Stanford's Susan Payrovi, MD, on Functional Medicine Approach to Health

good evening and welcome i'm nora kane i'm the director of the stanford health library and it's my pleasure to have you here this evening for what looks like it's going to be a really terrific talk um our talk this evening is um functional a functional medicine approach to health and our speaker is dr susan perovi dr perovi is a physician practicing integrative and functional medicine at stanford center for integrative medicine she earned her bachelor's degree in microbiology and molecular genetics at ucla and completed her medical education at uc san diego in 2003. she completed a residency in anesthesiology at usc in 2007. dr payrobi is board certified in anesthesiology hospice and palliative medicine as well as integrative medicine she has additional training in functional medicine and acupuncture so as you can see this will be an interesting evening um and as we go along i encourage you to use the q a function at the bottom of your screen if you have a question that you'd like to have dr perovia address and she will try to address as many as she can tonight um within our our time frame so without further ado i'd like to turn the screen over to dr perovi thanks so much dr for being with us thank you so much for having me and it's a pleasure to be here and to be able to speak about the practice of medicine that i've been pursuing over the last decade or so because it has a very deep and personal connection to me personally and it's something that i feel very passionate about sharing with patients so i really appreciate the opportunity to be here so today we are going to learn a little bit about functional medicine and how you can use functional medicine as a tool to create health and this is something that i struggle with as a western trained physician because in western medicine we talk in depth about how to diagnose a condition and how to treat that condition with the use of pharmaceuticals or technologies like radiology or laboratory tests you know those are all part of that workup in functional medicine it's a very different approach and rather than really just looking at treating symptoms we take a different approach so what is functional medicine this is a good question because there's a lot of misconceptions about what it is so i got interested in functional medicine after dealing with my own health issues and really wanting to find a better way of improving my health which i felt um was not being directly um addressed by a western medicine approach only i felt like there needed to be something more and i found it ironic that as a physician i actually didn't know what the other tools were so in my desire to figure out how i can do things better for myself i came across integrative medicine and from there i got interested in functional medicine and the difference between integrative medicine and functional medicine isn't really important it's but it is important to discuss that they are both very holistic systems of medicine and they both really try to bring in evidence and data and to base therapies on the latest research that is available to us so in functional medicine what we learn about is a systems biology approach so rather than thinking about the human body in terms of organs we think about the body as various systems that all interact with each other and they all affect each other and in order to bring balance to a person you need to address all of the different aspects of a person so you're going to look at the physical but you're also going to look at the mental the emotional the spiritual because they are all important and we work at the root cause level meaning that rather than trying to ameliorate symptoms by giving various um medications or botanicals we really try to figure out like what are the imbalances at the biochemical or cellular level that we can try to bring into balance and there are three classes of therapies that i work through with each patient so first and foremost i'm looking at lifestyle habits from my own personal experience as a patient and in my experience of taking care of many patients i really believe that lifestyle habits are the core of health if you really want to improve your health so if you can eat better sleep better exercise manage stress that's going to take you far and i am really invested in giving people information that is not going to be a waste of their time energy and resources so if you can really um focus on improving your lifestyle habits that might even be 90 of what it takes to improve your health beyond that there are natural supplements including herbal therapies vitamins and minerals and then the third class involves complementary therapy so we'll talk about all three of those levels today to give you an idea of what it takes for you to improve your health no matter what your condition whether it's cancer autoimmune disease cardiometabolic disease mood skin issues it's all really dependent on how you work through your day and how you treat your body so that your body can actually have a chance to heal so when i talk about the power of lifestyle habits i'm talking about what is happening at the dna level um at the cellular molecular level at the biochemical level and in functional medicine we spend a lot of time learning biochemistry so the concept of epigenetics me is that it's the study of the external factors that turn genes on and off so you can have a series of genes but that doesn't mean that those genes are going to be expressed just because they're there they have to be turned on and off and there are various factors that do that and lifestyle habits are some of the most powerful external factors that modulate the turning on and off of genes and that should make you feel really good because you actually have a lot of um control over what you're eating how you're sleeping how you're managing stress how you're moving and then there are some other factors that are a little bit out of your control it might be trauma whether it's emotional or physical trauma infections exposure to toxins but these are the factors that help turn genes on and off so what happens when these genes when these factors start interacting with our dna well as i said genes are turned on and off and that determines which biochemical pathways are turned on it determines which hormones are secreted it determines how your immune system is going to function whether it's maybe going to up regulate inflammation or down regulate inflammation or turn on other pathways and it really has a lot to do with whether or not you're giving your body a chance to heal and we use the word heal a lot but if you have to think about well how do you heal well that's what we're going to talk about today like these are truly the tools that are available to all of us to help us go on that path of healing so