Chris Kresser Functional Medicine

Chris Kresser
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Juliet: [0:03:50] Chris Kresser, welcome to The Ready State Podcast

Chris Kresser: [0:03:55] I’m so happy to be here. Thanks for having me.

Kelly: [0:03:56] All right, Chris. So let’s get into it. I know you, and correct me if I’m wrong, I know you as an expert in medicinal functional health. Would that be a fair characterization? And for everyone who’s listening, Chris and I have never met officially, but I have been in the same circles of Chris for like a decade. It’s crazy.

Juliet: [0:04:18] Or longer. Longer. Yeah. 

Kelly: [0:04:18] So I am thrilled to pick your brain today. But did I get that characterization of some of your work and thinking correctly?

Chris Kresser: [0:04:26] Yeah, I think so. I aspire to be an expert and I think it’s a lifelong learning process. But that is my field, functional medicine and functional health and nutrition. Those are my primary areas of focus for sure. And I’ve been a practicing physician since 2010. Currently on a sabbatical this year, finishing up the sabbatical from treating patients. But that’s always been my focus and my learning laboratory, if you will. But I’ve also been an author and an educator. I train other doctors and practitioners in functional medicine. We train health coaches. And done a lot of writing and speaking as well in the space.

Juliet: [0:05:07] So for those of us in our industry, I think we all throw around the term functional medicine, and I think we all know what it means. But can you tell our listeners what is functional medicine? What does it actually mean?

Kelly: [0:05:20] And why should they care?

Juliet: [0:05:21] Yeah. And who would be the type of person who should seek out a functional medicine practitioner?

Chris Kresser: [0:05:27] Yeah. I mean I’ll start with that. I think functional medicine is just the way medicine should be practiced, period. And that might sound like a big claim, but the reality is it’s what makes the most sense. I like to use an analogy: If you have a rock in your shoe and it’s making your foot hurt, you go to a conventional doctor, they’ll prescribe a painkiller. And that might be moderately effective, but it’s not as effective as noticing first that you have a rock in your shoe, and second, taking your shoe off and dumping out the rock. And that’s basically functional medicine. So instead of just addressing symptoms with drugs, we try to get to the root cause of the problem and address those causes so that symptoms resolve, but they do so in a lasting way, and often without unnecessary drugs or surgery. So if you go into the doctor and you get some blood tests and you have high blood sugar, chances are they’re going to prescribe a drug like Metformin for your blood sugar.

Kelly: [0:06:24] Seems reasonable.

Chris Kresser: [0:06:26] Seems reasonable. If you have high cholesterol, guess what? They’re going to give you a statin. And if you ask the doctor how long you’re supposed to take those drugs, what’s the answer going to be?

Juliet: [0:06:34] Forever.

Chris Kresser: [0:06:35] Forever. For the rest of your life. And there’s rarely any investigation in that situation of why is your blood sugar high in the first place, why is your cholesterol high in the first place. And I’m not saying there isn’t a place for drugs. There can be in some cases. But it’s so much better in those situations to look at diet, sleep, stress management, physical activity, other factors like gut health, heavy metal toxicity, infections. Because if you don’t address those things, there’s going to be a new thing. So it’s like playing whack-a-mole, right? 

So you have high blood sugar, you take the drug for that, and then because you didn’t address the underlying issues that led to that in the first place, there’s going to be another problem down the line. Take another drug for that, then all of a sudden, you’re having side effects from these multiple drugs you’re taking, you go back to the doctor, and guess what they’re going to do? They’re going to give you a drug for that side effect. I’m not joking. I mean this is how people over the age of 65, the average number of medications they’re on is five. And this is exactly what happens.

I just watched a family member go through this, where she was dealing with some cardiovascular issues, and she just kept getting put on one drug after another and she was having terrible side effects. And so then she got prescribed drugs for that. And then she got really depressed that she was taking all these drugs and having these side effects, so she got a drug for the depression, which caused more. I mean, it was ridiculous. And this is unfortunately the state of our sick care system right now.

Kelly: [0:08:05] I come from, I have physicians in my family, D.O.’s, radiologists. I would say that they didn’t set out to practice that way. But the system really, from having the big pharma, big business, and this isn’t conspiracy, because it really does impact, the fact that a physician has six to eight minutes to address your concern and doesn’t get to ask these things. Is that a physician problem or a system problem, do you think?

Chris Kresser: [0:08:36] It’s a system problem for sure. So they are as much victims of the system as patients are. One of the reasons you mentioned is an absurd patient caseload where they’re seeing 25 or 30 patients a day, eight-to-twelve-minute visits. They have a panel of 2,500 patients overall that they’re meant to keep track of at any given point in time, which is also absurd. And the incentives are totally misaligned. So there’s no incentive to provide high-quality care. And I’m not suggesting that the average doctor is sitting there thinking about incentives while they’re seeing patients. They’re not. Most people who go into medicine do it because they want to help people. But the system, the incentives for the system make it almost impossible for a doctor who does care, which is 99 percent of them, to practice medicine in a way that would be effective. 

And this is a huge problem for physicians. Burnout amongst physicians and other healthcare practitioners, even before COVID, was just astronomically high. And one of the… There’s been a lot of research published on burnout and the causes of burnout, but one of the main ones is a feeling of being ineffective. And it sucks to go to your job and then at the end of the day feel like you haven’t been effective, you haven’t been able to help people the way that you wanted to.

And in our training program for doctors, that’s the story that we hear day in and day out. I’m totally burned out; I hate my job because I don’t feel I’m having the impact that I want to have. I really, I got into this to help people, and I feel like I’m just writing prescriptions and churning through patients. And it’s kind of soul draining for them too. They don’t actually really get to spend quality time with the people they’re seeing. And they’re working almost in kind of a factory environment and it’s really not satisfying. And of course, there are exceptions. There are doctors who found a way to thrive in that system, and there are doctors who, specialists maybe in particular, who get to spend a little bit more time with patients. And I appreciate what you said, Kelly, because this is not an indictment of individual doctors. It’s really more of a problem with the system that we’ve created. 

