Functional Medicine Bitesized | Defining Functional Medicine with Dr Pat Hanaway

What is Functional Medicine and what is its role in Covid-19?

Functional Medicine Bite Sized is the podcast where Functional Medicine Practitioner Pete chats to experts in the field of functional medicine and health, giving you the listener pearls of wisdom to apply on a daily basis.

In a recent episode, Pete Williams talks with long term mentor Dr Patrick Hanaway MD, special advisor to the Institute for Functional Medicine. 

Pete & Dr Patrick discuss a deeper understanding of Functional Medicine  - what is Functional Medicine? (and what is it not?) They discuss The Functional Medicine work at the prestigious Cleveland Clinic and validating this approach in the wider scientific community. Functional Medicine and COVID-19 is also discussed - how and why a systems approach achieves better results.

Listen to the podcast episode here, or find the written transcript below.

Welcome to functional medicine bite sized the podcast where Pete chats to experts in the field of functional medicine and health, giving you the listener pearls of wisdom to apply on a daily basis.

Well, good afternoon everyone. Functional Medicine has been a long journey for me over 25 years. And within that journey, there's been some key if you like, mentors who have helped me along the way, and I've got one of them on my first show today, which is Dr. Patrick hanaway, I'm going to just give you a brief on Pat. But what I would say,  Pat  has definitely been one of my mentors over the years, he's been just brilliant at always recognising, particularly the early adopters of functional medicine in the UK. He's always appreciated our journey and helped us out in any way that he could. So Pat, you continue to do that. And I really appreciate that mate. And that won't be just coming from me that will be coming from Joe and from Anne and all of those ones who started off at the beginning, but many of you may not know Pat, but Pat is probably one of the big I'm going to say the biggest hitters in, in functional medicine behind the scenes. Because Pat has been doing some incredible things over the last 25 years of moving a new way of looking at healthcare, functional medicine, into the mainstream. And Pat, I'd love to have a chat to you about the Cleveland Clinic stuff as well a bit further on. 

But let me sort of more formally introduce you from a point of view of just some of the stuff that you've done. So Pat is a medical doctor, he's board certified in family medicine. And he's been doing that for over 20 years. He has been, he's served on the executive committee of American Board of integrative medicine, and has been the past president of the American Board of integrative and holistic medicine, Pat I think we can safely say that you've been one of the kingpins and key players in the development of the Institute for Functional Medicine, you served there as Chief Medical Officer for many years and have been one of the key figures of sort of overseeing the development of I suppose the IFM's I suppose incredible success. I mean, I can remember being there, my first time was 2004. And it was, it was quite a nice little community feel to it, then. And now it's really a quite a big juggernaut. You spent 10 years as the Chief Medical Officer at Genova Diagnostics, again, one of the main, I suppose functional medicine labs worldwide. And you're still involved with the GI Advanced Practice module at the IFM. But importantly, now, and I suppose this is sort of age and experience, you are one of the I suppose, behind the scenes, expert advisory and people at the AFM. 

And I think importantly, for me, now that you've sort of been one of the key players who's developed the collaboration between the Institute for Functional Medicine, and one of the I suppose the one of the most famous private medical institutions in the US, the Cleveland Clinic where you're trying to integrate there, I suppose functional medicine within the bigger world of medicine, and I want to come if I can Pat, I want to come really back to that point as well, because I think that's a key discussion to have. But welcome. And thank you so much for forgiving your time.

Thank you so much Pete, I'm always glad to be able to help and support you and your team over there in the UK.

Well, and mate, just from me that that's something that you've always done. So I look at you from a point of view of that you didn't need to do it, but you did you have done it. And that's for me just says a lot about you being a good egg, on that side as well. So look functional medicine is expanding hugely in the UK, it's obviously it's becoming quite big worldwide. But what is it, I think that's probably a good way to start?

Well, in functional medicine people have have a misunderstanding of functional medicine, functional medicine is really looking at an individual from a systems view. So what that means is that the lens is that we aren't just a bag of organs, and in that way, but rather, we are a unique set of systems. So if we look at our community or our family, or our body, you know, there's a function that has to do with being able to get the nutrients that we need, the light, the love, everything, we have to have a mechanism of getting rid of that which we don't need, you know of, if you will detoxification, we have to have a mechanism of being able to defend ourselves. And whether it's our immune system or our police system or our military, we have to have that within a culture within a body within each organ. Within each cell. We need those functions, we need the function of being able to produce energy, of being able to have transportation and communication and an infrastructure. Those are the functions of functional medicine. And so we begin to look with a different light. I was on a podcast, or a presentation yesterday with mentor, Jeff, Dr. Jeffrey bland. So the grandfather of functional  medicine. And we were noting that like, within all of the research on COVID, no one's talking from a systems view, like no one's talking about the immune system and the mitochondria and the gut microbiome. 

