistance and working with how to be able to optimize my own health and wellbeing. Then two and a half years ago, right before Thanksgiving, being diagnosed with a stage four laryngeal cancer and that I’m say caught me off guard and was one of… I’ve talked about cancer as an agent of transformation with my patients, going back 30 years.

It’s like, so what do I need to transform? What do I need to change? What do I need to learn? How do I do this? And really working to ask for help, not a typical role for me. Usually it’s offering help and support to people, but asking for help and just finding an unbelievable support system that was there including, and especially within the functional medicine community to be able to offer me perspectives and views. And what my relationships allowed me to be able to find or what is the best way to approach this? And learning from others who had gone through it, like our mutual friend John Weeks. We spent a lot of time talking about that because John had a similar diagnosis 10 years prior to me.

So being able to go through from a root cause analysis of what was going on. Certainly, I talked with people who I think Tom Siegfried, I first heard about through you, some many, many years ago, and Dom D’Agostino and looking at that ketogenic diets and fasting and approaches. And what I found was a way to not just take the concepts, but really to discern through and how to I apply them and how does it work for me specifically, working with and integrative oncologist, who’s been a part of the functional medicine community that was referred to me by our friend Mark Hyman that is Nalini Chilkov in Santa Monica. She helped me in the process.

So I just moved through the idea of what I want to do everything I’m working with, the conventional medicine approaches of radiation therapy and chemotherapy, but also looking at the use of a ketogenic diet and doing that through a tube feed, which is a whole different ball game of a learning nutrition in terms of, okay, well, it fits through a thin tube going into my stomach because the radiation was going to affect my ability to swallow, and through it all. Then using Dr. Longo’s approach on who…

And I’ve known about this and I’ve been working with tools like ProLon and fasting mimicking diet. And I knew that it arose originally from how to decrease side effects and increase efficacy of chemotherapy. But I never really engaged that until I was, and then I have to get chemotherapy, oh, I should do this and I dove into that more deeply than one as Dr. Longo was going to talk at our annual national conference.

But I have since you said, “How has it affected practice?” I’m seeing a lot more cancer patients and the idea of fasting before chemo, it’s like, there’s a ton of very interesting data on that. And I find it’s the area where some of my oncology colleagues have the greatest resistance, like they’re not ready to engage that and yet the benefits to the patients that I’ve seen are incredible in terms of decrease, especially in terms of decreased side effects. That’s what we can see really right up front.

To me, they’re all aspects of the functional medicine view, which is looking at all of the elements in the therapeutic relationship and the root causes and how to bring these things together in a systems biology and you, as you said, holistic framework to be able to do that and apply it. That’s what I did and that’s what I got the support from the community to be able to do, to the extent that my oncologists would continue to say, “You’re not acting like all of our other patients who’ve had this kind of therapy.” While it was difficult it was something that I was able to move through.

So now two plus years out from finishing therapy, no evidence of disease on PET scan and continue to look at biomarkers and doing well, and seeing more and more cancer patients in my own practice, applying the same kinds of approaches and tools to be able to help them to be the healthiest cancer patient going through what they’re going through.

I’m not trying to define what the whole course of treatment should be. I’m not an oncologist, but I am a physician who’s helping people to move towards being the healthiest they can be to optimize their own resilience to what’s going on. And that’s been really both an incredible journey and a teaching for me to be able to learn that in ways that were far more profound than I would have imagined, and just really blessed to be able to share this.

Then I’ll say one other thing about that as we go forward and that is, in it, there was a level of uncertainty of not knowing, not knowing what’s going to happen, which actually leads to a presencing. It’s like, “Oh, I have to be really present in the moment. I can’t presume I’m going to know what’s going to happen.” It’s also prepare, so it allows what are the things that are going to help the most.

So that, as it turns out has been great preparation for this time of the SARS-CoV-2 virus of the uncertainty around that. And to be able to say, how do we listen and how do we use the best tools that we have available and how do we listen to where science is at and help people to apply it? There’s a lot of good information out there, but there’s also a lot of noise. So how do we grab that signal of what best practices are and amplify that using the discernment that functional medicine teaches?

Dr. Kara Fitzgerald: Well, thank you for that. I want to unpack just a little bit of what you’ve said, because you’ve said many important things. And just witnessing Patrick, being witness to your journey, you’ve used, as you said, the breadth of interim interventions from very sophisticated functional medicine and both interventions and laboratory analysis, et cetera, to a standard of care oncology work to sophisticated nutritional interventions.

Actually, one of the things that really moved to me, you said this out at PLMI. Actually Jeff Bland was interviewing you in 2020 at PLMI and you talked about heart rate variability. The mind body piece, your journey is very mapped to the matrix. Really all of the nodes are involved in the lifestyle factors. The whole thing, you leaned on that tool big time.

But in speaking about just the center of the matrix, something that really struck me was when you mentioned your heart rate variability really kind of leaping forward. I’m paraphrasing this, you can correct me, was when you were like stomping around in your creek, right, on your property. So just the full thing.

Dr. Patrick Hanaway: It’s in the notes that you have, but it was just that I’ve been using a tool like the Oura Ring for about five years now. And what I find and I found it during this time with cancer is that when I’m in nature just playing that my heart rate variability improves like two to three-fold. And that was a great awareness point for me that I found during that time where I was quiet enough that I could actually see the changes and learn from them.

