Podcast: Practicing the Medical Arts

Practicing the Medical Arts

Full Transcript

Yoshino:

Hey everyone, welcome back to Artist Decoded. This is your host, Yoshino. And, this is yet another Mind/Wave episode. These episodes have been transforming over the course of time, but mainly my intention for these episodes is that I want to explore various modes of thinking. And, I want to hopefully give people an access point to create positive mental health routines. I’m a firm believer in conscious decision-making and in creating a solid foundation for self-reflection, self-care, and self-growth. Creating good habits in all aspects of life is extremely important, which takes a conscious effort to do so. I personally work out about 12 times per week, so that’s twice a day with one day off. I lift weights in the morning and do calisthenics in the morning, and do my cardiovascular activities such as walking, running, and cycling before sunset. I also know from personal experience that good habits, both physically and mentally, have to be developed slowly and over time.

This can be holistically compared to creating a solid foundation for a career in the arts, or just simply having an artistic practice because not everyone necessarily needs to have a career in the arts. But either way, this takes a conscious, consistent, and concerted effort to continue your craft. Which can be likened to anything in life, including developing positive mental health practices, which leads me to my guest for today, Dr. Bruce Hoffman, who is the founder of the Hoffman Centre for Integrative and Functional Medicine.

So let me tell you a bit about Dr. Hoffman. Dr. Bruce Hoffman did not choose the medical arts as a vocation. Originally, he wanted to be a writer and poet. His interest in health and healing developed later in life after a long and winding road of self-discovery, life experience and learning. He only applied to medical school so he could complete a residency in psychiatry and subsequently study Jungian analysis to understand the human condition and behavior. As life would have it, his destiny took him on a different journey. He never did formally pursue a psychiatry residency or Jungian analytic training, but his love for art, poetry, and psychology remains.

Dr. Hoffman was born and educated in South Africa and obtained his medical degree from the University of Cape Town. After two years of compulsory military training, his distaste for the local regime convinced him to immigrate to Canada in 1986, where he pursued family medical practice in rural Saskatchewan, Canada. Once ensconced in the practice of family medicine, he quickly realized that his interests in medicine were broader than just drugs and surgery. The allopathic medical practice was limited to treating symptoms and illnesses, but failed short in restoring the patient’s health entirely. Bruce embarked on a journey to understand what constitutes the human experience. What are the triggers and mediators that perpetuate human suffering? He wanted to assist his patients not only to be free of disease, but to realize their maximum potential.

Well, I hope you all enjoy this podcast episode. There’s a lot of rich information here, so stay tuned for that. But before we begin, please go to our iTunes page, leave us a review. It helps reviewers just like yourself to hear about the podcast. We’re also now on YouTube. There are a lot of new videos and content from past episodes up there. So, check us out over there and be sure to tune into our no wave cinema conversations on Clubhouse. The next conversation will be with me and Justin Dasher Hopkins. We’ll be talking about the classic 1964 Hiroshi Tasha Guevara film, Woman and the Dunes. We will be having this conversation on Wednesday, April 7th at 6:00 PM Pacific Standard Time. So definitely go check it out and listen to us over there. Maybe even contribute to the conversation as well. So anyways, without further ado, here’s my conversation with Dr. Bruce Hoffman. Hope you enjoy it.

Dr. Hoffman, thank you so much for taking the time to do this. And the main reason why I want to bring you on is to talk about good mental health practices and as Maslow would put it to hopefully reach self-actualization. And I think it’s really important for people in general, to be honest with themselves about every single aspect in their life, to live a holistic practice. And I was wondering if you can speak about your early pursuits for wanting to become a writer and poet and how that eventually led you down a path of studying traditional medicine.

Dr. Bruce Hoffman:

Sure. I was brought up in apartheid, South Africa. And initially in quite a conservative traditional home. But at a young age, when my parents got divorced at around age 10, my mother drifted off into more creative endeavors and found herself hanging out with Keith Anderson, who was a head of a circus, also an artist, a set designer with the opera company and the director of the opera company. And so, I found myself hanging out with Keith and his group of merry pranksters, if you will, because they were circus people, artists, creatives, and opera participants. And I found myself as a trapeze artist in a circus that traveled around South Africa, hanging out with these rather unique individuals, clowns, dwarfs, transvestites, just a crazy band of merry pranksters, which at a young age in conservative South Africa was completely unheard of.

So, I was exposed to alternative lifestyles from a young age. But then when my father got wind of this, he sent me off to an all-male boarding school, a thousand miles from home. And when I got to this all-male boarding school, they took one look at me and said; Hoffman, we’re going to knock you back into shape. So, then I was forced into this narrow, masculine boarding school mentality, and I was horrified it was like the worst thing that ever happened. But the school was an outward-bound school based on the boarding school that Prince Charles went to Gordonstoun and Prince Phillip went to. Just based on those same principles, go out into the mountains and find yourself. But after a couple of years of being at a boarding school, I had a school teacher by the name of Roger Loveday. And Roger was a devotee of a guru called Ramana Maharshi. He exposed me to the teachings from India and particularly the subset of Hinduism called  Advaita or non-dual Vedanta. And also at the same time, I got exposed to the writings of Jung; Memories, Dreams, and Reflections- his autobiography had a huge impact on me. And what ended up happening was I had a satori experience.

One day, Roger was speaking to me outside the school, outside the classroom, after he’d given a big dissertation on the bible and Christianity. After I was very cynically inclined at that time. I said to him; Roger, you don’t believe in all of those myths, do you? And he said to me, “of course I do”. And in that moment when he said, of course I do, I had a sudden awakening. I went into the state called non-dual state or satori. And, that’s where all space-time sort of, linear time disappears and you see behind the curtain, so to speak. You see the appearance of reality through the quantum lens, which is, there’s no time, there’s no future, there’s no danger, there’s no fear of death. Everything just dissolves into this oneness and where everything’s light. Which is well-documented in all the literature, many people have had these experiences. But that then set the stage for further exploration of these principles and these studies. I just continued to be inspired by the fact that there was a reality behind the reality that the rest of the world was operating on.

And then my mother applied for me to go to medical school, unbeknownst to me. Why, because she had a friend who had a friend who could get a scholarship for medical school, for somebody from the particular part of the country that I came from. So, she applied and I was actually up in Johannesburg building sets, scenery for a play with Keith Anderson and his group. I got a phone call and my mother said; Oh, by the way, you got into medical school. And I said, what? What’s medicine, I’m go to do what? She said, no, you got to go study medicine. I said, are you out of your mind? I want to go and study literature. Anyway, I ended up going to med school and not knowing what I was doing there. It is quite a peculiar experience. But while I was in medical school, I happened to go and stay on a remote farm up on the mountain. And there were a group of people around that area who were very influenced by the beat poets, Kerouac,  Ginsberg, et cetera. And I started to read them with great sort of joy. And, and then I ended up in my second year of med school, going to San Francisco and started to hang out with Gregory Corso and a lot of the other beat poets. And that was another inspiration for me.

I just got involved in creative endeavors, integrating Jung and Eastern thoughts and philosophies, and then finished my medical training, ended up in rural Saskatchewan as a family practitioner and really loved being a doctor, when I actually discovered what being a doctor was, because I had no clue. But then after a period of a year or two, I realize that this whole N2D2, name of disease, name of drug method of practicing was ridiculous. Even though it serves a function. And then I came across the writings and the videotapes of a medical writer and thinker called Larry Dossey. Larry Dossey had explored the interface between Eastern philosophies and Western medicine. I’ve written quite extensively about it. And, I watched his video and I was like completely moved. I realized that; Hey, I can bring back everything I learned in my youth that I thought I had to leave behind forever into the integration of this kind of medical practice. I flew down, met Larry Dossey, at a conference, had dinner with him. Very inspired, and then started off with that. To eat, discover, and study anything I could across the whole spectrum of medicine. Healing and the healing arts, including anything that could help an individual live at their maximum potential.

People enter into the medical office. I’m sitting in my medical office. I’ve just seen patients this morning and they come in with symptoms of depression, mold illness, Lyme disease, mast cell activation syndrome, a whole host of chronic fatigue or whatever. Then you start to work with a bigger lens are really entry points into a much greater dialogue and a much greater roadmap that you need to bring to the table in order to assist the person through this transformation of illness to wellness. People think they have a disease in which they label, and they think that’s where it begins and ends. But in the system I use and the method I’ve employed, and I’m proud to say that some of the success I have is that I employ a much larger roadmap. It was a much larger set of tools and hence have written about this new curriculum that’s necessary in order to interface with complex patients who can’t just be mechanistically reduced to a diagnosis. It’s actually absurd when you start to think of it. We’re just not trained to think with a different paradigm. We’re very mechanistic in our thought process, but there’s a lot more mystery that goes on into diagnostics and treatment.

What happened after that was that I started to study Chinese medicine, Ayurvedic medicine, homeopathy and German biological medicine, and the the sub-disciplines. And, happened to spend number of years with Deepak Chopra and David Simon. And when I discovered Ayurvedic medicine, they had an explanation of the different layers and levels of what they consider to be human reality, which is stepped down from soul to spirit, to mind, to emotion, to energy, to physicality, to outer world, out there, the expanded universe.

And I started to use that diagnostic model to think of human behavior and illness. And now I’ve incorporated that and expanded that and happened to also, at the time, meet up with a German doctor who’s still alive and still very active, Dietrich Klinghardt. He had also thought of these things and integrated some of these systems into his roadmap. And then I just expanded the roadmap. And now I use the Seven Levels of Diagnosis and Treatment TM across all layers and levels. And when a person enters my room, I use western diagnosis and their symptomatology as an entry point into a much wider dialogue and a much wider diagnostic and therapeutic potential roadmap. So that’s how I work nowadays.

