podcasts

Kalea Wattles:
So fun to have the IFM crew here to talk about all of the exciting advances and emerging research that we saw in 2023. So I’ll start and talk a little bit about this National Academies report, because the Whole Health approach to care has been used in the US Military for several years, and the successes seen there formed a large part of the basis of this favorable report. So, Robert, I think I’ll pass the first question to you and ask you to tell us a little bit about how Whole Health care can work in the military and beyond, and what are some connections that you see with the functional medicine model?

Robert Luby:
Right, thanks, Kalea. Here at IFM, we have had some initiatives together with both the Department of Defense, the military, and the Veterans Administration, where they are using Whole Health, especially in the Veterans Administration, but more and more in the military. And I’ll introduce the audience to the five elements of that NAS report and the Whole Health model as they see it.

The first element is that it is people-centered. In other words, you take the patient’s values, preference, context, and circumstances into account. This includes, of course, their social determinants of health. And this is very, very highly aligned with the functional medicine model, because that’s what we do in the order and prioritize step. We take into account those values and goals of the patient and their circumstances so that we initiate interventions that will be feasible for them.

The second element is that Whole Health is comprehensive and holistic, and, of course, this is very aligned with the way we evaluate patients. The timeline is comprehensive in that it takes into account the entirety of the patient’s life, as well as preconception and, of course, in utero life as well. We do that when we gather, in the organize step; it’s holistic in that we are mapping the entire systems around the body on our matrix.

The third element of Whole Health care is that it’s upstream-focused and root cause-focused. So again, you know, functional medicine, we’re right on that with antecedents, triggers, and mediators being upstream-focused. Root causes, that’s modifiable lifestyle factors, mental, emotional, spiritual factors and, of course, all the dysfunctions and clinical imbalances that we recognize around the matrix.

The fourth element of Whole Health is that it demands that the care be equitable for the patient and keeps the patients accountable. And the equitability, we certainly, again, manifest in that order and prioritize step, where we are taking the patient’s circumstances and preferences into account, which I should also add that is evidence-based medicine, taking patient preferences into account, and we keep the patient accountable with our tracking step. And also, as I may talk about more down the line, with our toolkit resources and assets, so many ways to keep patients accountable in a positive way with our proactive toolkit resources.

And the fifth and final element of the Whole Health approach is team well-being. So as clinicians, we need to be as intentional about taking care of our own staff and our own collaborative care team as we do about our patients. And, of course, that’s part of the functional medicine approach and using the collaborative care team productively for our patients as well.

Kalea Wattles:
Well, Robert, you mentioned these five elements, and one of them was upstream medicine, and I was so excited when I read that in the report, because that’s language we use all the time in functional medicine. And to see that in a non-functional medicine report, it just made me feel like we’re really making progress.

Robert Luby:
Couldn’t agree with you more. I don’t know how influential we have been, but I certainly think we’re a player there. And the more important thing is we, at functional medicine, are so poised to take on the Whole Health report and to be a leader, because it’s what we’ve always done. It’s how we do our work.

Kalea Wattles:
Right. Dan, what were some of your takeaways as you read through that report and saw these very clear connections to the functional medicine matrix, to our GOTOIT model? It felt so aligned. 

Dan Lukaczer, ND:
Yeah, I think Robert said it very well, Kalea. And I had the opportunity to speak at AFMCP in London a few months ago, which was quite a treat to be traveling to London. But I was giving the presentation that Robert usually gives at AFMCP on the fifth day, we now call it the fifth chapter. And, you know, what you said in your introduction, not “What’s the matter with you?” but “What matters to you?” That’s exactly how Robert, I listened to it over and over again. That’s exactly how Robert framed, you know, the functional medicine matrix model and going through that GOTOIT model. And just as Robert said, I think we have been doing that. So we’re very well aligned with this Whole Health approach.

Robert Luby:
The other little inspirational message, if I may, Kalea, is in addition to that tagline, the other one that I think we want to keep in mind as functional medicine clinicians is changing the emphasis on from “What’s wrong with you?” to “What’s strong with you?,” drawing on the patient’s past successes, and they’ve been through difficult challenges, and they’ve overcome them, and using that to encourage them that they can overcome these new health challenges that they have.

