Imagine an approach to healthcare that:
· Prevents and reverses chronic disease, instead of just managing it.
· Offers inspiring, meaningful, and rewarding work to doctors and other practitioners.
· Uses health coaches, nutritionists, and other allied providers to support patients in making lasting diet, lifestyle, and behavior changes.
· Reduces the cost of healthcare for governments, organizations, and individuals.
This might sound like a pipe dream, given how far our current system is from this ideal. But the good news is clinicians are already seeing success applying this approach in private clinics, primary care groups, and even large institutions like Cleveland Clinic.
This book serves as both a manifesto and a call to action. Chronic disease is a slow-motion plague that is sabotaging our health, destroying our quality of life, shortening our lifespan, bankrupting our governments, and threatening the health of future generations.
If you’re reading this book, the failure of conventional medicine to address chronic disease probably isn’t a news flash. You wouldn’t have bought it if you thought our current system was doing a fantastic job. The problems I’m describing are not secrets; in fact, they’re frequently discussed in the media, and among politicians, healthcare professionals, and the public.
But most people don’t realize two crucial points. The first is the sheer scale and urgency of the crisis we’re facing. As I will argue in Chapter Four, we’ve reached an inflection point where we can no longer afford not to act on a massive scale. The second is that the action we take must not come out of the same system that caused—and continues to cause—these problems in the first place.
As the saying goes, “Insanity is doing the same thing over and over and expecting a different result.” We desperately need a new approach to healthcare that can address the challenges we face, and an army of healthcare providers—from licensed clinicians to nurses to health coaches to nutritionists—to embrace this approach and start healing the world.
My sincerest hope is that, after reading this book, you’ll be inspired to join the thousands of other clinicians and patients who are working together to save humanity from the scourge of chronic disease and usher in this more humane and effective approach to healthcare.
How I Got Here
I’ve come to this purpose of ending chronic disease through not only a decade of working directly with patients but also as a patient who struggled for many years with chronic disease. In my mid-twenties, I contracted a serious illness while traveling in Indonesia. The acute tropical illness was awful, bringing on fever, chills, vomiting, and severe diarrhea. Far more difficult for me, though, was negotiating the long road to successful treatment of the post-infectious syndrome that lingered long after the first symptoms subsided. Conventional medicine knew how to treat my immediate problems—parasites and dysentery—but when chronic illness set in, nobody knew how to help me. I was exhausted and listless and suffered nearly constant digestive problems, muscle pain, and severe insomnia. I’ve since recovered from that illness, but the experience changed my life.
I tried everything to figure out what was going on and get help. When I returned home, I went first to my local doctor. Making little progress there, I turned to doctors around the country and then the world. I probably saw thirty different doctors over the course of my exploration. Most had little idea what would fix my problems, so they turned to palliative interventions. Doctors offered medications that would theoretically help with symptoms. Antibiotics initially worked, but left me feeling worse. Some recommended drugs unrelated to my condition, like antidepressants. The suggested remedies were designed to treat my symptoms, but they didn’t even do that successfully. Or if they did, they caused other symptoms that were just as bad or worse. Eventually, the doctors would just throw up their hands; they had nothing left to offer. It was becoming clear to me that conventional medicine was not set up to handle the kind of problems I was dealing with.
I tried everything else I could think of. In addition to antibiotics, steroids, and anti-inflammatories, I took hundreds of different supplements and visited experts of all sorts, from psychotherapists to shamans. None of these healing modalities cured me.
Then one day, while browsing in a bookstore, I came across a book called Nourishing Traditions by Sally Fallon. Fallon advocated a real-food, nutrient-dense approach to nutrition based on the diets of traditional cultures around the world. (I’ll be referring to this later in the book as an “ancestral” diet.) The idea of following a more traditional diet resonated deeply with me, so I decided to give it a shot. I started eating the foods the book recommended, including bone broth, slow-cooked meats, fermented foods, eggs, and cold-water, fatty fish. I eliminated all processed and refined foods, and even whole grains and legumes because I found they didn’t agree with me. I felt better almost immediately.