Yoshino:

In terms of just like a, I want to say like a global scale, but I guess, you know, some of the pitfalls for allopathic medicine and the way that it’s practiced in a Western context, like what are some of the things that you’ve observed that needs to change within that context? And how do you think that you implement it in your particular practice?

Dr. Bruce Hoffman:

Well, being a trained western MD, I have the fortunate privilege of being able to look at disease through that lens. And the pitfalls are that the Western diagnosis implies that an organ system gets diseased, then you must find a pharmacology or a therapy or a surgical treatment for that. That is often the case, as we know. Sometimes when you got pneumonia, you want to get intravenous antibiotics, nothing wrong with that. But now we have a whole new paradigm upon us of complex multi-system multi-symptom disease presentations. And that model, that DSM- 10 classification of organ systems and pharmacological interventions is hopelessly inadequate to address those complexities. And it’s quite uncanny really when you start to work with complex patients as to how often western medicine gets it entirely wrong. And it’s only because their tool bag is so limited, it’s this perception that human beings are these mechanistic beings that, a little biochemical particles, that disease just falls out of the sky. And then you got to find a drug to kind of turn down the symptom.

Yoshino:

Do you think that that’s more of a systemic issue or what do you think the actual issue there is?

Dr. Bruce Hoffman:

Well, we think of human beings as being physical bodies, mechanistic bodies. So, it’s the paradigm, it’s the lens through which human beings are observed. That becomes a limiting factor. And we think diseases just fall out of the sky. There’s no antecedents, mediators, and triggers over the inflammatory disease process that is constellated. And we now know generationally, people exhibit, as you spoken with Mark Wolynn, people can come and present with disease processes that the initial triggers have been three generations before they were even born. And that epigenetic transfer of data is real. It’s studied at all the major universities. So that isn’t taken into account in the mechanistic model and the drug-based model. 5 minutes, 10 minutes, what diagnosis, what symptom cluster, what drug, boom. And in America is even worse because your insurance companies control what goes through the gates. And it’s ridiculous. I mean, it’s silly. It’s not how it works.

Yoshino:

Yeah. I think in America, it’s more capitalized, but that’s just part of the whole system. So pharmacologically, it could be traced from that. And also like the way that the educational system is structured as well.

Dr. Bruce Hoffman:

Yeah. It’s a disease-based model, it’s a mechanistic model. And the only therapeutic input that’s of any use is pharmacologically based, and the gateway to that is controlled by the drug industry and the drug lobbyists. It’s very bizarre how it’s all got set up. It’s very peculiar really. Because it’s not real. The human body is the final resting place of every incoming influence. And every top-down influence. The hidden and the obvious. And the body is the final kind of resting place of an individual for all of those influences. And if you don’t start looking at the toxicological logical input of a very diseased planet, the genetics of the individual, which can either detoxify or not that process. And then the influences of the energy body, because we basically, our DNA emits light, which then stands as a standing wave around us, either coherent or incoherently and is highly affected by electromagnetic fields. If you don’t take those things into account, and then the emotional influences we bring up from early childhood, we know from all the literature that children that have been either suffered from abuse trauma, or neglect trauma. Neglect trauma being often more damaging than abuse trauma. They have an infinite amount of increased disease processes later on in life. So, the environmental body, the physical body, the structural body, dentistry, chiropractic, if you don’t take all of those moving parts into play.

Like today, this morning, I saw a woman with a headache, but she had a bite misalignment. She had an overbite, with TMJ issues, had root canals, implants, and had a swollen back of the throat, which we call a Mallampati grade four with sleep apnea. I’m not trained about dentistry as a medical practitioner. I wouldn’t even look in the mouth as a doctor, but its obvious that her dentistry was playing a huge role in her headache presentation. I would just find a drug to treat the headache if I’m using my western practice.

So, the structural piece, then the energetic piece, and then the emotional piece, and then the ego development of the individual. The first half of life, ego structure, which takes us out into the world to become something that drives the first half of life. If we don’t know the internal dialogue of that person, the defenses they develop in order to stay safe, the thoughts that they have, the beliefs that they carry, the value systems, the hierarchy of values that they have. If you sitting in front of a patient and you don’t know their hierarchy of values, you can’t treat them because if their health is a fourth on their value system and running their businesses is the first on their value system, guess what? You have chaos in your low value systems, and you have order, you run your business well, but you’re going to delegate your health to your wife. And you’re not going to show up for all that’s required for you to transform your life. So, if you don’t know the hierarchy of values of people, you can’t really effectively relate to them where they are. Because they will come in and say, they want to feel better. But when you examine their hierarchy of values, it’s fourth on their value list. And unless they raise it, they’re not going to achieve any ends.

Yoshino:

Yeah. I think that’s really important to bring up because, even in that ICI presentation that you were giving, you were talking about how traditional allopathic approaches not taking into account different states of consciousness. And, you know, you could speak obviously more about this than I can, but I’m curious, how would you diagnose someone that doesn’t really take their health into consideration, but is more focused on maybe their business and work and value that as like something that is more important?

Dr. Bruce Hoffman

Oh, I take a history and I have a questionnaire. One of my set of questions, in my 70-page questionnaire, is determining your hierarchy of values. And I ask the question; how do you spend your time, your money, your attention, what you talk about, what you’re surrounded by? And if somebody says, well, I get up at six in the morning, I go to work. I talk business all day. I come home along the cell phone, I’m doing business deals and I’m surrounded by financial books and I watch business TV. It’s pretty obvious where their hierarchy of values is. Well, you got to “rob Peter to pay Paul”. If you want to get your hypertension under control, and  your diabetes under control, how much time are you going to devote to exercise, diet, meditation, sleep, et cetera? And they go, I’ll do my best. I’ll do my best, usually means not much.

Unless you’re inspired to have health as a high value, you have to be motivated from the outside, not inspired from the inside. Motivation lasts six weeks and then you give up, you can’t sustain somebody else’s value system to motivate you if it’s not inside of you.

Yoshino:

Yeah. It’s kind of like that traditional saying, you can lead the horse to water, but ask to take a sip. Maybe sometimes a much bigger sip. So going back to non-duality and speaking of…

Dr. Bruce Hoffman:

Hey, can I just say something? Sorry Yoshino, can I just say something quick just before we leave that subject. Mahatma Gandhi said that the problem with Western medicine is it works. You know, he said that. If you’ve got heartburn, you take a PPI, you take Pepcid, it goes away, nothing to do with what you ate before, how much you drank, blah, blah, blah. So people just take a whole bunch of suppressing drugs and they get on with their life, which is fine. But if you want, if you value health and wellbeing, you want to do a lot to get where you want to be. There’s this whole new group of younger people who are called bio-hackers, who make it their life’s work to study all that it takes to sustain a healthy cell membrane and a healthy internal milieu of the mitochondria. And a brain functioning and sexuality and libido, and they just devote the whole life to enhancing that. And that’s a full-time job. So, there’s is a gradation of what you can expect from a patient from just take a few supplements, to really devote your life, to turning your life around from a health perspective.

Yoshino:

But going back to the non-duality approach, how do you at the Hoffman Centre integrate that into the practice of educating people that are your patients, and then also integrating those more nuanced approaches with allopathic approaches and Western medicine?

Dr. Bruce Hoffman:

Well, the non-duality concept can’t be taught as you know, it’s either happens or it doesn’t happen. You either wake up to non-duality or you don’t. And it’s one of those strange events that other people experience or don’t experience. That’s when you start to see reality from behind, you see it with what they call One Mind. There’s no dual mind, there’s no you and me. We are just part of the same consciousness. Everything is consciousness, and that can’t be taught. Many gurus have set for decades on their stools, talking about the fact that the very thing you seek is preventing you from finding it. So, the very seeking prevents it, it just happens. But that’s a non-dual, that’s Level Seven in my model. But then there’s the other levels which I integrate in my model of assisting people achieve maximum potential within the realms of the dual life. The non-dual part is it can’t be imparted. It happens or not.

Yoshino:

Can you break down your seven-step method, essentially? I’m curious what exactly is in each part of the system.

Dr. Bruce Hoffman:

So, the Ayurvedic or Vedantic breakdown of human reality is we arise from Brahman. The one mind, the unified field, which we call spirit. You won’t be able to see this and I’m not going to attempt, but I sort of broken it down like this. Spirit, soul, intellect, emotion, electromagnetic, physical, extended (bodies). And on each of those stages, each of those layers of an individual’s reality, there’s definitely experiences, anatomical, designations, sciences related, diagnostics and therapeutics. So that’s the system I use. If you look at my website, I believe there’s a chart there, or that ISEAI lecture. That’s a system I practically use in order to assist people and get better. But they all enter through the physical, they come with a diagnosis and their symptomatology. And then I look at all the environmental influences, the biochemical imbalances, the genetics, the structure, the brain, I do, I have a brain treatment center. So, we’re always looking at brain function. And the electromagnetic, heart rate variability, et cetera. And I take a history of early developmental trauma. And then I look at ego structures and defenses and if need be, I send them for psychometric assessments. And then for the soul piece, for the family soul, I use a genogram and do Mark Wolynn’ s work or Bert Hellinger’s work, family constellation work. And for the individual soul, do dreamwork and Jungian type approaches.

So at each layer, there’s different ways of perceiving and experiencing human reality. And so, in a two-hour consult, you’re doing your best to sort of take as much in as you can to get to know that person and where the major blocks are. So even if they come in with Lyme disease, sometimes it’s a question of inherited family trauma, that’s really running the show. Or sometimes it’s due to a traumatic brain injury and they need brainwork. Sometimes it’s all layers, all levels. So having done this for a long time I sort of getting get better and better making the diagnostic and therapeutic recommendations.

Yoshino:

Can you talk a bit about your success stories with this process? I like to understand that a bit.