Kalea Wattles:
Feel free to insert those at any time, Robert. I feel like you may need to write a book at some point with these little inspirational phrases, that’s your specialty, so beautifully, beautifully said. And Amy, we see all these parallels between the work that they’re doing with Whole Health and IFM’s mission. So from your perspective, how does functional medicine and IFM, how can we support the Whole Health approach to care, and what might this mean for the future?

Amy R. Mack, MSES/MPA:
Well, thanks for asking that question. And I do, I share the same thought with you, Kalea, that I think Robert has a book in his future on analogies. As you can imagine and as you know, when that report came out on February 15 of this year, we were awestruck by how many things seem to resonate with what we were already doing. And so for a moment, we were like, “That’s us! That’s us,” right away. And then we realized, okay, that is us, and what does that mean for IFM and functional medicine? And there’s sort of two things that I think about broadly. The first thing is it certainly captures what functional medicine brings to different disciplines of medicine. So when we think about conventional care, conventional care supported with a functional medicine lens really improves patient care. And we know that that is a hallmark of actually how we need to move forward and scale the transformed healthcare system.

The same holds true with integrative medicine. Bring in a functional medicine lens and have the best of all worlds, the ability to apply integrative medicine modalities to long-term health and wellness of individual patients. So we saw this excitement, which then just further allowed us to know that our education is critically important to get in the hands of everyone who is interested, and we need to help others really explore their interest in it as well.

So when we think about functional medicine’s role in Whole Health, it’s really clear. It really supports the expansion of someone being able to apply Whole Health to patient care. And then IFM comes in as really a high-quality provider of functional medicine for the conventional medicine physician, for the naturopathic care practitioner, integrative care, and all other disciplines that are really interested in learning more. When it comes to really thinking about how you can become confident in supporting a Whole Health paradigm of care, you have to be thinking about it in all directions. It’s not simply about the diagnosis and here’s the path to treatment, it really is about understanding, what happened before and why are you sick today? And how can we help you get to those things that you care about? And functional medicine certainly provides that structure.

Kalea Wattles:
Hmm, you touched on this a little bit about a collaborative care team, and something we say all the time in IFM’s teachings is we have all of these, a whole spectrum of practitioner types going through IFM’s training and that it gives us this shared language, where we can communicate with each other and talk about our patients kind of grand rounds style. So we know and we saw from the elements of the Whole Health program that there’s an emphasis on interprofessional team-based approach to care that’s anchored in, and I thought this was so beautiful, trusted longitudinal relationships with providers to promote resilience, to prevent disease, and to restore health. So how does IFM’s training help to support that collaborative care team model?

Amy Mack:
You know, it’s interesting, it was another piece of that report that we felt so excited about, because we’ve been using this term collaborative care teams for a very long time at IFM. And when we think about what the Blands’ vision was for bringing IFM together and really forming it, it was to provide education across licensed fields of health care. They didn’t just say it’s only for MDs, or NDs, or DOs. They said there’s functional medicine approach and care that needs to be available to many different kinds of practitioners. So that whole idea of a team-based approach, we knew it was important a while ago, but today, when we think about what’s happening in health care and we look at burnout rates for physicians and nurses and nutrition professionals and on and on, the ability for people to take a team-based approach to care does two things.

It first expands the base of people that can provide really high-quality care for patients, but it also really leans in and allows for practitioners to practice at the top of the scope of their practice. Now, we never want someone to be practicing outside of their scope. We hold that to be a really critically important value for IFM, but we do want people to be able to bring the very best of what they’ve been educated to do to the individual care of each patient that they see. So figuring out the way for those kinds of interprofessionals to come together has been core to our mission. And this report actually leans in and says, “If we’re going to scale, if we’re going to provide the best health care for people across the nation, and quite honestly, around the world, we have to figure out how those teams work together.” And a functional medicine approach to care really supports that kind of development. And IFM is providing that kind of training, as you know, around the globe today.

Kalea Wattles:
It’s really exciting. And I have loved watching over the last couple years at events like our Annual International Conference seeing more topics discussed about shared medical visits, shared medical appointments. Is that one of the ways that we can help our providers who are in insurance-based clinics to scale this approach to care and actually make it feasible for them to do in the real world?