Dr. Kara Fitzgerald: Beautiful. Beautiful. Yes, I’m a fan of the Oura Ring as well. I think it does help bring attention to my heart. It’s useful for similar reasons. So in our show notes, folks, we’re going to link to Patrick’s our previous conversation. If we can link to the PLMI conversation with Jeff Bland, we will do that. There are a lot and we talk about. In fact, on Patrick’s show notes from our podcast, we have his treatment plan. He shared a lot of content with us. So if you’re interested in drilling down into that, just look at our current show notes.

So now you moved from this journey really into managing the IFMs response to the pandemic, along with Joel Evans. Can you just speak to that and what you’re doing, who’s a part of it, the tools that IFM has created for clinicians? And I think that some of the content is actually available to everybody. So just speak to what you’re doing and where you’re going with that.

Dr. Patrick Hanaway: Sure. Sure. Well, I’m going to just set it up in that at the beginning of last year, Amy and I were having conversations and I said, “I want to be able to support functional medicine and what is the way to do that?” And she said, “Well, helping with the development of research and some other areas that it would be great to support her in that way.” And I said, “Sure, I’ll do that.”

I said that like at the beginning of May and it felt like over the weekend. I think it may have been two weeks later. She said, “I’d like you to help lead this task force on COVID.” It was coming forth and we were seeing in our field, you and I were a part of an exchange of emails amongst 40 or so educators, where it’s like, oh, wow, there’s a lot of energy here. There’s a lot of questions. There’s a lot of knowledge. And it’s like, oh yeah, we need to do something.

So I was privileged to have the opportunity to be able to do that and with a great group of not only Joel Evans who you mentioned, but Robert Luby, Dan Lukaczer or a number of other educators who were part of our rapid response team. It was like gathering information and like, okay, well, we don’t know how to treat, how to decrease the symptomatic effect of the SARS-CoV-2 coronavirus.

But we do know something about coronaviruses, and we do know something about viruses, and we do know something about the immune system and how to build resilience. Let’s gather the best evidence and be able to take that through our own standards process of evaluating the evidence. What is the evidence of benefit and what is the risk of harm? We were able to apply standards that Amy and I had worked together as co-chairs on our standards committee to develop. So now we were applying directly.

So we began with that process and we put forth webinars and publications, and supported work that you were doing with Joe Pizzorno and Sam Yanuck, just helping to get the word out on what to do with how to be able to help support individuals. I recall seeing Chris Cuomo in his basement on TV saying, “Well, there’s really nothing you can do. Just sequester yourself if you get it and hide and hope you don’t get really sick. And if you do get really sick, go to the hospital and say, no, no, no, there’s so much more you can do to decrease the symptoms, to decrease the progression should you get it.”

We’ve been promoting that and as we look back now, literally a full year of even a little bit more than a year, a week from when we first put out our guidelines and recommendations, they hold the test of time what we’ve been recommending to people and will help with other viral pandemics in the future. So that’s really IFM’s role has been to be a platform for credible curated information about or what is the best evidence that we can go forward to be able to decrease symptoms, support the immune system, and decrease the long-term sequelae of what’s going on.

So we’ve continued with a course that we developed a resistance, resilience, and recovery patient care in a pandemic, which is a great six-hour course that has over 20 different educators doing small little snippets of teaching to carry practitioners and patients, if they wish, through a deeper understanding of how to work with decreasing the morbidity and mortality from COVID. We have on our website, information that’s available on diet and nutrition and lifestyle, on nutritional supplementation, on testing, on vaccines.

We’ve developed webinars, but by Dr. Joel Evans and Dr. Robert Luby on ongoing aspect, looking at post-acute sequelae of SARS-CoV-2 so-called PASC or long COVID, post-COVID many different names. But you’re looking at that and also giving credible information about vaccines, the concerns. We could talk for the whole time just about that, but for myself I’ve had an approach that is like standing in the middle ground, finding out the information about vaccines of what’s good and what’s not good. And what are concerns and how do we address those concerns and how do we give again, incredible information to individuals.

That’s what we’ve done, putting together a vaccine dashboard and webinars to educate people working with Heather Zwickey, who’s been on this show previously and working to give people the best information possible so they can make decisions that will help them to decrease the overall effects of COVID on their lives.

Dr. Kara Fitzgerald: Thanks for that, Patrick. Indeed, it’s very rewarding to witness what we began to unpack a little bit earlier than this time last year and what you’ve been educating on at IFM. Actually, I participated in the training, but just authoring, I’ll add Helen Messier to the Sam Yanuck and Joe Pizzorno paper. In fact, I’ll pop that on the show notes, folks. Just it’s a free peer-reviewed paper that has a nice table that you can access if you’ve not seen it yet for interventions that we’re recommending.

But it’s very satisfying to see that we’ve done a decent job here, vetting them. And you guys, especially being on the task force and in the mix. I just thank God, Patrick, that you had the resilience and that you all pulled together such a strong team, and you were able to lead the charge in this. I just want to ask you… Go ahead.

Dr. Patrick Hanaway: I want to add one thing because I just want to give props to Amy for seeing it coming down and saying, “We got to jump on this,” and really gathering the resources and the team together to be able to do that. She had the vision to do that. I really appreciate that.