Juliet: [0:10:46] Yeah, and I mean I think the patients also bear a lot of responsibility too here because we’re all part of this quick fix. You know, let me just take this pill and not ever have to eat a vegetable kind of mentality. I mean I think what Kelly said or you said, it’s a systemic problem that everybody is contributing to.

Kelly: [0:11:04] How do we begin to shift that ownership, because we definitely have seen this in the physical medicine space, I’m talking about musculoskeletal care, where people are basically devolving. They’re not moving, they don’t sleep.

Juliet: [0:11:17] And one thing before we talk about that too, I just have to draw a line in the sand. I don’t know if you know, Chris, but I’m a two-time cancer survivor. So I am grateful to modern medicine for being alive. But I also have had an equal amount of struggles with the healthcare system for dealing with literally anything else. So I had great experiences, right? Like I sort of have this feeling that, well, if you have cancer, it’s great. Go to your traditional doctor, they’re going to do a great job. They know what to do, they can prolong your life in ways that they couldn’t even 20 or 30 years ago. But we’ve just gotten so far afield when it comes to sort of everyday healthcare, I think. So I just had to draw that line in the sand.

Kelly: [0:11:57] Yeah. I like to say you’re on your fifth life.

Juliet: [0:12:01] Yeah. I’m on my fifth life. And there’s a reason for that. So anyway. But I also have had, more often than not, a lot of horrible experiences, just trying to deal with sort of like chronic conditions like anemia and other problems I’ve had. So.

Chris Kresser: [0:12:16] Right. Yeah. So my second book, which is called Unconventional Medicine, really addressed all of these topics. And in the book, I traced the history of what we call conventional medicine. And I think it’s important to understand that. And this gets actually where you were going too, Kelly. Back in 1900, the top three causes of death were all acute infectious diseases. So typhoid, tuberculosis, and pneumonia. The reason most people went to the doctor at that time, they were other acute problems. Like oh, I broke my arm at work or I cut myself really badly or I got in an accident. Some kind of acute emergency care situation. Those are the primary reasons that people were seeing the doctor. And that’s really the system that our current medical paradigm evolved in. And it became exceedingly good at fixing those problems, right? Like if I get hit by a bus, I don’t want to take some herbs at that moment and eat some healthy food. I want to get in an ambulance and go to the hospital.

And cancer I think straddles both worlds because there’s certainly nutrition and certain things you can do to support treatment, but if you need advanced intervention, conventional medicine is incredible, like you said. I mean not only there’s all kinds of new treatments too. Highly targeted gene therapies and stuff that’s going to totally change the game when it comes to cancer treatment. So my argument in the book is not one or the other; it’s both and. And it’s using the right tool for the right job, right? So what if we could take all of the insights of functional medicine in terms of addressing root cause and preventing problems before they occur, and then use the most amazing elements of conventional medicine in terms of diagnostics and therapeutics, if things do go south and you need that kind of care. We could extend our lifespan even further than they are now, but instead of spending the last 10 years in a diaper and a wheelchair, we’re thriving all the way up until the end of our life. And I think that’s what’s possible now with the tools that we have available to us.

Kelly: [0:14:33] And I’m not sure it’s the last 10 years. I mean it’s the last 50 years. 

Chris Kresser: [0:14:36] Yeah. That’s being generous, right?

Juliet: [0:14:40] Yeah, and I really appreciate you saying the and thing, because that’s how our own personal experience has been, right? There’s certain things now we realize that… For example, I struggle with chronic, lifelong anemia, and I’ve really struggled in the conventional medical system. 

Kelly: [0:14:55] You have jumped through a lot of hoops.

Juliet: [0:14:56] Yeah. And so I’ve realized that the only people that can help me with this are functional medical practitioners, that the conventional medical system just can’t wrap their head around it and work with me on the root causes at all. And simultaneously, when I got breast cancer, I obviously marched right in to my surgeon, and that’s the route I took there. So I appreciate you saying that. I think the other thing I wanted to point out, is that the thing we see in our practice is that we read a statistic that the number one reason why people go see their primary physician is musculoskeletal injury.

Kelly: [0:15:30] Or pain.

Juliet: [0:15:30] Or pain. And your traditional physician is wholly unprepared to help people with those kinds of problems. So I think we have to somehow help people learn that you have to, if you want to get real resolution, you have to choose the expert in their field, and maybe going to your Kaiser primary care physician because you have knee pain may not be the best path. I don’t even know if there was a question in there.

Kelly: [0:15:58] Wow. You were fired up, girl. You go.

Chris Kresser: [0:16:01] I think it goes back to what you asked, Kelly, as well, which is everyone has suffered in this system. Doctors have suffered, nurses, all kinds of healthcare providers, because the quality of the work is often not what they want or what patients need. And it’s kind of draining or leads to burnout. Then you have the patients themselves who suffer because they’re not getting the care that they need. The other side of that is that they’ve been conditioned from birth to expect that the solution to every problem is a medication or in some cases a surgery. And so in some ways, you can’t blame them because-

Kelly: [0:16:39] That’s the system they came from. That’s absolutely right.

Chris Kresser: [0:16:41] Literally from day one, when they were kids, before they could really understand any of this, they made that implicit association in their mind unconsciously, like when I have an owie, I go to the doctor. It doesn’t matter what the owie is. When you’re a four-year-old, already they’re making that association. I’ve got an owie, I need to go to the doctor.

So yeah, you’re right. There’s a lot of retraining and education that’s going to need to happen for both practitioners and patients to figure out what is the right… I said right tool for the job. What you were suggesting, Juliet, is the right person for the job as well. If you have pain, maybe you should see a physical therapist or an OT, or maybe you should even just talk to the trainer at your gym as a starting place. If they’ve had good training, they can help you with your biomechanics and look at what you’re doing that’s causing that pain. And you don’t even need to interface with the healthcare system at all. So yeah, I think there’s a lot to be said for that.