Amy Mack:
It is, there are, you know, every year, the ability to utilize insurance improves. Over the course of COVID, we actually saw that there was more of a softening of the ground for even online medical appointments that happen within a virtual setting with many people. And that way of actually engaging with patients and having patients engage with each other, we are seeing, and the Cleveland Clinic, in fact, reported on it, that actually that enhances the care that each individual feels, that their outcomes coming out of a shared medical appointment are stronger and better than without that engagement. And they have figured out at Cleveland Clinic and in other clinics across the country how to actually do that in an insurance model by allowing the individual practitioners to practice to the top of their scope of practice, allowing the physician or the naturopathic doctor to come in and provide the care that they can provide, and then lean in on a nutrition professional, lean in on a nursing practitioner to bring the care that they bring so well to that individual patient, and allowing the patient to help find that journey and path for themselves to be able to create that health outcome that they’re looking for.

Dan Lukaczer:
I just think it’s so important what Amy said, because it brings together a couple of things that we’ve just talked about, and that is the collaborative care team that can work directly collaboratively in a shared medical appointment. We didn’t actually talk about it so much, but, you know, the increased access to care, I think because of the, you can be with 10 or 15 people depending upon, so it’s easier for those clinicians, or it’s more cost-effective, time-effective for those clinicians. Something we didn’t talk about that I’ll add is, I think Robert alluded to it a little bit, is the clinician burnout that we’re all aware of, and that we all feel, I think, I certainly feel it. I think that’s an important aspect of shared medical appointments or the other acronyms that it goes by. And then the last thing I do want to add to this is this, the idea of social connection and, you know, this is, everybody’s aware of this, this is part of the functional medicine matrix model, is part of a lot of models, and it’s so important, that social connection to be incorporated in health care. And this is one way, and I think it’s a great way, to incorporate that directly into the healthcare model. So as you can see, I’m very bullish on shared medical appointments, and I just think we need to highlight them as we did in the 2023 Annual Conference. We need to continue to highlight them. The Cleveland Clinic is highlighting them. There is more and more research that’s highlighting it. So all of those things are important.

Robert Luby:
And one final tidbit is that with regard to those elements of the Whole Health model, it talks about holding patients accountable. What shared medical appointments do is patients hold each other accountable. We keep hearing that over and over. There is no better way to achieve that element of the Whole Health model than with shared medical appointments.

Kalea Wattles:
Indeed. As we’re talking about our social connections, I see this theme of social determinants and determinants of health emerging. So let’s talk about one that was highlighted throughout 2023, and that’s nutrition, which, of course, we believe in food as medicine. It’s an aspect of Whole Health. And one of the main pillars of the Whole Health approach is a focus on root causes of poor health. And as we know, nutrition is a major factor that can underlie both our health and our disease states. We had some really important nutrition-oriented themes that came up in the literature in 2023. So, Dan, maybe I’ll ask you first, what were some of the biggest findings from the year that made you excited that will be important for us to focus on through 2024 and beyond?

Dan Lukaczer:
Wow, there are, I guess, quite a few there. So I’ll bring out a couple. I think the microbiome is a continuously important theme, that there’s more and more literature coming out about the microbiome. I think, specifically, an area that we should be looking at, and it is becoming more apparent, is not just the prebiotics and the probiotics that affect the microbiome, but all of these specific short-chain fatty acids and organic acids and peptides that are produced by these probiotics munching on the prebiotics. And how those have without question, have significant effects on not only the microbiome itself but systemically on health. And I think that we are, as we often say, we’re at the beginning. I wouldn’t say we’re at the beginning, we’re really at the doorway of understanding all of those things much better. And we continue to gain more knowledge about them. And now, there is now a whole category of therapeutic interventions that are called postbiotics. So I think that’s a really interesting area in nutritional health for, you know, 2023, 2024.

And the other one I want to mention before I turn it over to Robert and Amy in terms of others, I could go on for a while, is the, what I think are the changing understanding, and this is not just this past year, but really, the past five years that at least I’ve been aware of, the changing understanding of protein requirements in aging. And I think that the RDA for protein has been, you know, the RDA for the past, I think since the 1960s, I believe, so we’re talking well over 50 years, and really needs to be reevaluated. And this idea that, you know, 0.8 grams per kilogram body weight is what we need in terms of our protein requirements I think is without question, is particularly as we age, is not sufficient, and whether that level is, and that transmits to about a third of a gram per pound body weight, which is what I think better in. So we’re really thinking of between half a pound, I’m sorry, half a gram per pound of body weight, even up to a gram, some people think. I think that may be excessive, but half to three quarters of a gram of protein per pound of body weight seems to be much more in line with at least the research that has now come out over the past few years. So I think that’s another area that has really been heightened in this past year.

