Whether you are just getting started trying to shift your dietary choices to a more ancestral approach, or whether you’ve been living this way for a while, it’s possible that you’ve worried about the financial costs of eating this way. Maybe you’re motivated to eat a more evolutionarily-aligned diet, but anxiety kicks in every time the total comes up at the Whole Foods check-out. Or maybe you would just like to be able to whittle down your spending, but don’t want to have to sacrifice nutritional quality by purchasing cheap foods.
Disclaimer: If you are on a therapeutic diet under the direction of a practitioner, some of these tips may not apply. Strict adherence is often necessary. Always consult your practitioner before making dietary changes.
I was so fortunate to be invited by my dear friends Steve Fullerton and Somers Stephenson to beautiful Monterey Va, in the grassy mountains of Highland County to give a talk on the Future of Medicine.
The talk is broken down into two main sections.
The first includes a discussion of the 7 Relationships- the 7 key lifestyle areas I see as important for optimal health.
I offer detailed descriptions and even some science for each area and offer practical tips to improve one’s habits within the 7 Relationships.
In part two I breakdown my definitions of ancestral and functional health and provide the basics of my clinical approach and systems based thinking.
I then walk through a real life case study, making parallels to the key dysregulated systems and offer my thoughts on testing and diagnostic approach. I provide a therapeutic hierarchy and offer my comprehensive treatment recommendations including lifestyle based therapies targeting the 7 Relationships as well as targeted supplementation addressing the identified physiologic disturbances and dysfunctions.
I conclude the talk offering my hopeful solution to our epidemic of chronic disease which includes collaboration with health coaches and nutritional therapy clinicians. I describe my recent work collaborating with Angie Alt as part of her SAD to AIP in six program addressing autoimmunity through nutritional and lifestyle approaches.
I really hope you enjoy this talk and will sharing more of my work in the near future!
In conjunction with his recent guest post: Is Baking Soda An Effective Treatment For Autoimmune Disease? we are so excited to announce Rob’s partnership with Mickey Trescott and Angie Alt and the entire team at Autoimmune Wellness. Over the next few months Rob will be sharing space with Mickey and Angie as part of this new collaboration, taking part in social media q/a sessions, writing quarterly articles and engaging in a new exploration of clinical research: studying the role of multidisciplinary, health coach and nutritional therapy practitioner led diet and lifestyle interventions for stopping and even reversing chronic autoimmune disease. More clinical research into the efficacy of the the Paleo Autoimmune Protocol (AIP) and health and nutritional coach based interventions is a must and we are here to push this movement forward!
Dr. Abbott is a college friend and previous podcast guest. He is also a member of the Future of Functional Medicine Review clinical newsletter. He has put many of the concepts we discuss into practice and produced an excellent case study. If anyone from our audience has a case study worth sharing, please email firstname.lastname@example.org and I will happily review.
70 y/o female
Food for Thought
Visit 2 – Testing and Initial Recommendations (returned 1 week later following echocardiogram)
Financial considerations, insurance coverage, availability of testing and desires of the patient all were taken into account when determining to test. Patient desired a minimalist approach and was open to herbal treatments over drugs. Given previous testing and the patient’s complaints, I focused on nutrient status, markers of inflammation and thyroid health. I did not pursue hormone testing as I believed her symptoms would improve as part of a targeted gut approach. I also choose to not test thyroid antibodies and instead elected the initial screen with TSH and free hormone levels..
Initial treatment followed an anti-microbial pathway given suspicion for methane predominant SIBO with dysmotility. Treatment was empiric in nature without comprehensive stool testing. Prokinetics and anti-biofilm agents were added given concerns for constipation and the potential for increased efficacy with herbal antimicrobial treatment. The treatment was targeted for 6-8 weeks with reassessments over the next 2 months prior to changes in therapy. A combined dietary and herbal regimen was a good place to start and it was predicted that the patient would show significant improvement.