These are systems approaches that we take in functional medicine. And that's what really differentiates it. So by taking this system's view, the system's medicine view, and being able to ask questions in that way, we begin to personalise the recommendations for an individual based upon where those imbalances are. So we're listening to the person's story, and being able to understand where is the imbalance? And where did things go wrong? And what were the triggers that tipped that over. And so that is what functional medicine is, a lot of people think it's like, oh, I'm going to get a test. And I'm going to take a supplement, and I'm going to be okay, and it's not, you know, a pill for now, whether that pill is a pharmaceutical pill or a supplement pill, it's really about understanding the individual and where are the imbalances and being able to help guide them. And this becomes key as well, because it's not just telling them what to do, but rather, it's working with them. And walking along the journey of, of healing, you know, from illness to wellness, walking along that with them, and helping them in the process, helping them to understand and helping to encourage them and listening to them. And dealing with the inevitable ups and downs that happen. It's not always everyone doesn't get better all the time. You know, but what we find, and as we've actually proven at the Cleveland Clinic, is that we are able to improve the health and well being over and above the standard of practice.

So should we should we talk about that now, I was sort of going to build into that one. But I think there's a couple of I think there's a couple of, I suppose if we look at the medical world isn't there are a lot of people who poopoo a functional medicine approach. And there's obviously a lot of resistance to this sort of thinking. And I suppose if you like, I suppose that's probably been one of the criticisms, if you like, of functional medicine that, you know, that where's the science to show that this method works, you know, as opposed to just, you know, anecdotal success in, you know, in clinic, it's fair enough. And it is actually, to me fair enough of the of the dominant paradigm to say, you know, show us show us the data, that it this actually is better, because what we do in functional medicine is we're working, you know, to take an approach to using the precautionary principle of using tools that are low level of intervention, not not aggressive interventions, and that are working primarily with, with lifestyle with diet, nutrition, exercise, sleep, dealing with stress, having meaning purpose in your life, that's the first thing and then moving into that systems approach. 

What's fascinating to me is that all the major guidelines, whether we're talking about diabetes, or hypertension, or heart disease, or, or immune issues are all say, Well, yeah, do the do the lifestyle things first. And they kind of give lip service to it, but don't actually engage it, you know, so we're doing that. And so we have a system that's fully integrated. where that is, is a part of the whole conversation, and part of the designed way in which the model works, so they're not separate from each other. So you're going to use those tools if you've got someone who's coming to you, who's an athlete who's trying to optimise wellness, or you're going to use those, if you've got someone who's in the ICU with COVID or something else, they're going to use the same tools, because they work across the board. That's what the model is. And that's how it works. Now, when they'll become increasing dosage, increasing aggressiveness as we move from wellness to illness in that continuum, but they're still the same tools to be used. 

So what I'm reminded of a couple things is, you know, the things that we've been talking about in terms of the role of a of a low glycemic diet, of time restricted eating, of working with insulin resistance, of the role of cardio metabolic syndrome in the development of diabetes, we've been talking about that for 25/30 years, you know, Dr. Gerald Raven's at Stanford, talking about that in 1990. And we've embraced that and been talking about that. Now we're beginning to see our medical compatriots saying, huh, you know, there seems to be some research here. And we're like, Well, yeah, yeah, we've been working on it for 30 years, and it works, you know, and, you know, some of my compatriots feel like, oh, there's, they're not giving us credit. Like, I don't care if they give us credit or not. I read a review article on irritable bowel syndrome by a famous pair of famous GI doctors about a month ago. 

And in it, it talked about irritable bowel syndrome, and it talked about the role of inflammation, the role of infection, the role of Post infectious IBS, the role of pancreatic insufficiency, the role of the gut brain microbiome access the role of the microbiome in in doing these things, the role of intestinal permeability, and I'm like, that's exactly what we've been teaching in our courses for over 20 years. And when we talked to them about doing research together, 20/15 years ago, they laughed, and they said, there's no data to support any of us this. Now, they're promoting this as this is the way to look at it. And so we're always going to be on on the front edge of things on the cutting edge of things. And and we've been fortunate in, in getting it right most of the time, because we're listening, we're translating the science effectively into clinical practice. And we're doing that before our academic colleagues are really even able to do that. So that's an idea. 