Dr. Kara Fitzgerald: And Amy, we’re going to swing over to you in a minute, but we also were faced with the second pandemic of this crisis of racism and health inequality and just right there, right there, as just powerful and important. And we’ll pick up that thread because it’s important that we talk about it. But Patrick, I wanted to ask you, and I think what’s on folks’ minds now, what on clinicians treating folks with COVID or identifying them as long haulers. Can you just unpack a little bit about what you’re doing? What kind of resources do you have on this next generation stage of COVID?

Dr. Patrick Hanaway: Well, developing those. And as we were talking about in April of last year, it’s like, well, really the organizing focus is the matrix of the functional medicine matrix itself, and looking at the imbalances of what’s going on and we’ve seen that become a bit more refined where the elements of looking at what’s going on with the gut microbiome, its relationship to the immune system and the two of their relationship to mitochondrial function and energy production. Because we see people who are having issues with the gut-brain-microbiome axis, people who are having issues with energy production and brain fog and fatigue and cardiac issues that are going on.

Now, there’s a subset. There’s some different phenotypes that are being expressed in some will have more clotting kinds of issues of going on. Some will have some respiratory issues going on, but the predominant one seems to be this one around this post viral fatigue. We’ve seen Jeff Bland has talked and written about where this is not new to us in functional medicine. We’ve been dealing with this kind of thing. It’s just that now we have a very clear point source that’s happening, It’s this virus, which is causing this post-viral imbalance.

So we use the tools of looking at the gut-immune axis and the gut-micro mitochondria axis to be able to work to understand what’s underlying this. We see some patients where it’s really clearly focused on their modifiable lifestyle factors in their diet, in their way of dealing with stress and those issues. Then we look for are some extrinsic underlying causes in my patient population that that’s how post-COVID. I’m seeing that it’s those people who have underlying infections, hidden infections and other toxicity that are the greatest risk for that. That was sitting there, kind of unmasked or covered. Then it becomes, if you will curious choice of terms, unmasked through the COVID infection and its effect on the immune system.

So that’s where the focal point is in the PASC at this point in time and what we’re doing. We’ve actually been having conversations with the Institute for Systems Biology and Dr. Lee Hood will also be speaking at our conference in looking at characterizations that they have where they’ve published and recognized that in acute-COVID, there is a shift that goes between mild and moderate to severe, where there’s a significant change in what’s going on with immune system and in the utilization or actually almost like capturing of macronutrients and micronutrients that causes a fundamental shift. And it appears that that is the shift that in those patients, they’re much more at risk for the post-acute sequelae from COVID.

In that, the thing that we are hoping is that by giving the vaccination and decreasing the severity of even if they get the SARS-CoV-2 infection, that they will not move into that immune imbalance and dysfunction, that then progresses into the post COVID picture. We don’t actually have data that says that that’s the case, but we do know that it’s the people who have more [severe], more severe acute-COVID, who have a much higher degree of post-COVID kinds of symptoms.

People are hospitalized, it’s like 40%. People who are not hospitalized, it’s probably like 10 to 15% will develop these post-COVID pictures. If we use the vaccine and decrease the number of people who are hospitalized, we should be decreasing the number of people who are having post-acute COVID.

Dr. Kara Fitzgerald: That’s correct

Dr. Patrick Hanaway: We still need data to support that, but that’s one of the reasons why we’ve moved to really take a proactive stance looking at the data, in this case, the efficacy of the vaccines which is from the randomized control trials. Now we see from Israel and other areas, the effectiveness, the real world data on the effectiveness of the vaccines, not only in decreasing the morbidity and mortality, but also helping the people who have not received the vaccines.

We see decreased incidents of disease in that population as well, moving towards herd immunity, not getting there yet, but moving in that direction. So in this case, we find that the vaccines are a very useful tool in the armamentarium, but we also recognize it has to be integrated with those modifiable lifestyle factors, looking at diet, eating a non-inflammatory diet, not eating processed foods or ultra-processed foods, and using those kinds of nutrients that are going to support immune resilience.

Dr. Kara Fitzgerald: Thank you. I know that you’re carefully unpacking the different phenotypic expressions of post-COVID. So for those of us who are working with post-COVID patients now and we’re not sure where to go, map to the matrix or as Tom Sult says, lapse the matrix, lapse the matrix, lapse the matrix as Patrick is saying, and I think you’ll walk with your patient to where they need to go in their recovery journey.

But also Patrick, just the fact that you’re teasing out the different phenotypic presentations of long COVID is just going to be incredibly useful. I cannot wait to hear Lee Hood present at AIC on their data. It’s ridiculously exciting. So it’s satisfying for me as a clinician, but it’s also satisfying for me as a researcher. And being able to deliver smart, translate the science so that we can deliver it to our patients as quickly as possible. So bravo on all fronts there.

Let me see. I want to jump over to Amy, but beyond, we’re going to be digging into… So all of the tools are available to clinicians and some to, actually anybody can access the tools that you’ve put online, but we’re going to be digging down at the AIC (Annual International Conference), into COVID-19 from a handful of different vantage points. Anything that you want to mention, any beyond Lee Hood and of course, Dr. Longo, Valter Longo is going to be there as well. But any other lectures that are standing out that it would behoove us to be at?