Kalea Wattles:
I thought for sure we’d hear about fasting from you, I have to admit.

Dan Lukaczer:
I’m happy to talk about fasting.

Kalea Wattles:
Robert, how about you, what were some of the most exciting things that came through on your PubMed search this year?

Robert Luby:
Right, a couple things that I think are really important emerging are the importance of real food. Simply real food, you know, we talk about social needs of health when there is, we talked initially about food insecurity, but it’s really nutrition insecurity. There’s usually access to low quality, low nutrient density food just about everywhere in this country and maybe even around the world. But the research that has come out now about ultra-processed foods, artificial sweeteners, maybe not such good alternatives as we would’ve originally thought. So I think just getting back to basics, and real food is really important. And the other thing is, you know, we talk about food is medicine. We are what we eat, we are what we ‘eats,’ those kinds of principles. We are how we eat, we are with whom we eat, because eating is relational, as well. But we also are when we eat and when we don’t eat.

So there’s my intro into the intermittent fasting and the time-restricted feeding issues. So important now that the research coming out that we really get our minds around this and get our clinical teams trained in this is the personalization of when to be eating and when not to be eating. And I guess a final thing would be with regard to real food. You know, it’s so important, the food prescription types of initiatives and programs, but even beyond food prescriptions, if we focus too much on food prescriptions, we still want to focus, especially policy measures on industry and making the nutrient components of their products more transparent, and not letting them off the hook in terms of the kind of language that is used. And, you know, giving consumers choices, and giving them clear choices about what is nutrient dense and what is not. That’s where some of the emphasis in the public health sphere and the policy sphere, and even the, you know, the national budget needs to go with this food as medicine model.

And then the final, the very hopeful thing, is with food as medicine, you know, there’s every hope for disease remission. I never learned that in medical school that I could help a patient knock a diagnosis off their problem list. But there’s a flurry of research now that shows that with food and other very basic interventions, you can put diabetes into remission. And I’ll just say there’s no other organization that is so well poised to take this on in the Whole Health model, because they talk about holding your patients accountable, being people-centered. Think about, again, our toolkit assets and resources. We have ethnic versions, cultural-specific versions, globally regionalized versions. Many of our toolkit assets are now being translated, and the personalization of our therapeutic food plans with regard to food as medicine, functional medicine training through IFM is so poised to make you, the clinician, able to introduce the Whole Health model through nutrition interventions with your patient.

Dan Lukaczer:
Let me, Kalea, let me just insert the very important point that Robert made about circadian rhythms, time-restricted eating, and to the point that I was talking about of protein. I think that there are now a number of social influencers, as you might be one of them, Kalea, hopefully, not in this way, that are now talking about, oh, you know, fasting, or specifically time-restricted eating and intermittent fasting, so longer than overnight fast, you’re going to lose muscle mass if you do that. So we shouldn’t be thinking about doing that. I think that’s an oversimplification and has gone too far the other way. And there are now, one should think about that, but there are certainly studies that suggest that time-restricted eating done appropriately, and also, which we all should be thinking about more, resistance training done in collaboration can result in no muscle mass loss when you’re doing that, so I just wanted to plug that in there, because I think there is now some controversy about that. I’m not sure if, Robert, if you have anything to add to that?

Robert Luby:
No, I think it’s well said and on target, and we just need to keep our fingers on the pulse as we do here.

Kalea Wattles:
All right, maybe we’ll need a myth busting episode with Dr. Lukaczer, we’ll put that on the wishlist. Robert, you introduced this term of nutrition insecurity, which I think is really relevant to what I wanted to ask Amy about, because we know that not everyone has equal knowledge about and access to healthy food choices. And I’m wondering how IFM can help in really a policy advocacy role to improve nutrition, education, and just access.