And I do think it’s changing. I mean if you look at the demand for functional medicine and other so-called alternative healthcare practices, that’s grown astronomically over the past 10 to 15 years. And I think it will continue to grow because the writing is on the wall. People know they’re not getting the support that they need and chronic disease just continues to rise. 

And so the way I talk about this is we’re going to get there one way or another. There’s the hard way or the really hard way. And I’m advocating for the hard way, which is that we wake up and proactively move in the right direction. But the really hard way is the healthcare system goes bankrupt and falls apart. And I’m not exaggerating. Even the Congressional Budget Office has admitted that by 2030 or 2035 that healthcare expenditure will consume the entire federal budget, if it continues to increase at its current pace. So this is like a real existential problem that we’re facing. 

Juliet: [0:18:47] We could probably talk about this for three hours because it’s a massive and complex issue.

Kelly: [0:18:52] And I just want to jump in and say this is the same sets of conversations we’re having around physical movement behavioral health. This is reflected exactly in all the things, Ivan Illich, plus musculoskeletal care. And I feel like physical therapists have become little doctors in the same way, where they’re really hamstrung by a system that isn’t serving people. So this conversation, for everyone if you’re listening, really resonates with Juliet and I both on a lot of levels.

Juliet: [0:19:19] Yeah. I mean we’re having these conversations sort of on a movement health level, but so much in common in terms of what you’re thinking about. I would love to just go back in time because I know and have read that you got into this because you yourself suffered with some serious chronic illnesses. And I don’t think actually maybe you started your professional life this way, that you sort of took a right turn because you had a whole host of chronic health issues. So could you tell us a little bit about those and that journey?

Chris Kresser: [0:19:46] Sure. I’ll give you the short version. So I was traveling around the world in my 20s, mostly surfing. I’m a lifelong surfer.

Kelly: [0:19:54] So say we all.

Chris Kresser: [0:19:55] Yeah. good times, until it wasn’t.

Kelly: [0:20:01] I will steal that.

Chris Kresser: [0:20:01] So I was in Indonesia on a little island called Sumbawa, surfing this placed called Lakey Peak, for any surfers in the audience who might know about that spot. And there were some cows defecating in a stagnant pool of water. The locals dug a trench into the river mouth, and the river took that water into the surf break. And many of us who were there, there were only a handful of people in the village in that time, but I would say about 60 percent of people got violently ill. And the classic tropical illness: Diarrhea, vomiting, nausea, delirium. It was pretty rough. I had some Cipro in my medical kit, which is also pretty rough. But it brought me back from the brink, from that acute phase of the illness. And then I continued to travel.

From there I went to the Maldives and then on to South Africa and Mauritius and Madagascar. By the time I got to Madagascar, I realized there was something seriously wrong. That acute phase that I went through was not the end of it and it just continued to progress. So made my way back to Australia, saw a doctor or two there, and then finally decided to head home.

And then that evolved into a 10-year journey back to health. And I saw probably 35 or 40 different doctors in at least three countries: The U.S., Australia, a tropical disease doctor in the UK, and left no stone unturned. And along the way, every doctor that I saw was well intentioned, well meaning, doing their best to help given the training that they’ve had. They were just utterly unequipped to deal with the kind of problems that I was experiencing. And there was kind of two phases. Phase one was figuring out what was going on in the first place, which was multiple parasites and infections and amoebic dysentery. And then phase two was dealing with the aftereffects of all of that. And that was what the conventional paradigm was particularly inept with, was how you address the complex, chronic symptoms and issues that arise after a bout with an acute infectious disease like that. 

And so that’s where I discovered the Paleo diet and met Robb Wolf. This was early days and still the vast majority of people hadn’t heard of Paleo and didn’t have any clue what that was. And I also discovered functional medicine. Very early days for that as well. And those were two of the major paradigms or approaches that brought me back to health. 

And yes, Juliet, as you mentioned, that was not my career at that point. I was not one of the kids that when you asked them what they wanted to be when they grow up said doctor. I don’t even think that was on my short list of five professions. Pro surfer was probably number one until I realized that was not in the cards. But doctor was not even really on the list. But as I started to recover my health and people around me started to notice what was going on, and I become the go to friend or family member that everybody would call when they had some kind of health issue. And then at some point I decided that what I had learned was really valuable in helping other people and that there was a need for it because it was so hard for me in my journey to find the support that I needed. So one thing led to another and I became a functional medicine practitioner and then started training others, writing, et cetera. So that’s how I ended up here, in this moment, talking to you.

Kelly: [0:23:41] I hear that a lot. And even we define injury in musculoskeletal health as you can no longer occupy a role in society. You can’t do your job. It’s a medical emergency if you can’t do your job and take care of your family, right? You can’t occupy your role as a mother or father or brother or sibling, whatever. But there’s a lot of gap between, hey, my knee hurts after this run or I’m a little achy or I feel stiff, and I can’t do my job, I can’t go to work. We feel like the modern musculoskeletal care is really good at saying, okay, you’re back within normal limits and you can go do your job. And that’s what I just heard you say, is that, hey, you’re alive, Chris, what’s your beef now, you know what I mean?

Juliet: [0:24:21] Yeah. You feel like shit. You feel horrible. But you’re alive, so you’re fine. 

Kelly: [0:24:25] It’s super great that you got over this dysentery and fever and you took this Cipro and destroyed your ligaments and tendons and your gut health. But aren’t you alive, isn’t that enough? And it’s enough because our traditional systems aren’t even set up or don’t even know how to ask what is nominal, what is normal, where should the boundaries of health and wellness be. Those words are bandied around, but once you’re out of the fire, then we don’t even know where to go or where to point people in the direction. And that is what Juliet and I are struggling with massively. And I feel like you’re in the same boat.