Dr. Patrick Hanaway: Well, I do have to just honor one of my mentors and early teachers, Leo Galland. And Leo has been on the frontline of looking at COVID simply by being in New York City at the beginning of this, and really thinking through how to be able to approach this. So I’m particularly interested in hearing from Leo. Joseph Pizzorno, our president, is going to be talking about the aspects of nutrition, really and essential nutrients and how that unfolds. So those are some that I’m particularly looking forward to.

Then we have this whole series of concurrent sessions that are going on, where we get to hear from our clinical colleagues of different kinds of approaches. And whether it’s people like, Sara Gottfried and Georgia Tetlow, Mark Hyman, friend, Kat Toups. I just looked down through this Sunjya Schweig, who’s with the California Center for Functional Medicine. There’s a lot of great things that the clinicians are out there doing and working on. So I’m super excited about that.

We have the big names and then of course, Amy will talk about the lead off with one of the new board members, and newer board members for IFM and that is Dr. Gail Christopher and her work that really helps to open our eyes. Then Bob Naviaux has been doing great work on understanding the whole kind of chronic fatigue, myalgic encephalomyelitis, which is really this whole post-viral piece. I think he’s going to be offering some big views and talking about as Joe Pizzorno does, about the exposome as well.

The Annual International Conference is really the cutting edge of how do we begin to learn and grow and their ideas that I learned 20 years ago that I’m applying now. so I know that the things we’ll be learning there will be applying for many years in the future.

Dr. Kara Fitzgerald: Yes, absolutely. Well, and just the fact that we’re circling back to post-viral syndromes looking at chronic fatigue and bringing back that rich body of knowledge we have from those other viral induced long-term problems, that’s the lecture that I’m really looking forward to. And also different populations. So Liz Mumper is going to talk about anxiety and depression in kids. She’s an awesome pediatrician who is on faculty at IFM and that’s useful and looking at veterans. So it’s good information.

Thanks so much, Patrick. Thanks for hopping on and joining me in this and talking about some of this important content. Amy, I want to just circle over to you now. Last year when you opened AIC, first of all, that was… I don’t know if the previous year’s AIC ‘s are available for download, but your opening remarks were some of the most powerful that I’ve ever heard, very moving, because we were indeed settling into the reality of these two pandemics. God, it was an extraordinary time, just this time, last year. On one hand, we were opening our eyes to COVID-19 and the extent of the damage.

Then we were also just thrown into the events, the murder of George Floyd and the other tragedies that were occurring. And we were also realizing that there was this massive health inequity going on with regard to COVID. So much was happening at that time and you were able to introduce it and just be in that fire this time, last year. And guide IFM honestly, just in an extraordinary way, your courage and your vision. So talk to us a little bit about how this whole process, these pandemics has shaped your thinking over this past year in your work with IFM in the field of functional medicine in general.

Amy Mack: Thanks, Kara, and thanks for having us on today. I was actually getting fueled even further by hearing the conversation between you and Patrick. So thank you. Well, I think what’s most encouraging actually about what you just said in that question, is that where we find ourselves today with the two pandemics of the COVID-19 pandemic, but the public health crisis of racism that actually the public health crisis of racism is still a conversation that we’re having. And I think one of the major challenges that we’ve had in that space over the years, tens of years that as a country we’ve in some ways tried and failed to solve this issue is that we talk about it for a little bit and then other things take its place. And we go back into our thinking.

So I really appreciate that actually as a country, and I’ll say for the piece of it that we’re talking about today as an organization, we’re not just still talking about it. We are actionably in it. And we are in it in ways that make us super uncomfortable, and that’s exactly what it should be. So for me, I feel energized. Earlier this week I had a chance to have a conversation with Gail Christopher, who she joined our board this last year. And honestly, she’s one of the most inspiring and yet approachable people that I’ve ever met in my life. And every time that you engage with her, you learn something new about how to think, but it’s put in front of you in a way that doesn’t make you flinch. She’s like, “Yeah, we need to hear that. Please keep talking to me about it.”

She’s going to open up for us at the conference in a powerful way that will connect back to the opening that I gave last year. I’ll do a continuation of that theme, but she’s really going to talk to us about not only the two pandemics we’ve been talking about, but then adding in the economic crisis as a third pandemic. How that has shaped, how those pieces have really shaped us over this year is we really in this moment feel like, and know that it’s true, that functional medicine or personalized medicine root-cause medicine, integrative medicine, however you want to label it, has answers that if you’re watching the news every day, we’re being told aren’t available.

So what it does for me is say, conferences like AIC are critically important, not only for our tribe, but for us as individuals of our tribe to talk about in other places where we get uncomfortable, where we know that our thinking isn’t as popular or in some ways can even be seen as not science. But we know that we have the evidence to back it up that this uncomfortableness that we’re living in and lots of communication, we should be taking it right into the how do we start talking about what we’re doing to other people who have been resistant to us in the past.

So I see this culmination of all of the work we’ve been doing with COVID and the good work that’s still to come leading into this conference, and then us really taking on starting to build the training modules that we need to be building as a leader of the functional medicine movement around implicit bias, around really talking about racism, around not just saying the social determinants of health, but actually understanding what that means and what the impact is. And that’s really what we’ve led up to with this year’s conference.