Not long after this, I had my first appointment with an acupuncturist. The acupuncture treatments were the only intervention I had tried, aside from the ancestral diet, that made a positive impact. But what truly impressed me was the way the clinician looked at the whole picture of my health. None of my other doctors had looked at my case from a holistic perspective, but she spent time with me, using a systems approach to try to figure out causes, instead of playing Whack-A-Mole with my symptoms.
As I gathered knowledge, made connections, and continued to heal, people began coming to me with their own questions, and I started informally helping others in their healing processes. I realized that I wasn’t alone in my suffering, and that many people were not well-served by the conventional medical system. My own journey had shown me that there must be a better way—not just for me but for others. So I returned to school to study acupuncture and integrative medicine. I was drawn to these modalities; they had helped me make the most progress with my illness.
Shortly after I started school, I attended a seminar on Functional Medicine. I was immediately hooked. I realized that this was the approach to medicine that I had been looking for, both as a patient and as a practitioner in training. It focused on addressing the root cause of disease, instead of just using drugs that work like Band-Aids but seldom fix the underlying problem. I continued to train in Functional Medicine while I finished my acupuncture and integrative medicine degree. By the time I graduated, I knew that Functional Medicine (rather than a traditional acupuncture practice) was my path, and I started a Functional Medicine practice right out of school.
The patients I attracted to my practice were, perhaps not surprisingly, people with experiences like mine: they had chronic, complex, multi-systems illnesses that were poorly understood and even more poorly treated by conventional medicine. They had already seen several doctors, tried numerous treatments, and been told that little could be done for them. They were at the end of the line.
I was grateful for my background in Functional Medicine and an ancestral diet and lifestyle, because these approaches enabled me to help these patients in a way that the conventional system could not. It was amazing to watch chronic diseases of all types—digestive issues, autoimmune diseases, mood and behavioral problems, metabolic disorders, and more—improve significantly and even completely resolve. I became convinced that the combination of Functional Medicine and the ancestral approach was the most effective and powerful means of reversing chronic disease available.
After several years of practicing this way, however, it became clear that something was still missing. I realized that the episodic model of care, where the patient sees a clinician once every three to six months, was simply not sufficient for most patients struggling with chronic disease. They needed more support than I could provide in an occasional thirty-minute appointment, especially when much of that appointment was spent interpreting lab test results and prescribing treatment based on those results.
What if the patient needed more guidance and support on diet, managing stress, adopting a new physical activity routine, or making other important behavior or lifestyle changes? I simply didn’t have enough time to provide the level of support in these areas that the patient needed to be successful. I knew that the “expert model” of simply telling the patient what to do, and expecting her to follow through, wasn’t enough. (We’ll find out why later in thebook.)
The answer to this challenge was a new, collaborative model of care that uses allied providers—both licensed clinicians like nurse practitioners and physician assistants, and non-licensed practitioners like nutritionists and health coaches—to provide a much-needed additional layer of support for patients. These allied providers hold the patient’s hand through every step of the process, including answering questions about how to complete the lab testing, providing recipes and meal plans, offering guidance on starting a meditation practice or a new exercise routine, or simply providing moral support.
This was like the final piece of a puzzle clicking into place. I had already witnessed the power of Functional Medicine coupled with an ancestral diet and lifestyle, but adding a care model that offered the support patients need to successfully implement the interventions that a functional, ancestral approach prescribes was truly a game-changer.
The Birth of the ADAPT Framework
In 2014, I began to write and speak about a new model of healthcare combining the three elements I’ve mentioned above—Functional Medicine, an ancestral perspective, and a collaborative practice model—which I call the ADAPT Framework.
ADAPT has multiple meanings. Naturally, it implies adaptation. Our genetic code is hard-wired for a specific environment. When that environment changes faster than our genes can evolve, a mismatch occurs. As we’ll see later in the book, this mismatch is the primary driver of the chronic disease epidemic.
The term also suggests that medicine itself needs to adapt. At the turn of the twentieth century, acute, infectious diseases were the top three causes of death, and our medical paradigm evolved in that context. Today, seven of the top ten causes of death are chronic disease. Our system of medicine needs to adapt to better match the challenge of chronic, rather than acute, disease.