we're going to start just diving right into lifestyle habits and i generally like to start with nutrition this is something that we all think about a lot at least a couple times a day and more and more people are really getting interested in how do i eat better or how do i choose better foods and i can you know i agree that it can actually be difficult to know what is good food or healthy food because our food system has become so complex so food supplies the nutrition supplies the building blocks for every tissue in your body food supplies the building blocks for you to build energy molecules so that you can feel your body food sends information down into your dna to tell which genes to turn on and off and eating is very dynamic so what you eat today doesn't affect you next week it affects you today within a few hours so depending on what you eat you are determining what information is being sent down into your dna to turn genes on and off so you can eat a burger it looks like a veggie burger on the left side of the screen versus what's on the right side of the screen those two meals are sending very different information down into your dna and they're going to have very different biochemical effects so the different biochemical pathways will be turned on different hormones will be turned on different levels of inflammation um will be created just as a result of what you ate today so if we had to break down what is the diet that you should be on i have a generic answer for everybody and so i teach nutrition in terms of very broad principles and then your job is to figure out what works for you right so i always talk about a whole foods plant-based diet and basically this means that you are eating foods that are unrefined and unprocessed you are eating these foods as they grow in nature like what you see at a farmer's market and plant-based doesn't mean you have to become a vegetarian or a vegan you just have to try to get to at least 80 percent um of your foods from plants and plants aren't just vegetables they're also fruits nuts and seeds legumes whole grains so we are going to talk about all of those foods that are available to help you get to that 80 percent so people say well no i want to be on an anti-inflammatory diet well this is an anti-inflammatory diet because you are eating unprocessed foods without additives and added sugar and you're eating mostly plants so it's anti-inflammatory it's high in antioxidants and it's lower in toxins in comparison to eating a diet high in animal products so there was a study um called the broad study that was done and it was a controlled trial of a community-based program teaching whole foods plant-based diets and at 6 months and 12 months there was significant improved in weight and total cholesterol right and so they didn't put everybody on the same diet they just said here are the principles eat within these guidelines and within six to 12 months people actually showed really significant um changes that were um very different from the control group so i want to talk about vegetables because they are the true super foods um of all the foods that are available to us in the plant kingdom so they are high in phytonutrients antioxidants and fiber and lots of other great things and i want to talk about fiber phytonutrients in a little more detail because phytonutrients are these molecules that actually emit visible color so when you look at colorful foods like a beet or red cabbage blueberries you are actually looking at the phytonutrient molecules that are antioxidants phytonutrients can also be anti-inflammatory they can be cancer fighting they can help stabilize blood sugar they can actually help improve digestion so this is why you want to really focus on phytonutrients and so how do you do that well you're going to go for color and recently we've been talking a lot with everybody about eating the rainbow so every day you will want to get all of the colors of the rainbow in your diet so at least one to two servings and you don't have to eat huge amounts but if you can get a little bit in on a regular basis of every color that goes a long way and one way to do that is to make sure you have at least four colors on your plate for every meal and that takes a little bit of work and you have to kind of get into the mode of looking for color when you're shopping but it's not that hard to do so for example either you can get just the regular orange carrots or you can get the rainbow carrots which are going to give you the purple and the yellow it's just another way to bring color into your diet and then go for a variety when you're eating vegetables you don't want to eat the same five things over and over i try to get my patients to eat at least 75 foods a week although we should probably be doing well over a hundred but if you can get to 75 to start where you're you know giving yourself credit for every spice and seed and nut you know in that week that's a great place to start so fruits are also important to discuss because while they do contain a lot of phytonutrients because they are very brightly colored they do also contain sugar so my suggestion is to stick to vegetables and use fruit in conjunction with other really healthy foods so if i make steel cut oatmeal with a bunch of nuts and seeds and spices i'll put fruit into it just to sweeten it and to make it more more palatable more we make you know vegetable smoothies and add some fruit to it to make it taste better so you definitely don't want to overdo the fruits and the best fruits are the berries because they have the least impact on blood sugar beans and legumes are great because they are a source of clean protein which means that they don't have a lot of toxins in them you know they're plant-based um uh products and they also there's a lot of good fat in in beans and legumes including omega-3 fats now there's a lot of controversy about whether or not it's okay to eat beans and legumes because there is concern about some anti-nutrients that can prevent certain nutrients from being absorbed like iron or other minerals there's also concern of um inflammation in the gi tract and um a resultant leaky gut which i'll talk about in a little bit but i think if you can tolerate nut beans and legumes they're great to have in your diet especially if you're trying to be plant-based because they'll help keep you feeling full longer and they're a complex carbohydrate which means it is a large carbohydrate molecule that is hard to break down and so there's no quick spike in insulin and blood sugar when you consume them now some ways to improve digestibility is to soak them rinse them pressure cook them you can even throw a piece of seaweed called kombu into the water that you're cooking the beans with and that helps i also love sprouting beans because it's fun to watch them grow kids love it and you can eat the beans