Dr. Kara Fitzgerald: It’s just so exciting. It’s really exciting. It’s absolutely essential and now is the time for us to expand. Resilience is the theme that we’ve been talking about here, that this weaves our entire conversation and obviously, it’s going to be… It’s intrinsic to probably every lecture that will be delivered. So in this year when we’re all dealing with so much, can you talk a little bit more about how you chose this theme and how it’s impacting your thinking around the conference?

Amy Mack: Yeah, absolutely. We’ve been having conversations with practitioners and with institutions of course, over the last year and really trying to understand what the impact has been on them. And one of the things that’s been interesting about those conversations is that what we’re finding is practitioners that we’re utilizing a functional medicine approach that had a telehealth plan in place or could easily make it accessible, that actually their practices worked during this time.

So there was a resilience simply in the message that they already understood how to put in place right out of the gate. But in addition to that, the fact that we… One of the main pillars of the work of IFM is about building confidence and competence. That’s what we set out to do through our education. And that work isn’t simply about memorizing things in a slide deck.

That’s actually about providing the tools to be able to think about things and be able to boost the resilience of the practitioner for the work that they need to do, and their ability to partner so well with their patients to tap their patients’ resilience and their patients innate ability to heal. And that healing is both about their health, absolutely about their health, but actually about how do we step into that healing for communities.

So what you’ll see coming out at AIC, this is the place where every year, the whole point of it is to come together and learn the latest and the greatest of functional medicine. What’s out there? What do we want to be sure that our family knows about? But we’re taking that further. We’re going to be presenting about the latest research in functional medicine, but how it actually connects to community.

We’re talking about resilience in every sense of the word, the resilience of patients, practitioners, administrators, researchers, how do we continue to boost their resilience to do the work that they need to do. The resilience of the human body in the face of adversity, what it that we need to be doing to support that and how do we communicate that in a way that it can be heard?

So that theme you’ll see it interwoven and our hope, really what will be our ask is that you take that message back out from the conference and you extend it further into audiences that need to be hearing about it. The last thing I’ll say about it, I’m a news junkie. So I’m really pretty much all the time in our house, the news is up on the screen, silent, but up on the screen. It can be bad, but it is where I live.

When I watch it and I listened to people say, “Well, we don’t have a lot of solutions for that, so the masks are still important and remain socially distant.” We knew that we needed to do those things. We knew people needed to wear masks and we knew people needed to wash their hands, remain socially distant, but we knew we had so much more to offer than that. And we kept pointing at the screen and saying, “Well, they aren’t talking about our stuff. Why aren’t they talking about our stuff?”

This conference has to be the point where we start to break through that. They will be talking about our stuff if we’re getting into the hands of the right people. So hopefully people will walk away from the conference ready to do that.

Dr. Kara Fitzgerald: This is a call to action. This is really direct call to action. I hear you and I hope in your opening remarks, you continue… That you say it again. That you say it loud and clearly. It’s not just those of us who have the honor and privilege to be on faculty. It’s all of us. All of us have integral essential roles in changing the paradigm and all of us are expert at something that is essential to changing the paradigm.

There’s just absolutely no doubt in my mind that this is an all hands on deck moment. So when you’re at the conference and you’re feeling that hint of inspiration, I’m saying this to the folks who are listening, pay attention and think about it. How can you pull that thread forward? And the people who are presenting at this conference and the IFM community is phenomenally available.

We are a web. We are interconnected. And if you have a vision, if you want to make movement in your community and you need support, chances are, you can find it. Gosh, Amy, I’m just feeling like we need a clearing house around this. I’m specifically thinking about a friend of mine who is training. He’s moving through certification and he’s in an urgent care, a large urgent care center in Connecticut. There’s offices all over the place.

He’s going to have a functional medicine, They’re going to have functional medicine clinic hours at this system. I know it’s so cool. It’s so exciting. I know that we’re not the only state, but he said to me, so he wanted to… His expectation was that he was going to need to sort of jump into, I’m going to say our boutique scale functional medicine practice.

Tom Blue calls it tertiary care or boutique medicine, but it’s a little bit old school. It’s not the functional medicine model of the future. What he’s doing and the fact that that urgent care chain is going to allow him to do it is where it’s at. And immediately I was able to connect him with some folks through IFM. And maybe this sort of resource, we can evolve it so that people who are out in the community can lean on us, no pressure.

Amy Mack: No, It’s okay. I’d love to just comment on that for a moment because those conversations with institutions, we’re having more of those right now. We knew coming into the COVID pandemic, physician burnout was such of important question that again, people were stumbling around, like what’s causing it? How can we change it? When we talk about confidence and competence, again, that’s not just memorizing.

When you’re in leadership, when you build confidence in someone, it’s not making sure their head has all the right material in it. It’s helping them to pattern the way that they think and helping them to be able to, in the moment, digest what’s in front of them, apply the things that they know, and then make it so for that problem, they’re trying to solve.  And that’s really what it is that we bring through functional medicine. It’s that frame, that way of thinking.

And practitioners and institutions, they have so many rigid rules that they have to follow for lots of good reasons in many cases. But if we can infuse it, and this is literally how it’s described to us, as we have these conversations. We’re looking to infuse in the functional medicine way of thinking to support our practitioners in the work they do every day. Now that’s very different approach then there’s functional medicine and then there’s other things.

