#tony took his to a psychiatrist and he got diagnosed

[anonymous-tals]

My sister said the way I described little Gob staring at the waiter from underneath a table in a scene I was writing reminded her of the autism creature so I drew him as a kid and also as an adult as the autism creature.

Additional sketch of the scene I described to her(he’s under there cause he’s a little gremlin with no impulse control and wanted to explore, he’s eventually coaxed out with a soda):

[phoenixstark1708]

the daughter of an archangel pt.4

The man came in once she left, and set down a bunch of books, and a strange electronic thing that folded. “hello phoenix, my name is mark. Im just going to ask you some questions to figure out where you’re at academically.” oh! I know what academics are! That is my favorite thing! My face visibly lit up at the prospect. The man began with painfully simple math equations “134+23” and “33x11” they progressively got harder, and I continuously got them gorrect. The man seemed astonished I knew all that I knew all this stuff. Trigonometry is where I got confused. He noted that on his clipboard. Then came science, which I was again, above average. Then history, I didn’t know much, because the stuff I was taught was purely propaganda. Then came literature, which I was average in. And finally, foreign languages. The man was obviously shocked when he realized I was fluent in 53 languages.

I later met with a psychiatrist, and spoke for nearly four hours. I explained my childhood, and past, and she listened intently, asking some questions, and recording the conversation. I had several preliminary diagnoses, but she wanted to meet in a few weeks to see where I was at. By the end of the day, I was tired, but I stayed awake because I knew I would be punished if I fell asleep. I sat on the edge of the bed until tony came in “hey phoenix, how’re you doiung? Pepper told me how well you did today. Im going to get you some tutors so you can get an education. Is that okay?” I nodded “great. Then, there was something else we needed to talk about.” I looked up at him “you are not a prisoner here. You can explore as you please, you can eat whatever you feel like, and do watever you need to. You don’t need to ask. For an example, if you wanted to shower, you can. If you wanted to sleep, you can. Eat? Of course. Drink? Yes ma’am.” I was looking at him quizically, confused as to why I was allowed to do these rhings. I was definitely not complaining. “but, I think it would be best for you to stay here, in the house. Of course you can go outside if you want, but stay close. Its not safe for you out there yet.” he finished. “take care kiddo.” he ruffled my hair and walked out of the room. I laid down on the bed and slept.

After a months of living with tony, I finally began to gain weight, I was finally gaining confidence, my face began to fill with color, and my academics took off. I was getting more confident, and happy. Actually happy. For the first time in my life. I still had times when I felt terrible for leaving bucky; How could I not? He saved me. I was having frequent flashbacks. After meeting with the psychiatrist again, I was diagnosed with PTSD. I refused the medications they offered, vividly remembering the various drugs hydra expiramented on me with.

Everything was going good, until one day, a black man came with an eyepatch. Tony explained he was here to help, and he called him because of me expressing my desire to help the world after all the damage I'd done. We sat at the patio table, tony giving us privacy. “so, I hear your name is pheonix stark?” he sort of questioned “yes sir, that’s me” “good. But I know that you don’t have any official family- yet. I wanted to talk about tony adopting you. He has already agreed, but has made it expressly clear that its off if you don’t want him to. This way, you can become an official citizen of the united states, and you can go to a real school. How does this sound, phoenix?” I waited a moment “good. It sounds good, but tony said that you were here to talk about me helping the world?” he chuckled “straight to the point. I like that. Yes, that’s the other thing I wanted to talk to you about. Im the head of an organisation called SHEILD. I know you are relatively familiar with us?” my eyes widened in fear when he mentioned SHEILD. “y-yes. You know me, what ive done. Why would you want me there?” I asked in a small voice “we want you because you would be an excellent addition to our organization. HYDRA controlled you, we all know you didn’t have a choice. We want to help you learn to control your powers, and how to fight. We want to train you to be excellent. And make no mistake, you are not forced to, you will not be harmed by us, and you don’t have to do any of this if you don’t want-” I cut him off in excitement “i’ll do it” I was beaming with joy not showing in my voice. “we will also send you on some missions when you’re ready. Nothing like what you did at HYDRA, you would be saving people, not hurting them.” I nodded “this may seem like a lot, phoenix, but I think this would be a good thing for you.” “i want to do it. All of it. I want to be adopted by tony, and I want to join SHEILD. This will be my opportunity to make amends for the things ive done. Thank you.” just then, tony come out of the door. I ran to hug him – an astronomical improvement from when I arrived; afraid to even talk. “thank you.” I murmured “thank you kid. Phoenix Stark has nice ring to it, huh?” I nodded, beaming with excitement.

After that day, we signed a LOT of paperwork for the adoption. I found it hilarious that we had to sign hundreds of papers, quite a change from what I was used to. and I became an official U.S. citizen! I had never felt so much like a person, rather then a machine. I struggled with terrible nightmares of the punishments I endured, and the missions I partook in. I couldn’t stop thinking about the sacrifice bucky made for me. I hated HYDRA for it, well I hated them for a lot of things, but especially that.

i saw you like the other 3 parts, so tagging you in this one :)

@breadhead19

[clingyduoapologist]

Did you know that the Broadway musical Falsettos, written and composed by James Lapine and William Finn (it's sung through so there's no dialogue), was originally 3 separate plays? It was a series of 3 one Act plays, featuring mainly the same characters but all following the male lead, Marvin. The first show, titled In Trousers, was written in 1979 and is shown from Marvin's perspective as he reflects on his life and questions his sexuality. The second play, March of the Falsettos (1981), shows the aftermath of him leaving his wife and child to be with his lover, Whizzer. His wife, Trina, then falls in love with Marvin's psychiatrist (and a whole bunch of other shit happens but I'm talking about the weird history of the musical, not the plot). The 3rd and final play, Falsettoland, written in 1990, shows Marvin turning his life around just in time for Whizzer to be diagnosed with AIDS.

March of the Falsettos and Falsettoland were then adapted into a single two-Act musical (Falsettos) that made its Broadway premier in 1992; the show won 2 Tonys for Best Original Score and Best Book of a Musical, and was nominated for 5 others. It ran for a year on Broadway, went on 2 national tours in 1992 and 1993, and then went off the stage entirely until its revival in 2016. While March of the Falsettos and Falsettoland both got cast recordings, 1992's Falsettos did not, and the only cast recording of the show is by the 2016 revival cast. Since it's a sung-through musical you can get all the lines from the play just by listening to the album, without worrying about missing anything. Unfortunately, the 2016 cast only ran for one season, but they took a pro-shot (professional stage recording) of it that was uploaded to YouTube 2 years ago (no grainy iPhone bootlegs!! Yippee!!!). Falsettos (2016) was nominated for 5 Tonys, but somehow Stephanie J Block lost the Best Featured Actress award to someone in dear evan hansen (<- I am normal about that fact)

Bronze let’s go kill Even Hansen in real life

[pwilzfan73]

True story behind The Conjuring 3 – inside Arne Cheyenne Johnson’s “the devil made me do it” court case

The latest instalment in The Conjuring franchise once again has its roots in a real-life case.

By Patrick Cremona, Radio Times. UK.

Published: Friday, 21st May 2021 at 2:56 pm

The Conjuring 3 takes its title from a real-life court case that dates back to the 1980s. The Conjuring: The Devil Made Me Do It takes a look at the case and the Warrens’ involvement in the case that originated the phrase “the devil made me do it”.

Patrick Wilson and Vera Farmiga return as paranormal investigators Ed and Lorraine Warren for the next instalment in The Conjuring horror franchise, with the new movie heading to UK cinemas on 28th May 2021.

As with the previous movies in the franchise, The Conjuring 3 is taken from a real case file with reported connections to the supernatural. Previously we’ve seen spin-off movies focused on the Annabelle doll, also inspired by the Warrens who keep it in their occult museum.

Vera Farmiga and Patrick Wilson as Lorraine and Ed Warren. Warner Bros Pictures.

The case in question this time around is the trial of Arne Cheyenne Johnson, a man who was convicted of manslaughter in Connecticut in 1981 – becoming the first person to have claimed a defence of demonic possession during a murder trial.

The Conjuring: The Devil Made Me Do It true story

The Conjuring 3 is inspired by the trial of 19-year-old Arne Cheyenne Johnson, who was charged with murdering his landlord Alan Bono in February 1981. During the trial, the defendant gained infamy for becoming the first person to claim a defence of demonic possession in a United States court – although perhaps unsurprisingly this version of events was not accepted by the judge.

His defence rested on testimony given by the family of his fiancée, Debbie Glatzel. Debbie’s 11-year-old brother had reportedly been the subject of demonic possession in the months prior to the murder, with his parents having grown increasingly worried by a number of unexplained and ominous events.

The story really starts in July 1980, when the 11-year-old David Glatzel was helping Johnson clean up a Connecticut rental property he was prepping to move so he could move in.

While there David claimed to have come across a “burnt and black-looking” old man who he claims pushed him into a waterbed saying he would bring them harm if they moved into the house.

When David returned home he continued to see the old man. He described him as having a white beard, wearing jeans and a flannel shirt. David claimed the man’s skin was charred as if he’d been burnt too. The young boy experienced night terrors and woke up with bruises and scratches on his body. He’d wake screaming and tell his parents he’d seen the sunken features of the old man “like an animal”, with horns, pointy hears and jagged teeth (via People). (The Conjuring 3 demon appears to have gone a different route, with early photos showing a white masked man wearing a striped red long coat.)

The family said they also had heard unexplained noises coming from their attic.

In trying to get to the bottom of the issue they had called in Ed and Lorraine Warren – who by this point were already well-known paranormal experts – to diagnose and cure their son.

Ed Warren said he heard banging and growling sounds coming from their basement, and that he also say a rocking chair move on its own. Speaking to paranormal researcher Tony Spera, Ed claimed David’s toy dinosaur also walked on its own towards the family. He also said a deep voice spoke to them saying: “Beware, you’re all going to die.”

Lorraine also claimed she saw a black mist appear next to David while her husband interviewed him. “While Ed interviewed the boy, I saw a black, misty form next to him, which told me we were dealing with something of a negative nature. Soon the child was complaining that invisible hands were choking him—and there were red marks on him. He said that he had the feeling of being hit,” she told People magazine.

David’s mother Judy had previously claimed it was a ghost, but the Warrens rejected this idea saying it was an indicator of a demon.

Lorraine also claimed she saw David being choked by invisible hands and he told her “he had the feeling he was being hit”. She told People that she could see red marks afterwards and she heard him growl and hiss. Lorraine also claimed he spoke in unrecognisable voices, that he recited passages of the Bible as well as Paradise Lost. Debbie Glatzel also claimed he spit, bit, kicked and swore at her and he flopped around “head to toe like a ragdoll”.

She also told the Chippewa Herald Telegram that “he manifested. Just a face on the wall. High cheekbones. A narrow chin. A thin nose. Big black eyes hidden in dark holes. He showed his teeth.”

Ed Warren also told The Washington Post: “Right away, I knew there was something to this. I felt like a good fisherman when he knows there’s something on the line.” He added that he thought there were 43 demons inside the boy, and David named them all.

David Glatzel’s exorcism

In the movie, Father Gordon (Steve Coulter) blesses the home. The priest’s name was changed for the movie, but a Roman Catholic priest did visit the home to bless it.

After continued efforts from the Warrens, the Glatzels, and multiple priests (including Rev Francis E.Virgulak) a formal exorcism took place, with witnesses claiming that a demon fled the child’s body.

Ed Warren claimed Arne, who was present at the exorcism, shouted: “Take me on, leave my little buddy alone!”

Apparently, David showed signs of improving, but Arne started to deteriorate. TV series A Haunting covered the case in the episode Where Demons Dwell, claiming that the demon took control of Johnson’s car forcing it into a tree. While he was uninjured, he was shaken by the experience. The series also blamed a demon when Johnson fell from a tree while working.

Judy told The Washington Post she paid $75 an hour for a session with a local psychiatrist too, but it was up to church officials to set up and pay for further psychological testing (via Newsweek). David’s parents were told he was “normal” but had a “minimal learning disability”.

Alan Bono’s murder

Clearly not content with its newfound freedom, though, the story goes that the spirit then immediately took control of Johnson and it was under his control that the murder of the landlord took place several months later.

Johnson and Debbie Glatzel decided against renting the original home, and instead rented a small house near Debbie’s work. Debbie was working a dog groomer for the landlord, Alan Bono, 40, who was also the kennel manager.

Bono, who has been renamed in the movie as Bruno Sauls, lived in an apartment above the kennels.

On the day of the murder, Johnson had taken the day off work and spent the day with Debbie, 26, at the kennel. Along with some other companions, Debbie, Johnson and Bono had lunch at a local restaurant and enjoyed a few drinks, becoming drunk in the process, and when they later returned to the kennel a heated fight broke out with Bono becoming increasingly agitated.

During this argument, Bono seized Debbie’s nine-year-old cousin Mary, who had also been present, and refused to let her go – which then led Johnson to confront him and eventually stab him repeatedly with a five-inch pocket knife, all while growling like an animal. Bono suffered “four or five tremendous wounds” mainly to his chest area.

Bono died several hours later and Johnson was later arrested roughly two miles away from the murder. The murder is believed to be the first murder in Brookfield, Connecticut’s 193-year history, and the first in the 30 years since the town had police records.

The next day, Lorraine Warren immediately claimed that it was a case of demonic possession, which naturally led to much media coverage around the world.

Ed and Lorraine Warren

Ed and Lorraine Warren arrive at Danbury Superior Court - Getty

Arne Johnson’s Trial

Johnson’s trial began on 28th October 1981 at Connecticut’s Superior Court in Danbury.

Johnson’s lawyer Martin Minnella attempted to enter a plea of “not guilty” due to demonic possession stating Johnson “was possessed by a demon, and it was a demon who actually manipulated his body.” It was the first known court case in US history that had attempted this defence.

Minnella, speaking about the case and the fame that followed, said: “The courts have dealt with the existence of God. Now they’re going to have to deal with the existence of the Devil.” (via the New York Times).

However, the plea of not guilty due to demonic possession was immediately thrown out by presiding judge Robert Callahan who said that it would be “irrelative and unscientific” to allow testimony on these grounds, and so despite the ensuing media attention the jury was not legally allowed to consider demonic possession.

Johnson’s defence claimed that he hadn’t been the same after Glatzel’s exorcism, and witnesses were called upon saying they saw a demon transfer from Glatzel to Johnson. Debbie Glatzel also testified that Johnson behaved similarly to Glatzel. Ed Warren claimed Johnson had made a “fatal mistake” by taunting the alleged demon.

Debbie claimed Johnson had come to Bono’s apartment to repair a stereo for him, but that Bono had been drinking red wine and the pair got into an argument about payment for the repair. She also said Johnson was in a trance when he stabbed Bono.

According to reports, in the three months Debbie and Johnson had lived next to Bono they had been friends. The police believed that Bono and Debbie’s relationship was more than boss and employee, but Debbie denied this despite the police claiming the argument was over her rather than the stereo. The Conjuring: The Devil Made Me Do It does take this angle into the story, exploring the ‘jealous lover’ plot, which was also shown in the 1983 movie The Demon Murder Case (starring Kevin Bacon).

L-R Patrick Wilson (Ed Warren), Sarah Catherine Hook (Debbie Glatzel) and Vera Farmiga (Lorraine Warren) in New Line Cinema’s ‘The Conjuring: The Devil Made Me Do It.

After the jury deliberated for more than three days, Johnson was convicted of first-degree manslaughter on 24th November 1981 and was sentenced to between 10 and 20 years in prison. He was released in 1986 having only served five years of his sentence.

Even though demonic possession was not actually allowed as a legitimate defence in the trial, the case became colloquially known as “the Devil made me do it case” – hence the subtitle of this film.

Where are the Glatzels and Johnson now?

Johnson married Debbie Glatzel while he was in prison. He also got his high school diploma while inside. The pair went on to have two children.

Lorraine Warren went on to write the book The Devil in Connecticut with Gerald Brittle detailing the case, and they shared the profits from the sales with the Glatzel family. David’s brother Carl Glatzel did speak out against the book when it was republished in 2006 saying it was a “complete lie” and that “the Warrens concocted a phoney story about demons in an attempt to get rich and famous at our expense.”

Carl claimed the Warrens told the family they’d be millionaires – it was later confirmed they were paid $2,000. Carl also says David was suffering with his mental health at the time, but he recovered. In 2007, David and Carl filed a lawsuit against Brittle and the Warrens for unspecified financial damages. They sued the authors and publishers for violating their privacy, libel and “intentional infliction of emotional distress.”

Brittle claims his book is based on fact and he interviewed the Glatzel family for more than 100 hours, which he has video of. Lorraine Warren also said the six priests who performed exorcisms on Glatzel agreed that he was possessed.

Debbie Glatzel and Arne Johnson have always backed the account of the possession, but David’s father denies his son was possessed.

How the movie tackles such a complicated case and how closely they stick to the real life events remains to be seen.

The Conjuring: The Devil Made Me Do It is released in cinemas on 4th June, 2021 on HBO Max and 28th May in the UK.

[mymarvelbunch]

Different Roads... Same Destination: Part One

Pairing: Steve Rogers x Reader (established)

Summary: When the Avengers went back in time to get the Infinity Stones, new timelines were created. By not delivering them back to their exact same spots, you and Steve created major changes in those timelines. What happened? (Non-American!Reader)

This is a sequel to “Be Your Own Hero”. I highly recommend you read it first, since it features many major changes in canon that are addressed here.

Notes: Y/N = your (first) name; Y/Co = your home country; Y/Ci = your home city; Y/N/L = your native language (to be ignored in case you speak English).

Masterlist

Part One

New York, 2012

The Avengers were still trying to understand what happened when a loud ‘thud’ was heard. Tony turned to see the Scepter lying on the ground.

“Well, here is the thing Loki used to brainwash people”, he said. “But where is the Tesseract?”

“This isn’t the Mind Stone”, Loki said. “They placed the Tesseract in the Scepter.”

Everyone turned to him. He had already been right minutes prior, when he pointed out there were four Avengers from the future. Now the team was more inclined to believe him again, especially Thor.

“How do you know this, brother?”, he asked, frowning.

“The glow is different, for starters. And... I don’t know how to say this accurately, but I feel different when the Mind Stone is near me. Ever since those warriors came from the future and took it, I felt... lightweight, even if for brief moments. As if...”

Thor’s eyes widened. “As if the Mind Stone has some sort of power over you.” Loki nodded weakly. “Well, this is important information. Mother will certainly know to fix this. Stark, hand me the Scepter. It will be safer in Asgard.”

A SHIELD agent opened his mouth to protest, but there was little they could do as Tony gave Thor the Scepter. The Asgardian walked to the open balcony, his brother in his arm, and left, though not without asking his ‘brothers-in-arms’ to find the Mind Stone first.

“We’ll do surveillance around the Tower”, Runlow said, “with your permission, Mr. Stark.”

“Yeah, yeah, sure. I don’t want that thing near any of us.”

~~

“Wait”, Tony said. “Loki was under mind control back then?” 

You turned behind to face him, but a quick glance told you almost everyone was surprised. “You didn’t know? He told me back in 2014.”

Loki wasn’t there to defend himself, busy as he was being king, but Thor was. “Honestly, I didn’t know either, not until Asgard was destroyed. Loki told me on our way here that Mother chose to perform her purification spells out of everyone’s eye because... It would be better (or less worse) to have people believe Loki had turned evil than to have them know about Thanos. But yes, he was under Thanos’ influence through the Mind Stone. It wasn’t exactly like what he did to Barton and others, but close enough.”

That made an awful lot of sense. No one had a good answer for that, and they turned back to the ‘screen’.

~~

It took five years for the Mind Stone to be found. In the meantime, SHIELD was dismantled, the Winter Soldier was revealed to be a brainwashed Bucky Barnes and HYDRA was taken down piece by piece.

There was no Scarlet Witch, no Quicksilver, no Ultron, no Sokkovia Accords, no Zemo. Steve found Bucky in Bucarest in 2016 and, after weeks of talking and with Sam’s help, took him to New York. There, they faced another battle, as many people wanted him in jail for the crimes he committed as the Winter Soldier.

Surprisingly, their help came from Tony. “I know what he did to my parents, yeah. I read all those files Romanov leaked. But we all saw what brainwashing does to a person, huh?”

No, Tony and Bucky didn’t become friends. Despite his forgiveness, Tony was still wary of him; poor man had his own mental health issues to face already. But he was willing to pay the best lawyers to convince the public that Barnes had no control over himself for the past seven decades, and that the Winter Soldier was nothing but a weapon in HYDRA’s hands. It took time and money, but it was worth it, for Bucky was absolved and reclaimed his status as war hero.

Even so, he didn’t want to stay in US. “Too many memories”, he explained, and Steve understood. It all got worse when one of Tony’s employees found a glowing Stone in the elevator shaft. Thor wasn’t on Earth when it happened, so the Mind Stone stayed at the Tower for a while. Needless to say, Steve was worried, and Bucky was terrified.

“I found a place that might be good for you”, Maria Hill told him one day. “Y/Ci, in Y/Co. It’s a place untouched by HYDRA and with no evidence that the Winter Soldier ever stepped foot in there. No memories, no triggers.”

Bucky accepted the offer almost immediately, and Steve was happy to follow him. “I’ve had enough fights for a lifetime”, he said. “We should have retired from soldier duty decades ago, Bucky. We both deserve a normal life.”

It was early 2018 when they finally settled, and, upon Steve’s insistence, Bucky started looking for mental health care facilities.

~~

Your grip on Steve’s hand tightened when you recognized the mental health facility Bucky got inside. “I was an intern there at college”, you said. Steve’s eyes widened, and he grinned.

“Maybe Bucky will be the one to get you instead of me”, he teased.

Behind you, whispers could be heard.

“It’s weird to not see myself with you guys”, Wanda said. “I wish I could know if Pietro is alive.” Vision rested his hand on her shoulder, likely reflecting on how would his life be if he had stayed as a disembodied voice.

“Wakanda wasn’t even mentioned”, Shuri said. “I guess with father still alive, the borders remained closed.”