Dr. Bruce Hoffman

Well, all cases in the end sort of blur into one. But you know, there’s endless amount of patients that present with, say a diagnosis of Lyme disease or mast cell activation syndrome, who believe that that’s the only reason why they are sick. But when they start to explore all the other potential diagnostic possibilities, they all of a sudden realize that that was truly a teleological entry point into a much larger dialogue with themselves. And then they start to explore the whole of their lives and they start to make the necessary adjustments. I’ve got case histories in my upcoming book. I can’t pull one right now because this sort of endless variety of different presentations that I see on a daily basis. I mean, it’s just one little thing today. I saw somebody just very recently who was in her thirties, failed marriage, young child, no direction in life, presents with depression.

Her diagnosis is depression, on antidepressants. And could I help her with her depression and poor self-esteem. Upon further inquiry I found out that she’s moving back home with her parents at the age of 38. And she was very ashamed by all of that. At 38, I don’t know what I’m doing. I’m going back home. What a tragedy. And the man she just divorced, was castigating her for being hopeless, no good, et cetera, et cetera. But when you take a deep inquiry, you see that this soul has had interrupted bonds with her mother at a young age. Mother was separated from her for six weeks. She had a very poor diet. When she went to her mother in teens with developing puberty, her mother was offline, and didn’t see her. She never felt seen. And then she had the series of events, sexual abuse, medication and drug abuse, and then never really found her calling.

So, subsequently turns out that going home to mother and father at age 38 was an opportunity to actually reconnect and heal the interrupted bonds that she’d never been seen in heard for in the first half of her life. So instead of being castigated and feeling so ashamed, she now sees this as an opportunity to reconnect with her mother and father in a truly humble way where the parents, carry the greater weight, and she’s the child. And she can go back and start to integrate her life with her mother’s life and her grandmother’s life, both of whom were artists. She was a makeup artist, but always thought that her makeup career had nothing to do with art. But when it was reframed that she was disconnected from the feminine lineage and her makeup artistry was a continuation of that lineage, she all of a sudden blossomed into the realization that she was part of that maternal lineage and she need not be ashamed of it.

And even though she’d put the makeup artistry aside because of her child and she has to take care of the child because the hours were wrong, she realized she could always pick it up again, and she could step into that female lineage. And she did have a calling. She thought she didn’t, all of a sudden, she knew her whole calling was still on that feminine lineage. Her mother had had a transformation and had said to her; “darling, I realize I didn’t see you when you were younger. I apologize for that”. And all of a sudden, she had this entry into this greater feminine lineage that she could not use so she can pass on to her daughter. So, the daughter doesn’t feel as strained and shameful, et cetera, et cetera. So, yes, she’s depressed. She’s depressed because he’s in an existential crisis of not knowing. She was floundering in life, but she had all this opportunity that’s presenting itself. If she just turned the switches and started to see how it was all part of a grand design that was going to help her realign with her life calling. So, it just gets reframed in a new context and all of a sudden, the life force opens back up.

Yoshino:

Yeah. So, can you speak about the neurological significance of reframing, perceived negative events in one’s life and then transforming them into something positive in one’s mind?

Dr. Bruce Hoffman:

Well, the way I was introduced to, it’s a combination of neuro-linguistic programming and Jungian psychotherapy done cognitively, strangely enough, was through the work of a person by the name of John Demartini. And being exposed to his work, I was able to see how the perceptions that we take into life are often not real. And he uses this teaching tool. He says, look, basically in the quantum world it’s all light. Light gets broken down or dumbed down into matter. Matter is both equal positron and electrons, it’s got both sides. Our lower mind, which always seeks pleasure. One side is always excluding the other side. We always looking for dopamine and trying to avoid pain. And he says, the lower mind can see both sides simultaneously, but you can train your mind to see the integration of both sides to any event, if you just train it. It’s a cognitive restructuring of your mental processes. So, I learned how to do that. I learnt his methodology of how to re-perceive reality through non-dual, if you will, both sides, eyes. So, any event in the future, which looks disastrous, you start asking yourself, where is the upside to this so-called disastrous event? Anything you judge very negatively, like if you judge somebody with very negative trait, you’ll find out where you have the trait, how that trait serves, how that person’s negative trait is benefiting you. It’s not just something that should be a thorn in your side. And how, when you being challenged by a so-called person, who’s is sort of challenging you, where are you being supported? The universe is constantly in this flux of support and challenge, positrons and electrons, which is the basic nature of the quantum reality.

If you can train your higher mind to collapse the world into its opposites, as quickly as possible, you can stay poised in what John calls love. And love to him is just a synthesis of all opposites, where you see both sides simultaneously. And there’s no judgment or no lowering yourself into black and white unipolar perception. So, I try and assist patients like “you going home to mom, this is the most terrible thing at 38, but what is the soul wanting of you? “What is being asked of you? And once I took a history after, she came in saying that this is a horrible thing. She felt so ashamed. She left, she couldn’t wait to go home to see her mother to reconnect because it was reframed. She just saw how it had served her soul’s experience. It was necessary to go home, to receive the love of the mother in a new light, because she had had interrupted bonds all her life with mother. Her mother was ready. She had to be ready. She had to shift the perception from negative, to not positive, but just as opposite. As soon as reframed, boom, I’m going home. Thank God.

Yoshino:

No. Yeah, definitely. I mean, that’s a beautiful story, but I think, especially in the metaphorical sense, you know, when you think of a situation such as a purgatory situation, you can even think about it in certain ways, in a biblical context or in many different stories of purgatory. But we sometimes put ourselves in that purgatory by not seeing the positive association that could be taken out of that negative or what we perceive, quote, unquote, “as that negative lesson of the past”. And if there was something negative that happened the past, if I could say, Oh, that actually helped build my character for who I am today. And then constantly frame it in that context, you can find those lessons. But all those lessons are always there screaming at you to essentially, show themselves in a way that can benefit you. This is at least from my observations.

Dr. Bruce Hoffman:

Yeah. I have the firm belief that every experience that you have, whether it’s positive or negative is serving the projection, the evolution of your life experience. You sort of born over here; you die over there. The acorn does become the oak tree. The acorn needs the wind, the sun, the stresses and support of the environment to become who it’s meant to be. And, I’ve no doubt in my existence, your voids, the things you find most missing, the things you judge the most negatively actually become your highest values. In the end, you look back and I have the unfortunate and fortunate privilege of being in my second half of life. So, when you’re more soul based than ego-based not that you, without ego, not saying that, but you’re more trying to integrate the parts of you that you left behind in your pursuit and the drives of the first half of life when you’re driven. Adler drives, Freud’s drives, that you’re driven to become something in the first half of life.

And then in the second half of life, you try and pick up the pieces of the parts you left behind. And you try and reintegrate your authentic, innate self. And, in that process, you realize everything that ever happened to you was in service of your soul. There was never a mistake. You never were out of purpose for your soul’s trajectory. Nothing ever occurred to you that wasn’t in service of yourself. You have no regrets. And there’s nothing to forgive because everything was in service. Forgiveness is a ridiculous concept because it’s implying that, that one was given to you was wrong. And now you must forgive them. No, everything’s in service. Thank you for giving me that experience. Forgiveness implies I’m bigger than you. What you did to me, you were wrong, I’m right. And now I’m going to forgive you. How dare you, you know. Say, yes, thank you for giving me that experience. It’s always in service of our soul.

Yoshino:

So, speaking specifically about that forgiveness and you speak so passionately about it, but you know, if someone is suffering from some sort of shame or guilt, what sort of questions would you prompt to them to be able to have them question that shame and guilt and where that comes from. I’m curious about that.

Dr. Bruce Hoffman:

So, guilt is the perception, that in the past you’ve done something that’s caused others more pain than pleasure. So, the only question you need to ask is where do you think that experience that you gave that individual, where did it serve them? How did they perhaps benefit from that experience? Could you please look in the seven areas of their life? We have spiritual, which is our calling. We have relationships, social friends, we have health and beauty. We have careers, we have making money. And we have intellectual, mental development. If you feel guilty by some act you’ve done, it’s incumbent upon you to ask; where do you think that person benefited in those areas of their life that served their evolution? Keeping in mind that everything serves, everything is in evolution of the soul’s progression. So where might it have served them? Not where did it damage them? We know that there’s both sides. Yes, it was maybe painful to them, but how did it serve their evolution in the end? And if you ask those questions, which of the seven areas did they benefit, you could find? Some people because of pain, you’ve caused them, branch out and start to develop. They read, they go to courses, they connect with their family because they sort of destitute and in pain that they have to reach out to whoever they can. So, they start forming relationships back with strange family members. They form new friendships. They go online, they go to self-help, they go to retreats. They build careers around the adversity that you caused them. So, at the end of the day, you’ve got to ask the right questions of individuals.

Nobody suffers without gaining. If it doesn’t exist, the universe is not one sided. It doesn’t work that way. Which brings into question the whole victim mentality of “I’m a victim”. No, I’m not, this can provoke a whole outlandish backlash that victims will be up in arms but if you look through the lens of moral and ethics, yes, there’s victims and perpetrators. I’m not questioning that. But if you look through the eyes of the soul, there’s a balance there that’s evolutionary. And, if you look through the right lens, you can see an evolutionary projection. It’s just how I tend to see the world.

Yoshino:

No, that’s great. And I think that it’s interesting because of your background in more traditional western forms of medicine. And also, how you combined the western perspectives and also these eastern perspectives. Or what would be deemed as western and eastern. And, you’re able to eloquently, within practice, like what you do at the Hoffman Centre within practice, to be able to mold these things. And even on your bio, you said writing and poetry, which led you to the medical arts. I think that’s very important because that is what you do. Cause you’re essentially utilizing all of your experiences, your own personal pursuits, such as your pursuit of literature and poetry. And letting that inform you in a way to ask the right questions of your patients. But at the same time to ask the right questions of yourself.