Now, we were then asked in 2014, to set up a centre of excellence, a centre for Functional Medicine at the Cleveland Clinic, this was something that we have wanted to do, because we want to be able to demonstrate real world evidence. And so with the help and support of the CEO, Dr. Toby Cosgrove and Dr. Mark Hyman who, who collaborated with him, and brought IFM in, and I had the opportunity to be the first medical director there. So setting that up, it's like, okay, well, I've had a practice, I've had a clinical practice, I know how to do this, but setting up a centre of excellence in an academic medical centre. I didn't have experience with that before. So when we set it up, we thought, Oh, well, we'll have time you know, it'll take a while for this to take off. And as it worked out, we started off in a small little space about 1500 square feet. We had one doctor, one nurse, one nutritionist, and on day one, we were full, we had like, Okay, we got to make it work from day one. By the end of the year, by the end of one year, we had three doctors and three nutritionists and two nurses and a coach. And we had a waiting list of a couple 1000 people at that time about 1000 people. And then we continued on and by the end of the next year, we moved into a new space. And we had 10 practitioners, six nutritionist three coaches, a behavioural therapist, and we had a waiting list of over 2000 people, we moved into a 17,000 square foot space to be able to do our work. 

Now that's just sort of like, people want it and it was beneficial. And we would add more more clinicians. And what would happen is our waiting list would grow. And we never advertised it was all word of mouth because it was effective. Now you can say okay, so that's a lot of anecdote. So where's the data? So we we worked on doing some randomised clinical trials, and those are still in process and to be published. That's always interesting. And I learned a lot in that manner because a randomised clinical trial isn't like our clinical practice, you get, you got to figure everything out ahead of time and say, these are all of the decision trees and everything that's going to happen. And yet in clinical practice, it doesn't work like that. So what we did also is we said, we're going to evaluate everybody who comes in, in terms of their overall state of wellness, we're going to measure their physical health, and we're going to measure their mental health. And in those two factors, we used a tool developed by the National Institutes of Health called Promis, Promis 10. It's very similar to one that's used on in Europe, by the WHO called WHODAS.  WHODAS 12 is very similar to the Promis 10. So these are ways of being able to take a vital sign of the overall health and well being of our patients. And we did that and we evaluated that. 

Now, this was fortunate that that this was a tool that the Cleveland Clinic was using, and was available. And so we said, Okay, we're going to do that we're going to do that every single visit. And then we began to compare ourselves to the other the other centres and the other departments in the Cleveland Clinic. And what we found out first of all, was that we had the third most or the third sickest cohort of patients at the Cleveland Clinic, which is a tertiary care centre. And it's like the people coming to see us were really sick. And so it's like, okay, we can see that now let's do a comparison. And we'll do a comparison with a internal medicine and family medicine Centre at the Cleveland Clinic, one of its it's got many different hospitals. So we took one of the hospitals, and we compared ourselves to them. And what we showed was that the people who were getting functional medicine had a one standard deviation, significantly better outcomes at six months and a year than they did at the Cleveland Clinic in family medicine and internal medicine. 

So it wasn't we weren't comparing ourselves to, you know, the urgent care centre down the street. We were comparing ourselves to the Cleveland Clinic and we demonstrated that we can do better. We're currently involved in research still, involved in research, looking at the total cost of care. It appears that the costs are decreased as well. So not only do you get better care, and people do better, which means their healthcare costs are going to go down. But the cost of actually delivering that care are cheaper than the standard of care as it exists right now. So that, to me is like the Holy Grail. It's something that I've been interested in studying since I was in medical school in the early 80s. I mean, that was my interest is how do we demonstrate that wellness and prevention and taking a thoughtful approach actually helps people stay healthier, and decreases the cost of care? seems intuitively obvious. But now we're in the process of being able to demonstrate that. So that's really where the big shift is, in understanding. Now, what's occurred is that people have picked apart the studies and and you know, now we have data, and they're like, Oh, we don't like that data, or we don't have that data. And then it's like, well, where's your data on outcomes? Because, frankly, we can do a study that shows that, that this certain drug, or this certain pill, or this certain supplements, decreases blood pressure, you know, by by this degree in this small subset of patients, what does that tell me that that actually helps them to live a better life and to decrease the cost of care? And to be happier and healthier? Or is it possible that there's some unintended consequences long term, that is actually a bad thing that's not being studied? We're studying outcomes. And we feel like that that's what we want to do. And we're, curiously enough, what the NIH calls these and what WHO calls these are functional outcomes. We're measuring the outcomes of function, how are you doing in your life? So functional medicine measures, functional outcomes, and we do better than the standard of care. 