Amy Mack:
Yeah, thanks, Kalea. You know, as I listened to Robert and Dan, and I hear the clinical aspects of food as medicine, I think the thing we always have to remember is we’re putting out into the world these ideas that have to be able to land in a basket that somebody can do something with it. So the role that we can play is not simply educate and then hope that people understand it. We actually have to help to create that basket that people can catch it in and understand what it means in their community.

Now, you know, my background actually is in nonprofit work. The work that I was doing before I came to IFM was in youth development. And one of the things that we talked about so much in youth development was that the mentoring service that we were providing wasn’t going to have impact if there weren’t services around that individual that could help them in other ways, that we were just engaging them in that one hour a week mentoring. So how are we going to make sure that one hour a week actually meant that they were going to move forward? And that approach, what is called community impact, and it’s really looking at the systems around an individual to truly understand what’s happening, why it’s happening, what things could be tweaked or changed, kind of makes us think about antecedents, triggers, and mediators, what things could be tweaked or changed that would help that individual to succeed?

And when I think about our role in this work, I get excited when I hear food as medicine, but I only get excited to the extent that people understand what that really means, and that it is, as Robert and Dan have been talking about, not simply calorie-dense, but nutrient-dense foods. Okay, what does that mean to that individual in their community? Well, in their community, that might mean that they don’t have access to that. So how do we make sure, not IFM making sure, or the practitioner making sure, but how do we help that practitioner to understand that a part of their conversation is really not simply saying, “What did you eat today,” but “What did you eat today, and where did you get that? And how might we be able to connect you with somebody that could help you to be able to get foods that are going to help you get better?”

It makes me think about a case study that I actually just read this weekend in the New England Journal of Medicine, and it was a short little snippet called a “Double Take.” And the whole case study was about a mom bringing a child into an emergency room, and the child was starting to have pain in his legs, and they didn’t know why, and they did a lot of tests to this little young man. And in the end, what they realized was he wasn’t eating a diet that was rich in the things that he needed. He had rickets, and he was not in a family that was unable to access food. He’s a picky eater, so he just didn’t want to eat the right things. And that whole approach of watching that, you know, young boy go through a lot of testing, and in the end, what the practitioner said was, “I should have asked the questions in the beginning. What’s your child eating and how can we change that diet?” And they quickly, that’s what they discovered, when they got to the end of the workup. I think that ability to ask those questions is at the heart of what we do in functional medicine and what we teach at IFM.

So the policy work that we’re doing is not necessarily, how can we change this policy? It’s this policy needs to change and to support that change, let us provide the education that can make that happen for a practitioner in their community. So that’s the work we’re doing. It’s sort of bread-crumbing to the change, but the change happening if we can, you know, get better food in schools and better food and all systems that are helping to make food available, if we can make that happen, it has to be supported with practitioners that know what to do with an understanding of how food can be medicine, and I think that’s what we bring at IFM.

Kalea Wattles:
That made me feel really proud to be an IFM Certified Practitioner, because nutrition and diet and lifestyle, that’s one of the first questions we’re asking. Dan, I’m wondering if you could quickly speak to the evolution of IFM’s curriculum over the last few years and how we’ve seen an emphasis in the actual teachings on social determinants of health. I’m so proud of how that’s evolved over the last couple years. Will you just let our listeners know a little bit of that backstory?

Dan Lukaczer:
The short story is, I think that we, at IFM, and I put myself at the top of that list, were not focusing enough on social determinants of health around food. And we certainly over, I would say now the past four years and the pandemic and all of the additional problems that were, I wouldn’t say unearthed, but that became much more apparent then, it became much more important for us to really clarify that stake in the ground. And I think that we have now taken that up in a much more significant way. Not that we didn’t have any input on that or not that it wasn’t involved in our programs, but now it is much more infused at a foundational level into all of our programs, which I think is a testament to everyone at IFM thinking about that more deeply and how we can push that into our programs both educationally. And then the other aspect of which, that I think Amy can speak to much more adroitly and articulately, is on how we’ve just really focused on looking at how we can help the underserved and particularly help clinicians help underserved communities with scholarship opportunities. So that’s the short answer to your question, Kalea.

Kalea Wattles:
Thank you. Amy, anything you want to add about our work supporting clinicians in a really, a variety of communities that have thus far been underserved? And now we’re seeing increased access in 2023, it was big.