Chris Kresser: [0:25:04] Absolutely. I talk about this a lot in the book. There is no real definition of health in medical textbooks. There’s a lot about disease and a lot about how to treat disease with drugs and surgery. There’s very little if any discussion about what is health, what does that even mean. And it’s an interesting question to ask people, how would you define health. One of the definitions I like the most comes from Moshe Feldenkrais, who is more kind of in your field than in mine, really. He’s like a movement… He created a whole method called the Feldenkrais Method, which is pretty amazing way of reeducating the nervous system and really helpful for movement-based stuff. But he said, “Health is the ability to live your dreams,” which is a really interesting way of thinking about it.

Juliet: [0:25:52] I love that.

Chris Kresser: [0:25:53] Because it removes… Health is not just the absence of disease. There’s more to it. It’s the presence of something. It’s not just the absence of something. And that’s how we mostly understand health, is the absence of disease, the absence of symptoms, the absence of signs, but I think what we need to move to is what is it the presence of. Of vitality, of, like you said, the ability to occupy a functional role in society, whatever that role might be. 

And I would even extend it further to Feldenkrais’s definition, is the ability to live your dreams. So that means somebody who had a pretty crippling injury let’s say at one point in their life can still achieve health because if they figure out a way to live within the constraints of that injury and function in a way that’s satisfying and meaningful for them and allows them to live their dreams, then I would define that person as healthy. Conversely, you could have someone who has no obvious symptoms or signs or problems from a health perspective but they’re miserable and they’re a jerk. So I would not define that person as healthy using that definition. So I think we need to expand our thinking on this subject a little bit. 

Juliet: [0:27:03] So Kelly and I are working on our next book, called Built to Move, and a word that we’re really focused on around this book and I think it’s because we’re in our 40s, about to go into our 50s, is the word durability. And I bring it up because you mentioned the thing that none of us want, which is, great, we live to 90, but for the last five to ten years of our lives we have a horrible quality of life. And I think-

Kelly: [0:27:25] Or, I’m afraid, at 65 or 70.

Juliet: [0:27:26] Yeah. We sort of prefer the word durability to longevity because none of us want to live to be 100 at any cost, right? That’s not worth it, right? So we sort of have fallen to love the word durability because to us that means you live in a healthy, happy way where you can do what you love until some point, at which you can’t at all. So I don’t know. I just wanted to get your thoughts on that. 

Chris Kresser: [0:27:52] Yeah. I think that’s great. The word resilience is really overused I think, but it gets at something similar, where like our daughter’s ski teacher and previous horse teacher is 80, and she is one of the best skiers on the mountain. Not like, oh, a good skier for being 80, but one of the best skiers that you will see on the mountain, at 80. So fluid and just beautiful and conservative in her movement. And the alignment is so perfect. And you can just, it’s just fun to watch. And she’s also on the ranch shoveling out poop from horse stalls for several hours a day. And she’s just amazingly active and functional. And I look at her and I think, that’s my goal, to be like that into my 80s and as long as I can be. And the problem is that we don’t have many models for that because most people that we’ve seen in our lives start to decline at a pretty early age. Not at 80, but probably at 50 they start to become a lot less functional in their movements, start to have a lot more injuries, start to experience a lot of health problems, diabetes, cardiovascular disease, et cetera. 

And I think that is part of the reason for that, going back to one of the earlier discussion points, is we don’t have a good mental map for what it means to be healthy. The whole focus in conventional medicine is I wouldn’t even say avoiding disease, I would just say treating disease. It’s basically, the assumption is, you will get disease so we will treat it and try to ameliorate the symptoms with drugs. The focus isn’t even on preventing disease. It is in functional medicine, but it isn’t in our typical…. That’s why I don’t call it healthcare; I call it sick care. Sick care paradigm. Or I’ll also sometimes refer to it as disease management because that’s the primary orientation.

Kelly: [0:29:53] There’s a feeling in physical therapy that there’s a lot of normative, typical changes in your tissues as you age, and that all discs will herniate and that all joint surfaces will become arthritic, and that’s okay. And it’s muddied a little bit because the conversation is about pain to no pain. Pain is driving a lot of these conversations. Pain is complex. You can have all of these things and not have pain. You can have these things and get out of pain. 

But one of the things I think Juliet and I… You just illuminated beautifully with the skier who is shredding, right, this is really the goal, is what are those behaviors that allow that person. It can’t just be genetics. And certainly genetics… I mean it would be great if I could just have chosen my parents maybe slightly differently, you know. But I didn’t really have a say in that. So beyond genetics and good luck, we believe that we have to be able to engineer some foundational principles, some bedrock keystones around what it means to be a human, like walking more, like sleeping, getting sunshine.

Juliet: [0:31:02] Eating some vegetables.

Kelly: [0:31:03] Yeah. That has become a radically, radically dangerous idea, Juliet. Vegetables are trying to poison you. That is a problem in modern… Right? So if that’s where we’re dealing because we feel like it’s not inevitable that your tissues have to break down to a place, that there are a whole set of behaviors that we need to engage in probably from our elementary school selves onwards where we might roll into these later with a little bit bigger cushion. Am I thinking in the right way or am I getting this wrong?

Chris Kresser: [0:31:35] I think so. I mean this is why I’ve always been so compelled by the ancestral health argument, which is set aside all the caveman blah blah blah blah, when you look at ancestral populations that are still living in traditional ways, they age way better than we do. They typically remain pretty functional up until the day that they die. They are able to participate in society in a meaningful way. And they don’t have that long, steady decline that we see in the Western world. They don’t acquire the chronic inflammatory conditions that characterize our old age, like diabetes, heart disease, dementia, Parkinson’s, et cetera. Those things are very, still, to this day in the few societies that have been able to maintain their traditional lifestyle, those conditions are very rare. 