Now, one other thing I want to say about this, Pete, is that I'm excuse me, is that,

you know, you asked me at the beginning about what functional medicine is and what it isn't. And I want to actually differentiate the term functional medicine from integrative medicine and complementary medicine. So integrative medicine is a set of tools, a broad set of tools, where we're doing research and investigating what's going on, and what works and what doesn't work. But it's not a way of thinking about things. It's not a system of being able to put all those tools together. So if I've got a toolbox downstairs, in my work room, and it's filled with hammers and wrenches, and all kinds of hardware and screwdrivers and Phillips drivers, and and, you know, drills and everything, but I don't know how to use them. I don't know, what is the best time here's a problem that I'm trying to solve. I'm wondering which tool I should use, you know, and from a systems approach, we're actually thinking through, well, how do we use these different tools in order to optimise function. And that's where it is not complimentary medicine is really sort of integrative medicine, but saying, it's here to be able to support the dominant paradigm of medicine as it's been practised, because this is just a complement to what's happening. Now, in the end, you know, functional medicine is a holistic view. So in that whole ism, that includes all of the angiograms and the heart surgeries, and it includes everything, and is not dismissive of that it is just putting it in its proper priority, and used at its proper time. And in complex chronic disease, the aggressive forms of of Western medicine that are excellent, in emergency, excellent in trauma, excellent  when surgical interventions are needed. Excellent when aggressive treatments like my stage four cancer are needed. You know, that is, you know, they should be used, and they are used, and they're used in concert with a functional medicine systems based approach.

Well, that was an incredible 20 minutes on that path. I think there's a, there's a couple of keys on this. And, you know, obviously, myself and my team we've been in practice for for quite a while now. And I suppose there's lots of things that we've talked about is I think, number one is that functional medicine is the perfect tool, if you like for those chronic diseases of lifestyle. And I just want to pick up those points with you because if you look at something like the American Heart Association, the Diabetes Association both around the world, the first line therapies are aggressive lifestyle, and changes. Why do you think we don't treat and I suppose when we look at where is the biggest bang for your buck as far as outcomes they generally come in to those aspects where we change our diet, where maybe we take some more exercise, where we have good social relationships, we stress reduce. Why do you think given some of the very large outcomes favourably that can come from that? Why do you think that we've never taken those aspects of sick so seriously, even though the science is there to back it up? 

Well, I agree with everything that you just said. And I think first there is a feeling of it can't be that simple. You know, and I'll just say for myself, when I went into medical school, I was interested in nutrition and began to learn about it. And I said, This is amazing. Why isn't this being done more? You know, and we learned it as, as medical students on our own, we weren't, we had to seek out people who could help us to understand that they wanted to teach us about total parenteral nutrition, ie, nutrition that goes in your vein, when you have when you're when your gut isn't working, or is unable to work. And we said, No, we were thinking about the kind of food you put in your mouth that you eat every day, like all of us eat every day. And they're like, Oh, we don't we don't teach about that. So we we learned about that. My point here is that, as I went forward and I began to learn more about nutrition, I began to learn oh, wow, it's more powerful than I thought it was. And then as I went forward into practice in functional medicine, oh, wow, it's actually more powerful than I thought it was. And it's the initiation of almost every patient interaction that I have. Then I went to the Cleveland Clinic and started working with a team and had nutritionists and coaches with me hand in hand, and I'm like, wow, it's more important than I thought it was. And then when I've alluded to, you know, three years ago, was diagnosed with stage four cancer. And I use nutrition as an important part of the intervention with it both in terms of a ketogenic diet, and as well as in fasting before Chemotherapy. And I'm like, wow, it's actually even more important than I thought it was. Because it's like, here, it's helping, even at the level of a stage for cancer. 

So I think that there's a even in those of us who are fans of it, who have studied it, it's like its importance is even greater than we think it is. So that then again, begs the question that you're saying, so why isn't it front and centre, and that is because there's no one within the medical industrial complex, who makes money off of promoting that, in fact, they lose money, because they have everything set up to be able to do that. And so if our if the mindset is to look through a scope, or the mindset is to do surgery, or the mindset is to give a pharmaceutical medication, then that's what those people are going to do. And so the system is kind of set up in an upside down way, where instead of just focusing on that, for those specific cases, as in, you know, traumas and emergencies to use that they're trying to use the same tools for complex chronic disease. And those tools don't work for complex chronic disease. And we've actually demonstrated that over the past 40 years, you know, we see a deterioration in the overall health status, we see hugely increasing costs. And so one could say expect from a real world experiment, all those tools don't work for complex chronic disease. But these do, why don't we put all of our energy into or much more energy into making that happen in an effective way. 

But that's not how the system is set up. And, you know, and what's happening now with, with COVID, and I think the the huge post COVID issues, the post viral fatigue and the dysfunction that happens from long haulers, post COVID, PACS, whatever you want to call it, is going to bankrupt the system and say, Oh, we have to do it differently. And we have to think from a different perspective. And we have to prioritise these lifestyle issues, first and foremost in helping our patients.