Dr. Bruce Hoffman:

It’s so important Yoshino that you know to stay in an inquiring mode, a student mode. And once you have the privilege of having lived longer is you start to see patterns and trends. You’ll see an individual present with anxiety and OCD and anorexia and so forth and so on, and like a young woman in her thirties. And then you’ll see this archetypal trend that exists that she’s addicted to perfection. And she’s following the value system of a patriarchy, which is inculcated. And she’s introjected somebody else’s value system, like an overbearing father and wants it to achieve. And you see these archetypal trends emerging in your practice. And that’s based on reading, is based on literature, is based on knowing. In the ancient Greek temples, once you’ve gone through, this is in my lecture, the outer healing and the inner healing, you are then sent out into the theater where you watch Greek tragedies, which were archetypal or depictions of life. And you see these trends occurring. You see these people in certain stages. If you don’t know the stage of life the person’s in. Your first half of life patients, very different from second half of life patients. They’re not the same. They’re different flavor, different. You approach them differently. You got to be sensitive to the stage of life. And if I wouldn’t have known that. If I hadn’t been exposed to all these different paradigms of insights.

Yoshino:

Uh, I’m curious. You were speaking of liking essentially, or interested in Jungian philosophy, but also have you read a lot of Joseph Campbell? I’m sure you have.

Dr. Bruce Hoffman

Well, when I first got interested in Jungian work, Joseph Campbell was very popular. He had that PBS series, I think, in the 90’s…

Yoshino:

Power of Myth. Is that right?

Dr. Bruce Hoffman

I don’t know how old you are, Yoshino. Hahaha

Speaker 5:

No, I’m 34.

Dr. Bruce Hoffman:

You probably were. But, Joseph Campbell did the Power of Myth. It was everywhere on PBS. And we watched that series. I’ve got all the videos. We have all the VHS videos of that. I still have that.

Yoshino:

I know I’ve seen them.

Dr. Bruce Hoffman:

I still got them in my library right there. And I read his books and yes, very moved, very beautiful. He was a big influence.

Yoshino:

No, I was just curious, because you were talking about seeing certain patterns and archetypes.

Dr. Bruce Hoffman:

You do see them; you see them over and over again. It’s quite uncanny when you tune to those archetypes. And, you can see when a person is presenting with symptomatology, when it’s got nothing to do with the western diagnosis. When it’s actually a calling from the soul to wake up to a deeper transformation, that’s being asked of them. And you just get used to knowing how to have that dialogue with people and when to watch out for signs and symptoms. And know that, oh, the Lyme disease is not Lyme disease. It’s the fact that they are misaligned with, they haven’t integrated an aspect of themselves, which is calling to be integrated. They’re still living out the first half of life, dictates, which need to be given up at some stage. You can’t,  a 70 year old man in a Ferrari, that’s diagnostic. It’s just is.

Yoshino:

Yeah. I mean, I’m sure you can see many examples of that from either people that are also in your working profession or there’s so many examples of that. And, just someone having a Ferrari at any point of life, you just have to ask, like, what is the reason for that? You know, and also you can only drive one car at a time. They can’t drive two at a time, at least not from what I understand.

Dr. Bruce Hoffman:

Yeah, there’s all those clues, the history taking is filled with clues. And you just got to be sensitive to them and hopefully tuned in as much as you’re able to. And so that requires a whole new curriculum for the healers of the future. It has to be rewritten. The curriculum must be rewritten. Not to say that MDs must become healers. I disagree. Doctors should stay doctors. Stay with all that. Stay with a mechanized symptom-organ system- method medicine. Be very good at it, be the best at it. And leave them alone. Don’t ask them to become healers. Let’s have a new curriculum for healers. People are called into a different way of interrelating with their patients. And let’s have that curriculum outlined. And let’s co-exist with each other in equal exchange, which doesn’t happen. Doctors have this peculiar arrogance that what they’re not up on, they down on. And so, anything that doesn’t fit into that model, they tend to dismiss, which is unfortunate.

Yoshino:

Makes sense. I mean, it’s essentially breaking up the paradigm that if you believed in this certain way of life being educated by the system. And it creates a certain type of way that you think about the world and your perception of your space in it, essentially.

Dr. Bruce Hoffman:

Absolutely.

Yoshino:

I have one more question for you because I don’t want to take too much of your time and I appreciate you for taking the time to be on the podcast, but what sort of advice do you have for artists and creatives?

Dr. Bruce Hoffman:

Wow. I spoke to you before we got on,  that my great love is art. Now in the last 10 years, I rediscovered this huge passion, interests, and I was deeply moved by art and still to this day. Before I answer the question, I was estranged, I was South African living in Canada, and I felt deeply homesick. But as soon as I started to buy South African art with its imagery and symbology, I could bring it over and have it in Canada, I settled down, I had living symbols of my African heritage with me, and there was no such need to go back home. So, I mean, artists generally are tuned in, at a deeper dimension and they bring forth symbolic messages and are able to translate archetypal stories, like poets. When they tuned in and the higher their skill, both intuitive and skill, the deeper the symbolism, the deeper the impact on that, because we all resonate at some level with archetypal symbolism. It hits us like a break when it’s true. And it speaks to us.

So advice, I’m in awe of artists. I mean, those surrealists’ artists like Leonora Carrington. Oh, my goodness. I mean, what were they bringing forth? And what’s really going on. I’m fascinated. I believe some of their outer lives are maybe quite chaotic, but they sort of balanced it with this inner rock of their own unconscious that just pours through them. So, I think it’s an equal balance between outer neuroses, if you will. Then in a solidity and what a beautiful exchange, what a beautiful gift to humanity.

Yoshino:

Well, I mean that’s a sound observation. It sounds like you have a very deep love for and appreciation for the arts and what the arts can provide for humanity.

Dr. Bruce Hoffman

Yeah. Poetry. I mean, Mary Oliver, The Wild Geese. Oh man. When it speaks, it speaks and you just fall over into ecstasy. It’s so archetypally resonant. It’s just makes life meaningful. Provides meaning. It’s a beauty. Beauty and meaning.

Yoshino:

I agree. I agree.

Dr. Bruce Hoffman:

Have you ever seen that movie? The Great Beauty?

Yoshino:

I haven’t, no. When did that come out?

Dr. Bruce Hoffman:

Oh, it’s by that French (incorrect- Italian) director, Paolo Sorrentino. It’s about a man who gets to be in the 60s and nothing inspires him anymore. And so this whole movie is about him visiting sights and sounds. And is in Rome, all this opulence and decadence and nothing excites him. And he’s just like desperate. Until he realizes that at some stage he was moved by a great beauty. It happened to be in the form of a woman he loved. But all of a sudden, he just wakes up to some things that he’s left far behind. And he wakes up into another phase of his life, realizing how many years he’d lived in this outer world without connecting to his true inspiration. It’s a beautiful movie. Wow.

Yoshino:

You know, what that reminds me of,  have you seen Citizen Kane recently?

Dr. Bruce Hoffman:

You know, I saw it once and I read it. I’d read how perfect a movie it was. And when I watched it, I thought, what are they talking about? But after 10 minutes, I watched each frame and I immediately got the majesty and the marvelous sort of symmetry and exactness of the whole development of that movie. And I’ve got why it’s one of the greatest movies of all time. I just could see it just so obvious actually, you know, Jungian.

Yoshino:

Definitely. Well, I just bring that movie up because what you’re talking about specifically at the end of the film. I don’t think I need to say like spoiler alert because this film came out in, I think 1945 or 43, but at the end of the film he just keeps on saying rosebud. And then you find out what that symbolized to him. And so, I think, he does all these things throughout his life to attain power, to attain wealth, but then this was it, I believe it’s a sled when he was a child carried so much meaning and symbolism to him. And it’s just interesting how there’s that consciousness shift. So it just kind of sounded similar to the film that you were telling me about.

Dr. Bruce Hoffman

Well, now I’m going to watch both movies back-to-back and then keep that in mind to see the connections. Well, we live our lives through symbols and meaning in the end, the outer world is just a playground for meaning and symbol.

Yoshino:

It’s interesting. Just to leave you with this, but yeah. I’ve been meaning to crack open Jung the Book of Symbols. Is that what it’s called? I have it downstairs and I need to spend some time, cracking that open. But anyways, thanks so much for doing this and taking the time. I appreciate you for doing this.

Dr. Bruce Hoffman

Yeah, absolutely lovely. I’m going to look at your podcast and see what else you’ve done. That it is inspired me through your connection to the artists and artistry.

Speaker 2:

Yeah. You might like some of the artists, you know? All right, Bruce. Well, thank you very much. I appreciate it.

Dr. Bruce Hoffman:

Thanks for the talk. I appreciate the talk. Thank you.

The Cell Danger Response: Restoring Cellular Health with Phospholipids and Bioactive Lipids

The Cell Danger Response: Restoring Cellular Health with Phospholipids and Bioactive Lipids

Dr. Kara Fitzgerald: Hi, everybody. Welcome to New Frontiers in Functional Medicine, where we are interviewing the best minds in functional medicine, and today is no exception. I am delighted to be with a very longtime colleague, Dr. Bruce Hoffman. We’ve got an exciting sort of depth conversation planned for you today. Let me actually spell out why it’s going to be a deep conversation just listening to his extensive training will suggest where we’re going.

So Dr. Hoffman is a Calgary, Canada-based integrative and functional medicine doctor. He is the director of the Hoffman Centre for Integrative Medicine, also The Brain Center of Alberta, specializing in complex medical conditions. He was born in South Africa and obtained his medical degree from the University of Cape Town. He’s got a master’s in nutrition. He’s a certified functional medicine practitioner through the Institute for Functional Medicine.