So what are they doing differently? Well, they’re eating generally nutrient dense, anti-inflammatory, whole foods diet. Okay? Let’s just keep it that simple. They’re not eating a lot of processed and refined junk. That’s the biggest difference. Number two, they’re moving in functional ways regularly. So-

Kelly: [0:32:47] And not exercise. You’re not saying exercise.

Chris Kresser: [0:32:50] I’m not saying exercise. They’re not necessarily deadlifting and squatting or doing CrossFit WODs or any of that stuff. They are just moving their bodies in functional ways. So that could be physical labor. You know, building stuff, moving heavy things around. Could be walking, you know. We’ve all heard the 10,000 steps idea that came out of observing traditional societies and what they do. They generally go to sleep a little bit after when it’s dark and wake up when it’s light, and sleep through the night. They live in close knit, tribal social groups. This is a tough one for us in the Western world where life has become so nuclear. They’ve got a lot of social connection. They make time for play, I think which is another big one. It’s really a part of our evolutionary heritage, and we’ve often lost connection with that. 

So on the surface, it’s all like duh, right? Like it’s pretty simple stuff. But it’s really actually… The number of people that are living that way in the modern world is infinitesimally small at this point. And so I think that’s where we’ve gone off the rails. And when I look at someone like the woman that I’ve been talking about that is 80 and still ripping and still working on the ranch, she’s never exercised a day in her life. She’s done things that she’s loved like riding horses and skiing, and she’s worked and done manual labor. And she’s continued to inhabit her body in a highly functional and practical way. And what she didn’t do is get a job and sit in an office for 12 hours a day in a chair, which I’m doing right now. So it’s not like… I’m not immune from that. But I’m saying we’re living in the human zoo and it’s not going well, right? 

Kelly: [0:34:37] It’s not going well. I think-

Juliet: [0:34:38] It’s not going well. And I would just like to make the point and get your reaction, but I think there’s that side of the pendulum, and then on the other side is I think the ways in which we’ve gone far afield in our own industry, sort of the health, fitness, wellness industry, where-

Kelly: [0:34:55] You don’t have a couch.

Juliet: [0:34:56] Or that you think you can sleep in a Michael Jackson pod and take 50 supplements and do a bunch of weird injections, but then not really do the basics, right? 

Chris Kresser: [0:35:07] The biohacker mentality.

Juliet: [0:35:08] Yeah. There’s the biohacker mentality, which is a little tough for me, I’ll be honest, because I think it’s often, I think the root of it is I’m just going to see if I can cut the basic corners and use all this tech and stuff to reach optimal health, which I also don’t think is possible. I sort of am of the mind that you get to earn those things. Like maybe you get to-

Kelly: [0:35:30] Well, it also doesn’t scale.

Juliet: [0:35:31] Yeah. It’s great if you track your heartrate variability, but why don’t you just actually try sleeping for eight hours first, and then maybe later on track some more high-tech data. I don’t know. I just think maybe we’ve also gone far afield in our own industry in an area.

Chris Kresser: [0:35:48] I’m totally on the same page with that. In fact, I have not very much tolerance for the whole biohacking mentality. Now look, I think there are… It depends what you include in biohacking. If you’re going to call infrared sauna a biohack, then I’m all for that because there’s clear evidence that sauna use and then photo biomodulation through infrared light has pleiotropic benefits, meaning it works across a wide range of conditions and provides a wide range of benefits. I look at that almost like exercise. It’s something that we can add to our routine if we can afford it and have access to it and it’s just a win in all ways.

But what you suggested, Juliet, this is the idea that I can just drink Soylent Green and put e-stim pads on my muscles while I’m coding all day and be healthy is ridiculous. It’s a sick joke. And it’s so obviously false and wrong that I can’t believe anyone actually thinks that. So to me it also points to kind of like, not to get too philosophical here, but a kind of profound disconnection from our bodies and from the world that we live in, where we think that that’s a viable path towards health, because there’s more to everything that I just mentioned, like being outside, being connected to nature. Like to me, skiing or backpacking, hiking in the back country, surfing, just being outside for long periods during the day, all of those things have benefits that are above and beyond what we can measure and calculate in terms of blood markers or anything else that we can test for. And we all know that, right, intuitively.

Yeah, I think that the basics are always more important. And when I talk to my patients or when I teach, I always try to drive that home. It’s like spend 90 percent of your energy on the basics and get those down first before you even think about some of these other things.

Kelly: [0:37:50] We’re seeing sort of I think a natural evolution of we’ll say gym culture where we are now supplementing all of the things that you’re supposed to do outside of the gym: Play, cut, run, job, drag, carry. We’re trying to put all of that into the gym. And it’s now, the gym has become… We’re adding in so many supplements to the movement, health, diet piece. And it’s confusing. Instagram exercise entertainment has confused the thing. If I’m working really hard in SoulCycle, that’s confused. What is good physical practice?

I feel like the same thing has happened with supplements around there. And yet because people can’t sometimes occupy a lifestyle that is more conducive to general health, we find that there is great utility in the gym by helping people restore what it is they should be able to do, their normative ranges, tissue exposure. So we can use that as a diagnostic tool to supplement what people should be doing outside and aren’t getting outside. Is there an analog in someone’s sort of blood markers? So how would they know what’s going on under the hood? If the average person can’t work with a functional medicine practitioner because it’s beyond their resources and they are saying, okay, I’m starting to sleep and move more, is there something that they could ask for or start to look at around essentials that we think are the big… Because it’s all important, but what are the most important things, or where would someone begin to tug that out if they didn’t have all the resources?

Chris Kresser: [0:39:32] Couple things I want to address there. First is, in the same way that if someone’s not able to have a fully functional movement-based lifestyle, they can benefit from going to the gym. I’m not against supplements. I use them myself; I prescribe them every day for patients, we include them in our courses. I think the point there is it’s not like a hall pass. You can’t supplement yourself out of a terrible diet and lifestyle. On the other hand, if you’re doing your best, and you’re working within the constraints and limitations that you have, supplements can be a lifesaver. And I think about it in two categories. One is maintenance and the other is therapeutic. So maintenance supplementation is like replacing any nutrients that for whatever reason you’re not able to get the optimal amount of. Vitamin D-

Kelly: [0:40:20] We don’t like fish. We don’t eat a lot of fish.