And I suppose if we're looking at COVID, and long COVID, if you like, I think as a as experienced functional medicine practitioners, the fact that you've been taught, the model immediately means that you can go on and think, you know, okay, immune dysregulation, we probably want to think about the gut we want to think about where some of the viruses are entering. And that makes makes a lot of sense. And you start to think about systems, about excessive inflammation, about gene variants that drive inflammation, about poor microbiome, and suddenly it's so natural for you the thought process, the difficulty is probably being able to put that into practice over time. 

That leads us beautifully on to I think where we are with the world and COVID. And I just want to spend a few minutes on this part because I've just seen, I think the IFM have done an incredible job over the last 18 months have been putting together what I would consider a place to go to get on the fence information. So you're sat on the fence looking at both sides with regards to you know, almost like that, who can you trust to go to with all these different messages that come out with regards to where we are with COVID and so I watched the recent webinar that yourself, Dr. Joe Pizanno, Joel Evans and Dr. Tom Salt did with regards to just updating where we are. And you've been doing an amazing job of updating sort of where the evidence is going as the literature comes in. And I just want to quote, again, what Dr. Joe Pizzorno said at the beginning, and he said, really vaccinated or not, I think this is the sort of crux of his understanding how we think with functional medicine.  Vaccinated or not, we need to become more resilient to the virus. And what he's saying there is that we can't just expect that we can be vaccinated and everything gets solved, because that's absolutely not what the data is showing us. So can you just expand on that one? Because, again, there were some just really incredible bits out of that, that, again, gives us that understanding that, you know, if we maybe look after our diet a bit better, if we think in a slightly different way, then we're going to have some major inputs for reducing our risk.

Yeah, I can, I can riff on that for quite a long time. So you'll have to steer me here in how you want to talk about this. But yeah, what we did initially, back in in March of 2020, when we saw this was occurring, we said, oh, we need to put together a response, we put a team together. We looked aggressively at you know how to work with viral issues, how to work with, you know, the SARS virus with Coronavirus, and, you know, and made a series of recommendations, which, you know, I'm very proud, you know, that that's still on the website. But those recommendations are by and large, the top 12 things that can be done, are still the top 12 things that can be done. And you know, that includes lifestyle issues and working with Dr. Deanna Minik. It included working on you know, how do we how do we diagnose it and understand it? And what is the natural history of what's going on with, Dr. Helen Messier, and then with our team to be able to put together the recommendations of both nutritionally and of supplements that will help and what are the risk factors associated with it? And how is this working. And so we did all that we we published papers on that. And then we put together a course that we call the 3R  course, which is about resistance, or resilience, resistance, resilience and recovery. And so as we as we work with that, and we've we've actually brought that back in a shorter form that's available now on the IFM. website, I And you can go down and you can look at the resources and understand like how the virus works, and and what to do about it. So we did that. And we worked on that. And then as we got to the beginning of this calendar year, actually, we could see it coming about, about this time last year of the vaccines, and how to be able to understand what the different vaccines are and how they worked. And, you know, we have taken a science based approach on this. And it's like, we're listening to the science and we're seeing like, wow, there's some incredible benefit to these vaccines. 

And, and there are some concerns that are still out there about the vaccines in terms of, of let's call it a monovalent vaccine with mRNA, where we're just using the spike protein, when we get an infection from SARS-CoV-2 to our immune system is developing antibodies in a T cell response to the whole virus, all the different aspects of it. Whereas the mRNA vaccine is really just a single aspect of it. And so it's kind of like a rifle shot at it rather than a shotgun blast, if you will, of the immune system to try to respond to it. But then what we also have continued to find and as is evident in Dr. Pizzorno's comment is that the vaccine, the issue of SARS-CoV-2 infection and the development of long COVID and the seriousness of the illness, you know, can happen even if you've been vaccinated. Now the vaccine is shown to be eight to 13 times, you know, protection from what's going on. And so it is helpful, there's no doubt about that. But it is not a panacea, it is not the single answer. And in fact, people who have have had the vaccine, you know, can still be carriers, can still get sick and still have breakthrough infections. And if they have those breakthrough infections, they can still get post COVID as well. So what we want to do is we want to help the person to be the healthiest possible to be able to do that. 