Amy Mack:
Yeah, I… one of the proudest moments for me as CEO is to watch how our scholarship program has grown from, we want to make sure that faculty members know about IFM and know about our programming to how do we truly reach practitioners that are serving in communities that are not being reached by the benefits of functional medicine? And so just in the last year when we calculate up what we’ve done by the end of 2023, we will have given out close to a million and a half dollars in scholarships. And each one of those individuals is reaching patients in communities that, but for the scholarship, would not be receiving functional medicine care. And, you know, it gives me a red nose to hear what the individuals receiving the care are saying. One of my most favorites is the work we’ve been doing with the VA. When a veteran said, “I’ve had the first good day in my life because of the care that I’ve gotten from a functional medicine trained practitioner in the VA. I feel like a person. And it didn’t stop with one day.”

That sentiment, we know, is happening around the globe, and it’s partially happening because we’re getting these scholarships into the hands of people who really want to know about functional medicine. They want to bring it into their practice, and they’re bringing it in in ways that previously, we really didn’t understand could be done in a practice. And what I mean by that is they’re not necessarily bringing in the four-hour or two-hour intake, they’re figuring out ways, because of the training that Robert and Dan have been bringing to the table, they’re figuring out ways to bring a 15-minute appointment to their individual that brings in functional medicine care.

And then through Michelle Harreld and the Medical Education Resources Department, we are bringing forward tools that allow for further understanding of how functional medicine, and food as medicine, and lifestyle change can really help an individual. It’s not going to cost a lot of money; it just allows them to bring those modifications in and for them to feel better. So scholarships make a difference, improvements in access to all of our toolkit items that happen through our Medical Education Department. All of those pieces are extending the reach and allowing for more people to experience root-cause medicine.

Kalea Wattles:
Can’t wait to see what happens in 2024 with all of this forward momentum. Now, Amy, you mentioned there’s more and more a call for functional medicine information from patients, from clinicians, from the public. And I think part of that is due to the visibility and social media and in groups and influencers like Dan mentioned. And so I want to talk a little bit about this concept of biohacking, or as we like to call it, bio-HAC-ing, where the HAC stands for health-activated consumers. This has gained a lot of attention over the year, and we know that this is just another way of saying what we’ve been saying, that we should optimize health and longevity. Robert, I am interested to hear your perspective on how this normalization of what we have seen to be emerging approaches to wellness and what we’ve been teaching at IFM can really help patients to optimize their wellness and their self-care using some of these foundational tools that we’ve long been teaching.

Robert Luby:
Yeah, thanks, Kalea. You know, historically, functional medicine practitioners and clinicians have been treating patients with many chronic diseases, many chronic syndromes, you know, mysteriomas, as I like to say, things that defy diagnosis, and that’s going to be changing. And we, as clinicians, want to be aware of it. And we, at IFM, want to train our community to be able to take care of these wellness seekers and these biohackers, as you called them. So a couple things in relating it to the Whole Health model, in terms of being people-centered, we kind of have to shift our goals here, because these biohackers often have very strong preferences about how they want their health care to be. I think what’s important for functional medicine clinicians is to guide them to be really choosing evidence-based solutions and interventions as opposed to maybe marketing based, what they’re hearing from some influencers, because all influencers are not equally grounded in the evidence. So I think that’s real important for our community to take on as these individuals will seek us out more often.

And in terms of the element of the Whole Health model of being holistic, well, the biohackers are often very focused or maybe, you might say, hyper-focused on diet and exercise, but often to the neglect of the importance of sleep, stress reduction, human relationships, mental, emotional, spiritual factors. Here’s the opportunity for well-trained functional medicine clinicians to balance out their portfolio of how they spend their enthusiastic time, energy, and effort on, you know, not just exercise and diet. Let’s broaden it for them. And in terms of being upstream and root cause, these biohackers are often quite interested in physiology, and I’m continually amazed at these individuals with very little scientific and usually no clinical training, how much they do know about the physiology, because of what the influencers are teaching out there on social media. We can help them in the area where they’re relatively less aware and help them get their care and their perspective on physiology more personalized, because they’re often unaware of their own antecedents, triggers, and mediators, quite frankly. And we can help them realize what those have been throughout their life, because they will be very eager to personalize their care; that’s already what they’re doing. We can amplify and magnify their positive focus on personalizing their own self-care by the use of really getting them to engage in reconciling their own antecedents, triggers, and mediators.

