Five years in

I must have been crazy—but anyone who plants their own flag is a little crazy by definition. 

This past year, I marked a significant milestone: five years of practicing integrative medicine at Dignity Integrative Health and Wellness. 

Having finished medical school 35 years ago, I see some symbolism in how long I’ve been a doctor, mostly in emergency medicine, and these last five years in integrative medicine. My personal belief, to which I hold strongly, is that our lives are lived in five-year increments. It’s an appropriate time to ‘take stock’ and reflect on both past and future. 

Think about where you were five years ago and compare it to now. Sit with that thought for a moment. Amazing, right? More interestingly, cast yourself five years into the future and imagine your life as it will be. 

I think of myself five years ago, having just opened Dignity Integrative. The hubris I had in thinking I could start a new career after so many years practicing a certain way. I was in the midst of my two-year integrative medicine fellowship and thought, ‘yeah, let's just do this and see what happens.’ 

Society was in the throes of COVID lockdowns, and the world was off balance. A great time to start a new venture! In reality, it was the perfect time. People were seeking out clinicians who could answer questions about complex constellations of symptoms. Virtual care was being embraced as a key part of the therapeutic continuum. COVID itself raised questions about multisymptom conditions not easily explained by a presumed viral infection. Questions about vaccines (generally effective) and vaccine injuries (rare but real) became a louder conversation. 

In the midst of this, I had to do all the things a new practice has to do:

• Outline a model of practice

• Decide virtual or in person

• Develop a brand image

• Choose baseline testing 

• Select an EMR

• Get med mal insurance

• Find space to practice

• Research and develop or modify tools to help patients

• Develop a cost structure and billing process

• Select how I would use supplements

• And about a thousand more decisions to make

I was starting ‘cold’ with no patients and no other practice to lean on to refer patients to me. I must have been crazy, although anyone who decides to strike out on their own and plant their own flag is a little crazy by definition. 

I am eternally grateful to the patients who trusted me early in this process. I was still synthesizing what integrative medicine means and how to practice it. How to take what I learned in 30 years of practicing allopathic medicine, with all its wonder and shortcomings, and blend in the principles of root cause medicine, combined with taking the long view of health. 

Many of my colleagues will criticize any mention of integrative or functional medicine as non-science-based. That’s unfair and a broad brush for those of us genuinely trying to bridge the gap for patients who have been poorly served by our current system. There are MANY in that category. 

The woman in her perimenopausal years, who has a combination of anxiety, vasomotor symptoms, profound sleep disturbance, and difficulty concentrating, has been shuttled to multiple experts looking at one small slice of symptoms. The 50-year-old man with a strong family history of cardiovascular disease, looking for more than maximizing statin therapy to maximize his long-term health. The 28-year-old woman who has suffered for years with diagnosed ‘functional abdominal pain’ and anxiety, who has Intestinal Methanogen Overgrowth, a particular type of small intestinal bacterial overgrowth. These and many others are actual patients I have seen and effectively listened to their symptoms as we developed a structured plan using personalized genetics, standard labs, and microbiome analysis to achieve both short and long-term goals. 

In the last five years, my approach has focused on ‘the basics’, including:

• Whole food nutrition, minimizing processed foods

• Moving daily with a focus on cardiovascular health and maintaining muscle mass

• Prioritizing sleep for restoration and brain health

• Intentionally supporting sympathetic and parasympathetic balance for stress reduction

• Targeted supplementation based on focused testing

In addition, over that time, I have lectured to thousands of business executives on the importance of these principles and how to structure them into their daily lives. These are always lively presentations with great questions that clarify long-established health principles and discredit an increasing amount of the misinformation by social media personalities and wellness influencers. Unfortunately, I have also found that many individuals, both some of my patients and the business executives, fall into the following pattern:

• Most know what needs to be done 

• Most do not do it

• Most want the magic pill

Most know what needs to be done

Let’s face it, there is no shortage of places to find information. From verifiable sources like national medical organizations, to newsletters, books, blogs, and podcasts. With the advent of large language models like ChatGPT, Claude, Perplexity, and others, accessing the latest and greatest medical advice is at our fingertips. We all do it, including me. 

LLMs are great at finding obscure answers to complex health questions. Better than many clinicians. But complex health questions do not need to be pondered to maximize overall health and healthspan. Here are the results of the top seven things you can do to achieve that, according to two of the LLMs:

From Perplexity: 

• Regular physical activity

• High-quality, Mediterranean-style diet

• Not smoking and minimal alcohol

• Adequate, regular 7–8 hours of sleep

• Healthy body composition and stable weight

• Stress management and emotional well-being

• Supportive social connections and community

From Chat GPT:

• High cardiorespiratory fitness

• High muscle mass and strength

• Healthy body composition and insulin sensitivity

• Consistent, high-quality sleep (7–8 hours/night)

• Strong social connection and sense of purpose

• High-quality whole-food nutrition (adequate protein, minimal ultra-processed foods)

• Avoidance of harmful substances (no smoking, minimal alcohol)

As the saying goes, this is not rocket science. 