“Probably the reason why Bucky moved to Y/Co instead of Wakanda”, Sam added. “If people still think Wakanda is a poor country, no one would think of it as a mental health care reference.”

“I’m not mentioned either”, Scott said, “which is kind of weird, because I don’t see why I wouldn’t meet at least Sam.”

“Yeah, but there was no fight in Germany for you to take part of”, Hope replied. “They probably never contacted you again. Parker isn’t mentioned either.”

Someone shushed them.

~~

Even though he had scheduled it all by himself, Bucky didn’t want to go his first appointment alone. So, when Y/N called for Sebastian Stan (his new alias), he and Steve (who called himself Chris Evans) stood up together from their seats.

Inside, Bucky soon confessed his true identity. Your surprise was visible for five seconds, and then you smiled. “I’m glad you trusted me with such a delicate information, Mr. Barnes. But I wish you’d tell me your story with your own words, not just what was said about you on newspapers.”

Steve stayed inside the whole time, having also revealed who he was. Bucky didn’t tell his whole story at once, give there was a time limit for his appointment, but you asked him to come back in a week. “We can’t give you any concrete diagnosis for now, Mr. Barnes, though we have a few suspicions. But I assure you we’ll help you in every step of your recovery. You won’t be alone.”

After three more sessions, he was diagnosed primarily with PTSD, along with general anxiety disorder and memory problems (he had yet to remember key details of his past).

You were supposed to leave the facility at the end of the month, but your mentor offered you a prolonged stay. “You mentioned your next internship would be in surgery, and you don’t like it, right? I can pull some strings to keep you here. It’s not like you’ll need those skills to become a psychiatrist.”

You happily accepted his help. You’ve always been sure of what you wanted to do after finishing college; skipping surgery internship was honestly a dream come true, and you were eager to follow Barnes’ case. Your classmates didn’t know his true identity, but the case discussions made it clear you got one of the most complex cases at the facility, and some classmates envied you.

Your teacher was successful, and for the following three months you stayed, taking care not only of Barnes, but of other patients as well. It was a wonderful experience, and you were sure you had fallen into the staff’s good graces, which increased your chances at getting into residency program there after graduation.

As the weeks went by, though, you noticed something rather odd. Barnes had been getting inside the room alone since his fifth appointment, but Rogers still accompanied him, waiting for him outside. Eventually, you asked your patient why that was, assuming he’d say he still didn’t feel safe coming alone. Instead, he grinned.

“Oh, he pretends he comes for my sake, but he actually just wants to get a glimpse of you.”

You nearly choked on your own saliva.

~~

At your side, Steve laughed and hugged you tight.

“Guess I didn’t steal Y/N from you after all, punk”, Bucky said, grinning just like his alternate counterpart.

“Thank God”, you replied. “No offence, Bucky, but seeing us dating would have been way too awkward.”

“Couldn’t agree more.”

---x---

It wasn’t easy for Steve to convince you to go on a date with him. You were hesitant, given he was her patient’s best friend and roommate, but eventually you conceded.

“We won’t talk about Barnes at all”, you said firmly. “And if I sense this will affect my relationship with my patient, it’ll be over.”

“Yes, ma’am”, he replied instantly, willing to do anything to see you more.

You had charmed him from day one, and his interest on you only grew as weeks went by. When the day of your date arrived, he was a nervous wreck.

“Haven’t seen you like this since Peggy”, Bucky mentioned.

“Shut up, jerk”, he retorted. “And go hide, I don’t want Y/N to see you and cancel our date.”

“She’s got you wrapped around her finger and you haven’t even kissed yet”, he teased, but left to his room anyway.

A date led to another, and another, and another... Steve waited for you to leave the facility and stop seeing Bucky to ask you to be his girlfriend, and she promptly agreed.

A year later, when you met the Avengers for the first time, Thor told the story of how he, Loki and others fought Thanos when he invaded Asgard to take the Space and Mind Stones. Your eyes widened as he gleefully detailed the purple alien’s demise.

“Glad you defeated him still in Asgard”, Tony said. “We just found out about another of these Stones here on Earth. A wizard here in New York is its guardian.”

“Really? Give me his address, I figure we have much to discuss.”

You didn’t really understand all those talks, but Steve’s visible relief was enough information for you.

~~

On the current timeline, that same relief was visible among everyone. “A peaceful timeline”, you commented. “I hope there are more of these.”

After Strange showed what happened to the Avengers who were not featured, Wong took his place to show another timeline. You straightened your back as the ‘screen’ showed you briefly kissing Steve in Morag.

~~

Did you like it? I was looking forward to write about the consequences of those changes. Butterfly effect is strong here.

For those who don’t remember, in ‘Be Your Own Hero’ Loki tells the Reader he was under the influence of the Mind Stone in the events of the first Avengers movie. This is a popular theory that explains some differences between his behavior in that movie and his behavior on... well, any other movie he’s in.

In this, I try to touch on how things would be different if this information was made known right away, instead of being kept a secret. Being seen as a victim instead of a villain changes a lot for Loki’s story, and therefore Thor’s arc as well (The Dark World and Ragnarok’s. It also helps Tony understand Bucky’s story and actions better, since he saw the effects of mind control on Clint and Loki.

Scarlet Witch, Quicksilver, Ultron and Vision are all products of the Mind Stone, meaning that, in its absence, they don’t exist. The events of Age of Ultron are what make Civil War happen, meaning one doesn’t exist without the other. With no Civil War, nobody reaches out to Scott, T’Challa doesn’t become king to open the borders, and Peter Parker’s role in Tony’s life is probably less significant (though I do believe he mentors the teenager anyway).

If you want to follow my crazy ideas on time travel and its consequences, taglist is open!

[yessadirichards]

Tony-winning choreographer, actress Ann Reinking dies        NEW YORK

Ann Reinking, the Tony Award-winning choreographer, actress and Bob Fosse collaborator who helped spread a cool, muscular hybrid of jazz and burlesque movement to Broadway and beyond, has died. She was 71.

Reinking died in her sleep Saturday while visiting family in Seattle, said her manager, Lee Gross.

Tributes poured in from the Broadway community, including from Tony Yazbeck, who called her “an absolute inspiration” and Leslie Odom, Jr., who thanked Reinking for being a mentor: “She honored the calling for real. RIP to a legend.” Bernadette Peters took to Twitter to say her heart was broken and Billy Eichner said she was “one of the most mesmerizing people I’ve ever seen on stage. A singular genius. RIP.”

Trained as a ballet dancer, Reinking was known for her bold style of dance epitomized by her work in the revival of the Kander and Ebb musical “Chicago,” complete with net stockings, chair dancing and plenty of pelvic thrusts.

Reinking co-starred as Roxie Hart along with Bebe Neuwirth’s Velma, and created the choreography “in the style of Bob Fosse,” the show’s original director and choreographer who died in 1987. She and Fosse worked together for 15 years and she was also his lover for several of them.

Her work on “Chicago” earned her a 1997 Tony, Drama Desk and Outer Critics Circle awards. Reinking replicated its choreography in productions throughout the world — England, Australia, Austria, Sweden, the Netherlands and elsewhere. She was portrayed by Margaret Qualley in the recent FX series “Fosse/Verdon.”

The musical’s revival was first done in a concert version at City Center’s “Encores” series in 1996 and then moved to Broadway, where in 2011 it became the second longest-running show in Broadway history.

“You know how you hear sometimes a woman goes into labor and 10 minutes later she’s got this beautiful baby? You couldn’t believe that it was materializing in such a beautiful way,” she told The Associated Press in 2011 about the early days of the revival.

In 1998, she co-directed “Fosse,” a salute to the man who had the largest influence, both professionally and personally, on her life. He once called her “one of the finest dancers in the jazz-modern idiom.”

Her movie credits include “Annie” (1982), “Movie, Movie” (1978) and the documentary “Mad Hot Ballroom” (2005), which portrayed Reinking as a ballroom-dance competition judge for New York City kids.

Reinking’s career began in Seattle, where she grew up. In the beginning, she wanted to be a ballet dancer, “like all girls,” she said. As a student, she won a scholarship in San Francisco with the Joffrey Ballet, but at many of the students’ after-hours improvisations, she would just sing and not dance.

Robert Joffrey said that with her outgoing personality and other abilities, she should pursue musical theater. “I waited tables to save up enough money to get here,” she said of New York City, where she arrived with a round-trip ticket back to Seattle and $500. She didn’t need the return trip.

“You wouldn’t get into this if you had a guarantee. People who get into this have a certain sense of the high stakes,” she said. “You need the break and when you get it, you’d better be ready for it.”

Reinking’s break was strung out over several shows. She was in the ensemble for Broadway’s “Coco,” which starred Katharine Hepburn as Coco Chanel, in 1969, and was in the chorus of “Pippin” in 1972, picked by its director and choreographer, Fosse. The ensemble was so small — there were only eight — that the dancers were really seen.

Choreographer Pat Birch was one who noticed, and in 1974 put her in “Over Here,” a World War II musical starring two of the three Andrews Sisters and featuring another unknown, John Travolta.

It led to a starring role in “Goodtime Charley,” a musical about Joan of Arc opposite Joel Grey. The musical was not a success, but it did make theatergoers look at Reinking as a principal performer and not just a member of the chorus.

Her other big break, she said, was in “Dancin’” in 1978, “because I realized you had to be in an original part and that show has to be a hit.” The music-and-dance revue directed and choreographed by Fosse was, running more than three years and earned her a 1978 Tony nomination.

But it was her work on the revival of “Chicago” where Reinking basked in the most attention. The original, a dark indictment of celebrity and hucksterism, opened in the summer of 1975 and ran for about 900 performances. Though not in the opening night cast, Reinking eventually slipped into the role of Roxie Hart, taking over the part from Gwen Verdon, Fosse’s third wife and dancing alter ego. In the 1996 revival, which is still on Broadway, Reinking kept the part of Hart opposite Gray and Neuwirth.

Reinking also gained experience — and stayed in shape — by replacing stars in hit shows: Donna McKechnie in “A Chorus Line”; Gwen Verdon in Fosse’s original “Chicago”; and Debbie Allen in the 1986 revival of “Sweet Charity.”

And she embarked on an eclectic film career — from playing Roy Scheider’s lover in Fosse’s 1979 semi-autobiographical film “All That Jazz,” to the screen version of “Annie” to Blake Edwards’ “Micki and Maude.”

She also created dances for a revival of “Pal Joey” at Chicago’s Goodman Theater and a musical about first lady Eleanor Roosevelt called “Eleanor.” She was on the national tour of “Bye Bye Birdie” opposite Tommy Tune.

After “Eleanor,” offers to choreograph “kept falling in my lap,” Reinking said. She created dances for a pre-Encores “Chicago” in Long Beach, California, with Neuwirth and Juliet Prowse.

In one of the more cringe-worthy moments in her career, Reinking was asked to sing and perform the Oscar nominated song “Against All Odds” by Phil Collins at the 1985 telecast. Reinking lip-synched as she danced a bombastic, cheesy rendition marred by fog.

In recent years, she choreographed “The Look of Love” on Broadway and the Roger Rees-directed off-Broadway “Here Lies Jenny” (2004), starring Neuwirth. In 2011, she helped choreograph “An Evening with Patti LuPone and Mandy Patinkin” on Broadway.

Reinking also produced a documentary called “In My Hands,” about working with children of Marfan’s Syndrome, a rare genetic disorder of the connective tissues that often leaves its victims with limbs that are disproportionately long. She also produced the film “Two Worlds, One Planet,” about “high-functioning” autism.

Reinking’s first three marriages ended in divorce. Since 1994, she had been married to Peter Talbert. She also is survived by a son, Christopher, who has been diagnosed with Marfan syndrome and autism.

“If there is a heaven, I think Bob can look down and be satisfied. He really did have an exponential effect on the next generation of choreographers and dancers,” Reinking once said.

“He demanded the best from you and you wanted to give it. So you got better. All great directors — however, they do it — make you want to be good. I hope I do it. It’s like being a parent, a psychiatrist, a disciplinarian and a friend. You really have to know when to hold them and when to show them.”

[irondadgroupie]

DAY 6: BETRAYED

This is probably the most personal fic I have ever written. This happened to me and it fucked me up for a long long time. 

“Thank you for coming so quickly,” May opened the door and ushered Tony in, Happy followed behind him.

“Oh course,” The dark haired man shrugged off his jacket and hung it over his arm. “Is he in his room?”

May nodded with tears in his eyes.

“It’s so bad- I don’t know what to do. He won’t speak to me-“

Tony set a reassuring hand on her shoulder.

“I’ll talk to him and see what’s going on.”

Peter is lying on his bed, his face towards the wall. Tony is silent as he stands, waits for the boy to acknowledge his presence but the words never come. He walks closer and leans over.

“Peter?”

The boy sniffs wetly. Tony could see his eyes were red rimmed.

“Oh, kid,” he sat down on the bed, a hand gripping his arm gently. “Are you okay?”

Peter shakes his head: “What does God have against me?”

Tony did not know how to answer the question.

“Your Aunt told me you had a complete breakdown at school.”

“I won’t go back there,” Peter’s response is immediate.

“Why?” Tony’s question is confused. He has numerous times offered Peter a chance to get transferred but the boy had denied it, saying dealing with Flash was not so bad. “What did that shithead do?”

“Nothing.”

“What do you mean nothing?” The man’s tone gets sharper and his grip tighter. “Peter, the school nurse told you were screaming your head off. You broke three windows and-“

“It was Ned.”

It was not the answer he was expecting.

“Ned?” Tony blinks. “Your guy in the chair.”

“Not anymore,” Peter curls into himself. “He betrayed me.”

No, Tony’s mind could not comprehend it. He had heard so much of the boy. Peter and him were inseparable. There was no way Ned would do anything to hurt Peter.

“Maybe it was a misunderstanding. Rhodey and I- We have fought numerous times and always manage to work things out-“

“Ned told me he never liked me. He was only friends because I am so good at natural sciences and he needed the help to keep his GPA high. Now he no longer takes the class and has no need for me.”

The words are said monotonously, like it was a decades old memory, a fact which no longer hurt.

Tony’s mind is running overtime- trying to make sense of the situation. Ned and Peter were no longer friends. Ned had never been his boy’s friend.

“I am all alone again,” Peter whispered and started crying. “I am never going back to Midtown!”

The man leaned over his kid: “You are not going there again, I’ll make sure of it. This- I’m so sorry, Peter.”

He could no nothing but hold the boy as he cried in hurt, humiliation and depression.

Peter had been walking a very thin wire for a long time. May and Tony had been aware how fragile Peter’s mind was after witnessing his Uncle’s murder and becoming a Superhero, a mutant. They had hoped more pain could be avoided but high school was no picnic, especially for a kid like Peter, so naïve and trusting.

“Okay,” Tony said eventually, when tears were drying out and Peter had blown his nose on his handkerchief. “I got you an appointment with a psychiatrist, she has years of experience dealing with adolescents. You remember our deal?”

Peter nodded as he recalled a day about two months ago when he had had his first breakdown. Luckily, that had happened at home. He had managed to avoid getting professional help but now, he would welcome any means to help deal with pain.

“Good,” Tony ruffled his hair fondly. “Go with Happy to wait in the car, put on some good music.”

As soon as Peter is out the door and far enough that he can’t hear a thing, Tony sighs and rests his body on the back of the couch.

“I am going to the school tomorrow,” The man rubs his face, exhausted emotionally. “Have him transferred, get tuition back and such.”

May nods as she puts on her coat: “I can’t believe it’s actually happening. I honestly thought he would graduate there.”

“It’s not the school that is the problem, it’s the kids.”

“What if he has trouble with the new school?”

Tony shrugs: “Then we will deal with it but I can’t imagine it being any worse than now.”

The woman takes her purse and then pauses: “What about Ned? He knows about Spiderman?”

The man crossed his arms: “Leave it to me.”

 The next morning, Tony Stark walked to the principal’s office and, after thirty minutes of negotiations, they had agreed on Peter dropping out of Midtown High and finishing High School on many of the schools that had showed interest in getting Iron Man’s protégé. Peter had a great selection to choose from as soon as he was mentally sound to pursue education again.

With Peter’s transcripts and health records clutched tightly in Happy’s arms, the pair made their way to Peter’s locker and started piling up books and notes to a cardboard box.

“Mr Stark?”

It was Ned with a Hall Pass in his hands. The man gave him a glare, a big, strong part of him wanted to scream at the kid for what he did to Peter but a reasonable side was louder. He looked back at the locker and took out a history book. He remembered how he and Peter had gone shopping for school supplies. The boy had been so excited.

“These pictures and cards, are these Peter’s or were they glued in before?”

“It’s-“ Ned gulps. “They are Peter’s.”

Tony nods and starts to take them out.

“Why are you taking Peter’s stuff?”

“He is not coming back here,” Tony did not look at the boy.

“What? Why?”

“You actually have the nerve to ask that?” The words slip out before his brain to mouth filter works.

“You think it is my fault?”

“Then whose fault is it that my kid was diagnosed with severe depression, has to take medication so he does not cut his wrists and is currently on sick leave?”

He had not meant for Ned to know he much he had hurt his family but a part of him wants the boy to feel bad, feel remorse and see the error of his ways.

“I honestly don’t believe he got sick because of me,” Ned’s voice is steady and Tony wants to punch him. Oh, if only the boy were of age.

“Maybe what you did was the last straw.”

“I can’t walk on leaves just because someone has a fragile mind.”

Tony stares at the boy and can’t believe this is the same Ned Peter spoke so highly of. He slams the locker door closed and turns his full attention on the boy.

“Did you ever even care about Peter? Were you pretending to be his friend from the very beginning?”

Ned does not look unapologetic.

“I already said it to Peter, I don’t know anyone who likes him.”

Tony sees red: he can’t believe he forced his kid to go through literal hell on earth.  Ned turns to leave, not willing to talk about the boy he betrayed any more.

“Not so fast!”

“I need to get back to class.”

Tony took out folded papers from his pocket: “This is more important. You know many things about Peter and I need to make sure not a word gets around.”

“I’m not an idiot,” Ned scoffs. “Spiderman does important work. I would not jeopardize that!”

“Then you’ll have no problem signing this,” Tony presented him a NDA- form. “I wrote it up but it’s foolproof and legally binding. You will not talk about Peter or Spiderman to anyone, if and when Peter decides to go to college, you will not apply to the same ones-“

“What?”

“-and if you ever tell anything that might be considered a lead to figuring out a link between them, I will sue you for so much that even your greatgrandchildren will be paying the fines.”

All color has drained from Ned’s face.

“You can’t do that!”

“If you don’t sign this, I will have no choice but to tell your principal how you did not complete homework even once last year and copied it off someone else.”

“You have no proof!”

Tony’s smile was predatory and sweet, like a cat that was playing with their future meal: “Really, huh?”

He took out his phone and pressed a button and Ned’s eyes bulged as the recording of yesterday reached his ears.

“How-?”

“It’s relatively easy,” Tony shrugged. “Pete has a Stark Phone, it records everything, a mighty useful feature when you need to confirm something. So, yeah, what will it be- lowered GPA, possible expulsion or signing the form?”

If look could kill, Tony Stark would have died on the hallway.

[paleorecipecookbook]

RHR: A Three-Step Plan to Fix Conventional Healthcare

In this episode we discuss:

The patient case that inspired the book

Who is this book for?

The mismatch between our medical paradigm and chronic disease

Drug companies and conflicts of interest

How clinicians can help create a new paradigm

The three core problems and how to solve them

What this new paradigm looks like

How do we pay for this? Is it scalable?

How allied providers are the key

Show notes:

Unconventional Medicine by Chris Kresser

Special offer for RHR podcast listeners - get the audiobook free if you buy the book by November 12th.

NaturalForce.com - use coupon “unconventional” and get $10 plus free shipping

[smart_track_player url="http://ift.tt/2yiM0Yd" title="A Three-Step Plan to Fix Conventional Healthcare" artist="Chris Kresser" ]

Chris Kresser: Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. Today we’re going to do something a little different. I am bringing on a guest host, Tony Federico, he’s the VP of marketing for Natural Force Nutrition, a physiology editor for the Journal of Evolution and Health, and a longtime contributor to Paleo Magazine, and also at Paleo f(x), which is where I met Tony, I think, originally, and I have interacted with him the most. And he’s moderated several panels that I’ve been on and I’ve always been impressed with the way he’s done that, the intelligent questions that he asks and just his balanced perspective on ancestral health and Functional Medicine, and this movement overall. Today is the day that my new book, Unconventional Medicine, comes out. It’s now available on Amazon, and I wanted to ask Tony to come take over the podcast and talk with me about the book because I know he’s really interested in all these topics and he’s read quite a bit of the book himself, and I thought it would be more interesting to have a conversation about it than for me to just sit here and do a monologue. So Tony welcome to the show and thanks for being here. Tony Federico:  Yeah, thanks for inviting me on, Chris. It’s always fun, when we’ve had the chance to chat, as you said. Whether in person or on podcast, I’m always happy to jump in and dish on health with you. Chris:  Fantastic. So, you have read a little bit of the book and we chatted a little bit about it via email, so let’s dive in. Let’s talk a little bit about this book. And for me it was really, it felt like the most important next step that I could take in order to get this message out about ending chronic disease. Tony:  Yeah, I got my copy of Unconventional Medicine a couple days ago. I just so happened to have some time off yesterday, and the next thing I knew I was 80 pages in. Chris:  Nice. Tony:  So, I have to say that, as somebody who’s been in the trenches, I worked as a personal trainer for 10 years, I could really relate to a lot of the things that you were saying in the book, and we’ll get into why a little bit later on in the interview. But you know I just am really impressed with what you put together here, Chris. So let's just, let's get into it, and the first thing that I actually wanted you to maybe tell me a little bit about was how you open the book, which I think is a really great story about a patient named Leo. So I wanted to talk a little bit about Leo and his story and kind of how that inspired you to go down this particular path of unconventional medicine.