Kalea Wattles:
Always bringing in that functional medicine component, which I so appreciate. We’ve seen hormetic therapies really take front and center, things like cold and hot and light and oxygen. Dan, has this been so satisfying for you to see these concepts that you’ve been talking about for years start to become part of pop culture, and now they’re cool and you’ve been saying this for a long time?

Dan Lukaczer:
I’m not that interested in being cool, so I’m not sure how satisfying that is. I think it is great from the standpoint of, you know, the foundations of going back to the functional medicine matrix model, the foundations of that are all hormetic therapies, or most of them are, or so your various exercises are hormetic therapy, you know, nutrition, and there are various phytochemicals that are hormetic therapies, and then there are other parts of hot and cold, and fasting is a hormetic therapy. So all of those, I think it’s nice to see, trailing a little bit off of what Robert said, these things that we all have, I think, been talking about for quite some time put into a bigger context and used in ways that can improve longevity and, you know, decrease inflammation and all the things. We know that all of these things now with this, if you will, different label of hormetic therapies all have a very positive aspect to overall health.

Robert Luby:
Well, I’ll take issue with you, Dr. Lukaczer. I think you do want to be cool, and I think we do want to teach our patients how to become cool as part of hormetic therapy. So that cold shower I had this morning, wonderful. As you mentioned, cold therapy is one of those interventions that can actually change sympathetic, parasympathetic nervous system tone, vagal tone can be a very effective means of favorably modulating physiological function. So Dan, you are cool, but we also need to train our clinicians to help our patients become cool. So I just wanted to add that as a…

Dan Lukaczer:
I think it’s a good point. I want to interrupt you, I want to be hot. I want to be hot.

Robert Luby:
Well, you know, I’ve got this proposal at Annual Conference to have a face dunking in ice bath contest, and I’m having trouble getting it past Amy and Dan. So if those of you in the audience could help me, please. I’ll promote that proposal.

Dan Lukaczer:
Saunas, saunas, that’s the direction I want to go. That’s a hormetic therapy. You go into the cold plunge, I’ll go into the sauna.

Kalea Wattles:
Mm-hmm, okay, well, Robert let us know that those who are interested in biohacking, they know what kind of health care they want. They know that they want to be cool or hot, maybe both. Amy, what’s IFM’s role in helping to support those patients who they know that they aren’t focused on sick care, but they want to optimize their wellness, and how can we support them through that journey?

Amy Mack:
It will not be through cold dunking or sauna-ing necessarily. I know I’m not doing that, but I think one of the things that is exciting about biohacking and sort of where it sits in IFM is that we, over the course of the last year, have really started thinking about, how do we bring more of these advanced learnings into our portfolio of education? So just a sort of teaser or trailer in this next year, we anticipate more advanced learnings around this and other topics. So I’ll just give you that little piece, and then everybody should keep watching to learn more.

Kalea Wattles:
Keep watching. All right, one more topic that I just have to touch on before we close today, and that’s the topic of brain and cognitive health. We saw so much literature emerging in 2023, and one topic that seemed to be highlighted was the importance of structures that surround us in our health journeys, our brain and cognitive health. So let’s talk a little bit about behavioral, physical, social drivers that influence not just individual but community health. And Robert, I think I’ll ask you first, but you talked to us a little bit about the impact of diet and lifestyle on our brain health and how we can personalize our treatment approaches using the functional medicine model.

Robert Luby:
We know even from our cognitive decline course that we taught six years ago how important nutrients and dietary components are in modulating brain physiology. I won’t go into them in detail here, but that’s so important. And with regard to lifestyle, the effects of stress on brain wellness, brain physiology, are undeniable, and the effects of exercise in terms of BDNF and other factors, the research is replete with that. So these are difficult outcomes to track, because it takes, you know, a lot of long clinical trials, long-term clinical trials, but the evidence is accumulating. I think we can rest very solidly on diet and lifestyle as favorably modulating brain health, and we need to leverage that in our training with clinicians.

Kalea Wattles:
In a related topic, there was an evidentiary basis to provide care for the caregiver. Dan, I feel like this is a theme that has come up for years in IFM’s Bioenergetics Module. Dr. Terry Wahls talks about this, about the importance of caring for the caregiver to those who are experiencing cognitive decline. Is that something that you’re continuing to think about how we can support that throughout 2024?