He’s board certified with a fellowship in anti-aging and regenerative medicine. He’s trained in the Shoemaker Mold protocol. He’s a certified Ayurvedic practitioner. He’s trained in Bredesen ReCODE brain treatment, in the MAPS autism training. He’s a certified family constellation therapy specialist. He’s trained in ILADS for Lyme and co-infections.

He’s also a contributing author to the recent paper, which is available. In fact, we’ll link to it on our show notes, from Dr. Afrin’s group titled Diagnosis of Mast Cell Activation Syndrome: a Global Consensus-2. So mast cell activation is something that he’s also focused on. I actually also want to bring to your attention more, just kind of the rich depth. I mean, clearly, Bruce, you’re a lifelong learner, but I think you’ve really kind of taken these things in. I just want to give you a little more of his background.

He’s trained in Chinese medicine, and homeopathy, and German biological medicine. You almost went to get board certified in psychiatry. You wanted to be a Jungian analyst. I found that really interesting, Dr. Hoffman, in your history. And so you bring that to your work now with patients. So you did some of that training, even though you didn’t move into psychiatry, but you did some of that training. You worked with Jon Kabat-Zinn, with Deepak Chopra, with Dr. Klinghardt, with Ken Wilber.

I mean, first of all, welcome to New Frontiers.

Dr. Bruce Hoffman: Thank you, Kara.

Dr. Kara Fitzgerald: And what haven’t you done?

Dr. Bruce Hoffman: It sounds like I don’t have a life.

Dr. Kara Fitzgerald: It’s extraordinary, I want to spell it out. I know that you’re just doing this amazing work with your patients, and you’re fusing this intense training that you’ve undergone, and that you continue to experience into what you described as the Seven Stages of Health and Transformation. So it’s not like you do a weekend course and then the books go away, or the PDFs are put away.

I mean, you’re actually working with these tools and making them into something your own. And it’s called the Seven Stages of Health and Transformation. And I know that you’re working with very complex patients in Canada, and actually beyond Canada. I know people are drawn to your work from all over the place. And so, I want you to talk about the seven stages, and what your approach is to these complex patients that are coming to see you.

Dr. Bruce Hoffman: Yeah, sure. When I was a young teenager, I was exposed to a schoolteacher in South Africa who was very different. And he took us out of our sort of South African apartheid, white, privileged background and sort of threw us into … threw me in particular into an alternative universe whereby I was exposed to the world of psychotherapy, psychoanalysis and eastern thought.

And I had, at a very young age, an experience which they call satori, which is this sense of seeing space-time as a continuous whole and not seeing cause and effect as being linear. And it was a sort of … Many people have these. They are sort of called awakening experiences or high experiences. And that just sort of catapulted me into a different way of looking at things, and then initiated in me a curiosity about all aspects of the human psyche and human development and human potential.

And originally, I sort of got interested in Jungian psychoanalysis and wanted to become an analyst and went to med school only to become an analyst. And I was actually accepted into the psychiatric residency, but actually didn’t go through with it. I worked for two years in psychiatry in the military. I had to go to compulsory military training. But I didn’t actually do my residency.

And I do feel quite privileged in the sense that by not taking that particular route, I was able to keep expanding across all layers and levels of experience. And what I found was when I ended up just being a family doctor in rural Saskatchewan, and seeing the limitations of drug-based, which Majid Ali beautifully named it N2D2 medicine, name of disease, name of drug.

Once you start to see the limitations, and then you start to look at the potential of human achievement and what they can aspire to, one sort of moves out of just treating disease to trying to get your patients to look at optimal potential of their entire existence. And so, what I do now through the seven stage model is view pathology, or the so-called disease states or complex symptomatology, as this entry point into a dialogue with a patient.

But I’m also looking at other aspects of the psyche and the experiences to see what it is that their soul, if you will, is asking to come through. What is it that they’re trying to achieve? Symptoms to me are etiological. They’re sort of pointing towards hidden subjects that need to be brought to the surface. I never see symptoms as linear. I always think of them as what is the body attempting to do by throwing out these particular imbalances?

And with that approach, and using my early exposure to Ayurveda and Advaita, which is a system of Hindu philosophy that I was exposed to by the schoolteacher, and I was able to build a model called the Seven Stages of Health and Transformation, which looks at the human experience as being divided, which is a silly term, because there is no division. But it’s conceptually divided into these layers and levels of experience.

The first level being the outer world, the external environment. And that’s sort of level one in this conceptual field. And from that, we draw everything to do with what’s going on in the chemosphere, outside of ourselves, the toxicology and the infectious load. And we look at that from etiological point of view. That’s level one.

Level two is the physical structure, which is made up of biochemistry and structural aspects. And that is what we do in both traditional medicine and in functional medicine, and in all the structural modalities like chiropractic, and bodywork, et cetera. And then level three is to do with the brain, the peripheral, and the autonomic nervous system, and its electrical effects on physiology and biochemistry. And then what are the manmade EMFs effects on that.

And then level four is to do with the emotional body. And as we know, that many people have these adverse childhood experiences, which then get laid down neurologically in the brain as specific defects particularly in right frontal lobe development, and activation of the amygdala, and the fight-flight response with down regulation of the vagal nerve. And because I have this brain treatment center, you can diagnostically look at this and treat it accordingly.

And then level five is to do with ego development, how people negotiate the slings and arrows of this … The world is a tough place. We’re sort of always somewhat vigilant against the next thing that’s going to arise. And so, we develop in the first half of life a very different set of strategies from in the second half of life in terms of how we develop our ego, which is our sense of how we negotiate the world and our belief systems, our values and our defenses.

People grow up with a way of orientating themselves, but they also remain highly defended to those things which are most traumatic. And depending on early childhood experiences, defenses can be highly helpful or healthy, you could say. But they can also be highly pathological when people suppress anything that comes close to an early experience of trauma, and the so-called PTSD response.

So level five is everything to do with the ego and how it negotiates its way in the world. And the first 30 years are all about ego development and they’re characterized by certain drives, drives of the libido, drives of full power, drives to know oneself. And all the great psychoanalysts of the 19th century were very … They had great insight into these mechanisms.

But they’re now used therapeutically in a system called ISTDP, where psychologists look at different structures that people bring to the therapeutic encounter and work one on one with them in transference and countertransference to try and get behind that which they’re defending against and which is asking to be brought forward. So that level is very important.

And then level six is that what we call the soul. This is the most authentic part of who you are, the most instinctual part of who you are, which never really comes to any sort of conscious assertion until the second half of life, I would say. Carl Jung, the great psychoanalyst wouldn’t look at patients before the age of 40. He said they’ve taken up two drives. There’s no conscious awareness of their deepest self to work with. And so he wouldn’t work with anybody under the age of 40, which is rather strange, but it’s true.

Dr. Kara Fitzgerald: It’s very interesting in this anti-aging obsession that we have, isn’t it? I mean, clearly, there’s some wisdom, but keep going.

Dr. Bruce Hoffman: Yeah. So, in our personal, when we’re born and we’re born into our experiences, very often when you’re not seen by your parents adequately, and being seen by parent, you don’t have to be perfectly seen but a good parent who will always support and challenge a child accordingly. But if there’s any neglect or abuse and neglect-trauma appears to be even more traumatic to a child, an abuse trauma.

The child will develop a provisional self, an adaptive self to go out into the world in order to achieve what it’s meant to achieve. But the authentic self, the instinctual self will often go underground and then be hidden by these defenses and this comes up. I can’t tell you how many people present to me in sort of midlife … Midlife being anywhere from 35 to 55. It starts at somewhat of a younger age when entropy starts to set in.

And they are being driven to ask deeper questions of themselves and to reclaim those parts of themselves, which they know instinctively, they left behind in their pursuit of safety and being seen. So their provisional selves go out, achieve something in the outer world, but there’s something crippled and something quite damaged, or well preserved. Some innocence, well preserved, but it’s hidden from sight.

And people in midlife generally kind of know that. And they want to often go back and retrieve those hidden parts of themselves that they know are manifesting as symptoms, but they have no conscious connection with them. So part of the work I do is trying to find out what … I don’t ask this question out loud, but I’m asking it while I’m interfacing with a patient is, what are these symptoms telling me, and what does the soul want?

What is the innate wisdom and innate creativity of this patient that needs to be brought to the forefront? And that’s the fundamental question that sits there while I’m looking at all the functional medicine, toxicology, biochemistry, hormones, mitochondria. I’m always having these conversations in my head, what does the soul want? What is being asked of this person? What do they need to manifest in order to bring parts of themselves back home?

And that is the second half of life quest really, how do you gain your creative, instinctual self. And not only that, but there’s also another hidden part and that’s a hidden part of your family system. Family systems carry secrets and carry hidden entanglements that often manifest themselves epigenetically and get expressed through biochemistry as symptoms.

And I’ve done some marvelous work with, or I haven’t. But I’ve partnered with Mark Wolynn, who is an exceptionally gifted functional family constellation practitioner. And we looked at, once a year, we used to do a workshop where we looked at the symptoms of patients who came to my clinic and try to link them to any inner entanglements or the family system two to three generations before the patient is even born.

And it’s extraordinary what entanglements you find and what dynamics you find, which can manifest as symptomatology in the patient. And this research is very well established now to all the major universities, that there’s an epigenetic chapter of trauma through the generations. And then lastly, is spirit. The level seven is the spiritual body. And that’s the part of ourselves that’s transcendent to any ego-based space-time demands. And that’s where you surrender to some intelligence greater than yourself and just sort of stay open to that potential. And that’s sort of the whole realm of what we call the one mind beyond space-time.

So I use that model. So when patients present, I’m just trying to sense, they come … One of the great tragedies that I find, or one of the great challenges, not tragedies so much as challenges, is that when you become well versed in functional medicine, people will present and they’ll write in their entry forms. You ask them, “Why are you here?” And they’ll say, “Well, I’ve got mast cell,” Lyme or mold, and whatever.