The patient case that inspired the book

Chris:  Sure, yeah. So, Leo was an eight-year-old boy that I treated in my clinic a few years back, and I wanted to start with his story because it's, unfortunately, a typical story, much more common than, of course, we would like. And it was powerful for me, it was a powerful experience. It's what actually led to me writing this book. So, like way too many other kids of his age, he was suffering from a number of behavioral issues. He was initially diagnosed on the autism spectrum. Eventually they settled on OCD and sensory processing disorder. He would throw these just crazy tantrums where he'd end up crying or screaming inconsolably, writhing on the floor, and this would happen for seemingly the simplest of reasons. Like trying to get his shoes tied as they were going out the door, not cutting the crust off his sandwich in just the right way or getting a stain on his favorite T-shirt. And he was really rigid around his behavior and its environment, everything had to be just right, just the way he wanted it to be, or else he would fly off the handle.

Is a new healthcare paradigm affordable? Scalable? You bet.

His diet was extremely limited, he only ate a handful of foods, pretty much all of which were processed and refined. So crackers, bread, toaster waffles, that sort of thing, and this is part of the kind of OCD-like tendencies. And any time his parents would try to introduce new food, he would go totally ballistic. And they were worried about nutrient deficiency, but they didn't feel like they ... they were just worn down. Any parent who has a kid like this will understand that. It's just they didn’t feel like they had the resources to battle him at every meal. And they took him to a bunch of doctors locally, and that’s where they got those diagnoses. Initially they were kind of relieved to have those, but then after a while they realized that they were just simply labels for symptoms. And when they asked what the treatment was, you can probably guess the answer: medication. Tony:  Something to do with drugs. Chris:  Something to do with drugs. Yeah. And when they asked how long he would be on that treatment, you can probably also guess the answer. Tony:  The rest of your life. Chris:  Yeah. Shrug of the shoulders, indefinitely, maybe he'll grow out of it, that sort of thing. And they weren't excited about the idea of of medicating their son, but they were also aware of how much he was suffering, and they were suffering, frankly, too. They decided to give them a try, starting with Adderall, and then they progressed to Ritalin and then antidepressants. And certainly the drugs did seem to help with at least some of the symptoms, but there were a couple issues. Number one, they also caused some very intractable side effects like headache, abdominal pain, irritability, and most significantly, severe sleep disruption. And they had a couple of other kids that were younger than Leo. So they were not happy about the sleep disruption. Nobody was because it was brutal for them and also brutal for Leo. Kids need a lot of sleep, and if they’re waking up throughout the night, that’s going to make ... So that was in some ways worse than the original symptoms they were trying to treat. And then Leo's mom had done quite a bit of research on the effects of these medications and she was scared. Particularly for children and adolescents, some of these drugs have some pretty scary side effects and long-term risks. So what really stood out to me, and I mentioned this in the book, is that not once during this entire process of seeing all these different doctors, primary care provider, psychiatrist, eventually behavioral disorder specialists, did anybody even hint at the possibility that something in Leo's diet or some other underlying issue like a gut problem or nutrient deficiency or heavy metal toxicity or something like that could be contributing to his symptoms. It wasn't even broached as a possibility at any time. Fortunately, Leo's mom, one of her friends followed my work and sent her a couple of articles from my blog. One was on the gut–brain–axis, and I think the other one was on the underlying root causes of behavioral disorders. And so that's what led them to bring Leo to see me, and long story short, we were able to ... we did a bunch of testing, found issues that you might guess at. So, disrupted gut microbiome, SIBO, fungal overgrowth, gluten intolerance, but also intolerance of soy and corn and rice and buckwheat, which were major ingredients in a lot of the processed and refined food products that he ate, and arsenic toxicity because rice milk was the only other beverage he would drink aside from water. And we know that rice products can be high in arsenic. So, we, over several months, it definitely wasn't easy to address these problems because of his OCD-like tendencies and his picky eating habits. But after several months he was like a different kid. His teacher even called home and was like, “What have you done with Leo and who’s this kid that you’re sending in?” Because it was a big issue for her. They often had to come to school and pick him up early because of the behavioral problems. And his diet expanded; he was eating foods he would've thrown against the wall just months before, he was more tolerant of disorder, more relaxed in his environment. They were able to travel for the first time in a long time because he wasn't so anxious in unfamiliar environments. His physical symptoms had improved significantly. So they were just over the moon. They couldn't believe it, and toward the end of our treatment together, she said something that really struck me, which was there’s so many kids out there that are like Leo and they’re suffering, they’re not finding help in the conventional system. Tony:  Sure. Chris:  And their doctors and parents are not even thinking about this stuff. Like it’s not even in most people’s consciousness that if a kid has a behavioral disorder that you should look at these physiological issues. It’s not, for 99 percent of people they don't even go there because they don't know. Tony:  Yeah, I mean I think that that was—reading about Leo and reading about a story and certainly there's people that I've known, myself included, who have had very similar experiences—I think it's great to have a narrative like this that you can really connect to because then when you tease it apart, all the pieces really make sense. It makes sense why having doctors treat symptoms has failed, it makes sense why a lack of communication between the health provider network that was supposed to be serving Leo failed. It makes sense why it didn't work when you actually start to tease it out. But then we’re still all, well not all, but most of us are still going down this path and it's an exercise in futility, really. You have an eight-year-old kid who's on powerful stimulant medications, he’s on antidepressants, and it was bad enough for his parents to reach out and to seek those interventions as solutions, and then the side effects are even worse. And that’s just something that just gets you right in the heart. And like you said, he’s not the only one, he’s not the only kid. His parents are not the only parents. And frankly, his doctors are not the only doctors because I can guarantee you that that probably doesn’t really feel good for the practitioner, for the healthcare provider to not get results as well. And they’re working with what they’ve got. Chris:  Absolutely. Tony:  And trying to use the tools they have. Chris:  Yeah, I mean, let’s be clear about this. Everybody is doing the best they can in this situation. The parents are doing the best they can, in the vast majority of situations, parents just love their kids and do everything possible that they can to help their kids thrive. I’m a parent, I know that that’s how I relate to my kid. I know that every parent I know, that’s how they relate to their kids. And I would even, I would say that’s true for doctors too. The vast majority of them are trying to do the best they can with the tools that they have and in the system that they’re working within. And that’s the rub. Tony:  Right. Chris:   It’s like most doctors I’ve seen have been caring and they’ve wanted to do the right thing, but the question is, can they do the right thing in the conventional medical system as it exists today? And, of course, that’s largely what the book is about.

Who is this book for?

Tony:  Yeah, so let’s kind of speak to that specifically. And we’re talking about doctors, we’re talking about medical professionals, we’re talking about patients, and then we didn’t mention it, but where I fit into this formula or potential formula as an allied healthcare provider, as a personal trainer/health coach, is that your audience for this book, do you really see that kind of triad is who you're speaking to here? Chris:  Yeah, definitely. I think if you look at the cover of the book, the subtitle is “join the revolution to reverse chronic disease, reinvent healthcare, and create a practice you love.” So that last bit would suggest that it's mostly for practitioners, but that's not true. It is really for anybody that is interested in the ideas of reinventing healthcare and reversing chronic disease. And, in fact, I would argue that that change is going to be initiated by people, primarily by people that are not practitioners. So it's like a grassroots, bottom-up approach, where a good example is with my training program, my ADAPT training program, now that we've been training practitioners in this approach for the last couple years, we always ask people how they learned about my work or how they learned about the training program. And in a surprising number of cases, the answer is from their patients. So these doctors or other practitioners, their patient brings an article in that I wrote or brings something in, tells them about me, and to their credit they’re open-minded enough to go and check it out. And then they like what they see and they end up taking the next step. So people even who have no intention of ever becoming a healthcare practitioner, I think would really benefit from this book if they're interested in these ideas. And then certainly, as you mentioned, licensed healthcare providers like medical doctors or nurse practitioners or physician assistants that are currently working within the conventional paradigm but have already seen its limitations and want to do something different but don't yet know what that might look like. And then people who are outside of the conventional paradigm but are already practitioners, so acupuncturists, chiropractors, naturopathic physicians, etc., in many cases they’re already well aware of the limitations of conventional medicine, which is why they chose to go down a different path. But speaking personally as an acupuncturist myself, I also saw some limitations in the traditional Chinese medicine approach, or at least some differences in the way that I wanted to practice it. I was looking for something that could incorporate modern diagnostic testing and create a more systematic approach that included ancestral diet and lifestyle and some of the other things we talk about in the book. So, I think many of those practitioners can benefit from the book from that perspective. And then you have the growing and already large number of people like yourself who are personal trainers, health coaches, nutritionists, etc., who I really think are going to play an increasingly important role in this revolution to reinvent healthcare. Tony:  Yeah, it so important now for people to really, for patients to be their own advocate, and I don't think we’re living in a time where I remember with my grandparents—if your doctor said something, it was basically gospel and you didn’t question it and you didn't think about it. Now, the first thing people do when they experience a symptom, it's Dr. Google first. So it's super important to equip and arm patients with good information, which I think this book does. Here's a path, here's a path forward for you as a patient. But then it's respectful of the role of doctors, and you highlight many situations where conventional medicine is great. If you break your arm or get in a car accident or have a heart attack or whatever the case may be, yeah, you need a doctor, and you need to go to an emergency room and you need those types of interventions. But it's really in this kind of gray area, it’s really not gray, it’s actually quite clear. And we could probably specify a little bit more, but there’s this middle zone where somebody’s not acutely injured, they’re not acutely in a disease state. They’re in a chronic disease state, or they’re just unwell. And it’s hard for a system that is all about pharmacological interventions, surgical interventions, to deal with a more subtle approach. And that’s where that whole middle ground and acupuncturists and massage therapists and everybody who's in that middle zone. I had clients constantly when I was actively training, constantly asking me questions where I was like, you know what? This is really something they maybe should be taking to their doctor. But guess what? The doctor only has 15 minutes under pressure to see as many patients as they can. I had a friend who was a physician in France. And he was telling me about their medical model, and he would spend tons of time with his patients. And it was actually incentivized for prevention. And here we see some maybe misplaced incentives, and perhaps you can speak a little bit more about that.

The mismatch between our medical paradigm and chronic disease

Chris:  Yeah, so, going back to your original comments, I think that the most important thing for people to understand is that our medical model, when it comes to our medical paradigm, is that it evolved during a time when acute problems were the biggest issues. So in 1900, the top three causes of death were all infectious diseases, tuberculosis, typhoid, and pneumonia. And the other reasons people would see the doctor were among those you mentioned, like a broken bone or a gallbladder attack or appendicitis. Tony:  War. Chris:  Right, injuries, trauma, etc. And so the treatment for that's pretty straightforward. It wasn't always successful, of course, but it was straightforward. You know, if the bone was broken, you set it in a cast. If the gallbladder was swelling, you would take it out. If someone was having appendicitis, you’d remove the appendix. So that's pretty ... it's one problem, one doctor, one treatment. Pretty straightforward. But you fast-forward to today, it's a totally different healthcare landscape. Seven of the top 10 causes of death are chronic disease rather than acute problems now, and 86 percent of the healthcare dollars we spend go toward treating chronic disease. And unlike acute problems, chronic diseases are expensive, difficult to manage and usually last for a lifetime. They don't lend themselves to that one doctor, one problem, one treatment kind of approach. The average chronic disease patient requires multiple doctors, usually one for every different part of the body in our system, and is taking ... Tony:  Specialists. Chris:  Right, specialists, they’re taking multiple medications in many cases, and they're going to be taking those medications for the rest of their life. So far, it's really, our conventional medical system is amazing for these acute problems. But it's the wrong tool for the job for chronic problems. So that's one issue, and it’s really important to point that out, because we just went through the whole healthcare debate again with the Affordable Care Act and the current administration’s proposal for a replacement, which has not come to fruition. But throughout that entire discussion, it really bothered me that there was an elephant in the room. All the discussion was around insurance. Like, who gets insurance and who doesn’t. And that’s important, it’s important to talk about that. But we have to recognize that health insurance is not the same thing as healthcare. Tony:  Yeah. Chris:  Health insurance is a method of paying for healthcare. And that’s really crucial to get that difference. Because my argument in the book is that there is no method of paying for healthcare, whether it’s the government, corporations, or individuals, that will be adequate and will be sustainable under the pressure of growing prevalence of chronic disease. It will bankrupt all of us. Government, the corporations, individuals, whoever is responsible for paying for the care will not be able to do it unless we can actually prevent and reverse chronic disease instead of just slapping Band-Aids on it. Tony:  I think the analogy you gave in the book was rearranging the deck chairs on the Titanic. “Making a few small tweaks to our current system and expecting that to work is like rearranging the deck furniture on the Titanic as it inexorably sinks into the ocean. Too little, too late.”  Chris:  Yeah, exactly. That’s the argument about insurance. As the whole ship goes under, sinks under. The other problems you mentioned are very real also. So we have a misalignment of incentives, like the insurance industry, for example, doesn't benefit when the cost of care shrinks because they only make more money when the overall expenditures rise. So it's actually not in their best interest necessarily to seek out the most cost-effective solutions.

Drug companies and conflicts of interest

Chris: And then of course, we have drug companies. People are pretty well aware of the conflicts of interest there. It’s in their interest to sell drugs, and even when that’s not in the interests of the general public or the patients or the doctors. In many cases, it’s not in their interest either. So the best example of this is a recent one. We’re in the midst of an opioid crisis, the worst we’ve ever seen by far, and the DEA has been wanting to create new regulations that restrict a pharmacy’s ability to sell opioids in ways that will protect people. So, for example, there was a pharmacy in West Virginia in a town that was tiny. It had like 30,000 people in this town, and they had ordered something like nine million opioid pills in the last year. It was clearly a front, like there’s clearly something shady going on there. There's no way that 30,000 people in that town needed nine million opioid pills, and yet there are no regulations to actually prevent that from happening. And so, the DEA had proposed some regulations to just safely protect people from that kind of thing. And the Big Pharma lobby basically shut that down and they played a big role in writing a law that limits the DEA's ability to do that kind of regulation in the midst of the worse opioid crisis ever. And to put this in perspective, we hear a lot about the gun lobbies and their control. They spend about $10.5 million lobbying Congress, I think, per year. And Big Pharma, they spent $250 million. Tony:  Wow. Chris:  Twenty-five-fold higher. Tony:  It's really tragic. I actually, I don’t think we’ve ever talked about this, but I grew up in South Florida, which was kind of ground zero for the opioid epidemic. And I remember in high school down in Miami and West Palm Beach, and kids would get a hold of a contact or whatever, somebody that had a prescription and basically would end up being a de facto drug dealer vis-à-vis a pill mill, etc. The kid across the street from me died, multiple kids in my high school died, multiple kids went into in-treatment programs, some of them battled addictions for decades. Some of them got out of it. Very few got out of it. Some of them didn't and have continued to be plagued with either switching from pharmaceuticals to street drugs like heroin, etc., and then we can see what's happening there. And that's just one example. If we look at drug consumption in the United States, is it that Americans are just that much sicker and we’re in that much more pain than people in other countries? Because we’re consuming far and away more painkillers than any other country on the planet. And I would venture to guess that you could say the same about antidepressants or ADD medication. It's very much a case of misaligned incentives. And incentives are working in the sense of the pharmaceutical companies are doing very well. Chris:  Yeah. Who are they working for is the question. Tony:  Exactly. Chris:  We’re the only country aside from New Zealand that allows direct-to-consumer drug advertising, and I think that's a big part of the problem. But it's not just Big Pharma. We also have conflicts in medical research that, of course, are related to Big Pharma because they pay for two-thirds of all medical research. We have broken payment models, where there's no real incentive or reward for good performance, and in fact, you could argue it's the other way around because doctors are compensated for, usually based on the number of procedures they order and the number of patients they see. So to your point about the doctor in France who is actually incentivized to prevent, rather than just treat disease, we don't have that at all, it's the opposite. And so there are a lot of deeply entrenched issues that we certainly need to address, and that's not essentially what this book is about. There are other books that cover that material really well, and frankly many of those issues are outside of our individual control as clinicians or practitioners.

How clinicians can help create a new paradigm

Chris: We can work toward addressing them, and I think we should, but the good news is that I think that the bigger changes that we need to focus on individually and collectively are addressing the medical paradigm which we’ve talked about, creating a medical paradigm that’s better suited to tackle chronic disease. Addressing the mismatch between our modern diet and lifestyle, and our genes and our biology, which we've, of course, talked a lot about on the show before. And then creating a new way of delivering healthcare that actually supports this new medical paradigm and this more preventative approach. Because those things are all within our control as clinicians. Tony:  Yeah. I like how you posed the question, and it was kind of a cool little, I think it was, not Hiroshi, but the person who is in charge of cooking at a Buddhist monastery. And basically a young monk comes up to this older man. He’s like, why are you doing the grunt work, basically washing rice out in the courtyard? And he says, it was like, what was it? “If not me, who? And if not now, when?” And I think that that’s really kind of the core of setting all this stuff up. Talking about the problem is really in the service of pivoting to the solution, and I’m a big believer in thinking globally, thinking big, but acting locally, hyper-locally, like yourself. Chris:  Yeah. Tony:  And then the people around you and who you can touch and impact. That’s ultimately where the power comes from. So let’s talk about that. What is in people’s power. And you started to describe some of those pillars of a new model. And you describe it as the ADAPT framework. And I don’t know how much you get into this on your regular podcast episodes, but to just kind of lay it out, ADAPT from a big-picture perspective. How does that actually address some of these systemic issues from an individually empowered stance? Chris:  Yeah, great question, and before I even go into that, I just want to say I agree that I think the change is going to happen on different levels. So, because a lot ... we’ve talked about this stuff at conferences or even some people who’ve already read the book. They say, oh, this is fantastic. I’m so excited. But how are we going to deal with Big Pharma and the insurance industry and these misaligned incentives and all of that? And can we ever deal with that? The answer is we’re not going to deal with that overnight and it’s going to take a while to unwind those things. Tony:  It’s the chronic disease, is what you call... Chris:  Exactly, exactly. And I use that analogy in the book. But the good news is that changes can happen very quickly on an individual and local level. And there’s already a lot of evidence of that happening. So my own clinic, CCFM, tripled in size in the last three years alone. We have Cleveland Clinic Center for Functional Medicine, launched by Dr. Mark Hyman, has just blown up like crazy. I mean they started in this tiny space. Now their 17,000-square-foot space, it takes up the whole second floor of the Glickman Tower at Cleveland Clinic. They've got a waitlist of 2,500 patients from nine countries around the world. This is really exciting! The Cleveland Clinic is always on the forefront of the newest trends in medicine, and the fact that they've invested that much money in this speaks volumes. Then we have groups like Iora Health, an organization based in the Rocky Mountain area that’s reversing diabetes using health coaches. So there are lots of really interesting produced concepts, and there's going to be more and more of these. Like we’re doing a pilot program with the Berkeley Fire Department where we’re working with their new recruits to help, we’re implementing a wellness program. Tony:  That’s awesome. Chris:  To reduce injuries and help with recovery and optimize their performance. And if that goes well, there’s been interest from the wider fire department and in the city of Berkeley as a whole. Robb Wolf’s done some incredible work with Reno that we’ve talked about before. So I think the change is going to happen more quickly on this local grassroots level, and then that's going to start to get the attention of people on a state and federal level. And then it will start to get really interesting.

The three core problems and how to solve them

To answer your question, in my book I basically lay out three core fundamental problems with the healthcare system in the US. And these, I argue, go even deeper than the misaligned incentives and Big Pharma and all of that stuff, although they’re, of course, connected. The first is that there is a profound mismatch between our genes and our biology and our modern diet and lifestyle. And I'm not going to say more about that now because almost everyone listening to this podcast knows exactly what I mean. The second problem is the mismatch between our medical paradigm and chronic disease, which we just talked about. We need a new medical paradigm that is better suited for chronic disease. And then the third is that the way we deliver care in this country is also, it's not set up to support the most important interventions. And we’ve touched on that too, where the average visit with the primary care provider is just actually eight to 12 minutes. Tony, you were talking about 15 minutes. That’s luxurious in our current model. The average amount of time a patient gets to speak before they’re interrupted by the doctor is 12 seconds. Tony:  Wow. Chris:  So I think it’s pretty clear that if a patient has multiple chronic diseases, which one in four Americans now do, one in two has one chronic disease, and they show up to the doctor’s office and they're on multiple medications, and they had been presenting with a whole set of new symptoms, there’s absolutely no way to provide high-quality care in a 10-minute visit. So we have to change our, not only the paradigm, but also the way that care is delivered. So that was my premise. So it follows then that my solution would address, I would hope at least those three points, right? Each of those three deficiencies. So the ADAPT framework combines an ancestral diet and lifestyle, which addresses that mismatch between our genes and biology in our modern diet and lifestyle. And then Functional Medicine is the new paradigm of medicine that is based on addressing the root cause of health problems, so we can prevent and reverse them instead of just suppressing symptoms. And then the third component is what I call a collaborative practice model, which links licensed providers like medical doctors, nurse practitioners, with what I call allied providers, which include folks like yourself, Tony, health coaches, nutritionists, personal trainers, etc., to provide a much, much higher level of care than what doctors are able to provide on their own. So, again, we're not trying to replace doctors in any, or even conventional medicine. We need people to do colonoscopies and remove cancerous tumors and use all of the incredible amount of training and expertise and skill that they’ve acquired over a lifetime of practice and study. We absolutely want that, but we need to add stuff to that that's not available now. Tony:  What that really says to me is, emphasize the importance of community, of connection, of collaboration. We’re social creatures, we’re tribal by nature. That’s another kind of Paleo/ancestral health part of the puzzle. And it would be foolish to think that we can dissect out and silo out all these different aspects of our lives without consequence. I really like this idea of bringing everybody into the fold, and it’s not saying that you can go to just the naturopath, or you can go to just the health coach. Because like I mentioned already, I certainly would’ve been ill-equipped to handle plenty of issues that a client would’ve brought to mind or brought up in conversation during a training session. But it would’ve been really great to say, ah, here's the Functional Medicine practitioner that I recommend you speak with, and to have a good relationship with that person and to be able to, as a health coach, help my clients better by getting them in touch with the right person. And that’s having this network that can really support people throughout their health journey whether it’s just feeling better and more energy, or addressing something like diabetes or hypertension. Which certainly there’s a place for all the players in that kind of scenario.