Finally, our model for delivering care needs to adapt. Statistics indicate that both practitioners and patients are dissatisfied with the current model. Clinicians are spending less time with patients, finding less meaning and fulfillment in their work, drowning in bureaucracy and inefficient systems, unable to practice the way they want, and not finding what they had originally sought in the practice of medicine. And they are working harder than ever before, without making more money. Patients are not getting the care, support, or answers they seek. They’re prescribed drugs that aren’t effective (and sometimes cause harm), and little investigation is done to determine the underlying cause of their problems. Therefore, we need to adapt our healthcare model to better serve patients and create a more fulfilling and rewarding career for clinicians.
In 2016, I launched a program to train clinicians in the ADAPT Framework. Since then, we’ve worked with over 400 clinicians and expect to train more in upcoming sessions. My training program educates a small subset of practitioners, but many more people need to learn about this new model. I hope this book will serve that purpose.
Who Is This Book For?
I’m writing this book for three primary audiences.
Practitioners working in the conventional system
The first audience is MDs, DOs, NPs, PAs, and other practitioners (including students training in these professions) working in the conventional system. This book is for you if you:
· Feel burned out and drained by the “assembly line” style of medicine prevalent in primary care settings today.
· Are tired of ten- to fifteen-minute appointments and managing symptoms with drugs, and want to offer deeper healing and transformation to your patients.
· Want to restore meaning and purpose to your work and rediscover your original passion for medicine.
· Have realized that diet, lifestyle, and behavior are the primary drivers of chronic disease, but feel unable to offer patients adequate support in these areas (or feel that the conventional recommendations are outdated and ineffective).
· Want to have more rewarding relationships with fewer patients, work fewer hours, and have a better quality of life—all without sacrificing income.
This group may also include podiatrists, nurses, registered dietitians, physical therapists, occupational therapists, medical assistants, and even dentists (we have several in our ADAPT training program). There are too many professional titles to list here, but I’m referring to any medical provider working within the conventional system.
Practitioners working outside of the conventional system
The second audience for this book is the wide variety of licensed and non-licensed practitioners (and students training in these programs) working outside of the conventional system. This includes naturopaths, acupuncturists, chiropractors, psychologists, nutritionists, physical trainers, and health coaches—among many others. This book is for you if you:
· Want to upgrade your clinical skills to get better results with patients/clients.
· Are seeking a more comprehensive and systematic framework to apply to patient/client care.
· Have learned about Functional Medicine or the ancestral diet and lifestyle and want to incorporate them into the work you’re already doing.
· Would like to form collaborative and mutually supportive partnerships with MDs, DOs, and other practitioners working in Functional Medicine, to better support your patients/clients.
This second audience is a huge group. I believe you will play an increasingly important role in healthcare. As we’ll discuss in Chapter Five, there simply aren’t enough doctors to address the chronic disease epidemic. Even if there were, most of them have neither the time nor training to support patients in the crucial diet, lifestyle, and behavior changes required for preventing and reversing disease. That’s where you come in!
Patients and the public
Finally, this book is for patients who are struggling with a chronic health issue and “citizen scientists and health enthusiasts”—members of the public who are taking their health into their own hands, and are passionate advocates for reinventing healthcare and reversing chronic disease. This book is for you if you:
· Are trying to address a chronic disease or health problem, but do not feel well-served by the care that you’re currently getting.
· Have learned about Functional Medicine and/or the ancestral diet and lifestyle, and are seeking a practitioner who uses these approaches.
· Want to help a friend, colleague, family member, or other person you’re close with who is suffering from a chronic disease.
· Feel passionate about reinventing healthcare, reversing chronic disease, and optimizing human potential, and want to support this movement however you can.
Although this book is primarily written for healthcare practitioners, it’s also intended for the growing audience of patients and members of the public who question the status quo. Instead of blindly following “expert” advice, you’re listening to a variety of voices. You read books and blogs, listen to podcasts, attend summits and conferences, and take in all that you can about how to get and stay healthy. Every time I speak at a conference, several of you approach me to express your passion for this mission of ending chronic disease. This book is for you, too.