Dr. Kara Fitzgerald: Right. That’s right.

Amy Mack: This is actually about bringing them together.

Dr. Kara Fitzgerald: That’s right.

Amy Mack: And that power, that power, actually will take this kind of medicine forward and allow all of you as practitioners to be able to do what you set out to do, which was help your patients to empower themselves to feel better. That’s how it happens.

Dr. Kara Fitzgerald: It’s really exciting and because of that, it can work in an urgent care setting or in a hospital setting. That’s right. Good point. And I know we’ve got lots of just thinking about resilience and supporting and expanding what we’re able to do. I’m looking forward to Tom Blue and Sonda Kunzi presentation, just the practical. But just the expansion of the insurance model in COVID and what we’re going to have access to now is phenomenal.

Amy Mack: So exciting.

Dr. Kara Fitzgerald: Yeah. I know there’ll be touching on that. So there’s a lot of good clinical and research content. We’ve already touched on it. If you want to give me just a rundown on additional expectations, what we’re going to be learning, what we’re going to take home with us.

Amy Mack: Well, you’ve mentioned a few, but I’ll touch on a couple. So I think we mentioned that Dr. Gail Christopher will be our opening keynote, talking about what she calls the triple threat, that’s triple pandemic of COVID-19, racism, and economic crisis. And I think that talk will not feel like being told the same thing you’ve heard. She actually comes at it from the standpoint of how do we move toward healing to move forward and actually being solution driven. It is a powerful talk.

Lee Hood will be onstage for us, which we are really excited that he is coming. He is excited about talking about the Million Person Project, which both you and Patrick have mentioned. And really that systems biology approach to healthcare. Valter Longo, I know you have mentioned him a couple of times. Patrick talked for a moment about Dr. Joe Pizzorno’s talk…

The thing that’s really interesting about what he’s going to be talking about, I think the title is sort of a funny title. It’s those nutrients that have vanished, those molecules that we thought were not important, but have vanished. And his way of telling that information is so digestible and you get drawn in to him.

Georgia Tetlow will be together with Riva Robinson. And if you don’t know either of those, I know Kara, you do, but for your audience, if you’re not familiar with either of these amazing women practitioners talking about physician burnout. It’s an interactive presentation that they’re going to be doing, something different that we’ve never done before.

We’ll of course be talking about food, lots of place to talk about food. Dr. Ocean Newby and Dr. Daria will be talking about functional medicine and whole health in the VA. We actually have a grant that we just got engaged with, with the VA around bringing functional medicine into the whole health model. That’s super exciting.

Then we have a couple of talks that are about functional medicine associated with surgery and wound care. And that place we’ve known was really important, but we’re starting to get some real traction there in a way that reaches beyond our family.

So I think the overall, the topics, we will be hitting health equity. Health equity and the role that functional medicine can play in there. And quite honestly, the moral imperative of us understanding and reaching deeply into that space and being active as leaders in that space, you’ll hear that thread throughout, mental health and the role that functional medicine can play in mental health.

As I mentioned, there will be food and nutrition and then surgical outcomes, but we also are going to get a few updates about what’s happening at Cleveland Clinic. So that’s a really quick. If you want to see more, please, please, please, go to the website and take a look at what else is there, because there’s a lot.

Dr. Kara Fitzgerald: Yeah, there’s a lot. What else do I want to pick your brain on? There’s a major milestone we’re going to be celebrating this year as well actually. I was excited to hear about it, even though I grew up. I’ve been going to IMF for my entire career. Actually, even when I was in school, I was attending Bland lectures, Jeff Bland lectures, and so forth. But talk to me about what’s going on with the milestone and what kind of acknowledgement we might see.

Amy Mack: So IFM will be 30 years young or we are 30 years young this year. So I think just if you imagine 30 years. And really what has happened over those 30 years? Kara and Patrick, it’s practitioners like you actually. You’ve carried this whole thing on your back. For 30 years, it’s been happening. And we get to celebrate both the achievements and the look forward, what is coming now?

So I was joking that it almost like we’re looking back through scrapbooks and digging into the archives, because we really are actually looking back to your scrapbooks and then even the archives, and finding video clips. Then also we will have video clips sprinkled throughout the entire conference from voices that will be both familiar and I think will bring a tear to your eye for what their influence has been on functional medicine.

We also bring back the Linus Pauling award. We went last year without a Linus Pauling award. We were like, “Oh, this is… We were going to be on site or we were going to be online.” At that time we were thinking, well, next year we’ll probably be on site. Well, we didn’t want to go another year without that award. That award is critically important to the functional medicine movement.

So we will be awarding a Linus Pauling award which is super exciting. Then I think the most important part is that and I said this a little bit earlier, but this is the single moment every year that is the largest gathering of functional medicine practitioners in the world. If you settle into that, the purpose of that moment is for us to lift up and celebrate the amazing work that continues to happen in our space.

And that’s where I go back to this notion of we have to lift it up and celebrate it and move it out. So I think this is refocusing back to the roots of who we are and remembering the carrying on the backs that so many people have done in this process. And then what does it look like to really take it forward? What does it mean for us to take it forward? That’s really what we’re going to be talking about in that celebratory tone, but also, hey, we have a lot of work to do.