What this new paradigm looks like

Chris:  Absolutely. And let’s use an example just to bring this to life for people. So, imagine you go to the doctor and they do some blood testing for your annual physical. And they find that your fasting blood sugar is 96 or 97. Your hemoglobin A1c is 5.5, and you’ve got triglycerides that are 110, 120, maybe 130. Currently, what would happen is nothing, usually. Tony:  You’re not sick enough yet. Chris:  Yeah, all of your markers are within the lab range, they say, and that means you’re normal, and so you might get some vague advice about make sure to exercise and follow a good diet. And thank you very much, that’s it. Certainly there are exceptions to the rule, of course. There’s some practitioners who can get a lot more proactive about that. But I can’t tell you how many people, patients I’ve had that have been given that basic line with those kinds of lab results. What could happen is this. The doctor says, “Well, you know, if we think of blood sugar disorders on a spectrum, on the left you’ve got perfect blood sugar. On the right you’ve got full-fledged type 2 diabetes. You’re not on the right yet, you don’t have type 2 diabetes or even technically prediabetes, but you’re progressing along that spectrum. And what we know from a lot of research is that if we don’t intervene now, that you’re going to continue progressing. And in fact, we have studies that show that the average patient who has prediabetes, will progress to full-fledged type 2 diabetes in just five years if it’s not addressed.” So what we want to do is be proactive here. We want to intervene now because it’s much easier to prevent a disease before it occurs than it is to treat it after it’s already occurred. So here’s what we’re going to do. We’re going to set you up with our staff health coach, and they’re going to give you all the support you need to adopt a better diet. They’re actually even going to take you shopping, they’re going to come to your house and clean out your pantry with you, and they're going to give you recipes and meal plans and give you ... totally hold your hand and do everything that they need to to get you on this diet. Because we know that information is not enough. We’ve got lots of studies. I can tell you as a doctor, go eat a healthy diet, and hey, we know that that’s probably not going to happen. Most people know what they should be doing, but they’re not doing it, and it’s not because of lack of information. It’s because they need support, and we’re here to support you. We’ve got this health coach. Furthermore, we've got this great personal trainer named Tony. We’re going to set you up with him and we’re also going to set you up with a gym membership. And the good news is, your insurance is going to pay for all this. They’re going to pay for the health coach, they’re going to pay for the gym membership, they’re going to pay for your sessions with Tony. And in six months’ time, you’re going to come back here and we’re going to retest your blood markers and I can almost guarantee that if you stick with the program, you’re going to have normal blood sugar by that time. And throughout that period you’re going to have weekly check-ins with a health coach, you’re going to have training sessions. And not only will your blood sugar be normal, you’re going to lose weight, your energy levels are going to go up, your sleep’s going to get better, you’re going to feel more confident and empowered because you’re making these changes, and you’re going to feel like a different person. Now that’s totally possible.

How do we pay for this? Is it scalable?

Chris: I can hear some people saying, “Oh, how are we going to pay for that? That’s ridiculous.” Tony:  Is it scalable? Chris:  The question we should be asking is, is treating type 2 diabetes scalable? Because I mentioned this in the book, it costs $14,000 a year to treat a single patient with type 2 diabetes. So let’s imagine that this patient progresses. We don’t intervene, five years later they have type 2 diabetes. All of a sudden the healthcare system is spending $14,000 a year paying for that person’s care. And let’s say that that person gets diagnosed at age 40, which is still reasonable these days. The age of diagnosis is dropping more and more, and then let’s say that they live until they’re 85 years old, which is also possible because of our heroic medical interventions that keep people alive a lot longer than they might have been otherwise. So 45 years living with type 2 diabetes, that’s a cost of almost $650,000 for one patient to the healthcare system. Tony:  And that doesn’t even touch on the lost wages, cost to employers, when someone’s on leave, loss of productivity. And then the cost to the family members. Chris:  Absolutely. Tony:  People that are actually, are helping the patient, their health is going to be going down too. Chris:  Yeah. Nor does it touch on the qualitative aspects. Being immobilized, not being able to play with your grandkids, all of that stuff. But let’s just even forget about that for a second—$650,000, okay? And then the CDC recently came out with statistics saying that 100 million Americans have either prediabetes or diabetes, and 88 percent of people with prediabetes don’t even know that they have it. Which means they're almost certainly going to progress, right? If you do the math and you multiply 100 million people times even $14,000 for one year, you get a number that’s so large, I don’t even know what it is. It’s like a google something. It’s like, it has so many zeros after it, I don’t even know how to characterize it. But then if you multiply 100 million times like 20 or 30 years, it’s more money than there is in the world. It's like it's not going to happen. Tony:  Not sustainable, not scalable. Chris:  Not sustainable, not scalable. So let’s say in our example that we ... the healthcare system spends $10,000, which is way more than would be necessary, but let’s even say we buy the person’s groceries for three months. And their gym membership and their trainer, and their health coach, and those weekly, let’s say we spend $10,000. We’re just super generous and we spend $10,000 for that six-month period. Again, the research and my clinical experience indicates with near certainty that if the person is at that stage of not even prediabetic and we intervene, there’s like almost no chance that it’s not going to, we’re not going to be able to normalize that person’s blood sugar. And if they do that and they stick with it and they are able to do that because they now have support rather than just information, we’ve just saved the healthcare system $640,000 over the course of that patient’s lifetime. And that’s a conservative estimate, as you say. We're not including even the indirect costs. Tony:  Right, right. Chris:  I think that this is not only possible, it's going to become necessary. And whether we get there with a proactive approach where we decide to move in this direction and we make these changes or whether we get there because we absolutely have no choice, we’re going to get there. Tony:  Yeah. I mean it really sounds like we can’t afford to not do this. Chris:  Exactly. Tony:  And if we get to that point where we continue down the reactive path and we wait until there’s a total collapse, it might be too late, just to put it frankly. And it’s going to come out at a huge, not just financial cost, a huge human cost. Chris:  Yeah, it’s going to be, we can use the chronic disease metaphor again, it’s a lot easier to prevent a problem or reverse it at an earlier stage than it is to wait until the patient is essentially on life support or the healthcare system is on life support. It’s harder to reverse it at that time. And that’s of course why I’m writing the book now because I want to get this message out as far and wide as I can. Tony:  Yeah. If not now, when? If not you, who? Go right back to there.

How allied providers are the key

Chris:  Exactly. And one more thing about that is the amazing thing, the beauty of this is that it takes about eight years and hundreds of thousands of dollars to train a doctor. And it takes a certain kind of personality and a certain kind of comfort level with science, and a lot of prerequisites. It’s not for everybody. And there’s a ... already we have a shortage of doctors, and that’s predicted to get worse. I’ve seen estimates that suggest by 2025 we’ll have a shortage of 52,000 primary care physicians. So that’s a big deal. [insert image] So we already don’t have enough doctors, it’s already going to get worse, but if you think of healthcare as like a ... I have something in the book called the healthcare population pyramid. And you were referring to it earlier, Tony, where at the very top of that pyramid you’ve got 5 percent of people who are in really acute situations. So they’re in the hospital or they’re in an intensive outpatient care setting. They need the conventional medicine paradigm as it exists, and it’s fantastic for those situations. Then you’ve got another 25 percent of people in that kind of high middle of the pyramid who are dealing with some pretty serious chronic health challenges. So they require more regular care, but they’re not sick enough to be in the hospital or in any kind of ... they’re living their lives, but they’re struggling a lot. A Functional Medicine practitioner/clinician usually working in concert possibly with the conventional specialist of some kind is a really great option for that 25 percent of the pyramid. But then you’ve got the 70 percent at the bottom. So these are people who do, may have health issues, but they’re more minor, so they might have skin problems, or a little bit of brain fog, some difficulties sleeping, some GI issues. And these can be definitely debilitating and total pain, but they’re not at the level of that 25 percent. My argument is that in many cases these people could be very well served by a health coach or nutritionist with good training. And possibly seeing a Functional Medicine provider once or twice a year, or something like that. And the thing is, we can train people in a year or two without an extensive science background to be very, very objective in this role. Because they’re mostly working with patients on changing their behavior. If you think about it, most of the risk factors for chronic disease come down to the wrong behaviors. Eating the wrong diet, not getting enough sleep, not exercising, or exercising too much, or any number of things that come down to choices that we’re making. And so if a skilled health coach who’s trained in things like motivational interviewing and coaching to strengths and other evidence-based principles of facilitating behavior change which we have a ton of research on, they can be incredibly effective for that 70 percent of the population. That's the majority of the population. So we’re totally underutilizing these practitioners, and my argument is that they’re going to play a huge role in this future of medicine. And that's of course one reason why we're launching an ADAPT Health Coach Training Program next year to complement the practitioner training program that we've been doing. Because I want to create this ecosystem we've been talking about where you have all of these different types of practitioners working to the maximum of their training and ability and scope of practice and supporting each other and therefore providing the highest level of care to patients. Tony:  That certainly kind of perks my ears up hearing about the ADAPT health coach option and something that I’m personally interested in. So who knows? Maybe I can get in on that. We can talk about it again in the future. Chris:  Yeah, for sure. For sure. Tony:  So, for this particular book, for Unconventional Medicine, people are fired up, they’re hearing about it, they’re like, “Okay, this resonates with me. I’m a practitioner, I’m an allied health provider, I’m a patient, I’m ready. Now’s the time. This is it. We’re going to do this.” What’s the best way for people to get their hands on this thing? Chris:  Well not surprisingly, Amazon. They have the best way to get your hands on anything. So it’s available in paperback, Kindle, and audiobook. We’re hoping [the audiobook] is going to be out today, the day this podcast is released. But it might be another two or three days. They’re just taking their sweet time to approve it. I narrated the audiobook myself. So you podcast listeners, I figured you might be into that, since you like to listen. Tony:  They know your voice. Chris:  Yeah, and just listening to something instead of reading it perhaps. So to that end, we have a special offer for podcast listeners, because I appreciate your support and I know many of you are already part of this movement, and some are wanting to get involved. So if you buy that paperback or Kindle version between now and Sunday night, you’ll get some really cool bonuses. The first is a free copy of the audiobook. So again, we wanted to include that for podcast listeners, since we figured you guys and gals are probably interested in audio. But there are two other things that are really, I think, fantastic. And one, they’re both tools to help you be more confident and persuasive and factual when you share your passion for Functional Medicine and an ancestral diet and lifestyle. Because we’ve had a lot of questions from people, both practitioners and non-practitioners alike. They say, “Oh, how do I talk about this stuff to my sister at Thanksgiving?” Tony:  “Isn’t that that caveman diet?” Chris:  Yeah, exactly. All of our ancestors died when they were 30, so why should we even care? How do you respond to those arguments? Or if you start talking about Functional Medicine and maybe one of your conventional medicine colleagues says, “Oh, that’s just, I saw something on Science-based Medicine that said that was all just hooey. There’s nothing to it. How do you respond to that?” So what we wanted to do is give people the ammunition they needed in a respectful way. You know, this isn’t about getting the better of somebody. It’s about responding in a factual and convincing but respectful way. So we’ve got two different, we’re calling these the Power Packs. And one is for practitioners, so clinicians, health coaches, nutritionists, trainers, etc., and these are facts, research that you can reference and persuasive reasons for your clients or patients or colleagues to consider this Functional Medicine and ancestral diet and lifestyle approach. And then we have one for non-practitioners called the Supporter Power Pack. And these are smart answers and compelling comebacks, again respectful, for those common objections that you hear when you start talking about this stuff with your friends and family. So these bonuses are available until Sunday night [November 12, 2017] at 11:59 p.m. Pacific Time. So you’ve got a few days to act on that, and you can go to ... we set up a special link for you to get these and that’s Kresser.co/bonus. That’s Kresser.co/bonus. So head over there to get your Power Packs and your free audiobook, and that’s after you purchase either the paperback or Kindle. There’ll be a place where you enter your order number and we ask for some information just to verify, and I hope you enjoy those and get a lot out of them. Because they were actually really fun to put together. Tony:  Yeah, I think the audiobook is huge. I like to listen to audiobooks when I’m driving around town or outside getting some exercise. Chris:  Yeah. Tony:  So, no excuses when you make it that easy. Chris:  Yeah, yeah. So, Tony, thanks so much for doing this. This has been really fun to talk to you, as it always is. And I appreciate it. Tony:  Actually, I wanted to throw in one extra little special thing, as we mentioned, at the top of the show. I spent 10 years as a personal trainer in the trenches, I was involved with Paleo Magazine for many, many years, going to all the events, and for me kind of an evolution in my professional life was, how do I impact more people? How do I help more people? And at first I was working one on one, and then it was as a facility manager helping other trainers and coaches get better. And then I was able to scale it up that way. And last year I had an opportunity to join the team over at Natural Force, which is all-natural, nutritional products, and I basically said, “You know what? I’m going to go all in on this because if I can touch a million people through really good, high-quality nutrition, that’s me maximizing my impact and really kind of living my purpose.” So one of the things I wanted to do today is put it out there for anyone listening who maybe uses collagen or MCT oil or whey protein. We really bend over backwards to source the best ingredients in the world, no additives, all that stuff. Everything is as clean as we can possibly make it. It takes a lot of work, working with manufacturers. Kind of like what you were saying, how patients have to know how to talk to their doctor. I don’t think people really realize, and I didn’t realize until I got on the inside, how much work it is for a brand to work with their manufacturers to convince them to get outside of the conventional mold. So it’s the kind of unconventional nutrition is really what we’re pushing here. So I set up a discount code for any Revolution Health listeners. Go to NaturalForce.com, use coupon code “unconventional” and get $10 off plus free shipping on your order. So I just want to put that out there as just a little extra bonus for anybody, and I would certainly love to help in that way and really get some good, high-quality nutrition into people’s hands. Chris:  Awesome. Yeah, and there’s so many ways people can help, and I ... at Paleo f(x) we’ve see the growth of companies that are serving this space, and it's amazing. Like the products that are available now. I had breakfast this morning, I had some eggs and kale and parsley and a little bit of bacon in a couple of cassava flour tortillas. Breakfast burritos. Whoever thought I’d be having a breakfast burrito again? Tortillas are made from completely cassava flour. They’re autoimmune friendly and they’re grain-free tortillas. It’s incredible. Tony:  I think I might have some of those in my fridge as well. Chris:  Yeah. I mean there’s so many things. And these people, they’re serving this movement with that kind of work. So it’s great to see. Tony:  It takes a village, man. Chris:  It does. Thanks again, Tony. I really appreciate it. Thank you, everybody. So again, Kresser.co/bonus to pick up your free audiobook and the other bonuses, and I hope you can all join me in this revolution to reinvent healthcare. We need you, whatever your background and goals. Take care, everybody.

Source: http://chriskresser.com November 08, 2017 at 04:12PM

[shapesnnsizes]

RHR: A Three-Step Plan to Fix Conventional Healthcare

In this episode we discuss:

The patient case that inspired the book

Who is this book for?

The mismatch between our medical paradigm and chronic disease

Drug companies and conflicts of interest

How clinicians can help create a new paradigm

The three core problems and how to solve them

What this new paradigm looks like

How do we pay for this? Is it scalable?

How allied providers are the key

Show notes:

Unconventional Medicine by Chris Kresser

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Chris Kresser: Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. Today we’re going to do something a little different. I am bringing on a guest host, Tony Federico, he’s the VP of marketing for Natural Force Nutrition, a physiology editor for the Journal of Evolution and Health, and a longtime contributor to Paleo Magazine, and also at Paleo f(x), which is where I met Tony, I think, originally, and I have interacted with him the most. And he’s moderated several panels that I’ve been on and I’ve always been impressed with the way he’s done that, the intelligent questions that he asks and just his balanced perspective on ancestral health and Functional Medicine, and this movement overall. Today is the day that my new book, Unconventional Medicine, comes out. It’s now available on Amazon, and I wanted to ask Tony to come take over the podcast and talk with me about the book because I know he’s really interested in all these topics and he’s read quite a bit of the book himself, and I thought it would be more interesting to have a conversation about it than for me to just sit here and do a monologue. So Tony welcome to the show and thanks for being here. Tony Federico:  Yeah, thanks for inviting me on, Chris. It’s always fun, when we’ve had the chance to chat, as you said. Whether in person or on podcast, I’m always happy to jump in and dish on health with you. Chris:  Fantastic. So, you have read a little bit of the book and we chatted a little bit about it via email, so let’s dive in. Let’s talk a little bit about this book. And for me it was really, it felt like the most important next step that I could take in order to get this message out about ending chronic disease. Tony:  Yeah, I got my copy of Unconventional Medicine a couple days ago. I just so happened to have some time off yesterday, and the next thing I knew I was 80 pages in. Chris:  Nice. Tony:  So, I have to say that, as somebody who’s been in the trenches, I worked as a personal trainer for 10 years, I could really relate to a lot of the things that you were saying in the book, and we’ll get into why a little bit later on in the interview. But you know I just am really impressed with what you put together here, Chris. So let's just, let's get into it, and the first thing that I actually wanted you to maybe tell me a little bit about was how you open the book, which I think is a really great story about a patient named Leo. So I wanted to talk a little bit about Leo and his story and kind of how that inspired you to go down this particular path of unconventional medicine.

The patient case that inspired the book

Chris:  Sure, yeah. So, Leo was an eight-year-old boy that I treated in my clinic a few years back, and I wanted to start with his story because it's, unfortunately, a typical story, much more common than, of course, we would like. And it was powerful for me, it was a powerful experience. It's what actually led to me writing this book. So, like way too many other kids of his age, he was suffering from a number of behavioral issues. He was initially diagnosed on the autism spectrum. Eventually they settled on OCD and sensory processing disorder. He would throw these just crazy tantrums where he'd end up crying or screaming inconsolably, writhing on the floor, and this would happen for seemingly the simplest of reasons. Like trying to get his shoes tied as they were going out the door, not cutting the crust off his sandwich in just the right way or getting a stain on his favorite T-shirt. And he was really rigid around his behavior and its environment, everything had to be just right, just the way he wanted it to be, or else he would fly off the handle.

Is a new healthcare paradigm affordable? Scalable? You bet.

His diet was extremely limited, he only ate a handful of foods, pretty much all of which were processed and refined. So crackers, bread, toaster waffles, that sort of thing, and this is part of the kind of OCD-like tendencies. And any time his parents would try to introduce new food, he would go totally ballistic. And they were worried about nutrient deficiency, but they didn't feel like they ... they were just worn down. Any parent who has a kid like this will understand that. It's just they didn’t feel like they had the resources to battle him at every meal. And they took him to a bunch of doctors locally, and that’s where they got those diagnoses. Initially they were kind of relieved to have those, but then after a while they realized that they were just simply labels for symptoms. And when they asked what the treatment was, you can probably guess the answer: medication. Tony:  Something to do with drugs. Chris:  Something to do with drugs. Yeah. And when they asked how long he would be on that treatment, you can probably also guess the answer. Tony:  The rest of your life. Chris:  Yeah. Shrug of the shoulders, indefinitely, maybe he'll grow out of it, that sort of thing. And they weren't excited about the idea of of medicating their son, but they were also aware of how much he was suffering, and they were suffering, frankly, too. They decided to give them a try, starting with Adderall, and then they progressed to Ritalin and then antidepressants. And certainly the drugs did seem to help with at least some of the symptoms, but there were a couple issues. Number one, they also caused some very intractable side effects like headache, abdominal pain, irritability, and most significantly, severe sleep disruption. And they had a couple of other kids that were younger than Leo. So they were not happy about the sleep disruption. Nobody was because it was brutal for them and also brutal for Leo. Kids need a lot of sleep, and if they’re waking up throughout the night, that’s going to make ... So that was in some ways worse than the original symptoms they were trying to treat. And then Leo's mom had done quite a bit of research on the effects of these medications and she was scared. Particularly for children and adolescents, some of these drugs have some pretty scary side effects and long-term risks. So what really stood out to me, and I mentioned this in the book, is that not once during this entire process of seeing all these different doctors, primary care provider, psychiatrist, eventually behavioral disorder specialists, did anybody even hint at the possibility that something in Leo's diet or some other underlying issue like a gut problem or nutrient deficiency or heavy metal toxicity or something like that could be contributing to his symptoms. It wasn't even broached as a possibility at any time. Fortunately, Leo's mom, one of her friends followed my work and sent her a couple of articles from my blog. One was on the gut–brain–axis, and I think the other one was on the underlying root causes of behavioral disorders. And so that's what led them to bring Leo to see me, and long story short, we were able to ... we did a bunch of testing, found issues that you might guess at. So, disrupted gut microbiome, SIBO, fungal overgrowth, gluten intolerance, but also intolerance of soy and corn and rice and buckwheat, which were major ingredients in a lot of the processed and refined food products that he ate, and arsenic toxicity because rice milk was the only other beverage he would drink aside from water. And we know that rice products can be high in arsenic. So, we, over several months, it definitely wasn't easy to address these problems because of his OCD-like tendencies and his picky eating habits. But after several months he was like a different kid. His teacher even called home and was like, “What have you done with Leo and who’s this kid that you’re sending in?” Because it was a big issue for her. They often had to come to school and pick him up early because of the behavioral problems. And his diet expanded; he was eating foods he would've thrown against the wall just months before, he was more tolerant of disorder, more relaxed in his environment. They were able to travel for the first time in a long time because he wasn't so anxious in unfamiliar environments. His physical symptoms had improved significantly. So they were just over the moon. They couldn't believe it, and toward the end of our treatment together, she said something that really struck me, which was there’s so many kids out there that are like Leo and they’re suffering, they’re not finding help in the conventional system. Tony:  Sure. Chris:  And their doctors and parents are not even thinking about this stuff. Like it’s not even in most people’s consciousness that if a kid has a behavioral disorder that you should look at these physiological issues. It’s not, for 99 percent of people they don't even go there because they don't know. Tony:  Yeah, I mean I think that that was—reading about Leo and reading about a story and certainly there's people that I've known, myself included, who have had very similar experiences—I think it's great to have a narrative like this that you can really connect to because then when you tease it apart, all the pieces really make sense. It makes sense why having doctors treat symptoms has failed, it makes sense why a lack of communication between the health provider network that was supposed to be serving Leo failed. It makes sense why it didn't work when you actually start to tease it out. But then we’re still all, well not all, but most of us are still going down this path and it's an exercise in futility, really. You have an eight-year-old kid who's on powerful stimulant medications, he’s on antidepressants, and it was bad enough for his parents to reach out and to seek those interventions as solutions, and then the side effects are even worse. And that’s just something that just gets you right in the heart. And like you said, he’s not the only one, he’s not the only kid. His parents are not the only parents. And frankly, his doctors are not the only doctors because I can guarantee you that that probably doesn’t really feel good for the practitioner, for the healthcare provider to not get results as well. And they’re working with what they’ve got. Chris:  Absolutely. Tony:  And trying to use the tools they have. Chris:  Yeah, I mean, let’s be clear about this. Everybody is doing the best they can in this situation. The parents are doing the best they can, in the vast majority of situations, parents just love their kids and do everything possible that they can to help their kids thrive. I’m a parent, I know that that’s how I relate to my kid. I know that every parent I know, that’s how they relate to their kids. And I would even, I would say that’s true for doctors too. The vast majority of them are trying to do the best they can with the tools that they have and in the system that they’re working within. And that’s the rub. Tony:  Right. Chris:   It’s like most doctors I’ve seen have been caring and they’ve wanted to do the right thing, but the question is, can they do the right thing in the conventional medical system as it exists today? And, of course, that’s largely what the book is about.