Chris Kresser: [0:40:22] There you go. So you don’t like fish, you might need a little extra EPA and DHA. You don’t live near the equator, you might need to supplement with Vitamin D. There are situations like that where supplements are just fulfilling the role of the gym, so to speak. And then there are also situations where, and this is getting towards your question, somebody has an issue. Maybe they’re not perfectly healthy or they’ve got IBS or they’ve got Hashimoto’s type of thyroidism or they’ve got some health problem that’s going on. But they want to figure out a more holistic root cause based approach to addressing it and not just take a medication. Or maybe there’s not even a medication that is available or would work for that condition. Then supplements can be very helpful. And even other “biohacking” type of steps can be very helpful in that situation.

Kelly: [0:41:09] In full transparency, I take… My Vitamin B is always a little low; my Vitamin D is always critically low, even if I supplement. So I actually get a little sunlight. I don’t eat enough fish. My omega-3 is always low. So I am a supplement user. But I see those as analogs to food and behavior things.

Chris Kresser: [0:41:27] Adjuncts.

Kelly: [0:41:28] Adjuncts, that’s right.

Chris Kresser: [0:41:29] Things that you add on to what you’re already doing. And that’s only the point I was trying to make, is they don’t replace a healthy lifestyle. I think that’s what you were saying too. So to answer your question, I wish there was an easier answer to your question, Kelly, is I guess what I would say, because as you imagine, I get asked this question a lot. And what I would like to be able to say is, oh, you just go to your doctor, you ask for their preventative health checkup blood panel, and they recommend that and it gets covered by your insurance, and then when they get those results back, they know how to interpret that blood panel from a preventative health standpoint, not from a red light blinking on the dashboard standpoint. And an example of that is, oh, let’s say your blood sugar comes back and it’s 98; they’re going to look at it and go, oh, it’s normal. You know?

Kelly: [0:42:19] It’s not 120. It’s fine.

Chris Kresser: [0:42:20] No. When it turns 99, it’s no longer normal. And somehow in that one point difference it went from being normal to abnormal. That’s kind of the ridiculousness of the ranges that we use. But yeah, so it’s not just a question of getting the right testing, it’s a question of knowing how to interpret it from the perspective of a preventative mentality, like let’s stop this problem before it becomes a problem that’s hard to stop, right? So if your blood sugar is in the high 90s and it’s consistently in the high 90s, it’s time to intervene before you even get to the prediabetic blood sugar level, and certainly before you get to the full diabetic level because Ben Franklin was not wrong when he said an ounce of prevention is worth a pound of cure. It is so much easier to reverse high normal blood sugar than it is to reverse pre diabetic blood sugar, than it is to reverse full diabetic blood sugar. 

So I think a comprehensive blood panel that looks at a wide range of metabolic markers, so fasting glucose, hemoglobin A1C, uric acid, triglycerides, even just the standard lipid panel with cholesterol and LDL and HDL cholesterol, Vitamin D, iron, full iron panel, comprehensive metabolic profile which looks at bilirubin, some of the liver, gallbladder markers, your liver enzymes like AST and ALT. The CBC complete blood count, which I’m sure you’re familiar with, Juliet, with the history of anemia, where it looks at your white blood cell count but also your red blood cells, hemoglobin, hematocrit, to make sure you’ve got enough red blood cells there and you’re not developing anemia, or on the flip side, you’re not going into hemochromatosis or something like that. That type of more expanded blood panel is I think the single most important tool that we have for just monitoring overall health and wellbeing. We could get into talking about the gut and testing for the good and things like that, but I actually think that as long as you’re doing the right things, like eating a nutrient dense diet with plenty of fermentable fiber, some fermented foods, maybe taking a probiotic, then you don’t actually probably need to do a lot of testing there until you develop any kind of symptoms that would justify that. So I think a comprehensive blood panel is the thing that would be most useful for most people.

Kelly: [0:44:48] That is a like white slate. People have no idea what’s going on underneath the hood. It’s a black box, you know, I eat whatever I want to eat and then stuff happens and I feel like I’m 110 years old and I’m not lucid. So I appreciate that as a starting place. And it is, it’s okay to say that it’s a little bit nuanced and complicated, that you’re going to have to educate yourself a little bit. 

Juliet: [0:45:12] So one quick side story I thought you’d appreciate is that I used to have Kaiser and scream into the air about my experiences there in some ways. But one of the more recent ones I had is my primary physician is like, “Yeah, we don’t test for Vitamin D anymore.” And I said, “No one?” And she’s like, “No, it’s a new Kaiser policy. We don’t find that people’s levels really change at all and it’s just not…” And I literally was like-

Kelly: [0:45:37] That was on the heels of her telling you you’re not that anemic.

Juliet: [0:45:40] Yeah, yeah, yeah, my hematocrit was like 34 and she’s like, “You’re not that anemic.” And then I was like, “Dude, dude.” Anyway, that’s just… I know. I knew you would put your hands over your face with the Vitamin D thing because think about that gigantic healthcare institution that is not testing for what I think is one of the things you can actually make a change to, right, as a human, as well. It’s not just like you’re doomed if you get a bad… You can actually change it, so.

Chris Kresser: [0:46:06] It’s also very important for our immune health, and particularly for protecting against certain viral infections, which, you know.

Juliet: [0:46:16] Yeah. Exactly. That was a real shocker for me.

Kelly: [0:46:19] Men, if you’re listening to this, all our friends who have tracked this or care about this, when people’s Vitamin D goes up, we’ve seen boosts in testosterone of like 200 to 300. Am I wrong that it’s kind of a pro hormone? It has a lot of functions.