raw like you could throw them into a salad or um saute them so it makes it very easy to digest so think about bringing more beans and legumes um into your diet if that is something that you enjoy and you tolerate it well and sometimes starting with lentils might be a good place to start because they're generally pretty well tolerated nuts and seeds are also really important because they are also clean protein and good fat they keep you full so if you're eating a bunch of vegetables if you add nuts and seeds you'll stay fuller longer and you probably don't want to overdo some of the nuts and seeds that are high in omega-6 fats because that balance between omega-3 and omega-6 is important but about a handful and a handful a day of nuts is great and a couple tablespoons of various seeds is is also a good amount to have in every day so down at the bottom on the left we have chia seeds in the middle we have flax seeds and on the right we have hemp seeds and i just mix them all in a jar and i have sesame seeds and pumpkin seeds and sunflower seeds i have them all in a jar and they're ready to go when i need to use them on a salad in oatmeal in yogurt then i don't have to open six different containers now um most people do a good job of eating nuts because they're familiar and we know how to eat nuts but seeds are somewhat unfamiliar to most people so you can just throw them into anything they're generally very neutral tasting and a couple tablespoons every day over many weeks and months adds up to a lot of good protein and big fat all right so i want to talk about whole grains or just grains in general the standard american diet tends to be really high in in grains so we're eating a lot of bread a lot of pasta and there's a few issues with that first of all a lot of the grains we're eating are white grains so processed grains where they've kind of broken the grain apart and they're just giving you the endosperm that's the carbohydrate rich part of the grain so if you're gonna do grains do look for whole grain to ensure that you're getting the entire grain and not missing out on a lot of the nutrients and also not going to get this big spike in blood sugar so go for whole grains and it's really actually hard to know um what is a whole grain and i don't recommend reading labels because it is almost impossible to tell um what is a whole brain so in the upper right hand corner i have this picture of the whole grain council's sticker that you might see on a different packages of bread or pasta so that will ensure that you're getting a whole grain product choose organic because grains are heavily sprayed with pesticides there's a lot of concern about um grains especially gluten which is the protein found in wheat barley and rye the concern is that you can get inflammation the gi tract and permeability in that lining of the gi tract which leads to an unintended activation of the immune system so there are studies um that show that both gliadin which is a protein found in in in um wheat and wheat germ agglutinin which is um a lectin it can they can both cause gi inflammation so um there are human studies that show that that gliadin molecule can actually lead to leaky gut or hyper permeable gut in some people meaning basically that barrier in the gi tract breaks down and then you get your immune system over activated so while i don't think the whole world needs to be gluten-free i don't think that grains should be a major part of our diets because they're just not nutrient-dense and if you want to prove that to yourself just go gluten-free or grain free for a few weeks and you will see that all of a sudden you will start eating a lot more vegetables okay and then we should talk about fats because there is this confusion around what's a good fat and what's a bad fat well first of all we all know that omega-3 fats are really anti-inflammatory studies show that omega-3 fats can actually inhibit arachidonic acid which goes on to produce these inflammatory molecules so omega-3 can actually inhibit this inflammatory molecule and there are some studies that show that omega-3 and omega-6 fats can actually inhibit the growth of prostate cancer cells so the problem we have in the standard american diet is that there's not enough omega-3 and there's too much omega-6 and when there's that imbalance with too much omega-6 our biochemistry goes towards the production of inflammatory pro molecules so what are some of the good fats that should be in your diet well um we omega-3 omega-6 omega-9 are all great there's a lot of controversy around saturated fats some of them like coconut oil can actually be metabolized to other healthy fats so i think in moderation they're fine even the saturated fat in animal products we think is maybe not as bad as we previously thought it might have the problems we see with saturated fats might be more to do with the inflammation occurring as a result of heating that fat and changing some of the chemical structures so if you're going to focus on good fats you're going to eat nuts and seeds beans and legumes you're going to focus on oils like avocado oil olive oil coconut oil fatty fish fish is great and you generally want to focus on the smaller fish such as mackerel sardines and herring because they're going to contain less mercury in them all fish now have mercury because that's what's in our oceans and if you want to eat more seafood or you want to make sure that you're getting sustainable seafood that's low in mercury go to seafoodwatch.org it's a wonderful website and very easy to use and then also grass-fed grass finished lean beef is not a bad option now you don't want to overdo it but small amounts of grass-fed beef with lots of vegetables around it where at least 80 percent of the real estate on your plate is plant-based and then you have a little bit of beef is fine okay and then we should talk about fiber because it plays so many important roles for us and the american diver di fiber is really low the american diet is really low in fiber so fiber is important for cholesterol metabolism it is important in detoxification which means how we get things that are unwanted out of the body like hormones toxins medications and so they support gi functions so that you can have regular elimination hopefully you know a daily bowel movement is something that's really important to work towards if it's not already happening for you and fiber supports your microbiome which is the collection of the good bugs that live in your gi tract that do a lot of functions for us that we don't know how to do on our own so it's really important to get the fiber in there to improve the microbiome diversity and also improve gastrointestinal health so the minimum requirement is 25 milligrams a day but we're over achievers so we do 30 30 grams a day of fiber minimum so start slowly if you're not getting that much make