Who is this book for?

Tony:  Yeah, so let’s kind of speak to that specifically. And we’re talking about doctors, we’re talking about medical professionals, we’re talking about patients, and then we didn’t mention it, but where I fit into this formula or potential formula as an allied healthcare provider, as a personal trainer/health coach, is that your audience for this book, do you really see that kind of triad is who you're speaking to here? Chris:  Yeah, definitely. I think if you look at the cover of the book, the subtitle is “join the revolution to reverse chronic disease, reinvent healthcare, and create a practice you love.” So that last bit would suggest that it's mostly for practitioners, but that's not true. It is really for anybody that is interested in the ideas of reinventing healthcare and reversing chronic disease. And, in fact, I would argue that that change is going to be initiated by people, primarily by people that are not practitioners. So it's like a grassroots, bottom-up approach, where a good example is with my training program, my ADAPT training program, now that we've been training practitioners in this approach for the last couple years, we always ask people how they learned about my work or how they learned about the training program. And in a surprising number of cases, the answer is from their patients. So these doctors or other practitioners, their patient brings an article in that I wrote or brings something in, tells them about me, and to their credit they’re open-minded enough to go and check it out. And then they like what they see and they end up taking the next step. So people even who have no intention of ever becoming a healthcare practitioner, I think would really benefit from this book if they're interested in these ideas. And then certainly, as you mentioned, licensed healthcare providers like medical doctors or nurse practitioners or physician assistants that are currently working within the conventional paradigm but have already seen its limitations and want to do something different but don't yet know what that might look like. And then people who are outside of the conventional paradigm but are already practitioners, so acupuncturists, chiropractors, naturopathic physicians, etc., in many cases they’re already well aware of the limitations of conventional medicine, which is why they chose to go down a different path. But speaking personally as an acupuncturist myself, I also saw some limitations in the traditional Chinese medicine approach, or at least some differences in the way that I wanted to practice it. I was looking for something that could incorporate modern diagnostic testing and create a more systematic approach that included ancestral diet and lifestyle and some of the other things we talk about in the book. So, I think many of those practitioners can benefit from the book from that perspective. And then you have the growing and already large number of people like yourself who are personal trainers, health coaches, nutritionists, etc., who I really think are going to play an increasingly important role in this revolution to reinvent healthcare. Tony:  Yeah, it so important now for people to really, for patients to be their own advocate, and I don't think we’re living in a time where I remember with my grandparents—if your doctor said something, it was basically gospel and you didn’t question it and you didn't think about it. Now, the first thing people do when they experience a symptom, it's Dr. Google first. So it's super important to equip and arm patients with good information, which I think this book does. Here's a path, here's a path forward for you as a patient. But then it's respectful of the role of doctors, and you highlight many situations where conventional medicine is great. If you break your arm or get in a car accident or have a heart attack or whatever the case may be, yeah, you need a doctor, and you need to go to an emergency room and you need those types of interventions. But it's really in this kind of gray area, it’s really not gray, it’s actually quite clear. And we could probably specify a little bit more, but there’s this middle zone where somebody’s not acutely injured, they’re not acutely in a disease state. They’re in a chronic disease state, or they’re just unwell. And it’s hard for a system that is all about pharmacological interventions, surgical interventions, to deal with a more subtle approach. And that’s where that whole middle ground and acupuncturists and massage therapists and everybody who's in that middle zone. I had clients constantly when I was actively training, constantly asking me questions where I was like, you know what? This is really something they maybe should be taking to their doctor. But guess what? The doctor only has 15 minutes under pressure to see as many patients as they can. I had a friend who was a physician in France. And he was telling me about their medical model, and he would spend tons of time with his patients. And it was actually incentivized for prevention. And here we see some maybe misplaced incentives, and perhaps you can speak a little bit more about that.

The mismatch between our medical paradigm and chronic disease

Chris:  Yeah, so, going back to your original comments, I think that the most important thing for people to understand is that our medical model, when it comes to our medical paradigm, is that it evolved during a time when acute problems were the biggest issues. So in 1900, the top three causes of death were all infectious diseases, tuberculosis, typhoid, and pneumonia. And the other reasons people would see the doctor were among those you mentioned, like a broken bone or a gallbladder attack or appendicitis. Tony:  War. Chris:  Right, injuries, trauma, etc. And so the treatment for that's pretty straightforward. It wasn't always successful, of course, but it was straightforward. You know, if the bone was broken, you set it in a cast. If the gallbladder was swelling, you would take it out. If someone was having appendicitis, you’d remove the appendix. So that's pretty ... it's one problem, one doctor, one treatment. Pretty straightforward. But you fast-forward to today, it's a totally different healthcare landscape. Seven of the top 10 causes of death are chronic disease rather than acute problems now, and 86 percent of the healthcare dollars we spend go toward treating chronic disease. And unlike acute problems, chronic diseases are expensive, difficult to manage and usually last for a lifetime. They don't lend themselves to that one doctor, one problem, one treatment kind of approach. The average chronic disease patient requires multiple doctors, usually one for every different part of the body in our system, and is taking ... Tony:  Specialists. Chris:  Right, specialists, they’re taking multiple medications in many cases, and they're going to be taking those medications for the rest of their life. So far, it's really, our conventional medical system is amazing for these acute problems. But it's the wrong tool for the job for chronic problems. So that's one issue, and it’s really important to point that out, because we just went through the whole healthcare debate again with the Affordable Care Act and the current administration’s proposal for a replacement, which has not come to fruition. But throughout that entire discussion, it really bothered me that there was an elephant in the room. All the discussion was around insurance. Like, who gets insurance and who doesn’t. And that’s important, it’s important to talk about that. But we have to recognize that health insurance is not the same thing as healthcare. Tony:  Yeah. Chris:  Health insurance is a method of paying for healthcare. And that’s really crucial to get that difference. Because my argument in the book is that there is no method of paying for healthcare, whether it’s the government, corporations, or individuals, that will be adequate and will be sustainable under the pressure of growing prevalence of chronic disease. It will bankrupt all of us. Government, the corporations, individuals, whoever is responsible for paying for the care will not be able to do it unless we can actually prevent and reverse chronic disease instead of just slapping Band-Aids on it. Tony:  I think the analogy you gave in the book was rearranging the deck chairs on the Titanic. “Making a few small tweaks to our current system and expecting that to work is like rearranging the deck furniture on the Titanic as it inexorably sinks into the ocean. Too little, too late.”  Chris:  Yeah, exactly. That’s the argument about insurance. As the whole ship goes under, sinks under. The other problems you mentioned are very real also. So we have a misalignment of incentives, like the insurance industry, for example, doesn't benefit when the cost of care shrinks because they only make more money when the overall expenditures rise. So it's actually not in their best interest necessarily to seek out the most cost-effective solutions.

Drug companies and conflicts of interest

Chris: And then of course, we have drug companies. People are pretty well aware of the conflicts of interest there. It’s in their interest to sell drugs, and even when that’s not in the interests of the general public or the patients or the doctors. In many cases, it’s not in their interest either. So the best example of this is a recent one. We’re in the midst of an opioid crisis, the worst we’ve ever seen by far, and the DEA has been wanting to create new regulations that restrict a pharmacy’s ability to sell opioids in ways that will protect people. So, for example, there was a pharmacy in West Virginia in a town that was tiny. It had like 30,000 people in this town, and they had ordered something like nine million opioid pills in the last year. It was clearly a front, like there’s clearly something shady going on there. There's no way that 30,000 people in that town needed nine million opioid pills, and yet there are no regulations to actually prevent that from happening. And so, the DEA had proposed some regulations to just safely protect people from that kind of thing. And the Big Pharma lobby basically shut that down and they played a big role in writing a law that limits the DEA's ability to do that kind of regulation in the midst of the worse opioid crisis ever. And to put this in perspective, we hear a lot about the gun lobbies and their control. They spend about $10.5 million lobbying Congress, I think, per year. And Big Pharma, they spent $250 million. Tony:  Wow. Chris:  Twenty-five-fold higher. Tony:  It's really tragic. I actually, I don’t think we’ve ever talked about this, but I grew up in South Florida, which was kind of ground zero for the opioid epidemic. And I remember in high school down in Miami and West Palm Beach, and kids would get a hold of a contact or whatever, somebody that had a prescription and basically would end up being a de facto drug dealer vis-à-vis a pill mill, etc. The kid across the street from me died, multiple kids in my high school died, multiple kids went into in-treatment programs, some of them battled addictions for decades. Some of them got out of it. Very few got out of it. Some of them didn't and have continued to be plagued with either switching from pharmaceuticals to street drugs like heroin, etc., and then we can see what's happening there. And that's just one example. If we look at drug consumption in the United States, is it that Americans are just that much sicker and we’re in that much more pain than people in other countries? Because we’re consuming far and away more painkillers than any other country on the planet. And I would venture to guess that you could say the same about antidepressants or ADD medication. It's very much a case of misaligned incentives. And incentives are working in the sense of the pharmaceutical companies are doing very well. Chris:  Yeah. Who are they working for is the question. Tony:  Exactly. Chris:  We’re the only country aside from New Zealand that allows direct-to-consumer drug advertising, and I think that's a big part of the problem. But it's not just Big Pharma. We also have conflicts in medical research that, of course, are related to Big Pharma because they pay for two-thirds of all medical research. We have broken payment models, where there's no real incentive or reward for good performance, and in fact, you could argue it's the other way around because doctors are compensated for, usually based on the number of procedures they order and the number of patients they see. So to your point about the doctor in France who is actually incentivized to prevent, rather than just treat disease, we don't have that at all, it's the opposite. And so there are a lot of deeply entrenched issues that we certainly need to address, and that's not essentially what this book is about. There are other books that cover that material really well, and frankly many of those issues are outside of our individual control as clinicians or practitioners.

How clinicians can help create a new paradigm

Chris: We can work toward addressing them, and I think we should, but the good news is that I think that the bigger changes that we need to focus on individually and collectively are addressing the medical paradigm which we’ve talked about, creating a medical paradigm that’s better suited to tackle chronic disease. Addressing the mismatch between our modern diet and lifestyle, and our genes and our biology, which we've, of course, talked a lot about on the show before. And then creating a new way of delivering healthcare that actually supports this new medical paradigm and this more preventative approach. Because those things are all within our control as clinicians. Tony:  Yeah. I like how you posed the question, and it was kind of a cool little, I think it was, not Hiroshi, but the person who is in charge of cooking at a Buddhist monastery. And basically a young monk comes up to this older man. He’s like, why are you doing the grunt work, basically washing rice out in the courtyard? And he says, it was like, what was it? “If not me, who? And if not now, when?” And I think that that’s really kind of the core of setting all this stuff up. Talking about the problem is really in the service of pivoting to the solution, and I’m a big believer in thinking globally, thinking big, but acting locally, hyper-locally, like yourself. Chris:  Yeah. Tony:  And then the people around you and who you can touch and impact. That’s ultimately where the power comes from. So let’s talk about that. What is in people’s power. And you started to describe some of those pillars of a new model. And you describe it as the ADAPT framework. And I don’t know how much you get into this on your regular podcast episodes, but to just kind of lay it out, ADAPT from a big-picture perspective. How does that actually address some of these systemic issues from an individually empowered stance? Chris:  Yeah, great question, and before I even go into that, I just want to say I agree that I think the change is going to happen on different levels. So, because a lot ... we’ve talked about this stuff at conferences or even some people who’ve already read the book. They say, oh, this is fantastic. I’m so excited. But how are we going to deal with Big Pharma and the insurance industry and these misaligned incentives and all of that? And can we ever deal with that? The answer is we’re not going to deal with that overnight and it’s going to take a while to unwind those things. Tony:  It’s the chronic disease, is what you call... Chris:  Exactly, exactly. And I use that analogy in the book. But the good news is that changes can happen very quickly on an individual and local level. And there’s already a lot of evidence of that happening. So my own clinic, CCFM, tripled in size in the last three years alone. We have Cleveland Clinic Center for Functional Medicine, launched by Dr. Mark Hyman, has just blown up like crazy. I mean they started in this tiny space. Now their 17,000-square-foot space, it takes up the whole second floor of the Glickman Tower at Cleveland Clinic. They've got a waitlist of 2,500 patients from nine countries around the world. This is really exciting! The Cleveland Clinic is always on the forefront of the newest trends in medicine, and the fact that they've invested that much money in this speaks volumes. Then we have groups like Iora Health, an organization based in the Rocky Mountain area that’s reversing diabetes using health coaches. So there are lots of really interesting produced concepts, and there's going to be more and more of these. Like we’re doing a pilot program with the Berkeley Fire Department where we’re working with their new recruits to help, we’re implementing a wellness program. Tony:  That’s awesome. Chris:  To reduce injuries and help with recovery and optimize their performance. And if that goes well, there’s been interest from the wider fire department and in the city of Berkeley as a whole. Robb Wolf’s done some incredible work with Reno that we’ve talked about before. So I think the change is going to happen more quickly on this local grassroots level, and then that's going to start to get the attention of people on a state and federal level. And then it will start to get really interesting.

The three core problems and how to solve them

To answer your question, in my book I basically lay out three core fundamental problems with the healthcare system in the US. And these, I argue, go even deeper than the misaligned incentives and Big Pharma and all of that stuff, although they’re, of course, connected. The first is that there is a profound mismatch between our genes and our biology and our modern diet and lifestyle. And I'm not going to say more about that now because almost everyone listening to this podcast knows exactly what I mean. The second problem is the mismatch between our medical paradigm and chronic disease, which we just talked about. We need a new medical paradigm that is better suited for chronic disease. And then the third is that the way we deliver care in this country is also, it's not set up to support the most important interventions. And we’ve touched on that too, where the average visit with the primary care provider is just actually eight to 12 minutes. Tony, you were talking about 15 minutes. That’s luxurious in our current model. The average amount of time a patient gets to speak before they’re interrupted by the doctor is 12 seconds. Tony:  Wow. Chris:  So I think it’s pretty clear that if a patient has multiple chronic diseases, which one in four Americans now do, one in two has one chronic disease, and they show up to the doctor’s office and they're on multiple medications, and they had been presenting with a whole set of new symptoms, there’s absolutely no way to provide high-quality care in a 10-minute visit. So we have to change our, not only the paradigm, but also the way that care is delivered. So that was my premise. So it follows then that my solution would address, I would hope at least those three points, right? Each of those three deficiencies. So the ADAPT framework combines an ancestral diet and lifestyle, which addresses that mismatch between our genes and biology in our modern diet and lifestyle. And then Functional Medicine is the new paradigm of medicine that is based on addressing the root cause of health problems, so we can prevent and reverse them instead of just suppressing symptoms. And then the third component is what I call a collaborative practice model, which links licensed providers like medical doctors, nurse practitioners, with what I call allied providers, which include folks like yourself, Tony, health coaches, nutritionists, personal trainers, etc., to provide a much, much higher level of care than what doctors are able to provide on their own. So, again, we're not trying to replace doctors in any, or even conventional medicine. We need people to do colonoscopies and remove cancerous tumors and use all of the incredible amount of training and expertise and skill that they’ve acquired over a lifetime of practice and study. We absolutely want that, but we need to add stuff to that that's not available now. Tony:  What that really says to me is, emphasize the importance of community, of connection, of collaboration. We’re social creatures, we’re tribal by nature. That’s another kind of Paleo/ancestral health part of the puzzle. And it would be foolish to think that we can dissect out and silo out all these different aspects of our lives without consequence. I really like this idea of bringing everybody into the fold, and it’s not saying that you can go to just the naturopath, or you can go to just the health coach. Because like I mentioned already, I certainly would’ve been ill-equipped to handle plenty of issues that a client would’ve brought to mind or brought up in conversation during a training session. But it would’ve been really great to say, ah, here's the Functional Medicine practitioner that I recommend you speak with, and to have a good relationship with that person and to be able to, as a health coach, help my clients better by getting them in touch with the right person. And that’s having this network that can really support people throughout their health journey whether it’s just feeling better and more energy, or addressing something like diabetes or hypertension. Which certainly there’s a place for all the players in that kind of scenario.

What this new paradigm looks like

Chris:  Absolutely. And let’s use an example just to bring this to life for people. So, imagine you go to the doctor and they do some blood testing for your annual physical. And they find that your fasting blood sugar is 96 or 97. Your hemoglobin A1c is 5.5, and you’ve got triglycerides that are 110, 120, maybe 130. Currently, what would happen is nothing, usually. Tony:  You’re not sick enough yet. Chris:  Yeah, all of your markers are within the lab range, they say, and that means you’re normal, and so you might get some vague advice about make sure to exercise and follow a good diet. And thank you very much, that’s it. Certainly there are exceptions to the rule, of course. There’s some practitioners who can get a lot more proactive about that. But I can’t tell you how many people, patients I’ve had that have been given that basic line with those kinds of lab results. What could happen is this. The doctor says, “Well, you know, if we think of blood sugar disorders on a spectrum, on the left you’ve got perfect blood sugar. On the right you’ve got full-fledged type 2 diabetes. You’re not on the right yet, you don’t have type 2 diabetes or even technically prediabetes, but you’re progressing along that spectrum. And what we know from a lot of research is that if we don’t intervene now, that you’re going to continue progressing. And in fact, we have studies that show that the average patient who has prediabetes, will progress to full-fledged type 2 diabetes in just five years if it’s not addressed.” So what we want to do is be proactive here. We want to intervene now because it’s much easier to prevent a disease before it occurs than it is to treat it after it’s already occurred. So here’s what we’re going to do. We’re going to set you up with our staff health coach, and they’re going to give you all the support you need to adopt a better diet. They’re actually even going to take you shopping, they’re going to come to your house and clean out your pantry with you, and they're going to give you recipes and meal plans and give you ... totally hold your hand and do everything that they need to to get you on this diet. Because we know that information is not enough. We’ve got lots of studies. I can tell you as a doctor, go eat a healthy diet, and hey, we know that that’s probably not going to happen. Most people know what they should be doing, but they’re not doing it, and it’s not because of lack of information. It’s because they need support, and we’re here to support you. We’ve got this health coach. Furthermore, we've got this great personal trainer named Tony. We’re going to set you up with him and we’re also going to set you up with a gym membership. And the good news is, your insurance is going to pay for all this. They’re going to pay for the health coach, they’re going to pay for the gym membership, they’re going to pay for your sessions with Tony. And in six months’ time, you’re going to come back here and we’re going to retest your blood markers and I can almost guarantee that if you stick with the program, you’re going to have normal blood sugar by that time. And throughout that period you’re going to have weekly check-ins with a health coach, you’re going to have training sessions. And not only will your blood sugar be normal, you’re going to lose weight, your energy levels are going to go up, your sleep’s going to get better, you’re going to feel more confident and empowered because you’re making these changes, and you’re going to feel like a different person. Now that’s totally possible.

How do we pay for this? Is it scalable?

Chris: I can hear some people saying, “Oh, how are we going to pay for that? That’s ridiculous.” Tony:  Is it scalable? Chris:  The question we should be asking is, is treating type 2 diabetes scalable? Because I mentioned this in the book, it costs $14,000 a year to treat a single patient with type 2 diabetes. So let’s imagine that this patient progresses. We don’t intervene, five years later they have type 2 diabetes. All of a sudden the healthcare system is spending $14,000 a year paying for that person’s care. And let’s say that that person gets diagnosed at age 40, which is still reasonable these days. The age of diagnosis is dropping more and more, and then let’s say that they live until they’re 85 years old, which is also possible because of our heroic medical interventions that keep people alive a lot longer than they might have been otherwise. So 45 years living with type 2 diabetes, that’s a cost of almost $650,000 for one patient to the healthcare system. Tony:  And that doesn’t even touch on the lost wages, cost to employers, when someone’s on leave, loss of productivity. And then the cost to the family members. Chris:  Absolutely. Tony:  People that are actually, are helping the patient, their health is going to be going down too. Chris:  Yeah. Nor does it touch on the qualitative aspects. Being immobilized, not being able to play with your grandkids, all of that stuff. But let’s just even forget about that for a second—$650,000, okay? And then the CDC recently came out with statistics saying that 100 million Americans have either prediabetes or diabetes, and 88 percent of people with prediabetes don’t even know that they have it. Which means they're almost certainly going to progress, right? If you do the math and you multiply 100 million people times even $14,000 for one year, you get a number that’s so large, I don’t even know what it is. It’s like a google something. It’s like, it has so many zeros after it, I don’t even know how to characterize it. But then if you multiply 100 million times like 20 or 30 years, it’s more money than there is in the world. It's like it's not going to happen. Tony:  Not sustainable, not scalable. Chris:  Not sustainable, not scalable. So let’s say in our example that we ... the healthcare system spends $10,000, which is way more than would be necessary, but let’s even say we buy the person’s groceries for three months. And their gym membership and their trainer, and their health coach, and those weekly, let’s say we spend $10,000. We’re just super generous and we spend $10,000 for that six-month period. Again, the research and my clinical experience indicates with near certainty that if the person is at that stage of not even prediabetic and we intervene, there’s like almost no chance that it’s not going to, we’re not going to be able to normalize that person’s blood sugar. And if they do that and they stick with it and they are able to do that because they now have support rather than just information, we’ve just saved the healthcare system $640,000 over the course of that patient’s lifetime. And that’s a conservative estimate, as you say. We're not including even the indirect costs. Tony:  Right, right. Chris:  I think that this is not only possible, it's going to become necessary. And whether we get there with a proactive approach where we decide to move in this direction and we make these changes or whether we get there because we absolutely have no choice, we’re going to get there. Tony:  Yeah. I mean it really sounds like we can’t afford to not do this. Chris:  Exactly. Tony:  And if we get to that point where we continue down the reactive path and we wait until there’s a total collapse, it might be too late, just to put it frankly. And it’s going to come out at a huge, not just financial cost, a huge human cost. Chris:  Yeah, it’s going to be, we can use the chronic disease metaphor again, it’s a lot easier to prevent a problem or reverse it at an earlier stage than it is to wait until the patient is essentially on life support or the healthcare system is on life support. It’s harder to reverse it at that time. And that’s of course why I’m writing the book now because I want to get this message out as far and wide as I can. Tony:  Yeah. If not now, when? If not you, who? Go right back to there.