Juliet: [0:46:35] I think it does like a thousand awesome things for you. I mean I’ll let Chris actually speak to the awesome things. But it does like a thousand awesome things for you, having some.

Chris Kresser: [0:46:44] It’s one of the most important nutrients that is in our bodies. And the rates of deficiency are shockingly high. And when you are deficient in Vitamin D, your immune system is not going to function optimally, it plays a very important role in calcium homeostasis and metabolism. So for folks who want to stay active and healthy and maintain healthy bones, it’s really critical. So yeah, that’s a really good example, Juliet, of where does that recommendation come from. We don’t see people’s levels change? Well, that’s because you’re not using high enough doses to change the levels. Oh, it’s like we’re not getting the results we want so let’s just stop testing so that we don’t have to see that we’re not getting the results instead of trying a different way to get different results. It’s like I went to the gym and I was lifting this three-pound weight a lot and nothing really happened so I just stopped lifting weights. It’s like insane. 

Kelly: [0:47:50] When Caroline, who’s our 13-year-old, was born, she was a preemie. She was six weeks premature. We spent three weeks in the NICU. They finally discharged us. Juliet is doing an incredible job breastfeeding, and they give us these vitamins for Caroline, these supplemental vitamins. And I was like, “Really? We need to supplement?” They were like, “You have to give these vitamins to your daughter.” And I was like, “Well, she is breastfeeding.” And they were like, “Yeah, right, you have to give her these vitamins.” And I was like, “Look me in the eye and tell me breastmilk isn’t kind of a perfect food for children.” And they were like, “Huh?” And I was like, “What is the problem?” And they were like, “Well, we noticed that women who are new mothers don’t go in the sun. Vitamin D is iatrogenic so the milk given to the child isn’t Vitamin D rich.” And I was like, “Oh, so if Juliet went in the sun, we put our daughter in the sun, I wouldn’t have to give her these fake vitamins?” And they were like, “Correct. But that won’t happen so take these vitamins.”

Chris Kresser: [0:48:50] Yeah. It’s bizarre. I mean here’s another one that comes up a lot which drives me nuts, which is iron overload in men. So this is actually, it’s not super common, but it’s more common, it’s the genetic polymorphism that leads to iron overload in men is the most common genetic polymorphism there is in North America. So very few people know that. It affects between one in 200 and one in 300 people. So that’s not super common, but it’s not super rare either, right? In a country of 300 million people, you get a lot of people with iron overload. And iron overload can be fatal when it’s severe, but even when it’s mild, it can shorten lifespans, because it literally rusts the organs inside of your body. It’s like when you take a bite out of an apple and it turns brown or you see rust on a car, that’s iron that’s doing that. So I will frequently have people come in and I do a full panel, like I said, a very comprehensive blood panel for every new patient. And it’s not just men, sometimes women, I’ll see ferritin levels at like 600 or 700, and a normal ferritin level might be 150 or something like that.

Kelly: [0:49:58] Juliet’s eyes just peeled back because she’s dreaming.

Juliet: [0:49:59] I was like oh my God, I would feel amazing if my ferritin-

Chris Kresser: [0:50:00] You would not. You would not, actually. You would not.

Kelly: [0:50:07] Careful what you wish for, woman. 

Chris Kresser: [0:50:08] Yeah, exactly. You know, it’s the Goldilocks zone, so many nutrients and markers. When iron is too high, the number one symptom is unexplained fatigue, but you also get liver issues, you get cognitive issues because of the effects on the brain, you get blood sugar issues because of the impact on the pancreas. And so I have seen these people with ferritin of 600 or 700, I will send them to a hematologist because they really need proper workup and therapeutic phlebotomy, which is removal of blood. They need genetic testing to see if they have the genetic thing, hemochromatosis, because their family members need to know about it. And I would say eight times out of ten, the hematologist turns them away and says, “You’re fine. You don’t need to worry about this.” And the justification is because all of the other patients that the hematologist sees have ferritin levels of like 1,100 or 1,200 or up, that a level of 600 or 700 is not cause for concern yet. 

So the argument is let’s wait until your ferritin gets to be 1,200, by which time there’s irreversible damage of your liver. Then we can start paying attention to it. Even though evidence clearly indicates that as ferritin climbs above let’s say 200, 250 in men, you see a linear increase in mortality risk, cardiovascular disease, stroke, all kinds of other problems. So that’s like a really good example of the mentality of the system, is like let’s wait until things are so far down the track that there’s really not much more we can do, because their practices are overwhelmed with people that actually are at that place, and they don’t really have the time or bandwidth to address the preventative care element, so.

Juliet: [0:51:57] Yeah. It’s the house is on fire.

Chris Kresser: [0:51:59] Exactly.

Kelly: [0:52:00] And instead of a fecal transplant party, there’ll be a bloodletting party.

Chris Kresser: [0:52:03] Yeah, pretty much.

Kelly: [0:52:03] I can see it. I’m sure there’s a YouTube channel for that.

Chris Kresser: [0:52:04] Yeah. Don’t do this at home.

Juliet: [0:52:10] Okay. So Chris, I would just love… I know you touched a little bit on it at the very beginning when you were just giving us a broad background, but can you tell us a little bit more about the Kresser Institute, what you’re working on there? I know you both see clients and train a ton of other health coaches. And also, I’d love to know about your sabbatical, as a third question in that group.

Chris Kresser: [0:52:30] So is our site for all our training and education. We have two programs. They’re both 12 months long. But one is for licensed healthcare providers like doctors and nurse practitioners, naturopathic physicians, et cetera, and it’s for folks who want to learn how to practice functional medicine. And then the second program is for nonmedical professionals or medical professionals who want to learn to become a health coach, which doesn’t require a medical background, unlike the practitioner training. And it’s really for people who just want to learn how to become advocates for others in achieving their health goals, whatever they might be. And the health coaches are trained, I like to call them behavior change ninjas because they’re trained in all the evidence-based strategies, like positive psychology, character strengths, goal setting, et cetera. It’s like just having a really awesome friend, but one that’s really smart and really knows how to help you achieve your goals. So those two programs. 