And they will sort of have reduced their entire symptomatology to what they believe to be a lab test or a symptom that they’re experiencing. And it’s never the case. It’s never the case. Those are just inquiries as an entry points into a much deeper dialogue, in my experience. And so, I’m always curious. Yes, you may have a trigger called Lyme or a trigger mold and mast cells have gone awry. Yes, that’s true.

But really, what’s the deeper reality that we need to sort of work with? And sometimes I get to it, and sometimes I don’t. Sometimes I just treat mast cell, and Lyme, and mold and be done with it. But other times, not. Yeah, sorry?

Dr. Kara Fitzgerald: I mean, what an extraordinary entry into our conversation, thanks for all of that. I mean, it’s amazing. And I can just tell that you are sitting with all of these levels. And I think that, in functional medicine, they talk about gathering before the patient encounter.

Dr. Bruce Hoffman: Yes, that’s right.

Dr. Kara Fitzgerald: And I can hear that you’re gathering at all of those levels, which creates a possibility in the encounter. It’s been extraordinary. So is this written? Have you written about this? Have you-

Dr. Bruce Hoffman: Yeah, I’ve written. I’ve got podcasts with transcripts, and I’ve written a book, which unfortunately, sits on my laptop.

Dr. Kara Fitzgerald: You can link to it on our show notes then. I’m kidding. But it’s powerful. And, well, we’ll bug you about it so that we can link to what you’ve got available in our show notes. It’s an expansion on functional medicine principles in a very important way. So that was one question. And then the other thought that I was having and you started to touch on is, so the presentation, this phenotypic presentation of mast cell activation, or Lyme, and it’s true that our patients will come to us with pretty rigid ideas on this, and what it means.

And as you said, either you move beyond it or you don’t, and you address it and life goes on. But you alluded to in the beginning of your unpacking the seven stages, you alluded to sort of these as having information in and of themselves, like what kind of a … Is there kind of a personality type or somebody who comes with a certain type of a family constellation structure that might be more vulnerable to Lyme and co-infection or might be more vulnerable to autism or MCAS? And can you speak to that?

Dr. Bruce Hoffman: Well, the interplay is complex as you know, from genetics to diet, to sleep, to rest, to toxicology. And to ever increasingly, obviously, to early developmental experiences. I can’t emphasize how profound those experiences play on auto-expression of biochemistry. It’s unbelievable.

Dr. Kara Fitzgerald: I want to just say as an aside that I am with you on that. I mean, we’ve just published a study in looking at DNA methylation, so looking at the epigenome. And one of the things that’s just stopped me in my tracks is this idea of biological embedding, which is exactly what you’re talking about, where the signatures of the psychic experience are laid down on the genome.

Dr. Bruce Hoffman: It’s quite extraordinary. And if people come and they see me, say for mast cell, and then they find themselves doing acute EEG, and the NeuroQuant MRI, and doing neuropsych questionnaires and they go, “Why are you doing all this? I’ve got mast cell.” Well, mast cell is the expression of your, mitochondria undergo the cell danger response. They released ATP, ATP caused the granulation of the mast cell, and the release of a thousand mediators.

So yes, you had mast cell activation syndrome, but what’s underlying, what are all the triggers in functional medicine, the antecedents, mediators and triggers that provoked this mast cell to go crazy? The brain is the interface between one’s epigenetic and early developmental experiences, and one’s outer experiences. The brain is the interface, and if you look at acute EEG, and even a NeuroQuant MRI, you can read biographies of those. They’re so alarmingly informative.

And so, I look at a body-based stress assessment. I look at heart rate variability, as we all do. But then I look at acute EEG, and I look at this sort of juxtaposition of the delta-theta-beta-alpha brainwaves, and you can really see imprints of early developmental trauma. And you can see people who are stuck in fight/flight responses, people who stuck in Porges’ polyvagal, dorsal vagal responses.

You can see it right there in the biochemistry and the physiology. And you know that that person, say, who’s stuck in Porges’ dorsal vagal shutdown response, that’s a whole different patient and somebody who just got a few allergies. You’re dealing with a whole different kettle of fish there. And you can’t just jump right in and just do your normal functional medicine and try a few supplements … It’s a whole another experience, which you have to be sensitized as a practitioner to those layers and levels of complexity. And I use these tools to interpret it.

If you look at it and do a NeuroQuant MRI, you can see the amygdala hypertrophy at like 97 percentile. It’s like twice the size of the standard, the paired match group. You can see amygdala hypertrophy. You can see the thalamus hypertrophy, and the thalamus is rich in mast cells. You can see white matter being decreased, and so forth and so on. You can see all sorts of fingerprints of these complex triggers that can create symptomatology in these complex patients.

Dr. Kara Fitzgerald: Absolutely. It’s just extraordinary. So somebody comes in a typical allergy, seasonal allergy, maybe they’re bad, and so you’ll just treat them accordingly and get them balanced, but it’s relatively straightforward. But you’ve got somebody else also coming in and sneezy, allergic, et cetera, et cetera, but you diagnose this amygdala imbalance. I mean, you go down this whole different direction. Just roughly describe your entry into treatment with these two, with similar phenotypic but very different underlying causes.

Dr. Bruce Hoffman: Well, first of all, I don’t see patients anymore with just simple allergies. I wish I did. But those, I would just treat with H1 or H2 blockers, and Quercetin and vitamin C like all of us know how to do. But people with complex illness who have these multiple layers and levels of imbalances, I throw quite a large diagnostic net. I mean, I do a lot of tests. I’m criticized for it because of costs. But I also know myself well enough to know that without it, I’m going to be just another practitioner along the long chain of practitioners who took a little swipe at something and didn’t get much done, and didn’t look at the complex interface of all the different parameters.

So I do throw a large diagnostic net and do ask for the tests we know so well. Food sensitivities, gut microbiome, histamine levels, zonulin, DAO. I do all the mast cell mediator markers. I do all the ION panels and things like levels in methylation. I do all of that. I look at toxicology.

But I also do quite a lot with the brain, heart rate variability, autonomic nervous system functioning, and often refer for psychometric assessment to look for psychiatric diagnosis, whether they’d be cluster B personality disorders or whether they’d just be mood disorders. So I refer out for those. And I gather all this data. I also refer a lot to dentists and chiropractors particularly NUCCA chiropractors, visceral manipulation therapists.

We do a lot of diagnostics and trying to gather an insight into what hierarchically will be the entry point into this person’s therapeutic experience. I left out the most important, which is I look, apart from food and gut, which of course trumps most things. We look at the mitochondrial functioning and we look at the fatty acids because as you know, the mitochondria, the canaries in the coal mine, and they’re the first thing to sense any danger whether the danger is perceived or real, chemical or imagined.

And we have this credible capacity now through the IGL test in Germany to look at mitochondrial functioning and through BodyBio or the Kennedy Krieger fatty acid test to look at fatty acids. And those are the two tools that have trumped everything else in my practice.

Dr. Kara Fitzgerald: Wow, what is that? Tell me just briefly what the IGL is and then we can link to the … And the Kennedy Krieger and we’ll link to both.

Dr. Bruce Hoffman: So before this test came along, we in functional medicine would look at mitochondrial dysfunction, all we really had was a cheek swab. We had the organic acid test, but now we’ve got this ability to look into about 300 lab parameters that tell us the following: A, mitochondrial numbers, if they’re normal or if they are low in number. And mitochondrion, as you know, when they’re low in number, they must be undergoing some form of autophagy or cell death which ties into Naviaux’s cell danger response theory, that when we’re under threat, perceived or real, mitochondria start to self-destruct and release their ATP extracellularly, that then sends off a whole inflammatory cascade that oxidizes lipid peroxide, cell membranes and leads to this innate immune activation, mast cell activation, et cetera, et cetera.

Dr. Kara Fitzgerald: What’s the specimen? What’s the specimen for that test, sorry?

Dr. Bruce Hoffman: Blood. It’s a blood test.

Dr. Kara Fitzgerald: Both are blood tests, okay.

Dr. Bruce Hoffman: Yeah. So, it goes off and then they measure ATP production. They measure percentage of ATP that’s blocked. They measure cell free DNA. I mean, DNA that’s outside the cell shouldn’t be there.

Dr. Kara Fitzgerald: Where it shouldn’t be here.

Dr. Bruce Hoffman: They look at DNA adducts, toxins sitting on the DNA interfering with protein expression, interfering with the DNA expression of all the factors that go to make up messenger RNA and enzymes, et cetera, et cetera. It looks at phospholipid production. Phospholipids, phosphatidylcholine genome, most potent of all the cellular membrane ingredients.

It measures phosphatidylethanolamine, the phospholipid on the inner membrane which transfers electrons and the electron transport chain. It looks at outer phosphatidylcholine. It looks at cardiolipin synthase enzymes to see if they are making cardiolipin which is part of the inner membrane. It looks at whether you have what your amount of cardiolipin is so you’re looking at your phospholipids content.

It also looks at mold markers, markers for fungal metabolites. It looks at microtoxin metabolites. It looks at superoxide dismutase level. It looks at occupation of cell membranes. It looks at glutathione peroxidase, glutathione transferase. It looks at cell membrane voltage, incredibly helpful. When you’re looking at membrane voltage below 170 millivolts, it’s like 150.

And you’re looking at intracellular calcium excess or magnesium-potassium deficiencies. It looks at methylthionine levels. It’s incredible insight into toxicology and mitochondrial homeostasis. And from that, combined with the Kennedy Krieger fatty acid panel, which looks at your polyunsaturated omega 3, omega 6 levels, and it looks at renegade in very long chain fats and it looks to see if you’re myelinating adequately, et cetera, et cetera.