Visit 3 – Lab Interpretation and Treatment Evaluation (4 weeks after initial appointment)
Overall no signs of anemia on CBC, normal liver and kidney function on CMP, fasting glucose of 82, HbA1c of 5.2 and Tg/HDL-C ratio less than 2 is supportive of good cellular metabolism. Iron levels are within normal limits and patient does not appear to need any intervention for anemia or iron overload at this time. Thyroid function is suboptimal but not requiring intervention at this time. Inflammation, as measured by HS-CRP, appears low. A suboptimal homocysteine and elevated B12 may indicate some disturbances in methylation, B vitamin metabolism. Given concerns for impaired estrogen metabolism and detoxification as well as increased need/suboptimal absorption in the small intestine given concerns for SIBO, the patient likely will benefit from a period of targeted B vitamin supplementation.
Visit 4 – Follow-Up (4 weeks later, 8 weeks after initial appointment)
Visit 5 – Follow-Up (3 weeks later via email)
Take Home Points
Dr. Ruscio’s Comments:
Again, an excellent case study which illustrates a few important concepts:
Thank you, Dr. Abbott, excellent work.
How Do You Prepare For Gameday?
Okay, I’ll admit, while I have drastically reduced the amount of time and energy I put into following sports, most of my life has been spent absorbed in the fascinating world of athletics, both as a competitor and as an engaged fan. Sports are arguably one of the most ubiquitous endeavours on the planet, and despite ESPN and other TV providers attempts to steal your attention away from other perhaps more noble pursuits, there is something to be said about joining a raucous crowd, and going absolutely bananas with people you may never see again in your life.
Sports are sports, and sports are here whether you like them or not.
So why am I starting this post talking about sports? Is there going to be anything medical about this at all?
Short answer, no, nothing strictly medical.
Longer answer, still no, but what I am about to share with you transcends the well defined boxes of sports or medicine and opens us up to a curious discussion of how did we find ourselves in these boxes in the first place?
If you read the title of the post, and have a more athletic mindset, your mind may be thinking of some very practical ideas on how to “prepare for gameday.” For the true fanatics, this may involve acquiring food and beverages to enjoy on a comfy couch with friends, or perhaps it involves getting on your computer to pick your fantasy team for the upcoming weekend’s slate of games. Perhaps it involves washing those smelly socks and undergarments so your son or daughter has something at least slightly clean to wear before tomorrow’s game. Or maybe even still, it involves getting yourself as far away as possible from family who may be more inclined to throw sharp or heavy objects as part of an emotional explosion during the big game.
There are lots of ways to prepare, and lots of “Gamedays” for which we could be preparing.
Which begs the question,
What really do I mean by “Gameday”?
Thinking back to my childhood where it seemed I was never NOT kicking a ball, wearing a glove, or putting on a pair of athletic shoes, Gameday carried a very literal connotation.
There was the physical preparation, the pregame meal, the team warm-up, reviewing the line-up and strategy, the final pause before everything began.
Some people on my team had intricate pregame rituals, listening to the same songs on their I-Pod, putting on their shoes in the exact same manner, engaging in a reflective prayer, finishing the warm-up by touching the backboard. You name it, it was part of the preparation for Gameday.
And while some of these odd rituals or practices may seem just that, the reality was, there was little judgement when it came to preparation for Gameday. You didn’t talk to your friend who was absorbed in his pre-game playlist, you didn’t stop your friend from being the last one to lay the ball in the basket, you didn’t bat an eye while you waited for your friend to finish lacing up his shoes and extend his thanks to God.
It was “Gameday.” And that’s all that mattered.
Reflecting back on those years, it’s amazing to think about the unconditional acceptance of people’s practices and it’s fascinating to see the impact television has had in shaping the pregame rituals of our youth.
Do you really think that 12 year old learned how to step into the batter’s box and hold out his hand from a coach or a book?
We as humans are master emulators, and masters too of unconsciously assimilating the habits and practices of our heroes and peers.
And as I mentioned before, no pregame ritual or preparation is TOO odd. Whatever you have to do, you just do it. No one questions Lebron when he kicks of a game with a cloud of chalk. No one questions the pitcher who juggles the Rosen bag prior to the first pitch.
And while no one judges our athletes on how they prepare for “Gameday,” we also forgoe perhaps the most important question we should be asking ourselves
How am I preparing for MY “Gameday”?
Yes, I said it. Your “Gameday”
Not Lebron’s or Bryce Harper’s “Gameday.”