sure you're drinking water as you increase your fiber intake and most of us think about fiber as what's in the picture on the left where it's a lot of like grains and nuts and seeds but there's a lot of fiber in vegetables so getting a variety is really important because the more variety in the fiber that you consume the more variety you will have in the bugs that grow in your microbiome and variety is really important so i've been saying the word variety since you know i started talking so variety in nutrition is super super important and to kind of drill down a little bit deeper on the microbiome how do you support your microbiome these are the good bugs that live in the large intestine that keep us healthy so there are foods you can consume that contain the good bugs so these are fermented foods not pickled but fermented where there's actually a good um concentration of these beneficial bacteria so this is yogurt kefir any fermented vegetable or kombucha you can also take a probiotic supplement but they're expensive and you're not getting the variety of bugs that you can get from food and i think a food first approach is always the way to go because the the long-term strategy can't be the use of a supplement for everything and then we talk a lot about probiotics but we don't talk about prebiotics and these are foods that are fiber containing but they contain the right kind of fiber that feeds the good guys so you're selectively allowing the good bacteria to grow and thrive and take hold of the large intestine some of these foods you're probably already eating like onions and garlic but there are many other foods and a lot of green leafy vegetables for example bananas kiwi are part of these foods that are prebiotics you can also take a prebiotic supplement but again i think it's better to just get it from food so there was a randomized controlled trial that showed that people who consumed diets that were higher in fiber actually ended up growing more of the bacteria that produced short chain fatty acids and these people had a significant drop in their hemoglobin a1c so their blood sugar improved okay so this is just one intervention that you can do to help support blood sugar regulation and this isn't important just for diabetics actually when blood sugar metabolism falls apart a lot of inflammation follows and so this is really important for all of us to think about i'll also while i talk about nutrition we'll also talk about fasting fasting has many benefits and there are many different regimens of fasting which i won't get into today but fasting allows us to um help bring regulation to the immune system so if there's an autoimmune dis disorder and you want to bring more regulation to the immune system one strategy is to do regular fasting fasting also leads to autophagy which is a fancy way of saying when the gi tract remains empty you start clearing out old dysfunctional cells and allowing new cells that are healthy to come into circulation so you're building you're working towards a healthier system um fasting slows cellular aging it turns on your antioxidant genes blood sugar improves there are some really interesting studies that show that a really strict fasting regimen with very close follow-up blood sugars has led to the resolution of like a diabetic state in people who've had diabetes for decades um so fasting is really an imp um an interesting tool and other benefits are dna repair tumor suppression i mean the and i think what this shows us is that when we eat all the time you know in our society food is available to us all day long we eat three meals and we snack between all of our meals the gi tract never has an opportunity to be empty so that it can clear things out and repair and so this is why it's important to allow for this empty period so that you can improve gi health and get all of the benefits that you see on this slide so when thinking about nutrition some additional things to think about are choosing organic because you don't want that those extra added pesticides you want to avoid genetic modification you want to avoid sugar um and getting things that are seasoned local and fresh is really important so support your local farmers market and if you are buying things that have labels make sure you read the labels you read the ingredients and if you can't pronounce the ingredients i would just skip it okay so we're going to transition from talking about nutrition to exercise so exercise is one of those tools that will change your life even if you haven't grown up exercising was not a part of your upbringing it's never too late to start because we know that exercise especially exercise of higher intensity levels is probably one of the most potent anti-inflammatory tools we know of and it's an immediate mood booster and if you have ever experienced the effect of you know finishing your workout you might feel elated your anxiety might improve low mood might improve i've never had anybody exercise and have a worsening of mood and this is something that western medicine can't do i mean we don't have any immediate mood enhancers as pharmaceuticals exercise helps you build a healthier microbiome it supports detox and if you want to keep your brain healthy by far the most useful tool is exercise so there was this interesting study that showed that they took patients with neurodegenerative diseases like various dementias parkinson's disease and they put them through an adaptive exercise program so an exercise program that was tailored to what they were capable of of doing and at eight months these patients actually showed that they maintained their motor function and delayed overall progression of of their disease now you know with with neurodegenerative diseases once they if they're diagnosed um there's not a lot of great therapies out there but you know to get this kind of a benefit from exercise i think is really encouraging and in this study i think two people even had an amelioration of their symptoms which was really interesting so the goal is to move every day start low and add very slowly to make sure you're being safe and just find something that you enjoy otherwise you're not going to do it so if it involves doing it with a friend or listening to a certain kind of music you know just make sure that it's something that you enjoy and that you look forward to and try not to do the same exercise every day if you are you're a walker maybe you can incorporate some weights um do some strengthening exercises it's really great to um challenge your body in different ways so the next lifestyle habit we're going to talk about is sleep and sleep is very very foundational and i can tell you from personal experience it was one of the most profound changes where um [Music] i entered a stage in my life where i didn't have to stay up to take call and i didn't have small children and i could