Over hundreds of thousands of studies, from randomized case controls, to epidemiological studies observing hundreds of thousands of people, to Mendelian randomization, they all point to the recommendations and practices mentioned above. We have the knowledge. What we lack is the ability to execute these seemingly simple recommendations.

We then get lost in the details. How much and what specific type of exercise? It does not matter, just move for 30 minutes a day. DO SOMETHING. What about keto, paleo, vegan, anti-inflammatory, lectin-free, or pescatarian? Which one is right? Just cut out the ultraprocessed foods and focus on a balance of more (but not exclusively) plants on a daily basis. 

Most do not do it 

Which leads me to the sad but true fact that most people do not follow the above. 

The reasons are both simple and complex. We live in a society (certainly in the United States) focused on efficiency. In how we move from one place to another, to the food we eat, to how we measure productivity at work and at home. That efficiency leads us to minimize manual work, in any form, in the search for efficiency. Moving from one place to another often requires automobiles, which strap us in a vehicle for a long period of the day, moving us from place to place, depriving us of the natural locomotion our bodies both need and from which it benefits. 

We could park a block away from our office and take those five minutes to move. But we don’t. In a major city with mass transit, we could get off the stop before and walk (sensing a theme here). We don’t. 

Our meals are often prepared from either a fast food restaurant or something we put in the microwave to heat up. Fast and efficient because we are pressed for time. We start the day with a bowl of something likely high in carbohydrates and grains. We could make a salad and bring it to work, or make it at home if we are there. It would provide 2-3 servings of vegetables of the 5 recommended by most reputable sources. 

We could learn there are meals that can be prepared in less than 30 minutes that are balanced, economical, and healthy for myself or my family. We are generally so exhausted from the day of work or rushing kids from one activity to another that a healthy meal looks like California Tortilla, Chipotle, or Chick-fil-A on the way home. 

We all (myself included) have some degree of phone addiction, starting with our children on up to the parents, that sucks our time away from personal human interaction towards mindless scrolling and being emotionally triggered. It increases stress and sympathetic tone while making us on edge, anxious, and unable to sleep. Our sense of tribe that has sustained humanity throughout most of our existence is being replaced by often negative digital interactions. They are a poor substitute and degrade our emotional and social health. We reason that we only have so much time in the day, and there is no time for these types of social experiences. 

Our lives have been so focused on how we can become more efficient that we sacrifice the things that provide true joy and health. 

Most want the magic pill

Cold plunges, saunas, peptide infusions, cryochambers, testosterone maxing in your 40s, NAD infusions, PRP injections, long-term ‘detox’ regimens, IV vitamin infusions, colonic hydrotherapy, alkaline water, and the list goes on and on. I will admit there may be some science to support some of these, but they are generally considered to be on the edge of what should be considered. 

Focus on the foundational things identified in the bulleted lists above. Incorporate them into your daily life. Once you have done that (and really done it, just not saying yeah, I do that), you can move on to the more esoteric. I think cold plunges have legitimate value. Do I think you should spend $2,000 on a cold plunge when you are not eating minimally processed foods, getting enough fiber and protein in your diet, making 30 minutes of movement, 10 minutes of a mindfulness activity (pick one), and 7-8 hours of sleep a day a priority? No, I do not. 

I also think there is a legitimate reason for individuals to search out these types of treatments. They have not been well served by the traditional medical system and are frustrated by their inability to get relief for their concerns. Their doctors either can’t take the time to answer their questions (common) or don’t have the ability to address multisystem concerns (gastrointestinal, joint, fatigue, trouble concentrating, sleep disturbances) in an individual person. That is why integrative (functional) medicine has found a home and an increasingly strong following. 

It is also where I have realized success over these last 5 years. Am I able to cure every person of every ill? No, and I am upfront about what we know and don’t know about a particular condition and the limitations of testing. I tell my patients in the initial 90-minute visit that I am not a magician, and they will have to do the hard work with support from our practice to achieve their goals. It has also been incredibly gratifying to help someone who has been struggling for years with a particular condition to get significant relief by taking this structured approach. 

After 35 years of being a physician, I am still energized to see patients, research new therapies, and use tools like LLMs to help synthesize data and develop comprehensive plans to guide patients towards a better life. There is much I need to learn, and five years from now, God willing, I will be able to look back and marvel at how far I have come. It has been an amazing journey, and I look forward to the next chapter of my life.