You can really transform a person’s biochemistry into something that ships them from this so-called cell-doubt, cell-danger response into a healthy response. And it takes an average four to six months of hard-work. But if you address the mental, the mind-body, the defense, the psyche and the biochemistry and toxicology in a hierarchical manner, and sometimes you got to stop biochemical work and you got to go work psychologically or even spiritually sometimes.

But if you start working with complex patients in this way, you’ll very soon know when to stop by a chemical work and to work at another level. If you’re sitting behind a desk and the patient is in front of you, and you’ve done beautiful biochemical work and you know that your work is impeccable and the patient is still sick, you know you’ve addressed the wrong level and it’s time to look at another level.

Dr. Kara Fitzgerald: I would imagine that you’re not … I mean, you said hierarchical, and I think that is true. But you’re doing it concurrently as well. I mean, you must be.

Dr. Bruce Hoffman: You always are. You always do it concurrently, but you learn to sense when it’s time to address, say, amygdala overactivity and vagal nerve shutdown as opposed to doing intravenous lipids and butyrate. Sometimes you’re doing all these beautiful biochemical interventions repeating the nutrition, food, gut and hormones and the patient stays resistant and/or hyperreactive.

And then you know they got an overactive amygdala and/or underactive vagal nerve. And so, you’ve got to shift focus and go down a different path. And just having done this for a long time, I’m sure you have experiences. You get to know when you probably are working at the wrong level.

Dr. Kara Fitzgerald: Yes, it does. This is such a simple thing, but in my residency, we don’t do IV therapy in my clinic here in Connecticut. We mostly do telemedicine these days. But in my residency, back when you and I used to talk, that was also in a clinic setting as well. And just that IV experience, I thought about it because I know you’re doing IV. We set up the environment to bring the energy down and so, even for those individuals who don’t want to hear it, that there’s a psychological component to their presentation.

There’s sort of backdoor ways to enter into that healing relationship or that healing, meeting the needs for healing in that space even when patients don’t want it.

Dr. Bruce Hoffman: It’s such a dance that goes on in this complex relationship between the so-called healer and the one who’s coming for your help. That if you’re not cognizant of the complexities that may arise, one can attempt to impose therapeutics onto a patient when the psyche is not intending to cooperate. It has no intent to allow that vulnerability.

And if you don’t know sort of the trauma of that person, the defenses, the fragility, the resistances, you can often rarely get into a difficult therapeutic encounter. And so it behooves us as healers, whatever the word may be, to stay very conscious of our own projections and our own inabilities and our own blind spots when we’re interfacing with patients.

And yes, they may have amygdala upregulation. They may be fragile and highly resistant. But does that mean that we get rid of them and say, I can’t help you anymore? Does that mean that we have to dig deeper into our consciousness to try and meet them where they are. And if we can unlock the door that’s previously been not open to them, we can assist in unlocking that door, there’s an incredible flood of therapeutic material and healing material that gets unleashed.

So I don’t like to do neuro biofeedback and amygdala training. If the psyche of that patient isn’t receptive to it, so it-

Dr. Kara Fitzgerald: Absolutely.

Dr. Bruce Hoffman: … a lot of conversation and a lot of negotiation sometimes around some of these issues. And people can remain hyper reactive and highly fragile and resistant. And that behooves us to just stay with that patient if we can until something shifts in the psyche and so often it does. Often it does.

Dr. Kara Fitzgerald: Yes, that been my experience as well that when they don’t achieve what they came to me to achieve or they get through some but not all, then perhaps they are open to a broader inquiry. I want to just ask, so I want to talk about, I want to get to your interventions. I know people will be very interested in how you’re addressing some of the mitochondrial issues that you’re seeing. But I just wanted to ask in your time and practice …

I mean, your practice now is self-selecting for challenging cases because you’ve been doing this for a long time and you’re just recognized as an expert, but are you also seeing sort of uptick in these kind of complex patient presentations?

Dr. Bruce Hoffman: It’s all I see now and sometimes, I wish it wasn’t.

Dr. Kara Fitzgerald: Right, I want to go back to insulin resistance case there.

Dr. Bruce Hoffman: Hormone replacement therapy, sure. But I am excited by the challenge. As you know, there’s no rest. I’m in my 60s and I don’t think I’ve studied more now. I mean, when I was a young medical student, that is nothing. This is boot camp all over again. You better stay ahead of all the research and all the latest series and all the latest issues that come across us.

But yes, am I seeing more complex cases? Absolutely.

Dr. Kara Fitzgerald: And there’s a change though, would you just say there’s sort of a change in the challenge of cases? I mean again, just going back to when you and I talked a lot, SIBO might be a challenging case. But those days seem …

Dr. Bruce Hoffman: SIBO is like one of 24 things that need to be looked at. As we’ve expanded our diagnostic possibilities and as new researchers have come up, Afrin and his mast cell activation syndrome along with the other writers and the other researchers, that’s thrown a huge level of insight into a certain presentation that we didn’t have 10 years ago. So, we have that and Naviaux’s mitochondrial cell danger response, unbelievable what that’s done to our consciousness as practitioners.

It just opened up … Now, before when we did functional medicine training, we learned about food, gut, hormones and nutrition. But now, that’s a subset within a subset of complexity. And that stuff, we have to know backwards, otherwise, we can’t get to anywhere. But what else do you bring to the table? And now, we’ve got to bring in all these other things, all these other factors into the healing relationship.

And it is far more complex. There are a lot more sicker people. And they are still looking for N2D2 solution. Even the ones who are educated, they will come and say, “I’ve got mold, Lyme, as I said in the beginning, and can you treat it?” I say, “Sure. But is that what you really have, or is that just what’s showing up as a presenting feature?” People come with false positive antibodies on Lyme test, and they say, “I got Lyme.” “Oh, it’s three on the Armin Lyme EliSpot. Is that really Lyme disease? Is that a false positive?”

And so you got to know all these subtleties. You got to constantly be in touch with the researchers and the lab directors and you got to listen to all the experts in our fields. You got to shine the light of the single aspect. And you got to know how to incorporate that clinically in patient because patients are smart now. They come with all their research.

Dr. Kara Fitzgerald: Yeah, they are.

Dr. Bruce Hoffman: And they know stuff and sometimes, it’s misguided. Sometimes, it’s spot on and they intuitively can often sort of guide a path that is previously hidden from you. They were often uncovered and helped shine a light down a certain pathway. People are smart.

Dr. Kara Fitzgerald: I want to talk a little bit about your approach. I mean we could look at mast cell activation or I mean, the mitochondria. The conversation I think is pretty provocative and one that’s interesting. I mean, are there core biochemical imbalances that you’re looking for?

Dr. Bruce Hoffman: Absolutely, yeah.

Dr. Kara Fitzgerald: Can you just talk about some of these? Let’s pull together somebody with mitochondrial dysfunction, like I want to just kind of pull together how you’re going to address it and maybe what you’re looking for in laboratory and other tools of evidence and then how you’re actually addressing it clinically?

Dr. Bruce Hoffman: Yeah. When people present their history, two, three-hour history, you do your biochemical workup. Take a very extensive dietary history. Usually get dental workup, get sleep studies, NeuroQuant MRIs, brain studies, et cetera. And once you have those in front of you, what do you do first of all? The first thing I do is always look, I use my traditional medical insight and I look at straightforward pathology.

Free T3 is low and the TSH is high, B12 is low. I’d look at straight biochemistry and I never bypass it. I pay very close attention to traditional medicine’s biochemical imbalances, and look at nutrition in great detail. And it behooves us now with all these complex illnesses to know all those approaches to nutrition that are out there whether it’d be GAPS or paleo autoimmune low histamine, et cetera, et cetera.

So, I look at traditional biochemistry. I look at nutrition and then I use nutritionist chef health coach, Justine Stenger, on our staff to take a dietary history and start to introduce a dietary approach which is commensurate with their presentation. And most of the time, it’s a paleo autoimmune low histamine diet, sometimes low FODMAPs, sometimes low oxalate. But generally, I find getting people off some of those major foods that are inflammatory and getting onto paleo autoimmune low histamine diet quietens the microbiome to an extent that we can begin to repair.

So, traditional biochemistry, nutrition, dietary approaches and then start to look at all the things that most functional medicine doctors look at. The food sensitivities, status of a gut, nutritional levels, macro and micronutrients, antioxidants, toxicology, heavy metals, chemicals, mold, fungi, mast cell activation in great detail, and look at hormone levels.

And I look at hormones in three distinct compartments. I don’t just look blood levels. I look at blood, saliva and urine all on the same day to look at the different compartments of how hormones are attached to transport proteins, how they show up at the cell surface and how they get metabolized through the methylation pathways. I’ll look at all three to start with.

And then I look at infectious agents, and I tend to do quite extensive infectious disease workups, both B cell and T cell assessments. I find if you just do T cell, do ELISpots, it’s not enough. And if you don’t do B cell, you often get very confused and go down the wrong pathways.

Dr. Kara Fitzgerald: What tests are you using? Tell me what tests are you using?

Dr. Bruce Hoffman: I’m using the ArminLabs. I do the ELISpot, and I use IGeneX. I do the IGeneX ImmunoBlots and I do the co-infection panels. I use Galaxy labs for the Bartonella. And I do also use MDL labs for some of the other infections, Garth Nicholson’s lab. Those labs are usually used to look at infectious load. And then, so once I had that diagnostic roadmap, and then therapeutically as I said, I’d correct any traditional metabolic imbalances, thyroid, hormone, whatever.

Dr. Kara Fitzgerald: So, you’ll start … So, you’ve got diet. And then you’re going to start them on some thyroid if they need it, some magnesium, some B12, et cetera. So, you’ll do those foundational first step?