sleep and i just became a different person and i think many of us feel that getting five to six hours a night is normal and we feel fine but i think i would challenge you to try getting eight to nine hours of sleep you might really love it and it might just be the thing that really helps um change the trajectory of your health so some of the re some of the functions of sleep is to repair and regenerate various tissues in the body there's detoxification that happens in fact the brain detoxes twice as well while you're sleeping versus during the day and if you want to get junk out of the brain like toxins that may get into the brain and cause inflammation and lead to something like alzheimer's disease um one way to support that is to sleep so that you can clear some of those problematic compounds through detoxification hormones balance when you're sleeping better and this is actually something that will just fall into place if you get into a regular sleep pattern um i generally tell people to aim for eight to nine hours and be asleep during the dark hours because you want to be in line with these shifts um in in the 24 hour cycle it's also really interesting that there's this crosstalk between sleep and the immune system so sleep affects what's happening in the immune system and um so if you want to bring your immune system into regulation sleep is a really useful tool and we don't have western medicine equivalence for what sleep can do good sleep allows you to form more solid memories and also to process um your emotions more appropriately so um in a study they took a deprived participants and showed them some images that were negative in content and compared to non-sleep deprived participants the sleep deprived people actually had greater um activation of the amygdala um in response to these images so this speaks to that processing of emotions it's and if you've ever been sleep deprived you may recall being snappy or you know having less patience and when you're well rested magically everybody's nicer around you and you're nicer so it's just something i think to pay attention to because it's really fascinating how sleep affects so many different parts of how we function and i think it's really important to get a sleep um bedtime routine going it's really the foundation of restorative sleep so as i said you want to eat for eight to nine hours at night be asleep by 10 o'clock at the latest and then maybe get up by 7 a.m and this will help you get a good spike of melatonin at night around 10 p.m and you wake up at 7 a.m within about 45 minutes you'll get a nice spike in cortisol hopefully and this is one very powerful way of bringing your hormones back into balance if you're using pharmaceutical aids long term i would highly recommend um using them very sparingly because um there was just the recent data that came out of the women's health initiative showed that um the use of pharmaceutical sleep aids um increased all-cause mortality and cardiovascular deaths and what's long-term it's not really clear but i would say like once every third night for many months and if you're using that long term um it can actually have a lot of very significant health effects so there are a lot of natural options um that are out there uh naps are great you just don't want to do them too late in the day where they um you know didn't interfere with sleep at night and then here's the hard one avoiding screens the last two hours before bed and we're all guilty of this um because that's that last hour where we can we want to relax and do something you know that we've been kind of wanting to watch a show or something but if you can reserve all your screen time for earlier in the day and then read a book listen to a podcast in those last two hours not being exposed to that harsh blue light um will help you get deeper longer and more restorative sleep and if you don't believe me just try it try a couple of nights where you're not using your phone and see how you feel the next day and compare that to the nights where you're using your phone regularly and you're on your phone for hours before you try to fall asleep so see how long does it take you to get to sleep and how long do you sleep and how do you feel the next day if sleep apnea is an issue for example if there's snoring or there's any daytime sleepiness or fatigue it might be really important to talk to your doctor about whether or not getting tested for sleep apnea is right for you all right and then um the last well we'll talk about stress management here because i think most of what i see in my clinic whether it's cardiovascular or autoimmune or cancer i think a lot of it is driven by stress and this is the some maybe the hardest lifestyle habit to kind of get a handle on but i think it's really important if you truly want to make progress and improve your health so my strategy to stress management is first of all what are the stressors that you can remove out of your life is there a person that is um perhaps bringing a lot of stress into your life well can you minimize interactions can you build boundaries maybe your house is really cluttered maybe kind of getting rid of stuff will help kind of make your space more comfortable and then build resilience by sleeping better exercising practicing good relationships with those around you there's many different ways to build resilience and then there's calming techniques such as meditation or just breathing practices or just being mindful and in the moment when you are you know going about your day i would also give you um credit for prayer or engaging in a hobby or exercise if they truly help you manage stress and you feel better and less stressed after you practice them and i don't recommend just jumping into a 45 minute day 45 minute a day practice i don't think that that works long term i think it's something you have to build so start with three minutes a day do it every day and if you love that then increase it from there but i'd much rather see people meditate or breathe a little bit every day rather than doing 45 minutes once a week it's the pattern of doing it regularly that helps calm the nervous system down and bring you out of that fight and flight response and you know being in a less stressed state matters in this randomized controlled trial of pregnant women they they took a group of pregnant women and put them through cognitive behavioral therapy versus controls who didn't get that and at the end of the pro at the end of the study the pregnant women actually had significantly lower stress scores does that matter well of course it does because when there's a stressed mother there is the release of hormones and other neurochemical activity and all of this will affect the fetus and it's actually really interesting because the this uh emotional state of the mom can actually deter affect which genes are turned