How allied providers are the key

Chris:  Exactly. And one more thing about that is the amazing thing, the beauty of this is that it takes about eight years and hundreds of thousands of dollars to train a doctor. And it takes a certain kind of personality and a certain kind of comfort level with science, and a lot of prerequisites. It’s not for everybody. And there’s a ... already we have a shortage of doctors, and that’s predicted to get worse. I’ve seen estimates that suggest by 2025 we’ll have a shortage of 52,000 primary care physicians. So that’s a big deal. [insert image] So we already don’t have enough doctors, it’s already going to get worse, but if you think of healthcare as like a ... I have something in the book called the healthcare population pyramid. And you were referring to it earlier, Tony, where at the very top of that pyramid you’ve got 5 percent of people who are in really acute situations. So they’re in the hospital or they’re in an intensive outpatient care setting. They need the conventional medicine paradigm as it exists, and it’s fantastic for those situations. Then you’ve got another 25 percent of people in that kind of high middle of the pyramid who are dealing with some pretty serious chronic health challenges. So they require more regular care, but they’re not sick enough to be in the hospital or in any kind of ... they’re living their lives, but they’re struggling a lot. A Functional Medicine practitioner/clinician usually working in concert possibly with the conventional specialist of some kind is a really great option for that 25 percent of the pyramid. But then you’ve got the 70 percent at the bottom. So these are people who do, may have health issues, but they’re more minor, so they might have skin problems, or a little bit of brain fog, some difficulties sleeping, some GI issues. And these can be definitely debilitating and total pain, but they’re not at the level of that 25 percent. My argument is that in many cases these people could be very well served by a health coach or nutritionist with good training. And possibly seeing a Functional Medicine provider once or twice a year, or something like that. And the thing is, we can train people in a year or two without an extensive science background to be very, very objective in this role. Because they’re mostly working with patients on changing their behavior. If you think about it, most of the risk factors for chronic disease come down to the wrong behaviors. Eating the wrong diet, not getting enough sleep, not exercising, or exercising too much, or any number of things that come down to choices that we’re making. And so if a skilled health coach who’s trained in things like motivational interviewing and coaching to strengths and other evidence-based principles of facilitating behavior change which we have a ton of research on, they can be incredibly effective for that 70 percent of the population. That's the majority of the population. So we’re totally underutilizing these practitioners, and my argument is that they’re going to play a huge role in this future of medicine. And that's of course one reason why we're launching an ADAPT Health Coach Training Program next year to complement the practitioner training program that we've been doing. Because I want to create this ecosystem we've been talking about where you have all of these different types of practitioners working to the maximum of their training and ability and scope of practice and supporting each other and therefore providing the highest level of care to patients. Tony:  That certainly kind of perks my ears up hearing about the ADAPT health coach option and something that I’m personally interested in. So who knows? Maybe I can get in on that. We can talk about it again in the future. Chris:  Yeah, for sure. For sure. Tony:  So, for this particular book, for Unconventional Medicine, people are fired up, they’re hearing about it, they’re like, “Okay, this resonates with me. I’m a practitioner, I’m an allied health provider, I’m a patient, I’m ready. Now’s the time. This is it. We’re going to do this.” What’s the best way for people to get their hands on this thing? Chris:  Well not surprisingly, Amazon. They have the best way to get your hands on anything. So it’s available in paperback, Kindle, and audiobook. We’re hoping [the audiobook] is going to be out today, the day this podcast is released. But it might be another two or three days. They’re just taking their sweet time to approve it. I narrated the audiobook myself. So you podcast listeners, I figured you might be into that, since you like to listen. Tony:  They know your voice. Chris:  Yeah, and just listening to something instead of reading it perhaps. So to that end, we have a special offer for podcast listeners, because I appreciate your support and I know many of you are already part of this movement, and some are wanting to get involved. So if you buy that paperback or Kindle version between now and Sunday night, you’ll get some really cool bonuses. The first is a free copy of the audiobook. So again, we wanted to include that for podcast listeners, since we figured you guys and gals are probably interested in audio. But there are two other things that are really, I think, fantastic. And one, they’re both tools to help you be more confident and persuasive and factual when you share your passion for Functional Medicine and an ancestral diet and lifestyle. Because we’ve had a lot of questions from people, both practitioners and non-practitioners alike. They say, “Oh, how do I talk about this stuff to my sister at Thanksgiving?” Tony:  “Isn’t that that caveman diet?” Chris:  Yeah, exactly. All of our ancestors died when they were 30, so why should we even care? How do you respond to those arguments? Or if you start talking about Functional Medicine and maybe one of your conventional medicine colleagues says, “Oh, that’s just, I saw something on Science-based Medicine that said that was all just hooey. There’s nothing to it. How do you respond to that?” So what we wanted to do is give people the ammunition they needed in a respectful way. You know, this isn’t about getting the better of somebody. It’s about responding in a factual and convincing but respectful way. So we’ve got two different, we’re calling these the Power Packs. And one is for practitioners, so clinicians, health coaches, nutritionists, trainers, etc., and these are facts, research that you can reference and persuasive reasons for your clients or patients or colleagues to consider this Functional Medicine and ancestral diet and lifestyle approach. And then we have one for non-practitioners called the Supporter Power Pack. And these are smart answers and compelling comebacks, again respectful, for those common objections that you hear when you start talking about this stuff with your friends and family. So these bonuses are available until Sunday night [November 12, 2017] at 11:59 p.m. Pacific Time. So you’ve got a few days to act on that, and you can go to ... we set up a special link for you to get these and that’s Kresser.co/bonus. That’s Kresser.co/bonus. So head over there to get your Power Packs and your free audiobook, and that’s after you purchase either the paperback or Kindle. There’ll be a place where you enter your order number and we ask for some information just to verify, and I hope you enjoy those and get a lot out of them. Because they were actually really fun to put together. Tony:  Yeah, I think the audiobook is huge. I like to listen to audiobooks when I’m driving around town or outside getting some exercise. Chris:  Yeah. Tony:  So, no excuses when you make it that easy. Chris:  Yeah, yeah. So, Tony, thanks so much for doing this. This has been really fun to talk to you, as it always is. And I appreciate it. Tony:  Actually, I wanted to throw in one extra little special thing, as we mentioned, at the top of the show. I spent 10 years as a personal trainer in the trenches, I was involved with Paleo Magazine for many, many years, going to all the events, and for me kind of an evolution in my professional life was, how do I impact more people? How do I help more people? And at first I was working one on one, and then it was as a facility manager helping other trainers and coaches get better. And then I was able to scale it up that way. And last year I had an opportunity to join the team over at Natural Force, which is all-natural, nutritional products, and I basically said, “You know what? I’m going to go all in on this because if I can touch a million people through really good, high-quality nutrition, that’s me maximizing my impact and really kind of living my purpose.” So one of the things I wanted to do today is put it out there for anyone listening who maybe uses collagen or MCT oil or whey protein. We really bend over backwards to source the best ingredients in the world, no additives, all that stuff. Everything is as clean as we can possibly make it. It takes a lot of work, working with manufacturers. Kind of like what you were saying, how patients have to know how to talk to their doctor. I don’t think people really realize, and I didn’t realize until I got on the inside, how much work it is for a brand to work with their manufacturers to convince them to get outside of the conventional mold. So it’s the kind of unconventional nutrition is really what we’re pushing here. So I set up a discount code for any Revolution Health listeners. Go to NaturalForce.com, use coupon code “unconventional” and get $10 off plus free shipping on your order. So I just want to put that out there as just a little extra bonus for anybody, and I would certainly love to help in that way and really get some good, high-quality nutrition into people’s hands. Chris:  Awesome. Yeah, and there’s so many ways people can help, and I ... at Paleo f(x) we’ve see the growth of companies that are serving this space, and it's amazing. Like the products that are available now. I had breakfast this morning, I had some eggs and kale and parsley and a little bit of bacon in a couple of cassava flour tortillas. Breakfast burritos. Whoever thought I’d be having a breakfast burrito again? Tortillas are made from completely cassava flour. They’re autoimmune friendly and they’re grain-free tortillas. It’s incredible. Tony:  I think I might have some of those in my fridge as well. Chris:  Yeah. I mean there’s so many things. And these people, they’re serving this movement with that kind of work. So it’s great to see. Tony:  It takes a village, man. Chris:  It does. Thanks again, Tony. I really appreciate it. Thank you, everybody. So again, Kresser.co/bonus to pick up your free audiobook and the other bonuses, and I hope you can all join me in this revolution to reinvent healthcare. We need you, whatever your background and goals. Take care, everybody.

[denisalvney]

RHR: A Three-Step Plan to Fix Conventional Healthcare

In this episode we discuss:

The patient case that inspired the book

Who is this book for?

The mismatch between our medical paradigm and chronic disease

Drug companies and conflicts of interest

How clinicians can help create a new paradigm

The three core problems and how to solve them

What this new paradigm looks like

How do we pay for this? Is it scalable?

How allied providers are the key

Show notes:

Unconventional Medicine by Chris Kresser

Special offer for RHR podcast listeners - get the audiobook free if you buy the book by November 12th.

NaturalForce.com - use coupon “unconventional” and get $10 plus free shipping

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Chris Kresser: Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. Today we’re going to do something a little different. I am bringing on a guest host, Tony Federico, he’s the VP of marketing for Natural Force Nutrition, a physiology editor for the Journal of Evolution and Health, and a longtime contributor to Paleo Magazine, and also at Paleo f(x), which is where I met Tony, I think, originally, and I have interacted with him the most. And he’s moderated several panels that I’ve been on and I’ve always been impressed with the way he’s done that, the intelligent questions that he asks and just his balanced perspective on ancestral health and Functional Medicine, and this movement overall. Today is the day that my new book, Unconventional Medicine, comes out. It’s now available on Amazon, and I wanted to ask Tony to come take over the podcast and talk with me about the book because I know he’s really interested in all these topics and he’s read quite a bit of the book himself, and I thought it would be more interesting to have a conversation about it than for me to just sit here and do a monologue. So Tony welcome to the show and thanks for being here. Tony Federico:  Yeah, thanks for inviting me on, Chris. It’s always fun, when we’ve had the chance to chat, as you said. Whether in person or on podcast, I’m always happy to jump in and dish on health with you. Chris:  Fantastic. So, you have read a little bit of the book and we chatted a little bit about it via email, so let’s dive in. Let’s talk a little bit about this book. And for me it was really, it felt like the most important next step that I could take in order to get this message out about ending chronic disease. Tony:  Yeah, I got my copy of Unconventional Medicine a couple days ago. I just so happened to have some time off yesterday, and the next thing I knew I was 80 pages in. Chris:  Nice. Tony:  So, I have to say that, as somebody who’s been in the trenches, I worked as a personal trainer for 10 years, I could really relate to a lot of the things that you were saying in the book, and we’ll get into why a little bit later on in the interview. But you know I just am really impressed with what you put together here, Chris. So let's just, let's get into it, and the first thing that I actually wanted you to maybe tell me a little bit about was how you open the book, which I think is a really great story about a patient named Leo. So I wanted to talk a little bit about Leo and his story and kind of how that inspired you to go down this particular path of unconventional medicine.

The patient case that inspired the book

Chris:  Sure, yeah. So, Leo was an eight-year-old boy that I treated in my clinic a few years back, and I wanted to start with his story because it's, unfortunately, a typical story, much more common than, of course, we would like. And it was powerful for me, it was a powerful experience. It's what actually led to me writing this book. So, like way too many other kids of his age, he was suffering from a number of behavioral issues. He was initially diagnosed on the autism spectrum. Eventually they settled on OCD and sensory processing disorder. He would throw these just crazy tantrums where he'd end up crying or screaming inconsolably, writhing on the floor, and this would happen for seemingly the simplest of reasons. Like trying to get his shoes tied as they were going out the door, not cutting the crust off his sandwich in just the right way or getting a stain on his favorite T-shirt. And he was really rigid around his behavior and its environment, everything had to be just right, just the way he wanted it to be, or else he would fly off the handle.

Is a new healthcare paradigm affordable? Scalable? You bet.

His diet was extremely limited, he only ate a handful of foods, pretty much all of which were processed and refined. So crackers, bread, toaster waffles, that sort of thing, and this is part of the kind of OCD-like tendencies. And any time his parents would try to introduce new food, he would go totally ballistic. And they were worried about nutrient deficiency, but they didn't feel like they ... they were just worn down. Any parent who has a kid like this will understand that. It's just they didn’t feel like they had the resources to battle him at every meal. And they took him to a bunch of doctors locally, and that’s where they got those diagnoses. Initially they were kind of relieved to have those, but then after a while they realized that they were just simply labels for symptoms. And when they asked what the treatment was, you can probably guess the answer: medication. Tony:  Something to do with drugs. Chris:  Something to do with drugs. Yeah. And when they asked how long he would be on that treatment, you can probably also guess the answer. Tony:  The rest of your life. Chris:  Yeah. Shrug of the shoulders, indefinitely, maybe he'll grow out of it, that sort of thing. And they weren't excited about the idea of of medicating their son, but they were also aware of how much he was suffering, and they were suffering, frankly, too. They decided to give them a try, starting with Adderall, and then they progressed to Ritalin and then antidepressants. And certainly the drugs did seem to help with at least some of the symptoms, but there were a couple issues. Number one, they also caused some very intractable side effects like headache, abdominal pain, irritability, and most significantly, severe sleep disruption. And they had a couple of other kids that were younger than Leo. So they were not happy about the sleep disruption. Nobody was because it was brutal for them and also brutal for Leo. Kids need a lot of sleep, and if they’re waking up throughout the night, that’s going to make ... So that was in some ways worse than the original symptoms they were trying to treat. And then Leo's mom had done quite a bit of research on the effects of these medications and she was scared. Particularly for children and adolescents, some of these drugs have some pretty scary side effects and long-term risks. So what really stood out to me, and I mentioned this in the book, is that not once during this entire process of seeing all these different doctors, primary care provider, psychiatrist, eventually behavioral disorder specialists, did anybody even hint at the possibility that something in Leo's diet or some other underlying issue like a gut problem or nutrient deficiency or heavy metal toxicity or something like that could be contributing to his symptoms. It wasn't even broached as a possibility at any time. Fortunately, Leo's mom, one of her friends followed my work and sent her a couple of articles from my blog. One was on the gut–brain–axis, and I think the other one was on the underlying root causes of behavioral disorders. And so that's what led them to bring Leo to see me, and long story short, we were able to ... we did a bunch of testing, found issues that you might guess at. So, disrupted gut microbiome, SIBO, fungal overgrowth, gluten intolerance, but also intolerance of soy and corn and rice and buckwheat, which were major ingredients in a lot of the processed and refined food products that he ate, and arsenic toxicity because rice milk was the only other beverage he would drink aside from water. And we know that rice products can be high in arsenic. So, we, over several months, it definitely wasn't easy to address these problems because of his OCD-like tendencies and his picky eating habits. But after several months he was like a different kid. His teacher even called home and was like, “What have you done with Leo and who’s this kid that you’re sending in?” Because it was a big issue for her. They often had to come to school and pick him up early because of the behavioral problems. And his diet expanded; he was eating foods he would've thrown against the wall just months before, he was more tolerant of disorder, more relaxed in his environment. They were able to travel for the first time in a long time because he wasn't so anxious in unfamiliar environments. His physical symptoms had improved significantly. So they were just over the moon. They couldn't believe it, and toward the end of our treatment together, she said something that really struck me, which was there’s so many kids out there that are like Leo and they’re suffering, they’re not finding help in the conventional system. Tony:  Sure. Chris:  And their doctors and parents are not even thinking about this stuff. Like it’s not even in most people’s consciousness that if a kid has a behavioral disorder that you should look at these physiological issues. It’s not, for 99 percent of people they don't even go there because they don't know. Tony:  Yeah, I mean I think that that was—reading about Leo and reading about a story and certainly there's people that I've known, myself included, who have had very similar experiences—I think it's great to have a narrative like this that you can really connect to because then when you tease it apart, all the pieces really make sense. It makes sense why having doctors treat symptoms has failed, it makes sense why a lack of communication between the health provider network that was supposed to be serving Leo failed. It makes sense why it didn't work when you actually start to tease it out. But then we’re still all, well not all, but most of us are still going down this path and it's an exercise in futility, really. You have an eight-year-old kid who's on powerful stimulant medications, he’s on antidepressants, and it was bad enough for his parents to reach out and to seek those interventions as solutions, and then the side effects are even worse. And that’s just something that just gets you right in the heart. And like you said, he’s not the only one, he’s not the only kid. His parents are not the only parents. And frankly, his doctors are not the only doctors because I can guarantee you that that probably doesn’t really feel good for the practitioner, for the healthcare provider to not get results as well. And they’re working with what they’ve got. Chris:  Absolutely. Tony:  And trying to use the tools they have. Chris:  Yeah, I mean, let’s be clear about this. Everybody is doing the best they can in this situation. The parents are doing the best they can, in the vast majority of situations, parents just love their kids and do everything possible that they can to help their kids thrive. I’m a parent, I know that that’s how I relate to my kid. I know that every parent I know, that’s how they relate to their kids. And I would even, I would say that’s true for doctors too. The vast majority of them are trying to do the best they can with the tools that they have and in the system that they’re working within. And that’s the rub. Tony:  Right. Chris:   It’s like most doctors I’ve seen have been caring and they’ve wanted to do the right thing, but the question is, can they do the right thing in the conventional medical system as it exists today? And, of course, that’s largely what the book is about.

Who is this book for?

Tony:  Yeah, so let’s kind of speak to that specifically. And we’re talking about doctors, we’re talking about medical professionals, we’re talking about patients, and then we didn’t mention it, but where I fit into this formula or potential formula as an allied healthcare provider, as a personal trainer/health coach, is that your audience for this book, do you really see that kind of triad is who you're speaking to here? Chris:  Yeah, definitely. I think if you look at the cover of the book, the subtitle is “join the revolution to reverse chronic disease, reinvent healthcare, and create a practice you love.” So that last bit would suggest that it's mostly for practitioners, but that's not true. It is really for anybody that is interested in the ideas of reinventing healthcare and reversing chronic disease. And, in fact, I would argue that that change is going to be initiated by people, primarily by people that are not practitioners. So it's like a grassroots, bottom-up approach, where a good example is with my training program, my ADAPT training program, now that we've been training practitioners in this approach for the last couple years, we always ask people how they learned about my work or how they learned about the training program. And in a surprising number of cases, the answer is from their patients. So these doctors or other practitioners, their patient brings an article in that I wrote or brings something in, tells them about me, and to their credit they’re open-minded enough to go and check it out. And then they like what they see and they end up taking the next step. So people even who have no intention of ever becoming a healthcare practitioner, I think would really benefit from this book if they're interested in these ideas. And then certainly, as you mentioned, licensed healthcare providers like medical doctors or nurse practitioners or physician assistants that are currently working within the conventional paradigm but have already seen its limitations and want to do something different but don't yet know what that might look like. And then people who are outside of the conventional paradigm but are already practitioners, so acupuncturists, chiropractors, naturopathic physicians, etc., in many cases they’re already well aware of the limitations of conventional medicine, which is why they chose to go down a different path. But speaking personally as an acupuncturist myself, I also saw some limitations in the traditional Chinese medicine approach, or at least some differences in the way that I wanted to practice it. I was looking for something that could incorporate modern diagnostic testing and create a more systematic approach that included ancestral diet and lifestyle and some of the other things we talk about in the book. So, I think many of those practitioners can benefit from the book from that perspective. And then you have the growing and already large number of people like yourself who are personal trainers, health coaches, nutritionists, etc., who I really think are going to play an increasingly important role in this revolution to reinvent healthcare. Tony:  Yeah, it so important now for people to really, for patients to be their own advocate, and I don't think we’re living in a time where I remember with my grandparents—if your doctor said something, it was basically gospel and you didn’t question it and you didn't think about it. Now, the first thing people do when they experience a symptom, it's Dr. Google first. So it's super important to equip and arm patients with good information, which I think this book does. Here's a path, here's a path forward for you as a patient. But then it's respectful of the role of doctors, and you highlight many situations where conventional medicine is great. If you break your arm or get in a car accident or have a heart attack or whatever the case may be, yeah, you need a doctor, and you need to go to an emergency room and you need those types of interventions. But it's really in this kind of gray area, it’s really not gray, it’s actually quite clear. And we could probably specify a little bit more, but there’s this middle zone where somebody’s not acutely injured, they’re not acutely in a disease state. They’re in a chronic disease state, or they’re just unwell. And it’s hard for a system that is all about pharmacological interventions, surgical interventions, to deal with a more subtle approach. And that’s where that whole middle ground and acupuncturists and massage therapists and everybody who's in that middle zone. I had clients constantly when I was actively training, constantly asking me questions where I was like, you know what? This is really something they maybe should be taking to their doctor. But guess what? The doctor only has 15 minutes under pressure to see as many patients as they can. I had a friend who was a physician in France. And he was telling me about their medical model, and he would spend tons of time with his patients. And it was actually incentivized for prevention. And here we see some maybe misplaced incentives, and perhaps you can speak a little bit more about that.