Dr. Kara Fitzgerald: Oh, that’s so exciting. It’s so exciting. I would not say that. Well, Patrick, maybe I can speak for you. I don’t feel like I’ve been carrying this. I am part of the stream. We’re on shoulders of greatness. We’ve got such an important… Just the fact that we have a Linus Pauling Award, our lineage is just so remarkable.

I was just a newbie student attending conferences with in awe, just in awe of the breadth and the depth and of the content, the science and the clinical and the translation of the science to clinical practice. And God, just one of the earliest lectures for me that is so sticky, it’s so sticky in my soul.

It was Bethany Hayes and estrogen metabolism. It was just such an important lecture that still informs my thinking to this day, anyway. So there’s many shoulders that we are inspired by and carry us all.

Amy Mack: I was a cheerleader, so I always thought about pyramids and bases and I was a base. So when I think about the base of where this started and really on the shoulders of Jeff and Susan Bland, and then David Jones and Joe Pizzorno and Mark Hyman, and I do put Patrick in there. That building and you mentioned Bethany Hayes, going back and being able to recognize that start, but then appreciate what’s to come, it’s just really important for us to do that.

Dr. Kara Fitzgerald: Fabulous. It’s almost essential because it will be very grounding to walk through that journey. And we are heading into bigger and bolder and important places. Patrick, did you want to say anything, I don’t want to jump forward?

Dr. Patrick Hanaway: No, I think you’ve covered it really well. I just know you were quoting Newton, we can see farther because we stand on the shoulders of giants. And IFM has grown to continue to expand the awareness, but also to expand the participation. We have more and more educators, more and more facilitators, more and more clinicians who are out there applying it and more and more research that’s being done.

It feels like we’re moving to that. That inflection point is where first we were irrelevant and then we were opposed. Now, we’re moving into the phase where it’s like, “Oh, all along, we knew this is good medicine.” Obviously there’s nothing to push against.

We find that from the thought leaders that we engage that the systems approach is just what makes sense. We have some experience with how to apply it and we’re being given that opportunity and more and more. I feel just honored to be a part of it.

Dr. Kara Fitzgerald: Yeah, it is. It is. It’s definitely deeply gratifying to be on this journey with everybody. That’s brings me to really, my last question is, the mothership lands, AIC for me is like mothership landing. And as you said, folks from all corners of the globe come who have embraced this model.

For years being onsite, I had my posse who I’ve danced a lot with and had so much fun with, and share notes with from originally just writing them on the blank exam books we would get to typing them out and on and on and on, but it’s always been a very nourishing time for me to connect with my people. And Patrick being one of them and just such an important and essential time.

Obviously, we’re going to be online and it’s going to be different. So how are you going to facilitate that connection that we’ve been able to do in person? How are we going to facilitate that for us online?

Amy Mack: Well, I think you’re absolutely right. It is the moment when you just can’t wait for the hug of that person that you haven’t seen for a year. Literally, if you could see me right now, I’m like teary-eyed with red nose because we know that that is missing and yet even last year, we were able to facilitate some connections that I think even surprised us.

We’ll be putting those back into place again this year. We have something called brain date, which is a really easy, spontaneous way to get together a small group or just a one-on-one video chat that you think, oh, well, I can set up a Zoom. Well, this is different.

It’s super easy to do it. You’d sign up and pick a time and you can interact in the way that you might say the same thing would happen with you bumped into someone and said, “Hey, let me meet you a little bit later at the bar and we’ll have a drink.” Well, let’s meet on brain date and have a chat. I want to catch up with you. So please look at those.

We will have cooking demos like we had last year, great cooking demos actually this year again and I hope that you’ll tune in for those. The poster sessions. Poster sessions, I think this is our third year, maybe fourth. We started those a couple of years back as a new way to be able to share more material that we couldn’t get into the conference, but we wanted to be sure that everybody thought.

And each year I think more and more people go, “Oh, gosh, I got to go to the poster session. I didn’t know that was available last year.” Please look into that because it’s not simply poster sessions like you go to a more science-based conference like my husband goes to research conferences that are all research.

It’s not like that it. Some of it will be that, but some of it is just talking about new ideas, new ways of thinking, sharing things that are upcoming. So please go to the poster sessions. Then we do have daily movement that happens every day. In the morning with early morning session, and then there’s a lunch session also, which is really a nice place to engage and interact. And those are on the Zoom platform, so you actually can see other people are doing that as well.

The Resource Center is a hub of all kinds of good information. Another new piece that we’ll offer this year is an opportunity to engage with board members. So we will have a couple of brain dates or sorry, Zoom sessions that are specifically about with board members, which is exciting.

Then the virtual exhibit hall gets better and better every time we offer it, really, really exciting. We’ll have close to 40 booths there, great material. Last but not least, this is a new addition this year is we will be just after the close of AIC. There is a new extended series around practice implementation.

These are going to be five 30-minute sessions. There are either clinical technical or business innovation, and they are about translating functional medicine education into practical application for your practice. So they are very much about take this that you learn and put it to work in your practice on Monday morning. So that’s new and something that I think people will be really exciting, excited to engage in.