on and off in in that baby and interestingly that can actually be passed down through generations so if you haven't given much time much thought to stress management i think it's really worth it and we're talking about a lot of different tools today and the goal is not for you to pick all of them um you know to choose something from all of the different lifestyle habits and to work all of them i want you to just think about what makes sense to you and you just start with one thing right maybe it's working on stress management maybe it's working on diet maybe it's sleep you know and there's no right or wrong answer because as long as you are working on health related um projects over time you will make a lot of progress all right so i always end every patient meeting every class with talking about toxins because i think this is a topic that you might miss if you are solely um working with western medicine there's really no counseling around this so this is a big topic um but i'll really try to condense it down into one slide so daily every day we are exposed to hundreds and thousands of man-made toxins that are in our you know um cleaning products personal care products in our buildings and we are starting to see many of the effects of these compounds getting into the human body many of them have endocrine disrupting effects which means they disrupt hormone function in humans and there there's um a link between these exposures and autoimmune thyroid disease for example and this is just one example among many um and also microplastics are now being becoming a very big problem you know this is when plastic products break down um they are causing dysfunction in the immune system and inflammation and leading to chronic disease we're sort of at the beginning of really understanding this but the reason i even bring up microplastics without a lot of data is that you know we are completely addicted to plastic it's impossible to shift away because everything from the grocery store to you know all of the personal care products everything is in plastic so think about how far you can get throughout the day before you use something that is um you know is linked to plastic i mean it's it's impossible but i think you can start minimizing your exposure by choosing different products and so how do you decrease your toxic burden you know the amount of exposure that you're getting um and i'll break it down there are many exposures that are passive it's in our air in our soil and in our water and they're hard to minimize but there are many things you can do so i've put some of the most high yielding interventions here so getting a reverse osmosis with carbon water filter is one of the most impactful things you can do so this is the water that you would use for cooking and drinking in your home uh the hepa air filters are really important uh to take out not just you know um exhaust or other kinds of cooking um smells that might be in the house they're also important to bring out a lot of the things that are sort of aerosolized in the air from building materials furniture foam um so getting an air filter is really important and with the wildfires we've been having i don't know how we would have survived last year without one because at one point our air quality index went up to 600 and i could actually see the smoke in the house so um air filters do tend to be expensive but another really useful trick is to open your windows every day for 15 minutes and just to air out the house because as all the man-made products in your house sort of kind of go through their off-gassing all of those molecules end up in your home and so try not to live in spaces where the windows haven't been opened in weeks every day even if it's winter time open your windows for 10-15 minutes choosing less toxic personal care products cleaning products is really important and my favorite tool is the environmental working group they have a wonderful website the ewg.org that you can actually go in and you could test to see you can put the name of your products that you're using to see how toxic they are and then you can also um look through their database for less toxic alternatives and eating local and organic also helps expose you to less toxins and pesticides and how do you so we talked about decreasing your exposure but how do you actually get your body to do more detox well eating colorful vegetables helps because those molecules the phytonutrients support the liver to help you do detox clean protein that comes from plants helps so this is why we talked to talk about eating a whole plant-based diet drinking water and having a daily bowel movement helps push things through um and then a healthy microbiome this is something that i didn't initially appreciate until i started studying integrative and functional medicine but our microbiome the collection of good bugs in our large intestine actually do quite a bit of detox for us and when we lose diversity and we lose the good bugs we're also less able to do detox now there are liver support supplements that can be used when appropriate but i rarely go there with people i think the long-term approach is really using um plant-based foods water good habits supporting your microbiome and then so we finished the lifestyle habits i'm going to just quickly go through supplements i don't really believe that um people need to be on a lot of supplements i believe in a food first approach because i think it's the long-term approach but in certain cases i think it's appropriate to use a supplement for example vitamin d is very um difficult to get from most of our foods and when we go outside we're covered with clothing hats sunglasses sunblock so there's very little opportunity actually to get exposure to the sun so and that doesn't mean that you shouldn't go out and get exposure to the sun especially if you don't have a history of skin cancer but most people do need to supplement because vitamin d is really important it's not really just a vitamin it's important in calcium and phosphorus metabolism it's important for bone health super important for modulating the immune system it actually has antimicrobial effects so with covid you know we've been really talking about getting people's vitamin d levels up so lots and lots of benefits of vitamin d i think fish oil and or omega-3 is also really useful it's hard to get enough of it from our diet unless we're eating a lot of fish and seafood um and especially if we're eating a lot of omega-6s in our diet omega-6 fats and not enough omega-3 as you recall i said that leads to inflammation so if you want to bring down inflammation and shut down a lot of inflammatory pathways omega-3 supplementation in the form of fish oil or even algae if you don't want to do fish oil can help okay and then the third class of tools is the complementary therapies now these are low-risk