Now some of you may have slipped back into sports mode and thought once again about how you prepare for your athletic competitions, but that’s not really YOUR “GAMEDAY.”
Your “Gameday”, you see, is the playground for your life’s calling, the blank canvas for your embodied artistry, the perfectly polished stone ready to be tossed across the hauntingly still pond.
Your “Gameday” is your opportunity for growth, your opportunity to succeed and fail, to make mistakes and get dirty, your opportunity to relate and connect with others in ways you didn’t think were possible.
Your “Gameday”, you see, is YOUR EVERYTHING, so why in the world do you show up like its just YOUR SOMETHING or even worse, YOUR JUST ANYTHING?
You cannot prepare for what you do not know, and you cannot know without some time to prepare.
Many of us have at least taken the steps to discover our passions, to follow our hearts and live out our callings.
The problem, is we don’t see our callings as GAMEDAY, and as such we don’t have any clue on how or why we should prepare.
Some of us are still searching for our playing fields, seeking out our true Gamedays, and are even perhaps playing on baseball diamonds with more rocks than blades of grass and soccer fields that haven’t seen nets for 20 years.
But just because you don’t know where your Game is being played, or are stuck playing in a Game you wish didn’t exist, doesn’t exempt or excuse you from preparing, for showing up, for readying your heart for what you do not yet know.
I will be honest and say despite my dedicated yoga practice, my constant reflection and my perspective of purposeful intention, I have only recently started to see my calling, my work as a family medicine physician as “My Gameday”, and as such have just started to dutifully pursue proper preparation for “My Gameday.”
Let’s get real, do you think Lebron is going to show up 5 minutes before the game is about to start having downed a double espresso and half a bagel with cream cheese after navigating through rush hour traffic with one eye still glued shut after 5 hours of restless sleep?
Yeah, it’s ridiculous, but what I just described to you is how WE are showing up, how we are preparing for our work.
So WHY IS IT OKAY?!?
My calling as a healer is to craft and hold spaces for patients to discover what they must let go in order to heal, and fully embrace what they must bring into their being to restore their joyful nature.
This does not happen by accident, this does not happen running on Red Bull and bagels, this does not happen while ruminating on how to tell your mother she could have loved you more.
We must get serious, we must get playful, we must be intentional, we must become AWARE.
The remainder of this post could involve me telling you how to prepare for Your “Gameday,” but that would be waste of space and your time.
What you need, and we need is a roadmap, a simple process to realize this preparation and live our “Gameday.”
So here it is
1. Discover “Your Gameday”.
In this moment “Your Gameday” may not be your calling, and may indeed involve getting scrapped by rocks as you slide into second base, but you need to get quiet, take pause, and discover “Your Gameday,” wherever that may be. Don’t get moody or angry about it. Pros prepare and show up no matter the conditions. Amateurs come up with excuses on why the game shouldn’t be played.
What do you want to be?
2. Begin Your Preparation
But I still don’t know my “Gameday”? What’s the point? The paradox of preparing for Your “Gameday” is that you will have to and will likely spend months or years preparing for Your “Gameday,” before you ever discover where in the world the game is being played.
My suggestion, get quiet, rest your mind, and start to breathe.
I don’t care if it’s 10 seconds or 10 hours.
Get Quiet, Rest Your Mind and Start to Breathe
And if you are one of the lucky ones who knows Your Gameday, start walking the pitch, start inspecting the grass, walk every inch of the diamond before you ever touch a glove, and never for second think you know enough to stop.
Evaluate what you are doing now, what are you eating, how much are you sleeping, what do you listen to on your ride in to work, what is the last thing you read or say before you go to bed. How many times do you say I love you?
The Beginner’s Mind will be your friend and will never stop the pursuit of preparation.
3. Just Do It
Nike got it right with this ubiquitous slogan and the truth is preparation is only preparation if you decide to play the game. We cannot spend our lives perfecting what cannot be perfecting, or planning for what cannot be foreseen. We must live our callings and carry out our work knowing we will make mistakes and we will miss things we “shouldn’t” have missed.
But guess what?
Growth doesn’t follow from perfect practice.
Perfect practice comes when see that it’s possible to grow.
So, How do you prepare for “Gameday?”
Maybe it’s time we all start playing a little ball.
Dedicated to the flourishing of your being