That’s kind of the quick rundown. And Kara, we’ve just talked with you about a bunch of different things and you’ve been sharing a little bit off and on about what excites you, about the conference every year, but what is the one or maybe two things that you’re thinking, wow, I just can’t wait for this year?

Dr. Kara Fitzgerald: You know what, I want to say that well, there’s a difference. Always, I’m excited to be engaged by the amazing presenters and then seeing my colleagues and hearing what things my colleagues are up to, it’s just this interconnected web where we just raise each other in our ability to practice medicine and change the paradigm. So that’s always at AIC every year.

What’s different this year is that we’re grounding in our past with this 30-year celebration and I think that that’s particularly poetic as we face our expansion. If we are going to change the global medical paradigm, if we are going to change the disease trajectory that we live in as our medical model, we have to expand into health disparities, into racial inequality.

We have to bring this medical model to everywhere. It just has to be like a river that’s overflowing into the land around it and beyond. We absolutely have to do that. I’m so clear in that and so we’re doing that this year. You’re leading the charge in this, Amy. I just really want to give you a lot of credit. We’re moving into the uncomfortable, but essential conversations around racial disparity in medicine.

So that’s happening. The other thing is happening, and this is credit to Patrick and the COVID-19 task force. We’re talking about COVID-19. We’re talking about how to address it from a functional medicine model. We’re talking about some of the fallout of COVID-19 with regard to mental health. We’re looking at veterans and all sorts of that.

So those are two things that I’m excited about that are incredibly important, but the other in the final piece and the piece that just speaks to me as a kind of a research nerd at heart, is Steve Horvath is going to be there. The biostatistician at UCLA who developed the DNA methylation biological age clock. He’s going to be presenting.

And last year I presented my research where he used his original 2013 clock. The work that they’re doing on being able to measure biological age using DNA methylation patterns is just extraordinary. So I obviously can’t wait to hear that. And of course Lee Hood and he’s one of the guys who mapped the genome, minor detail and what he’s up to now, as he blasts into the Omics stratosphere.

Actually, Sara Gottfried is going to be talking about using this multi omic model for diagnosing early metabolic changes. And Valter Longo, I cannot wait to hear what he’s up to. I got to podcast with him a few years ago when it was such a… It was a great conversation. He’s in the thick, he’s in the cutting edge of science.

As Patrick mentioned earlier, applied science actually, he brought it into his own life and we’re all using Longo’s research in our practice. So to hear what he’s up to, big deal. So I feel like it’s going to be satisfying, really almost at a level that we haven’t quite hit before, even as all our previous AICs have been wonderful. So anyway, thank you so much.

Amy Mack: Thank you. I tried to write down all the things you were saying because they were amazing. It was beautiful.

Dr. Kara Fitzgerald: Oh, well, I appreciate you two joining me today and just getting to indulge in what we have coming up next month. Patrick, always good to be able to chat with you. Hugs to you both.

Amy Mack: Thank you so much, Kara.

Dr. Patrick Hanaway: Thank you so much, Kara.

Amy Mack: All right. To be continued next month at AIC. Ciao, everybody.

Dr. Patrick Hanaway: Ciao.

Dr. Kara Fitzgerald: And that wraps up another amazing conversation with a great mind in functional medicine. I am so glad that you could join me. None of this would be possible, through the years, without our generous, wonderful sponsors, including Integrative Therapeutics, Metagenics, and Biotics. These are companies that I trust, and I use with my patients, every single day. Visit them at IntegativePro.com, BioticsResearch.com, and Metagenics.com. Please tell them that I sent you and thank them for making New Frontiers in Functional Medicine possible.

And one more thing? Leave a review and a thumbs-up on iTunes or Soundcloud or wherever you’re hearing my voice. These kinds of comments will promote New Frontiers in Functional Medicine getting the word on functional medicine out there to greater community. And for that, I thank you.

Amy Mack is the current CEO of the Institute for Functional Medicine, where she formerly served as COO. She has spent the last 30 years in mission and service-oriented organizations focused on empowering individuals and community to drive systems change. Before joining IFM, Amy previously served as the executive director of Year Up Pugent Sound in Seattle and CEO for two Big Brother/Big Sister affiliates. Amy graduated with a BS in biology from Indiana University and an MSES/MPA from the Indiana University School of Public and Environmental Affairs.

Dr. Patrick Hanaway is a board certified family physician trained at Washington University and past president of the American Board of Integrative Holistic Medicine. He currently serves as the Senior Advisor to the CEO at the Institute for Functional Medicine. Dr. Hanaway previously served as the Chief Medical Officer at Genova Diagnostics and Chief Medical Education Officer at the IFM. He was the founding medical director of the Cleveland Clinic Center for Functional Medicine, where he also served as the research director and currently serves as a research collaborator. Dr. Hanaway’s focus is to leverage his skillset to transform medical practice through education.

AIC 2021: Resilience

IFM AIC 2021 Schedule

New Frontiers podcast with Dr. Patrick Hanaway

PLMI with Dr. Jeff Bland

Paper: Phased Approach to COVID-19 From Prevention Through Recovery, from Drs. Pizzorno, Yanuck, Messier and Fitzgerald

Dr. Kara Fitzgerald FxMed Resources

Clinic: Patient consults with DrKF physicians

Clinician Professional Development: DrKF FxMed Clinic Immersion

DrKF FxMed Nutritional Residency Program