tools that are an inside-out approach to health and healing so approaches like acupuncture and traditional chinese medicine are wonderful for getting your body's healing mechanisms revved up so that your body can actually do what it needs to do to restore balance ayurveda from india also a very holistic system of medicine that can be utilized both chinese medicine and ayurveda really focus on balance and using food as medicine healing touch and reiki are therapies where a practitioner may put their hands on the person's body or over their body and it's a form of energy medicine it induces healing and relaxation and then hypnosis um is really useful and not everybody is hypnotizable but a great majority of people are so hypnosis can help with um you know mood sleep issues phobias addiction pain so we have in our clinic several psychiatrists who do medical hypnosis and they record the session for you and then you can um use it at home um to um utilize it at home um other complementary therapies are craniosacral therapy and chiropractic which is the manipulation of um bones or the spine um and if if you're interested in any of these i would say read about it online try to find a um a reputable practitioner and this is a great addition to um all of the other things i talked about today so in talking about functional medicine and the different strategies for creating health the goal is really to restore balance and to help ground and connect you so that you can move towards a higher state of health and something i always talk about with my patients is that if you think of a continuum of somebody being you know in very poor health to somebody being in perfect health you know we all lie somewhere on that continuum and i don't think that your place on that continuum is fixed and i don't um accept that we're all going to move towards you know very very poor health i think in engaging with what we've talked about today i think we can all move towards better health i've never seen people engage and move towards worse health as a result so now i don't know how far you'll move towards better health that has to do with how you engage and basically how far along you may be along that disease process but i think it's worth doing because these tools are powerful there's a lot of evidence behind them and they're safe and um definitely able to be used in conjunction with whatever you're doing with your conventional western physicians so thank you for the opportunity to have this discussion with you i'm going to stop the share here and we have our q and a section here so i'll try to get to as many of these as possible okay um question are there vegetables that can cause inflammation so i wouldn't say that there are vegetables that can cause inflammation in every single person but certainly many of us can actually develop food sensitivities and the way i deal with that is i put people on an elimination diet have them come off of certain vegetables that they think they might be reacting to three to six weeks see if they feel better during the elimination and then reintroduce um those vegetables one by one each over 72 hours to see if they react so the nightshade plants which are potatoes tomatoes eggplants peppers and some other things um can often cause sensitivities in people but not in everybody and i never want to just make a blanket statement about don't eat these vegetables because i think if we're going to stay on a plant-based diet we need to have a lot of variety in our in our diet okay is there a book that writes all this down oh there are many um or you know and i um actually teach an eight-week class where we actually take this and we go in much greater depth um i'm trying to think of a book um i mean just if you google uh you know um any functional medicine providers that have written books you'll find it okay um another question about nutrition of seaweed and kelp um that that are um that we've come across in health food stores um seaweed and kelp are actually um really healthy foods they contain iodine um and lots of other nutrients so um they can help with detox so if you i um i actually when i cook beans i actually put seaweed kombu which is a type of seaweed into the beans the water as i'm cooking them because it actually leaches more nutrients into my beans so yes i like them but i like them as foods um so i wouldn't go out and buy supplements that contain this stuff oh is there a maximum amount of fiber i was eating 60 grams a day and had terrible constipation so if you up your your fiber intake without upping your fluid intake you might actually get more constipated um i think our ancestors were eating maybe 50 to 80 grams a day of fiber but the standard american diet has about 10 to 15 grams a day so 60 is definitely on the higher side but i think you need to balance that with eating high quality fiber that's unprocessed so hopefully it's not metamucil hopefully you're getting those 60 grams from foods and getting a variety and also with fiber they're soluble and insoluble fiber so um so think i generally think about soluble fiber is like the inside of the apple the white part and the ins that's the soluble and then the insoluble is that um more coarse skin and both types of fiber are important so eat your apples or eat your vegetables whichever ones you can eat with the peel do eat the peel um oh when i say 80 percent plant-based diet do i mean 80 of the calories i'm actually a very visual person and i want you to think of it as 80 of the real estate on your plate comes from plants okay so um that way you can just not have to calculate numbers or get a food tracker because that's boring i want you to just be very visual go for color go for plants and make sure that the vast majority of your plate is taken up by plant-based foods okay are there times of the day when one should not exercise i would say that everybody is different a lot of people tend to be kind of stiff and creaky and early in the mornings so they don't really want to kind of move early in the morning or do you know running that early um some people feel like if they exercise late at night it might keep them up some people exercise at night and they feel that helps them go to sleep um better so what the way i would answer that is i think you should actually uh experiment with um exercising at different times throughout the day and see what works best for you first of all i mean it's your schedule so when can you get it in you know the best time to exercise is when you're actually going to do it and do it regularly a lot of people tend to have their best physical coordination at like two to four in the afternoon so if that works better for you great but there's no wrong time to exercise okay oh say more about fasting okay um so fasting is always done with um water you never want to limit water intake during a fast there are many many