And my sabbatical has been amazing. I did clinical work for 10 years in a certain way and I wanted to take a step back and really have the time and space to really think about whether the way that I have been doing it is still the best way to do it or whether there might be a better way to do it. And it’s been very fruitful and I’ve been very fortunate and grateful that I have the opportunity to do that and I think it’s such an amazing experience to have. And I wish others can have that experience too because to be able to just take time to reflect on how I’ve spent the last 10 years of my life and how I want to spend the next 10 years of my life is a big gift. And I have some ideas, nothing that I’m quite ready to talk about publicly yet, but I’m really excited about the next 10 years. That’s what I’ll say. 

Kelly: [0:54:17] Let me follow up, and I know we’ve been chewing a ton of your time, and Juliet and I are deep nerds on this and love talking to you. But could you highlight how some of your thinking, without going into the things that you’re not ready to talk about yet, some of the things that have changed in your beliefs over the last 10 years? We have some strong… We’ve become a lot more reasonable and holistic in 10 years. But do you have anything that jumps out at you about how you’ve evolved, knowing how the world has changed in 10 years, not just your own practice, but the sands have shifted underneath your feet, that was new.

Chris Kresser: [0:54:51] Yeah. It’s a great question and I have enjoyed talking to you two as well. I kind of alluded to it earlier. I think a theme that’s been very consistent in this last year of contemplation is what is health really and recognizing that it’s much more than just the absence of disease or symptoms, and it’s a lot more about the presence of certain things that we would all recognize as being essential things in our life. And I would say that if I started with a pretty intense core focus on nutrition and then functional medicine, my sphere is expanding to include… You know, I always talk about the importance of sleep and physical activity and stress management. But I would say that’s even expanding further to include the importance of play, of having fun, of social connection, of spending time outside, and even things like meaning and purpose in your life. Like really finding a way to express who we are essentially as human beings and to feel like our life is making a difference in at least one other person’s life. It doesn’t have to be a lot of people; it could just be one person’s life. 

But I think there are aspects of being human that are so fundamental to health and wellbeing that often get left out of the health conversation, which is sometimes reduced to just your diet and how much you can deadlift and bench press or swing with a kettlebell or whatever. Yeah. And I just think it’s so much more than that because we can look and see that the people that we really look up to and admire in life sometimes have really intense, chronic health problems, but not even in spite of that, because of that, they were able to kind of transmute those issues and really still play an amazing role in society and their life. So that’s what I’m interested in going forward.

Kelly: [0:56:53] Well, I have to say, I am so grateful that a cow took a poo in your surf spot. And I know that that’s a long way around the barn, but maybe it’s not a butterfly flapping its wings that’s changed the world. But we are grateful for your thinking. And we have a lot of coach friends who aren’t medical practitioners but have gone through your training and have become those nodes of excellence because realizing that the physician may not be set up for it, she may not, they may not actually be able to do the thing. And we’re moving more and more towards the trainer and coach becoming a primary care, primary awareness person, empowering that person filter the person in the right position. And I feel like you’re doing the same thing. And I just want to say thank you so much.

Juliet: [0:57:42] And so one last question, Chris, before we let you go onto your day. But first of all, I think you said is where people can learn more about the work you’re doing. And then for people more broadly who have been turned on by this idea of functional medicine, if you’re not near you, where would people start? I mean do people literally type in “functional medical practitioner near me” in Google? How do people find-

Kelly: [0:58:08] Paleo Cure, Unconventional Medicine books.

Juliet: [0:58:08] Yeah. Tell me where people would go.

Chris Kresser: [0:58:12] Yeah. Yeah. Good question. So to find a practitioner, we have a directory of practitioners that we’ve trained. So and up in the top right, it’s find the practitioner. So that’s the answer to that. And you can find a health coach as well. So it’s the directory there. is my main website. That’s more for, it’s for everybody, but it’s more focused on how to address chronic health problems using functional medicine, nutrition, and lifestyle change. And we have recently started to do some seven-week or eight-week online workshops that are focused on particular health topics. So we did one autoimmune disease recently. And the idea with those is like, okay, you can’t see a functional medicine practitioner for any number of reasons, and reading blog articles or listening to podcasts hasn’t been enough, what’s the middle ground? So that’s these workshops. And we’re going to do another one on boosting your immune system naturally in January. So if folks want to learn about that, go to and just sign up for my email list and we’ll keep you posted. 

But I’ve been doing that website for 14 years now, so there’s something like thousands of articles on almost any health topic you can imagine. So one of the most flattering things people say to me as they use my websites like Google health, they go to the website and just type in whatever they’re interested in and you’re bound to find some articles that are on that topic. So that’s what I would recommend.

Juliet: [0:59:42] Yeah, and also for our listeners, definitely check out The Paleo Cure and Unconventional Medicine, which are Chris’s two awesome books. So I’m sure they’re on Amazon.

Kelly: [0:59:50] Chris, I hope you get to, with this new snow and these atmospheric cyclone bombs, I didn’t even know that was a thing when I said landforms and soils and climates, right?

Juliet: [1:00:00] Last week. You didn’t know that that was a thing last week.

Kelly: [1:00:02] Double cyclone bombs. I hope we get to shred with you a little bit this year.

Chris Kresser: [1:00:07] Yeah, me too. And thank you both for the work that you’re doing. I’ve been aware of it for many years, and hope we get the chance to meet in person one of these days.

Kelly: [1:00:16] Cross the streams.

Juliet: [1:00:16] I think it will happen. I think it will happen. All right, thanks again, Chris.

Kelly: [1:00:19] Thanks, Chris.

Chris Kresser: [1:00:20] All right. take care. Bye-bye.

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