The mismatch between our medical paradigm and chronic disease

Chris:  Yeah, so, going back to your original comments, I think that the most important thing for people to understand is that our medical model, when it comes to our medical paradigm, is that it evolved during a time when acute problems were the biggest issues. So in 1900, the top three causes of death were all infectious diseases, tuberculosis, typhoid, and pneumonia. And the other reasons people would see the doctor were among those you mentioned, like a broken bone or a gallbladder attack or appendicitis. Tony:  War. Chris:  Right, injuries, trauma, etc. And so the treatment for that's pretty straightforward. It wasn't always successful, of course, but it was straightforward. You know, if the bone was broken, you set it in a cast. If the gallbladder was swelling, you would take it out. If someone was having appendicitis, you’d remove the appendix. So that's pretty ... it's one problem, one doctor, one treatment. Pretty straightforward. But you fast-forward to today, it's a totally different healthcare landscape. Seven of the top 10 causes of death are chronic disease rather than acute problems now, and 86 percent of the healthcare dollars we spend go toward treating chronic disease. And unlike acute problems, chronic diseases are expensive, difficult to manage and usually last for a lifetime. They don't lend themselves to that one doctor, one problem, one treatment kind of approach. The average chronic disease patient requires multiple doctors, usually one for every different part of the body in our system, and is taking ... Tony:  Specialists. Chris:  Right, specialists, they’re taking multiple medications in many cases, and they're going to be taking those medications for the rest of their life. So far, it's really, our conventional medical system is amazing for these acute problems. But it's the wrong tool for the job for chronic problems. So that's one issue, and it’s really important to point that out, because we just went through the whole healthcare debate again with the Affordable Care Act and the current administration’s proposal for a replacement, which has not come to fruition. But throughout that entire discussion, it really bothered me that there was an elephant in the room. All the discussion was around insurance. Like, who gets insurance and who doesn’t. And that’s important, it’s important to talk about that. But we have to recognize that health insurance is not the same thing as healthcare. Tony:  Yeah. Chris:  Health insurance is a method of paying for healthcare. And that’s really crucial to get that difference. Because my argument in the book is that there is no method of paying for healthcare, whether it’s the government, corporations, or individuals, that will be adequate and will be sustainable under the pressure of growing prevalence of chronic disease. It will bankrupt all of us. Government, the corporations, individuals, whoever is responsible for paying for the care will not be able to do it unless we can actually prevent and reverse chronic disease instead of just slapping Band-Aids on it. Tony:  I think the analogy you gave in the book was rearranging the deck chairs on the Titanic. “Making a few small tweaks to our current system and expecting that to work is like rearranging the deck furniture on the Titanic as it inexorably sinks into the ocean. Too little, too late.”  Chris:  Yeah, exactly. That’s the argument about insurance. As the whole ship goes under, sinks under. The other problems you mentioned are very real also. So we have a misalignment of incentives, like the insurance industry, for example, doesn't benefit when the cost of care shrinks because they only make more money when the overall expenditures rise. So it's actually not in their best interest necessarily to seek out the most cost-effective solutions.

Drug companies and conflicts of interest

Chris: And then of course, we have drug companies. People are pretty well aware of the conflicts of interest there. It’s in their interest to sell drugs, and even when that’s not in the interests of the general public or the patients or the doctors. In many cases, it’s not in their interest either. So the best example of this is a recent one. We’re in the midst of an opioid crisis, the worst we’ve ever seen by far, and the DEA has been wanting to create new regulations that restrict a pharmacy’s ability to sell opioids in ways that will protect people. So, for example, there was a pharmacy in West Virginia in a town that was tiny. It had like 30,000 people in this town, and they had ordered something like nine million opioid pills in the last year. It was clearly a front, like there’s clearly something shady going on there. There's no way that 30,000 people in that town needed nine million opioid pills, and yet there are no regulations to actually prevent that from happening. And so, the DEA had proposed some regulations to just safely protect people from that kind of thing. And the Big Pharma lobby basically shut that down and they played a big role in writing a law that limits the DEA's ability to do that kind of regulation in the midst of the worse opioid crisis ever. And to put this in perspective, we hear a lot about the gun lobbies and their control. They spend about $10.5 million lobbying Congress, I think, per year. And Big Pharma, they spent $250 million. Tony:  Wow. Chris:  Twenty-five-fold higher. Tony:  It's really tragic. I actually, I don’t think we’ve ever talked about this, but I grew up in South Florida, which was kind of ground zero for the opioid epidemic. And I remember in high school down in Miami and West Palm Beach, and kids would get a hold of a contact or whatever, somebody that had a prescription and basically would end up being a de facto drug dealer vis-à-vis a pill mill, etc. The kid across the street from me died, multiple kids in my high school died, multiple kids went into in-treatment programs, some of them battled addictions for decades. Some of them got out of it. Very few got out of it. Some of them didn't and have continued to be plagued with either switching from pharmaceuticals to street drugs like heroin, etc., and then we can see what's happening there. And that's just one example. If we look at drug consumption in the United States, is it that Americans are just that much sicker and we’re in that much more pain than people in other countries? Because we’re consuming far and away more painkillers than any other country on the planet. And I would venture to guess that you could say the same about antidepressants or ADD medication. It's very much a case of misaligned incentives. And incentives are working in the sense of the pharmaceutical companies are doing very well. Chris:  Yeah. Who are they working for is the question. Tony:  Exactly. Chris:  We’re the only country aside from New Zealand that allows direct-to-consumer drug advertising, and I think that's a big part of the problem. But it's not just Big Pharma. We also have conflicts in medical research that, of course, are related to Big Pharma because they pay for two-thirds of all medical research. We have broken payment models, where there's no real incentive or reward for good performance, and in fact, you could argue it's the other way around because doctors are compensated for, usually based on the number of procedures they order and the number of patients they see. So to your point about the doctor in France who is actually incentivized to prevent, rather than just treat disease, we don't have that at all, it's the opposite. And so there are a lot of deeply entrenched issues that we certainly need to address, and that's not essentially what this book is about. There are other books that cover that material really well, and frankly many of those issues are outside of our individual control as clinicians or practitioners.

How clinicians can help create a new paradigm

Chris: We can work toward addressing them, and I think we should, but the good news is that I think that the bigger changes that we need to focus on individually and collectively are addressing the medical paradigm which we’ve talked about, creating a medical paradigm that’s better suited to tackle chronic disease. Addressing the mismatch between our modern diet and lifestyle, and our genes and our biology, which we've, of course, talked a lot about on the show before. And then creating a new way of delivering healthcare that actually supports this new medical paradigm and this more preventative approach. Because those things are all within our control as clinicians. Tony:  Yeah. I like how you posed the question, and it was kind of a cool little, I think it was, not Hiroshi, but the person who is in charge of cooking at a Buddhist monastery. And basically a young monk comes up to this older man. He’s like, why are you doing the grunt work, basically washing rice out in the courtyard? And he says, it was like, what was it? “If not me, who? And if not now, when?” And I think that that’s really kind of the core of setting all this stuff up. Talking about the problem is really in the service of pivoting to the solution, and I’m a big believer in thinking globally, thinking big, but acting locally, hyper-locally, like yourself. Chris:  Yeah. Tony:  And then the people around you and who you can touch and impact. That’s ultimately where the power comes from. So let’s talk about that. What is in people’s power. And you started to describe some of those pillars of a new model. And you describe it as the ADAPT framework. And I don’t know how much you get into this on your regular podcast episodes, but to just kind of lay it out, ADAPT from a big-picture perspective. How does that actually address some of these systemic issues from an individually empowered stance? Chris:  Yeah, great question, and before I even go into that, I just want to say I agree that I think the change is going to happen on different levels. So, because a lot ... we’ve talked about this stuff at conferences or even some people who’ve already read the book. They say, oh, this is fantastic. I’m so excited. But how are we going to deal with Big Pharma and the insurance industry and these misaligned incentives and all of that? And can we ever deal with that? The answer is we’re not going to deal with that overnight and it’s going to take a while to unwind those things. Tony:  It’s the chronic disease, is what you call... Chris:  Exactly, exactly. And I use that analogy in the book. But the good news is that changes can happen very quickly on an individual and local level. And there’s already a lot of evidence of that happening. So my own clinic, CCFM, tripled in size in the last three years alone. We have Cleveland Clinic Center for Functional Medicine, launched by Dr. Mark Hyman, has just blown up like crazy. I mean they started in this tiny space. Now their 17,000-square-foot space, it takes up the whole second floor of the Glickman Tower at Cleveland Clinic. They've got a waitlist of 2,500 patients from nine countries around the world. This is really exciting! The Cleveland Clinic is always on the forefront of the newest trends in medicine, and the fact that they've invested that much money in this speaks volumes. Then we have groups like Iora Health, an organization based in the Rocky Mountain area that’s reversing diabetes using health coaches. So there are lots of really interesting produced concepts, and there's going to be more and more of these. Like we’re doing a pilot program with the Berkeley Fire Department where we’re working with their new recruits to help, we’re implementing a wellness program. Tony:  That’s awesome. Chris:  To reduce injuries and help with recovery and optimize their performance. And if that goes well, there’s been interest from the wider fire department and in the city of Berkeley as a whole. Robb Wolf’s done some incredible work with Reno that we’ve talked about before. So I think the change is going to happen more quickly on this local grassroots level, and then that's going to start to get the attention of people on a state and federal level. And then it will start to get really interesting.

The three core problems and how to solve them

To answer your question, in my book I basically lay out three core fundamental problems with the healthcare system in the US. And these, I argue, go even deeper than the misaligned incentives and Big Pharma and all of that stuff, although they’re, of course, connected. The first is that there is a profound mismatch between our genes and our biology and our modern diet and lifestyle. And I'm not going to say more about that now because almost everyone listening to this podcast knows exactly what I mean. The second problem is the mismatch between our medical paradigm and chronic disease, which we just talked about. We need a new medical paradigm that is better suited for chronic disease. And then the third is that the way we deliver care in this country is also, it's not set up to support the most important interventions. And we’ve touched on that too, where the average visit with the primary care provider is just actually eight to 12 minutes. Tony, you were talking about 15 minutes. That’s luxurious in our current model. The average amount of time a patient gets to speak before they’re interrupted by the doctor is 12 seconds. Tony:  Wow. Chris:  So I think it’s pretty clear that if a patient has multiple chronic diseases, which one in four Americans now do, one in two has one chronic disease, and they show up to the doctor’s office and they're on multiple medications, and they had been presenting with a whole set of new symptoms, there’s absolutely no way to provide high-quality care in a 10-minute visit. So we have to change our, not only the paradigm, but also the way that care is delivered. So that was my premise. So it follows then that my solution would address, I would hope at least those three points, right? Each of those three deficiencies. So the ADAPT framework combines an ancestral diet and lifestyle, which addresses that mismatch between our genes and biology in our modern diet and lifestyle. And then Functional Medicine is the new paradigm of medicine that is based on addressing the root cause of health problems, so we can prevent and reverse them instead of just suppressing symptoms. And then the third component is what I call a collaborative practice model, which links licensed providers like medical doctors, nurse practitioners, with what I call allied providers, which include folks like yourself, Tony, health coaches, nutritionists, personal trainers, etc., to provide a much, much higher level of care than what doctors are able to provide on their own. So, again, we're not trying to replace doctors in any, or even conventional medicine. We need people to do colonoscopies and remove cancerous tumors and use all of the incredible amount of training and expertise and skill that they’ve acquired over a lifetime of practice and study. We absolutely want that, but we need to add stuff to that that's not available now. Tony:  What that really says to me is, emphasize the importance of community, of connection, of collaboration. We’re social creatures, we’re tribal by nature. That’s another kind of Paleo/ancestral health part of the puzzle. And it would be foolish to think that we can dissect out and silo out all these different aspects of our lives without consequence. I really like this idea of bringing everybody into the fold, and it’s not saying that you can go to just the naturopath, or you can go to just the health coach. Because like I mentioned already, I certainly would’ve been ill-equipped to handle plenty of issues that a client would’ve brought to mind or brought up in conversation during a training session. But it would’ve been really great to say, ah, here's the Functional Medicine practitioner that I recommend you speak with, and to have a good relationship with that person and to be able to, as a health coach, help my clients better by getting them in touch with the right person. And that’s having this network that can really support people throughout their health journey whether it’s just feeling better and more energy, or addressing something like diabetes or hypertension. Which certainly there’s a place for all the players in that kind of scenario.

What this new paradigm looks like

Chris:  Absolutely. And let’s use an example just to bring this to life for people. So, imagine you go to the doctor and they do some blood testing for your annual physical. And they find that your fasting blood sugar is 96 or 97. Your hemoglobin A1c is 5.5, and you’ve got triglycerides that are 110, 120, maybe 130. Currently, what would happen is nothing, usually. Tony:  You’re not sick enough yet. Chris:  Yeah, all of your markers are within the lab range, they say, and that means you’re normal, and so you might get some vague advice about make sure to exercise and follow a good diet. And thank you very much, that’s it. Certainly there are exceptions to the rule, of course. There’s some practitioners who can get a lot more proactive about that. But I can’t tell you how many people, patients I’ve had that have been given that basic line with those kinds of lab results. What could happen is this. The doctor says, “Well, you know, if we think of blood sugar disorders on a spectrum, on the left you’ve got perfect blood sugar. On the right you’ve got full-fledged type 2 diabetes. You’re not on the right yet, you don’t have type 2 diabetes or even technically prediabetes, but you’re progressing along that spectrum. And what we know from a lot of research is that if we don’t intervene now, that you’re going to continue progressing. And in fact, we have studies that show that the average patient who has prediabetes, will progress to full-fledged type 2 diabetes in just five years if it’s not addressed.” So what we want to do is be proactive here. We want to intervene now because it’s much easier to prevent a disease before it occurs than it is to treat it after it’s already occurred. So here’s what we’re going to do. We’re going to set you up with our staff health coach, and they’re going to give you all the support you need to adopt a better diet. They’re actually even going to take you shopping, they’re going to come to your house and clean out your pantry with you, and they're going to give you recipes and meal plans and give you ... totally hold your hand and do everything that they need to to get you on this diet. Because we know that information is not enough. We’ve got lots of studies. I can tell you as a doctor, go eat a healthy diet, and hey, we know that that’s probably not going to happen. Most people know what they should be doing, but they’re not doing it, and it’s not because of lack of information. It’s because they need support, and we’re here to support you. We’ve got this health coach. Furthermore, we've got this great personal trainer named Tony. We’re going to set you up with him and we’re also going to set you up with a gym membership. And the good news is, your insurance is going to pay for all this. They’re going to pay for the health coach, they’re going to pay for the gym membership, they’re going to pay for your sessions with Tony. And in six months’ time, you’re going to come back here and we’re going to retest your blood markers and I can almost guarantee that if you stick with the program, you’re going to have normal blood sugar by that time. And throughout that period you’re going to have weekly check-ins with a health coach, you’re going to have training sessions. And not only will your blood sugar be normal, you’re going to lose weight, your energy levels are going to go up, your sleep’s going to get better, you’re going to feel more confident and empowered because you’re making these changes, and you’re going to feel like a different person. Now that’s totally possible.

How do we pay for this? Is it scalable?

Chris: I can hear some people saying, “Oh, how are we going to pay for that? That’s ridiculous.” Tony:  Is it scalable? Chris:  The question we should be asking is, is treating type 2 diabetes scalable? Because I mentioned this in the book, it costs $14,000 a year to treat a single patient with type 2 diabetes. So let’s imagine that this patient progresses. We don’t intervene, five years later they have type 2 diabetes. All of a sudden the healthcare system is spending $14,000 a year paying for that person’s care. And let’s say that that person gets diagnosed at age 40, which is still reasonable these days. The age of diagnosis is dropping more and more, and then let’s say that they live until they’re 85 years old, which is also possible because of our heroic medical interventions that keep people alive a lot longer than they might have been otherwise. So 45 years living with type 2 diabetes, that’s a cost of almost $650,000 for one patient to the healthcare system. Tony:  And that doesn’t even touch on the lost wages, cost to employers, when someone’s on leave, loss of productivity. And then the cost to the family members. Chris:  Absolutely. Tony:  People that are actually, are helping the patient, their health is going to be going down too. Chris:  Yeah. Nor does it touch on the qualitative aspects. Being immobilized, not being able to play with your grandkids, all of that stuff. But let’s just even forget about that for a second—$650,000, okay? And then the CDC recently came out with statistics saying that 100 million Americans have either prediabetes or diabetes, and 88 percent of people with prediabetes don’t even know that they have it. Which means they're almost certainly going to progress, right? If you do the math and you multiply 100 million people times even $14,000 for one year, you get a number that’s so large, I don’t even know what it is. It’s like a google something. It’s like, it has so many zeros after it, I don’t even know how to characterize it. But then if you multiply 100 million times like 20 or 30 years, it’s more money than there is in the world. It's like it's not going to happen. Tony:  Not sustainable, not scalable. Chris:  Not sustainable, not scalable. So let’s say in our example that we ... the healthcare system spends $10,000, which is way more than would be necessary, but let’s even say we buy the person’s groceries for three months. And their gym membership and their trainer, and their health coach, and those weekly, let’s say we spend $10,000. We’re just super generous and we spend $10,000 for that six-month period. Again, the research and my clinical experience indicates with near certainty that if the person is at that stage of not even prediabetic and we intervene, there’s like almost no chance that it’s not going to, we’re not going to be able to normalize that person’s blood sugar. And if they do that and they stick with it and they are able to do that because they now have support rather than just information, we’ve just saved the healthcare system $640,000 over the course of that patient’s lifetime. And that’s a conservative estimate, as you say. We're not including even the indirect costs. Tony:  Right, right. Chris:  I think that this is not only possible, it's going to become necessary. And whether we get there with a proactive approach where we decide to move in this direction and we make these changes or whether we get there because we absolutely have no choice, we’re going to get there. Tony:  Yeah. I mean it really sounds like we can’t afford to not do this. Chris:  Exactly. Tony:  And if we get to that point where we continue down the reactive path and we wait until there’s a total collapse, it might be too late, just to put it frankly. And it’s going to come out at a huge, not just financial cost, a huge human cost. Chris:  Yeah, it’s going to be, we can use the chronic disease metaphor again, it’s a lot easier to prevent a problem or reverse it at an earlier stage than it is to wait until the patient is essentially on life support or the healthcare system is on life support. It’s harder to reverse it at that time. And that’s of course why I’m writing the book now because I want to get this message out as far and wide as I can. Tony:  Yeah. If not now, when? If not you, who? Go right back to there.