And the answer as with functional medicine is not just within supplements, those are some things that can help the system along and we can talk about, you know, quercetin and N-acetyl-cysteine and vitamin D and and you know some of those agents but we also want to say like if you're eating a diet that in in our country is called a bad diet a basic American diet or a SAD, a standard American diet, you know, which has a lot of processed foods which has a lot of of sugars in them which has a lot of carbs in them. And then you're going to be at increased risk because that's how the SARS-CoV-2 works, it binds to the ACE receptor and is activated by a furin complex that is increased in people who are overweight or have diabetes or obese or are eating a high sugar high glycemic index diet. So it's like, oh, wow, you can make a difference right there. 

And you know, we talked about this beforehand, but looking at some of the data, it's like, if you're obese, you have a three fold increase risk of dying, an eight fold increased risk of having a serious infection. And, and that actually goes across every single age group, it's different. It's not just oh, well, if you're fat and old, it's a problem. No, if you if you're obese, like this is an issue. And this is not to shame anyone who has has weight issues, but it's saying, hey, we want to need to help to be able to put you on the right foods and to get the right exercise and movement then to get the right amount of sleep, and to deal with the stressors that are going on. These all have an impact on the development of obesity.

So let me be before you go on let me ask you, let me ask you that question again. Given the data that's coming out, you know, and I guess we could reel it off obesity, type two diabetes, and risk, you know, over three, nearly fourfold with obesity. We can look at vitamin D deficiencies and again, there's meta analyses being done. There's a very recent paper, it's just come out literally suggesting that there shouldn't be any COVID. Any chronic COVID side effects, if your vitamin D levels are a certain level, I don't know whether that's been peer reviewed. My point is, given given how effective these are, why do we not hear about them? I mean, in the UK, there is it's just simply get the vaccine, get the vaccine and get the vaccine. And there's nothing at all that goes oh, by the way, you know, if you're overweight, you know, you really need to think about trying to get get yourself to, to an ideal weight, and maybe you know that what you're eating is having an influence of risk. Why do you think there's no concurrent message?

Well, I think it goes back to the earlier question you asked about why why is nutrition and these lifestyle factors, why are they not front and centre in what's going on? I think it is part of the imbalance of our of our disease care system, right? It's not a health care system, we're not caring for people's health, we're caring for them when they have disease, you know, and if you will, that's where that's where the opportunity is. And that's how the system has been built. And so it continues to feed that. So, you know, there are systemic issues in terms of the infrastructure of the way in which been laid out both in the United States and in the UK. 

The UK is actually even a little better, better than the US in that regard. Because it's actually got an infrastructure to be able to evaluate populations as a whole and to see what's really happened. And and there's been really good data coming out of the UK, in terms of helping to understand the both the aetiology and the risk factors associated with the SARS-CoV-2 infection as well as with post COVID. So or long COVID. So to say, Well, why do I think it hasn't been that way? You know, what, what we have is the signals that are improved by changing diet, and being able to then do a randomised control trial with Okay, well, let's look at diet and let's look at add weight, and let's look at the development of SRA-CoV-2, you know that that would take 10s of millions, if not billions of dollars to do the randomised control trial to be able to demonstrate that, you know, part of the issue is that we're living in the medical world of saying, we're going to use randomised controlled trials as our determinant of what works and what doesn't work. 

And in fact, you know, like the article, I think it was in BMJ, you know, it was a it was a letter to the editor, and it said, you know, there's never been randomised controlled clinical trial that shows the parachutes work, you know, so like, what that means is like, no one's going to be in the control group of not having a parachute and jumping out of a plane, you know? So it's, it's not true that those are the only answers. And there are many different ways in which we gather information, and we need to change and be able to look at real world data and real world experience of what's going on. I think Israel is an important case in point. You know, the, for instance, you know, with the with the vaccine, what we saw was that there was a very rapid change, and that the effectiveness, which is the real world term of the vaccine was proven to be as good as the efficacy, which is the research term, but then we've actually been able to see that that with that aggressive intervention that we've seen a rebound and we've seen a waning of immunity, and we've seen the need for boosters. 

And so again, there what I'd like to see is, well, let's emphasise the the nutritional and dietary and lifestyle changes that need to happen so that we can deal with the progressive waves. Now, I would like to talk about post COVID for just a moment, and that is that it's almost as though this has come out of the blue. Like, how could this happen? This is so unusual. But if we go back, and I've been doing a little reading about that, you know in 1934, there was something called epidemic, neuro Myasthenia, which meant, like, you know, fatigue, and the and the drops. And that was after the Spanish flu pandemic, of, of 1918. And, you know, a post viral fatigue and post viral problems have been described in now in the literature for at least 85 years, you know, and it's been well studied since the mid 80s. And in here in the US, the Institute of Medicine, you know, finally formalised its criteria in 2015. And here we have another post viral process that's going on, it's just that it's so big at this point in time that no one can deny that it's happening. Some people want to say, Oh, it's a, it's a psycho emotional issue, or it's dealing with the stress of COVID. But actually, no, there's physiologic changes in the mitochondria, in the immune system, and in the microbiome, that are driving these changes. 