different regimens and this is a very hot topic dr jason fung f-u-n-g does a lot of work in this area and i really enjoy learning about um fasting from him he's a nephrologist who um has written a lot of books actually in this area so um some simple fasts are doing an overnight fast where you are having an early dinner and then delaying breakfast in the morning most people call that intermittent fasting but that's actually time restricted feeding start with 12 to 14 hours a day between dinner and breakfast and then if that feels good you can lengthen it if you're diabetic or have unstable blood sugars i would be very cautious and i would talk to your doctor before starting to delay meals especially if you're not if you are on medications that lower blood sugar um i generally don't like juice because juice tends to be sugary and we want to kind of just rest the gi tract um i don't like juice fasts at all actually because it doesn't make sense to me yes you want the phytonutrients which are all the colors but you um i think better off just sticking to water maybe some herbal tea maybe some green tea if i do a longer fast where it's 48 hours i might have some green tea on day two just because like i can't get through the day otherwise um so we talked about that overnight fast there are some there are other types of fats that i can't get into today but um intermittent fasting is another one um fasting mimicking diets are another one but the easiest way to start is just overnight between dinner and breakfast and you have to do that four to five times a week for it to um really start making an impact and you know hitting all of those bullet points that i had on the um slide okay um best foods to buy battle osteoarthritis plant-based foods really and one thing with arthritis is sorting out food sensitivity so maybe going off of gluten and dairy for six weeks to see how you feel and then reintroducing them back to see if they cause you more trouble with arthritis i also tend to want to have people cut out the nightshade plants but again you want to eat an anti-inflammatory diet because the itis at the end of osteoarthritis is inflammation so you want to be anti-inflammatory where does diet where does dairy fit into the diet dairy has some benefits it's a fermented food if you are not sensitive to dairy it's fine to have it but i generally um think it's better if to stick to the plant-based fermented foods some people have trouble you know tolerating milk but they can do cheeses or yogurt and that's fine i don't think it should be a major part of your diet but if it's something you eat and you're not reacting to great but if you have an autoimmune disorder i would highly recommend cutting out dairy and gluten for at least six weeks to see how you feel and then reintroducing it back okay um [Music] let's see oh let's see well this is a lot i don't know if we're gonna i'm gonna go five more minutes and i'll try to get through as much as i can here [Music] um so someone asked about what about living exercising in and playing in a power line park and electronic devices this is a hard one because these are some of the exposures that are um you know hard to avoid uh i would highly recommend not buying a house near power lines um not having your phone um near your head especially when you're sleeping just putting it in airplane mode if it must be in the room with you so electromagnetic radiation is something we have to think about actually the environmental working group has some really great tips on how to minimize exposure um [Music] is coffee okay uh i think if you overdo coffee it can actually kind of throw off your cortisol levels because it's sort of you know giving you this caffeine boost i think done i think if you like coffee because it's social and you enjoy the taste that's fine but if it's the thing you must have in the morning to get going that's more problematic so just make sure you're not addicted to it let's see someone's asking about how to do a detox who has diabetes i would start with food food first in my classes i give out food plans to everybody and one of them is a detox food plan and it gives you all the information that you need to know to figure out how to start working with food and then water daily bowel movements like i think that's the long way to long-term approach what's the best kind of provider to help figure out food allergies well i think a lot of nutritionists actually do a great job or functional medicine or integrative medicine doctors it depends on what your insurance covers reading is reading a book on kindle okay i think reading a book on kindle is better than reading it on your cell phone because um the light that's emitted is different but i'd rather you just read a paper book um [Music] i oh someone a speaker takes more than 100 supplements a day do all integrative doctors rely on supplements um [Music] well again it goes back to having a food first approach so i i do have patients that come in with 30 40 supplements and there are some studies out there that show that doing isolated nutrients like high-dose vitamin c um can actually not be as helpful in fact it could actually be throwing off your biochemistries but doing it with food is much safer it's very safe so this is why i always talk about doing it with food um [Music] okay well i'm gonna stop there i'm sorry if i didn't get to everybody's questions um because there were many and thank you for for your interest and for your curiosity i really appreciate it this is a fun area to talk about and i really enjoy learning about it but i i'm certainly happy to just i have many classes that i offer through the integrative medicine center which can really kind of drill down into all the details so this was just an introductory um talk to kind of give you the quick and dirty on what we do in that integrative medicine clinic thanks very much dr payro this was a really great introduction to this subject and um for the audience uh this talk has been recorded and it will be up on our youtube channel within another couple weeks and you can review it and um as dr p robbie said you can look up her classes in the integrative medicine part of the stanford website so thanks again this was a terrific talk so much to think about really enjoyed it and good night to everyone else good night

Channel: Stanford Health Care

Views: 33,218

Keywords: Stanford, Stanford Hospital, Bay Area Healthcare, Medicine, Medical Science, Stanford Health Care, holistic health, supplements, nutrition, whole-foods diet, plant-based diet, microbiome, fasting, intermittent fasting, prebiotic, probiotic, sleep, stress management, plastics, microplastic, toxins, caffeine, cancer, autoimmune, autoimmunity, heart disease, cardiovascular, wellness, chronic illness, chronic disease

Id: bjcZx8H9W_A

Length: 64min 10sec (3850 seconds)

Published: Tue Apr 13 2021