How allied providers are the key

Chris:  Exactly. And one more thing about that is the amazing thing, the beauty of this is that it takes about eight years and hundreds of thousands of dollars to train a doctor. And it takes a certain kind of personality and a certain kind of comfort level with science, and a lot of prerequisites. It’s not for everybody. And there’s a ... already we have a shortage of doctors, and that’s predicted to get worse. I’ve seen estimates that suggest by 2025 we’ll have a shortage of 52,000 primary care physicians. So that’s a big deal. [insert image] So we already don’t have enough doctors, it’s already going to get worse, but if you think of healthcare as like a ... I have something in the book called the healthcare population pyramid. And you were referring to it earlier, Tony, where at the very top of that pyramid you’ve got 5 percent of people who are in really acute situations. So they’re in the hospital or they’re in an intensive outpatient care setting. They need the conventional medicine paradigm as it exists, and it’s fantastic for those situations. Then you’ve got another 25 percent of people in that kind of high middle of the pyramid who are dealing with some pretty serious chronic health challenges. So they require more regular care, but they’re not sick enough to be in the hospital or in any kind of ... they’re living their lives, but they’re struggling a lot. A Functional Medicine practitioner/clinician usually working in concert possibly with the conventional specialist of some kind is a really great option for that 25 percent of the pyramid. But then you’ve got the 70 percent at the bottom. So these are people who do, may have health issues, but they’re more minor, so they might have skin problems, or a little bit of brain fog, some difficulties sleeping, some GI issues. And these can be definitely debilitating and total pain, but they’re not at the level of that 25 percent. My argument is that in many cases these people could be very well served by a health coach or nutritionist with good training. And possibly seeing a Functional Medicine provider once or twice a year, or something like that. And the thing is, we can train people in a year or two without an extensive science background to be very, very objective in this role. Because they’re mostly working with patients on changing their behavior. If you think about it, most of the risk factors for chronic disease come down to the wrong behaviors. Eating the wrong diet, not getting enough sleep, not exercising, or exercising too much, or any number of things that come down to choices that we’re making. And so if a skilled health coach who’s trained in things like motivational interviewing and coaching to strengths and other evidence-based principles of facilitating behavior change which we have a ton of research on, they can be incredibly effective for that 70 percent of the population. That's the majority of the population. So we’re totally underutilizing these practitioners, and my argument is that they’re going to play a huge role in this future of medicine. And that's of course one reason why we're launching an ADAPT Health Coach Training Program next year to complement the practitioner training program that we've been doing. Because I want to create this ecosystem we've been talking about where you have all of these different types of practitioners working to the maximum of their training and ability and scope of practice and supporting each other and therefore providing the highest level of care to patients. Tony:  That certainly kind of perks my ears up hearing about the ADAPT health coach option and something that I’m personally interested in. So who knows? Maybe I can get in on that. We can talk about it again in the future. Chris:  Yeah, for sure. For sure. Tony:  So, for this particular book, for Unconventional Medicine, people are fired up, they’re hearing about it, they’re like, “Okay, this resonates with me. I’m a practitioner, I’m an allied health provider, I’m a patient, I’m ready. Now’s the time. This is it. We’re going to do this.” What’s the best way for people to get their hands on this thing? Chris:  Well not surprisingly, Amazon. They have the best way to get your hands on anything. So it’s available in paperback, Kindle, and audiobook. We’re hoping [the audiobook] is going to be out today, the day this podcast is released. But it might be another two or three days. They’re just taking their sweet time to approve it. I narrated the audiobook myself. So you podcast listeners, I figured you might be into that, since you like to listen. Tony:  They know your voice. Chris:  Yeah, and just listening to something instead of reading it perhaps. So to that end, we have a special offer for podcast listeners, because I appreciate your support and I know many of you are already part of this movement, and some are wanting to get involved. So if you buy that paperback or Kindle version between now and Sunday night, you’ll get some really cool bonuses. The first is a free copy of the audiobook. So again, we wanted to include that for podcast listeners, since we figured you guys and gals are probably interested in audio. But there are two other things that are really, I think, fantastic. And one, they’re both tools to help you be more confident and persuasive and factual when you share your passion for Functional Medicine and an ancestral diet and lifestyle. Because we’ve had a lot of questions from people, both practitioners and non-practitioners alike. They say, “Oh, how do I talk about this stuff to my sister at Thanksgiving?” Tony:  “Isn’t that that caveman diet?” Chris:  Yeah, exactly. All of our ancestors died when they were 30, so why should we even care? How do you respond to those arguments? Or if you start talking about Functional Medicine and maybe one of your conventional medicine colleagues says, “Oh, that’s just, I saw something on Science-based Medicine that said that was all just hooey. There’s nothing to it. How do you respond to that?” So what we wanted to do is give people the ammunition they needed in a respectful way. You know, this isn’t about getting the better of somebody. It’s about responding in a factual and convincing but respectful way. So we’ve got two different, we’re calling these the Power Packs. And one is for practitioners, so clinicians, health coaches, nutritionists, trainers, etc., and these are facts, research that you can reference and persuasive reasons for your clients or patients or colleagues to consider this Functional Medicine and ancestral diet and lifestyle approach. And then we have one for non-practitioners called the Supporter Power Pack. And these are smart answers and compelling comebacks, again respectful, for those common objections that you hear when you start talking about this stuff with your friends and family. So these bonuses are available until Sunday night [November 12, 2017] at 11:59 p.m. Pacific Time. So you’ve got a few days to act on that, and you can go to ... we set up a special link for you to get these and that’s Kresser.co/bonus. That’s Kresser.co/bonus. So head over there to get your Power Packs and your free audiobook, and that’s after you purchase either the paperback or Kindle. There’ll be a place where you enter your order number and we ask for some information just to verify, and I hope you enjoy those and get a lot out of them. Because they were actually really fun to put together. Tony:  Yeah, I think the audiobook is huge. I like to listen to audiobooks when I’m driving around town or outside getting some exercise. Chris:  Yeah. Tony:  So, no excuses when you make it that easy. Chris:  Yeah, yeah. So, Tony, thanks so much for doing this. This has been really fun to talk to you, as it always is. And I appreciate it. Tony:  Actually, I wanted to throw in one extra little special thing, as we mentioned, at the top of the show. I spent 10 years as a personal trainer in the trenches, I was involved with Paleo Magazine for many, many years, going to all the events, and for me kind of an evolution in my professional life was, how do I impact more people? How do I help more people? And at first I was working one on one, and then it was as a facility manager helping other trainers and coaches get better. And then I was able to scale it up that way. And last year I had an opportunity to join the team over at Natural Force, which is all-natural, nutritional products, and I basically said, “You know what? I’m going to go all in on this because if I can touch a million people through really good, high-quality nutrition, that’s me maximizing my impact and really kind of living my purpose.” So one of the things I wanted to do today is put it out there for anyone listening who maybe uses collagen or MCT oil or whey protein. We really bend over backwards to source the best ingredients in the world, no additives, all that stuff. Everything is as clean as we can possibly make it. It takes a lot of work, working with manufacturers. Kind of like what you were saying, how patients have to know how to talk to their doctor. I don’t think people really realize, and I didn’t realize until I got on the inside, how much work it is for a brand to work with their manufacturers to convince them to get outside of the conventional mold. So it’s the kind of unconventional nutrition is really what we’re pushing here. So I set up a discount code for any Revolution Health listeners. Go to NaturalForce.com, use coupon code “unconventional” and get $10 off plus free shipping on your order. So I just want to put that out there as just a little extra bonus for anybody, and I would certainly love to help in that way and really get some good, high-quality nutrition into people’s hands. Chris:  Awesome. Yeah, and there’s so many ways people can help, and I ... at Paleo f(x) we’ve see the growth of companies that are serving this space, and it's amazing. Like the products that are available now. I had breakfast this morning, I had some eggs and kale and parsley and a little bit of bacon in a couple of cassava flour tortillas. Breakfast burritos. Whoever thought I’d be having a breakfast burrito again? Tortillas are made from completely cassava flour. They’re autoimmune friendly and they’re grain-free tortillas. It’s incredible. Tony:  I think I might have some of those in my fridge as well. Chris:  Yeah. I mean there’s so many things. And these people, they’re serving this movement with that kind of work. So it’s great to see. Tony:  It takes a village, man. Chris:  It does. Thanks again, Tony. I really appreciate it. Thank you, everybody. So again, Kresser.co/bonus to pick up your free audiobook and the other bonuses, and I hope you can all join me in this revolution to reinvent healthcare. We need you, whatever your background and goals. Take care, everybody. RHR: A Three-Step Plan to Fix Conventional Healthcare published first on https://chriskresser.com

[yes-dal456]

Looking Back At My First Psychotic Break: My Speech At Thresholds' Gala In Chicago

Roughly twenty years ago, in March 1997, I had no job, no girlfriend, no friends and no more goals.

I had just finished a draft of what would become Strikeout at Hell Gate, a novel that had taken me about a year to write, and I had just run and completed the L.A. Marathon for the second straight year.

I had met those two goals in spite of the fact that I was battling severe depression and was in the early stages of psychosis. I would later be diagnosed with schizophrenia.

Unlike the poet Robert Lowell, who believed that his writing benefited from his mania, I was never manic, and my psychosis and depression presented only obstacles to my prose.

I could barely read. I lost my appetite. I could not sleep even though I lay in bed much of the day.

Finally, as I have written before, I drove down the streets of Marina del Rey early one March morning. I was looking for a hotel that had a sufficient number of floors so that, if I jumped out of a window, there would be a good chance that I would kill myself, like my paternal grandfather and two other relatives.

I can still remember pulling into the driveway of a hotel on Admiralty Way, bustling into the lobby at about 5 a.m. or so, and asking a clerk at the front desk for a room.

He punched a few buttons on his keypad, looked at a screen, then announced that he was sorry, that there were no rooms available.

I left the lobby and trudged to my car. While I did so, a police car drove up to the hotel entrance.

That spooked me. I feared that my plot to commit suicide was doomed.

I then drove back to my Venice apartment and phoned my mother. I told her that I had been thinking about hurting myself.

I ended up spending a week at the USC psych ward, where, at 31, I was the youngest patient. I played Ping-Pong with an octogenarian rabbi, who had probably been born in Eastern Europe. He did not speak much, but when he did, he mumbled with a foreign accent. He led us in services on Friday night, which was very moving.

Yet he seemed deeply mournful in spite of the exuberance that he showed when he played table tennis.

He reminded me of the rabbi in Pete Hamill’s Snow in August, a rabbi who questions whether or not there is a God. The rabbi at the psych ward, like the rabbi in Hamill’s book, had no doubt seen too much. I suspected that he had been devastated by the Holocaust, among other tragedies.

As I was leaving the USC psych ward, Dr. Michael McGrail, my then-psychiatrist, told me that he was 99 percent sure that I would recover.

He recommended that I spend time in a day-hospital. And that is what I did in New Haven, Connecticut, where I was born and had lived much of my life.

I flew back East with my parents, and I enrolled in a day-hospital program at Yale, where I had studied years before.

I did not know how I would handle the program. I was still extremely depressed and psychotic.

I was also still somewhat suicidal.

My mother drove me downtown for my first day at the hospital, but after that I drove myself.

It was an “in-your-face” program, as my primary clinician put it.

The ethos of the day-hospital was such that no one would make lunch for you, no one would hold your hand, and you had to provide frequent feedback to your clinician.

At the beginning and end of each day, we gathered in the front hall of the building and announced our goals and whether we had met them.

I will never forget how one of my colleagues, Tony, an ex-truck driver, slumped in his chair and spoke glumly about how he needed to “take it one day at a time.”

He uttered the cliché with such sincerity and soulfulness that his words rang true.

I did not speak the first week in group therapy because I was too paranoid to reveal that I had been paranoid.

Then, during the second week, I opened up.

I told everyone that I had had trouble a year before at a marketing company in Los Angeles, a firm that I had quit because I felt that some people had undermined me.

It was true that they had undermined me, but it was also true that I had undermined myself by working in a field to which I was not suited, business, as opposed to journalism.

As we sat in the group therapy room, Tony, my colleague, said, “I’ve got just one question for you, Robert. What are you going to do now?”

I said, “I’m going to be a writer.”

I completed my two weeks in the program in late March 1997, and a month or so later, I returned for a third week.

By then, in early May, I was starting to get better. I regained my endurance on walks. I recovered much of my appetite. I forced myself to read. And I slept well with the aid of medication.

My father told me that I had not given L.A. “a fair shot,” that I may have had an apartment in Venice, but that I had not participated in the life of the city.

He pointed out that, when he had gone to my apartment to help me pack my belongings before we headed back East, he had noticed a flier for Golden Boy, a Clifford Odets’ play about boxing, on the floor.

A local repertory theater had been staging that play, whose lead part, that of the star-crossed boxer, had originally been written for John Garfield, one of my favorite actors.

Incredibly, I had not known that the play was being staged at all, not until my father brought it to my attention.

That was a mini metaphor, a microcosm, for my failure to experience and take advantage of the city of angels.

With my dad’s encouragement, I decided to return to L.A. and did so on Memorial Day weekend of 1997, almost exactly 20 years ago.

As I have written before, I got a traffic ticket on my first day back in Venice, but curiously I was not paranoid.

I sent out resumes to a few Hollywood marketing firms as well as a number of daily papers in New York City.

I did not realize it at the time, but in composing my resume and cover letters, meeting with a former employer and phoning companies, I was demonstrating that I was healing, that I was taming my severe depression and psychosis, which previously had stripped me of interest in doing anything.

I received no offers from the companies to which I applied in those early days back.

I knew that I had to get out of the house, but I did not know that my best job prospect would come from my next-door neighbor, Peggy Lake, who worked at L.A. Weekly in the graphics and advertising department.

At the end of June 1997, within a month of my return to Los Angeles, I got a job as a proofreader at L.A. Weekly. Peggy had recommended me to Connie Monaghan, then the proofreading manager, and I had taken a proofreading test and done very well on it.

A month later, I started dating Barbara, my angel and a retired schoolteacher, whom I had met the year before in a UCLA writing class.

Like President Emmanuel Macron of France, I must have seen the wisdom in dating a goddess, a former schoolteacher, who evoked Cleopatra and Rosalind, Shakespeare’s two most sublime heroines, whose age cannot wither them, nor custom stale their infinite variety.

Twenty years later, Barbara, my ageless beauty, to whom I have been married for 16 years, and my writing career remain the pillars of my life.

Work and love, as Freud said, have obviously played a huge role in my psychic health. So have therapy, medication, a will to survive, dear friends and an appreciation for play.

Play, of course, takes different forms for different people. For me, play can mean listening to Bob Dylan with Barbara, who introduced me to his music about 20 years ago, shortly after my first psychotic break. Play can also mean enjoying what Barbara has termed “tasty meals,” or reading stories to Ava, our 5-year-old granddaughter.

While my life has improved, I have never forgotten what a social worker at the Yale day-hospital told me. She was not my primary clinician, but she had taken an interest in me. She said that she had read or heard that creative people always need to be working on more than one project at any given time.

I took that advice to heart and have written approximately 300 newspaper articles in the years since I got a job at the Weekly. I have also written a good amount of fiction during that time, which I am only now finishing.

Whether I am writing or giving speeches at wonderful organizations like Thresholds, I always emphasize that everyone has free will and that we can subdue deep depression, psychosis and suicidal feelings.

I say this as one, who was diagnosed with schizophrenia in the late 1990s, who comes from a family with a history of suicide, and who received a 20 on the Global Assessment of Function (GAF) score when I had a relapse in January 1999.

That I have recovered from the deepest depths of psychic despair and dysfunction tells me that just about anyone can recover.

And it is organizations like Thresholds that are leading the way in helping people with mental illness get better.

Thresholds has a beautiful mission. All of you who work here know that your goal everyday is to advocate on behalf of people with mental illness, to aid us in our recovery, to help us find jobs and housing, and to enrich our lives, so that we too can benefit from productive work, love and play.

I recognize that I am lucky in many respects. I live at a time when psychotropic medication is readily available, something that was not the case as recently as a few decades ago.

It is also true that the stigma against people like me, people with mental illness, has lessened in recent times. I would like to think that all of my articles and speeches have contributed to the reduction of this stigma.

I may not be running marathons anymore, but I have a good life now.

I hope Tony, the ex-truck driver at the Yale day-hospital, and the octogenarian rabbi at the USC psych ward have fared well too.

They were good men, struggling to survive on this planet, struggling to make it through each day.

They had endured much trauma, much anguish.

But they were showing signs that they too could recover. They were seeking treatment at psychiatric hospitals, opening up in therapy, playing Ping-Pong.

In so doing, they were sharing their lives with others and making contact with the world.

Through such activity, through such contact, they were giving themselves the chance to succeed, to subdue their illnesses and to function at a relatively high level once again on this planet.

This article is adapted from a speech I gave on Thursday, May 11, at a gala event for Thresholds, a mental-health support organization, based in Chicago.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from http://ift.tt/2pXzkBW from Blogger http://ift.tt/2q0PGZs

[imreviewblog]

Looking Back At My First Psychotic Break: My Speech At Thresholds' Gala In Chicago

Roughly twenty years ago, in March 1997, I had no job, no girlfriend, no friends and no more goals.

I had just finished a draft of what would become Strikeout at Hell Gate, a novel that had taken me about a year to write, and I had just run and completed the L.A. Marathon for the second straight year.

I had met those two goals in spite of the fact that I was battling severe depression and was in the early stages of psychosis. I would later be diagnosed with schizophrenia.

Unlike the poet Robert Lowell, who believed that his writing benefited from his mania, I was never manic, and my psychosis and depression presented only obstacles to my prose.

I could barely read. I lost my appetite. I could not sleep even though I lay in bed much of the day.

Finally, as I have written before, I drove down the streets of Marina del Rey early one March morning. I was looking for a hotel that had a sufficient number of floors so that, if I jumped out of a window, there would be a good chance that I would kill myself, like my paternal grandfather and two other relatives.

I can still remember pulling into the driveway of a hotel on Admiralty Way, bustling into the lobby at about 5 a.m. or so, and asking a clerk at the front desk for a room.

He punched a few buttons on his keypad, looked at a screen, then announced that he was sorry, that there were no rooms available.

I left the lobby and trudged to my car. While I did so, a police car drove up to the hotel entrance.

That spooked me. I feared that my plot to commit suicide was doomed.

I then drove back to my Venice apartment and phoned my mother. I told her that I had been thinking about hurting myself.

I ended up spending a week at the USC psych ward, where, at 31, I was the youngest patient. I played Ping-Pong with an octogenarian rabbi, who had probably been born in Eastern Europe. He did not speak much, but when he did, he mumbled with a foreign accent. He led us in services on Friday night, which was very moving.

Yet he seemed deeply mournful in spite of the exuberance that he showed when he played table tennis.

He reminded me of the rabbi in Pete Hamill’s Snow in August, a rabbi who questions whether or not there is a God. The rabbi at the psych ward, like the rabbi in Hamill’s book, had no doubt seen too much. I suspected that he had been devastated by the Holocaust, among other tragedies.

As I was leaving the USC psych ward, Dr. Michael McGrail, my then-psychiatrist, told me that he was 99 percent sure that I would recover.

He recommended that I spend time in a day-hospital. And that is what I did in New Haven, Connecticut, where I was born and had lived much of my life.

I flew back East with my parents, and I enrolled in a day-hospital program at Yale, where I had studied years before.

I did not know how I would handle the program. I was still extremely depressed and psychotic.

I was also still somewhat suicidal.

My mother drove me downtown for my first day at the hospital, but after that I drove myself.

It was an “in-your-face” program, as my primary clinician put it.

The ethos of the day-hospital was such that no one would make lunch for you, no one would hold your hand, and you had to provide frequent feedback to your clinician.

At the beginning and end of each day, we gathered in the front hall of the building and announced our goals and whether we had met them.

I will never forget how one of my colleagues, Tony, an ex-truck driver, slumped in his chair and spoke glumly about how he needed to “take it one day at a time.”

He uttered the cliché with such sincerity and soulfulness that his words rang true.

I did not speak the first week in group therapy because I was too paranoid to reveal that I had been paranoid.

Then, during the second week, I opened up.

I told everyone that I had had trouble a year before at a marketing company in Los Angeles, a firm that I had quit because I felt that some people had undermined me.

It was true that they had undermined me, but it was also true that I had undermined myself by working in a field to which I was not suited, business, as opposed to journalism.

As we sat in the group therapy room, Tony, my colleague, said, “I’ve got just one question for you, Robert. What are you going to do now?”

I said, “I’m going to be a writer.”

I completed my two weeks in the program in late March 1997, and a month or so later, I returned for a third week.

By then, in early May, I was starting to get better. I regained my endurance on walks. I recovered much of my appetite. I forced myself to read. And I slept well with the aid of medication.

My father told me that I had not given L.A. “a fair shot,” that I may have had an apartment in Venice, but that I had not participated in the life of the city.

He pointed out that, when he had gone to my apartment to help me pack my belongings before we headed back East, he had noticed a flier for Golden Boy, a Clifford Odets’ play about boxing, on the floor.

A local repertory theater had been staging that play, whose lead part, that of the star-crossed boxer, had originally been written for John Garfield, one of my favorite actors.

Incredibly, I had not known that the play was being staged at all, not until my father brought it to my attention.

That was a mini metaphor, a microcosm, for my failure to experience and take advantage of the city of angels.

With my dad’s encouragement, I decided to return to L.A. and did so on Memorial Day weekend of 1997, almost exactly 20 years ago.

As I have written before, I got a traffic ticket on my first day back in Venice, but curiously I was not paranoid.

I sent out resumes to a few Hollywood marketing firms as well as a number of daily papers in New York City.

I did not realize it at the time, but in composing my resume and cover letters, meeting with a former employer and phoning companies, I was demonstrating that I was healing, that I was taming my severe depression and psychosis, which previously had stripped me of interest in doing anything.

I received no offers from the companies to which I applied in those early days back.

I knew that I had to get out of the house, but I did not know that my best job prospect would come from my next-door neighbor, Peggy Lake, who worked at L.A. Weekly in the graphics and advertising department.

At the end of June 1997, within a month of my return to Los Angeles, I got a job as a proofreader at L.A. Weekly. Peggy had recommended me to Connie Monaghan, then the proofreading manager, and I had taken a proofreading test and done very well on it.

A month later, I started dating Barbara, my angel and a retired schoolteacher, whom I had met the year before in a UCLA writing class.

Like President Emmanuel Macron of France, I must have seen the wisdom in dating a goddess, a former schoolteacher, who evoked Cleopatra and Rosalind, Shakespeare’s two most sublime heroines, whose age cannot wither them, nor custom stale their infinite variety.

Twenty years later, Barbara, my ageless beauty, to whom I have been married for 16 years, and my writing career remain the pillars of my life.

Work and love, as Freud said, have obviously played a huge role in my psychic health. So have therapy, medication, a will to survive, dear friends and an appreciation for play.

Play, of course, takes different forms for different people. For me, play can mean listening to Bob Dylan with Barbara, who introduced me to his music about 20 years ago, shortly after my first psychotic break. Play can also mean enjoying what Barbara has termed “tasty meals,” or reading stories to Ava, our 5-year-old granddaughter.

While my life has improved, I have never forgotten what a social worker at the Yale day-hospital told me. She was not my primary clinician, but she had taken an interest in me. She said that she had read or heard that creative people always need to be working on more than one project at any given time.

I took that advice to heart and have written approximately 300 newspaper articles in the years since I got a job at the Weekly. I have also written a good amount of fiction during that time, which I am only now finishing.

Whether I am writing or giving speeches at wonderful organizations like Thresholds, I always emphasize that everyone has free will and that we can subdue deep depression, psychosis and suicidal feelings.

I say this as one, who was diagnosed with schizophrenia in the late 1990s, who comes from a family with a history of suicide, and who received a 20 on the Global Assessment of Function (GAF) score when I had a relapse in January 1999.

That I have recovered from the deepest depths of psychic despair and dysfunction tells me that just about anyone can recover.

And it is organizations like Thresholds that are leading the way in helping people with mental illness get better.

Thresholds has a beautiful mission. All of you who work here know that your goal everyday is to advocate on behalf of people with mental illness, to aid us in our recovery, to help us find jobs and housing, and to enrich our lives, so that we too can benefit from productive work, love and play.

I recognize that I am lucky in many respects. I live at a time when psychotropic medication is readily available, something that was not the case as recently as a few decades ago.

It is also true that the stigma against people like me, people with mental illness, has lessened in recent times. I would like to think that all of my articles and speeches have contributed to the reduction of this stigma.

I may not be running marathons anymore, but I have a good life now.

I hope Tony, the ex-truck driver at the Yale day-hospital, and the octogenarian rabbi at the USC psych ward have fared well too.

They were good men, struggling to survive on this planet, struggling to make it through each day.

They had endured much trauma, much anguish.

But they were showing signs that they too could recover. They were seeking treatment at psychiatric hospitals, opening up in therapy, playing Ping-Pong.

In so doing, they were sharing their lives with others and making contact with the world.

Through such activity, through such contact, they were giving themselves the chance to succeed, to subdue their illnesses and to function at a relatively high level once again on this planet.

This article is adapted from a speech I gave on Thursday, May 11, at a gala event for Thresholds, a mental-health support organization, based in Chicago.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.

from Healthy Living - The Huffington Post http://bit.ly/2rvaBFr