And so that actually tells us, as we, you know, kind of reengineer it that that in looking back, we can see that, oh, those are the issues that need to be dealt with, even in helping to decrease the severity of the SARS-CoV-2 infection in the first place. And the point here is like, it's not as though we're going to eliminate the infection from happening, but we're going to decrease the severity of the infection. And when people who are healthy, you know, get that infection, naturally, their, their immune system is able to withstand it, and they have the natural immunity to be able to deal with it. That's what we're going for here. And that's what we're going for  in dealing with any kind of infection or any kind of insult, if I get exposed to a toxin, if I eat a food that's got an infection or a problem with it, if I have

have exposures to antigens, you know, I'm wanting to have my body be healthy enough to be able to withstand that, that's the whole idea of a term called hormesis. Hormesis is sort of the What doesn't kill you makes you stronger. And you know, that's how we build, you know, that's how when we exercise, right, we stress ourselves, and that helps us intermittently and focused in a disciplined way. And then we're able to recover and be stronger or faster after that. So that's really where the focal point is of what we're trying to do from the from IFM, from the functional medicine approach of working with COVID in helping overall health and well being.

I think the key is as you say it's not the virus, that is the problem. It's the way your immune system chooses to deal with the virus, that is problematic. And, you know, I think the key is here is that how do we because I think you hear a lot of you need to boost your immunity for the winter, which is probably not the most appropriate thing to say, I think what we're trying to do, aren't we is that, we're trying to get an immune system that looks like that looks like the really experienced bouncer on the, on the front of the door of the nightclub he's been and seen it all done, and he's experienced, he knows when to ramp up for a fight and he knows when to keep things calm. And that's what we're trying to do, we're trying to trying to create this immune system that is just really sort of well regulated, it's good on immunosurveillance. 

And, again, the most important things to do that, again, are the lifestyle things that we do. The diet in particular, I mean, exercise, and actually looking at exercise in immunosurveillance is is just incredibly important just to make sure that, you know, if you got a nice bit of blood flow, you can move a lot of that immune system to a lot of the peripheries where most of the action is and again, that microbiome with regards to getting as a diverse and robust microbiome as possible, increases your ability to defend against the outside world. And then that really comes into the, to the foods that you that you choose. And I know Pat we're running, we're running close on time here. 

What I wanted to just I'm going to dig in here now because now we're going this is becoming all too good a conversation. Can you just talk about potassium, and the role of potassium that we found with regards to the COVID infection and how that relates to plant foods and the furin proteins? Because I remember listening to Joe and Kara Fitzgerald right at the beginning talking about that, you know, there does seem to be some benefit from a very high potassium rich diet, with regards to helping COVID.

Well, I'm sorry to disappoint you, but it's like, you know, I probably know as much as you know, on this, and that is, you know, there's data that supports the the role of potassium in terms of its activation. And so, in terms of the, when there is low potassium, there is an increased activation of the ferin cleavage complex and and what that term means is that the way in which the spike protein binds to, to the ACE receptor, it actually requires a an enzyme that is present in all of us and present on our tissues, to be able to snip the virus in exactly the right place to allow it to inject into the cell. And, and that is increased when there is incomplete potassium, and is also increased that furin cleavage complex is increased when there is obesity, or diabetes, or high blood sugar. So it's all in the mechanism that goes on there. And you know, we're getting down into the details. But for me, what it has to do is looking at the processed foods end up emphasising much more, much more sodium and much less potassium, where as when we are eating a plant based diet or whole foods diet, we're going to have greater balance of potassium, and sodium. And so it sort of highlights the importance of and difference between those two minerals in terms of overall health and well being.

And Pat, can you just give us the difference that we're seeing in the literature with regards to risk for severe COVID effects with regards to a diet, high plant based diet versus a high meat diet processed?

Yeah a fascinating study that was done that was just looking at at dietary issues. And what it showed was that in kind of looking at all comers, and then saying let's parse it out by the diet that they're eating. And they said, Well, let's look at a pescatarian diet. And what they found was that there was a 60% reduction in the risk of COVID. If you were eating a pescetarian diet, there was a 73% reduction in COVID, if you were eating a vegan diet, or I'm sorry, not vegan diet, plant based diet, there was a three point if I remember the numbers, right 3.9 increase, increase, if you were eating a high protein, high, high meat diet, you know, and so these are going to be people you know, and it's part of the whole issue, as we've seen, you know, in in looking at something like paleo or ancestral dietary approaches, it's like eating good meats, from my perspective, are not the issue. Eating excessive amounts of them, eating non organic meats, and not eating sufficient amounts of vegetables to be able to create the diversity that's necessary for the microbiome is the issue. And so when we end up seeing the cohort of people who are eating high amounts of meat, they end up tend to be not eating the vegetables in the right way. And, you know, I'm not saying you should be vegan, I'm saying you should eat a low glycemic diet that has a good balance, not to, you know, not eating processed foods, eating whole foods, eating lots of vegetables, and then eating a purified protein of your choice. That is, is the amount that's necessary based upon the amount of physical activity that you have.