Dan Lukaczer:
The short answer is yes. And the, you know, the issues with clinician burnout, it’s hard to not see something on a daily, if not a weekly basis, about polls and research about that burnout and how to most effectively and efficiently improve and enhance the clinician’s ability to give optimal care without burning themselves out. I think has to be on the forefront of all of our minds to keep, to help to, as with a number of things that we’ve said, have helped to write a system that is in a lot of ways out of balance.

Kalea Wattles:
And we saw this reflected in the elements of the Whole Health program, right? There was an emphasis on community building amongst patients, but also caring for the team of providers, which I thought was a really vital part of that program and something I think that we’ve been supporting with IFM’s curriculum. So Amy, as we come to a close, what are some of the things that you’ll be looking forward to in the functional medicine space in 2024? I know that’s a loaded question, but we have to know what’s on your mind.

Amy Mack:
Okay, well, and I want to just add one piece on the caregiver and the connection around Whole Health. One of the things that I think is so important, and we know is so important in functional medicine, is the relationship in family and friends around the individual. So caregiver extends from not simply their physician and healthcare practitioners around them but that next step out about the caregiver that is assisting them in their home, the caregiver that is assisting them in their community, and burnout for those individuals is incredibly real as well. Having seen that in my family and watched what it did to my mom to have my dad struggle with dementia, it is a tough, tough body of care and frankly work for that individual. And oftentimes, they slip dramatically in what they give to that individual that they’re providing care for. So our ability to shore up and help the family member, the friend, as well as the practitioner, supporting that individual care is critical to whole health, and something that functional medicine does really well.

I will say 2023 has been a really fun year. We have learned a lot about where we can stand strong in policy spaces where we have real nuts and bolts to bring to how policy can change at a systems level and health care. The Whole Health model gives us that opportunity to really show where functional medicine can shine and support the expansion and scalability. But we’re also seeing, as we talked with biohacking, we’re also seeing that functional medicine is about a continuum. It’s about that person that has multiple chronic conditions and also that individual that is super healthy and wants to stay there and their longevity in between, right? It’s all across that spectrum. So our ability to lean in and really talk about the role of functional medicine there, that’s where IFM will continue to grow and really gain its voice.

We have AIC 2024 coming up, the theme “Repair, Restore, Regenerate.” I hope people are seeing that, that the undergirding there to that theme is “Healing of the Micro and Macro Through Functional Medicine.” So again, it’s holistic, it’s about whole care. It dovetails so nicely with Whole Health care and the approach at all levels with all members of the community. Not simply just saying to your healthcare provider, “It’s on you to figure out what’s wrong with me,” but having that be a shared conversation. That conference, as well as the addition of two more onsite programs this year, in 2024, really exciting, GI and Environmental Health will have small venues, but opportunities for people to go onsite for those programs. The addition of some more advanced learnings, something that IFM has done in the past, and really leaning into that, and having more advanced learnings that are available. And then a little birdie has told me that we have a new website coming in 2024 as well. So that and so much more. We have so many more things coming, and we are super excited about seeing people onsite.

Kalea Wattles:
So exciting, and I can just feel the excitement coming through your voice. Dan and Robert, anything you’d like to add about what you’re excited for in the next year?

Dan Lukaczer:
No, I think Amy really summed up the directions we’re going and what we think are going to be new and useful programs and connections that we can make with all of you.

Robert Luby:
And I’m excited for the wider variety of audiences that are being attracted to functional medicine. We’re not just talking about solo practitioners now. It’s large healthcare systems, it’s academic institutions, it’s, you know, industry and corporate wellness. And that just makes me so excited, because as we’ve said here, it takes a community or a village to help a patient get better. It’s going to take a community of us to help transform the current healthcare system.

Kalea Wattles:
Well, we’re ready to do it in 2024. So thank you all so much for this illuminating conversation. We’ll see all of you in the new year and at AIC 2024 in Las Vegas. See you next time.

To join the conversation on this topic, visit IFM’s pages on Facebook and Instagram. For more information about functional medicine, visit IFM.org.

Show Notes

• NAS report: Achieving Whole Health: A New Approach for Veterans and the Nation
• JAMA article on the NAS report: Achieving Whole Health for Veterans and the Nation