Yeah. And, you know, I firmly agree with that I just cannot looking at the dietary literature, not tell most of our patients, yes, there are maybe a couple of patients that have got digestive issues like SIBO, where for a small period of time, you've got to bring them off some of the best foods that we can eat, plant foods. But, you know, I look at where we are with humans and that we're by count, we're more bacteria than human cells, and most of that bacteria resides in the GI tract, and they want to be fed by plant foods, because if they're not, they're going to be in trouble. So again, I think we've got to, on the whole give the right diet for the right patient at the right time. And this medicine flows in and out, of course, but on a general basis, I think like completely concur with what you've got to say is that, you know, it's not a question of, it's always it's always a question of quality. And probably for me it definitely more plant based foods. But you know, with some high quality meat in there occasionally, Pat, I know. Your time is very precious, I've got one more question for you. And I would love in the future to have you on again. And I mean, we can literally talk for hours where we are with the COVID situation. And why I think the key and I remember Nature magazine in March of 20, where are we now, march 2021, there was actually a couple of research scientists there and said, we have to look at COVID with regards to a systems approach. And so, you know, hopefully, I think the IFM are at the forefront of that. And just to reiterate to everyone when the IFM, bring, analyse things, or bring scientists or scientists on board, you're not just popping down to the local tertiary college and bringing someone on there, you're going to some of the greatest minds in the field with regards to immunology with regards to virology, and amalgamating what they say and try and bring it into a systems approach. 

So, again, I want to end with just one simple question, which is that because this clearly is you, but what makes a great clinician, because we're in that we're on this path, aren't we, we're, we're in this, we're in this health care model, we're in this wellness model, but for many, we're failing. And, you know, I just want your opinion, what you believe is a is a great clinician, and what do we believe patients need? 

I think the, the single word answer is listening. You know, it's  creating a space, to be able to really hear what's going on for the individual patient. And I'll end helping them to feel held, and to be trusted, that there's someone they can trust that is going to walk that is listening to their story that cares about what's happening with them, and is going to help them on their journey as though it's a family member, you know, caring and helping them in the process of doing it.

And the best way to do that is to is to listen to the story to listen to where they're at, you know, put my own biases aside, in really be able to put myself in their shoes, with empathy, and say, you know, this is the best way that I can help you and support you in the process. And sometimes, you know, it may be putting a mirror in front of them. Sometimes it may be, you know, encouraging them gently, sometimes it may be shedding a tear with them. Sometimes it may be just bringing the knowledge that we've been gifted with to say, oh, there's a there's a pattern here that I've seen before, there's a different approach. But that requires listening in the first place to be able to really allow for healing to begin to occur.

That's a beautiful answer. And I'm just looking at my notes, I've got one more question for you. So I apologise. You've been made an indigenous healer, haven't you? Do you just want to give us a just want to give us a couple of minutes on that because I think this is kind of cool.

Well, I was um, I started having some dreams about 20 years ago and brought them to a teacher and he said, well, we need to, you know, have you go on a vision quest to a sacred site and I did that and found that I was asked to be to work with with Attica people, which are people in the Sierra madres and going to sacred sites and making offerings. And after doing that for a number of years, many years, I was initiated as a as a traditional healer, by by those people. And, you know, that is part of part of the the tools that I have in my approach with people and feel blessed to be able to do that. And, you know, find that as I'm getting older, more and more of the of the work that that I do relates to that specifically.

So a wise man, a wise man, regardless of what country you're in, I think is what we would look out from that one. And, you know, maybe that's, as you say, that's been your skill over time, your intuitive skills of everything that you've learned over the years of getting it right and getting it wrong is that you become more and more if you like an intuitive healer, if you like, which is one of our favourite books. Pat, I'm going to stop our conversation there. Listen, mate as  I say you've been an incredible mentor for me in particular for some of the I suppose the founding IFM certified practitioners in the UK. So we mega appreciate you just giving us your time as you've always done. I really appreciate it. And hopefully I'll see you soon.

Hope to see you. I hope to see you right over there. Thank you so much Pete

Cheers Pat  

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