Dr. Bruce Hoffman: Yes. And often if there’s great dysregulation in the qEEGs and/or in the stress assessments, and/or in the MoCA cognitive assessment or the CNS vital signs or TOVA, I’ll often start them in neurobiofeedback. I’ll start them on biofeedback programs and start them on neuromodulation techniques using different devices that we use from traditional feedback to Vielight to photomodulation. We’ll use different techniques.

So I often start those concurrent with food and traditional interventions whether it’d be hormones or nutrition. And if the toxic burden is extremely high, I never go ahead and start to detoxify them day one. And I never treat infections in the beginning. Even though Naviaux is very clear that unless you get rid of the threat, you’re not going to change the cell danger response.

So, I usually start out by using oral and intravenous lipid therapy or membrane therapy to try and provoke a mitochondria backing to more of a healing response. And I found that profoundly influential and help in patient outcomes.

Dr. Kara Fitzgerald: What is that?

Dr. Bruce Hoffman: I do a power drink or a membrane stabilizing shake, if you will, where we put into a blender phosphatidylcholine from BodyBio. BodyBio is the only phospholipid I use because of its very high phosphatidylcholine content, which doesn’t break down in the gut. And it contains the phosphatidylethanolamine. It contains all the subfractionations of phospholipids.

So, I use BodyBio phospholipids and BodyBio balanced oils, usually the 6:3 ratio and 4:1 ratio. You put that in the shake along with minerals and electrolytes and then any other ingredient that has shown up in the test that could be instrumental at restoring some homeostatic imbalance. So for instance, if they have low aminos on the ION panel, we use amino acids. If they have low glutathione, we use liquid glutathione as well as oral glutathione as well as oral NAC, all the standard things we learn as functional medicine doctors.

We put in tons of Resveratrol if we can. People tolerate it. And we use usually half a cup or quarter cup of blueberries. We found most people don’t seem to react adversely to blueberries. And then learning from Dr. Kharrazian, we chop up … On a Sunday, I advise patients to go and get every vegetable they like provided it’s not histaminic or oxalates or something on their testing shows they shouldn’t. Organic, chop it up, put it into the freezer. Every day in your shake, you take a couple of tablespoons or half a cup and you put that into the shake with the phospholipids.

And then that becomes a liposomal polyphenolic compound that then crosses the blood brain barrier and exhibits this antioxidant effect intracellularly. So, that’s been a gamechanger for my practice along with intravenous therapies. I start with very, very low dose phospholipids, sometimes vitamins and minerals just to provide the micronutrients for the enzyme systems, sometimes with intravenous amino acids.

But generally, I move over slowly but surely into phosphatidylcholine and glutathione intravenously, not to provoke a massive detoxification response but to try and repair cell membranes. Cell membrane repair is better done with oral phosphatidylcholine, but the IV phosphatidylcholine conjointly with the oral not only helps the cell membrane repair but it also starts to gently sweep adducts off the toxins that are sitting on the DNA of the mitochondria.

But it’s not aggressive. It’s very gentle. Later on, we start to use butyrate and other short-chain fatty acids to further the removal of adducts in toxins.

Dr. Kara Fitzgerald: How are you introducing those?

Dr. Bruce Hoffman: Intravenously and orally. I use them quite a lot. I use oral butyrate and IV butyrate quite a lot.

Dr. Kara Fitzgerald: What’s the oral butyrate? I mean, it’s kind of smelly, but in a capsule like in an enteric-coated capsule? What do you-

Dr. Bruce Hoffman: You can get different kinds. There’s the cal-mag butyrate. There’s the sodium butyrate. There’s sodium potassium butyrate. So, you got to look at the electrolyte balance of the patient and then introduce the specific butyrate formulation that is going to be most helpful for that person’s biochemistry.

So, if they’ve got intracellular calcium deficiency, you’re going to use the calcium one. If they have POTS syndrome … By the way, that’s one of the greatest. One thing I learned 10, 15 years ago was to make sure every patient does the 10-minute, cheap, lying standing test. If you misdiagnosed POTS, that patient is never going to get better.

And I know you’re familiar with it but I do suggest that any young or new practitioner, just get yourself an Omron blood pressure cuff. Every patient that comes in your door, lie them down, do their blood pressure and their pulse after they’ve laid down for a minute or two. Stand them up one minute, three minutes, five minutes, 10 minutes, look at their blood pressure and pulse and look for drops in systolic blood pressures and look at rises in pulse rates.

And those patients don’t perfuse the mitochondria or the brain and they won’t improve until you get increased perfusion to their cellular structures into their brains. They just won’t. You have to treat that first.

Dr. Kara Fitzgerald: And are you addressing it with this protocol?

Dr. Bruce Hoffman: I address that with the standard POTS approaches with increased fluids with salt, a lot of salt, two to three teaspoons of salt. Salt sticks compression stockings and I liberally use Florinef and Midodrin and other medications. And it’s a gamechanger. It’s absolutely a gamechanger in certain patients.

And many people are misdiagnosed. There’s a combination of sort of different … You can get orthostatic hypertension. You can get postural orthostatic tachycardia syndrome, and you can just get pure tachycardias. And they’re different and if I need to differentiate, I send them to cardiologists.

And we have one particular one in our city who does tilt table testing. He’s written lots of papers, very experienced. And so we refer to him to sort of introduce further medications if need be. And patients always know about the triad of dysautonomia and mast cell and gastric motility issues. Many patients present with mast cell activation, POTS, and Ehlers-Danlos syndrome with dysautonomias and gastric motility issues. And they’re called triad or pentad patients as per Afrin’s group.

Dr. Kara Fitzgerald: Why are we seeing more of these people?

Dr. Bruce Hoffman: I think the stresses imposed upon our modern society are overwhelming our defenses. We just become extremely vulnerable to this incoming toxic load. We’re not genetically resilient enough to withstand this onslaught, whether it’d be electromagnetic fields or chemicals or foods. Even the fact that we could open the fridge five times a day, eat what we want, I mean that’s a stressor on our system, it’s unbelievable.

We’ve got out of sync with our innate biorhythms and there’s been a huge movement in the functional medicine community through biodiversity and regenerative agriculture. And we’re paying lip service to this need, but I don’t know. I think our DNA and I think microbiomes will eventually adjust to these incoming onslaughts. I don’t think we’ll be extinguished. It always appears that stresses on the system create greater resilience down the line and barring a sort of huge six apocalypse. I think we will become more resilient as we sort of evolve through this toxic phase that we’re going through.

But right now, I think we’re very vulnerable and we are under a lot of stress, under a lot of toxic load.

Dr. Kara Fitzgerald: Well, we’re kind of heading towards the end of the podcast. This is to clinicians, and so this is going to create a lot of interests in your approach to care. I guess I have two questions. One is, where do people learn more about this model that you’re working from? This sounds so powerful, and I certainly appreciate you’re casting a very wide net and people are coming to you because of that and so forth.

But as you described such a careful start to the journey … By the way, we’re going to try to piece together that shake recipe. That was so awesome. We’ll put it on the show notes, people. It’s just the most sophisticated shake yet, so I want to see if we can pull that together and put something on the show notes.

But I mean you must be seeing some pretty good outcome just after this evaluation and you’re pushing the ship from the shore. I mean you must be seeing some good change. And if not, I’m sure you’re just really going back to rethinking.

Dr. Bruce Hoffman: I don’t have a research assistant in my office, so it’s hard to know outcomes. One believes that one’s practice is achieving remarkable outcomes, but I think unless you have a statistician in there, a hardcore research, we’ll never really know. But what I’ve noticed … By the way, a lecture I did is on my website. I lectured to the ICI Conference and it’s on my website. We are doing one and a half hour synopsis of the seven stages.

Dr. Kara Fitzgerald: Okay, perfect.

Dr. Bruce Hoffman: I think it’s the most insightful sort of snapshot of the levels and layers and complexity that’s possible. So, the outcomes we have from what I can tell, because one never really knows the drop-off rate. I don’t think it’s very large. When patients present with complex illness and you do your due diligence and you throw the net far and wide and the patients can keep up with it, and many patients can because they’re so educated and so driven, they’re so sick and tired of seeing hundreds of people and not getting any better.

And you’re looking at your data and you’re looking at mitochondrial function and fatty acids function and ION panels and things and you do repeat them from time to time. It has been my experience that within six months on average, on average, the test itself reverts from highly problematic to restored function, the IGL test. You will see mitochondrial numbers go from low to normal. You will see phosphatidylcholine go from extremely low to normal. You will see glutathione levels come back. You will see microbial toxins disappear. You will see mercury, lead, cadmium, glyphosate levels disappear.

But concurrent with that, the patient will tell you, “I feel completely different.” And we keep objective, we do different score systems. But I use the old MSQ from IFM. And patient’s levels drop from 180 to 20 once you start working from the mitochondria outwards into the whole complexity of the mind-body and familial inherited system. If you start using a broad map and you just don’t run down too many rabbit holes, and you keep your head above you and you just work it through. And if you hit the blank wall, you just ask more questions. You don’t give up.

Somewhere along in that experience, the patients, they feel better, their symptoms improve and they move through that cell danger 1, 2, 3, into the cell danger 3 response, the healing response. And they feel amazing. We have a large amount of patients who do experience that once they’d gone through their process, but we always preface it with, “Look, this is only as successful as the amount of effort you put in. If you stay passive, there’s nothing we can do. You have to be a cooperative partner in this experience. If you have side effects, you don’t throw baby out with the bathwater. You come to the table. We find out what happened, and you work through this process. And if you can’t, you get yourself somebody, an advocate, who can help you.”

In that sort of dynamic and with the staff, the great staff I have and the support systems and the ability to rerun lab tests from time to time, I would hazard a guess that the majority of our patients get better, the majority. I wish I had the statistic to tell you, but I don’t.

Dr. Kara Fitzgerald: Maybe now is the time to get a PhD student in your practice. It would be really nice to gather. I know you’ve been at this for a long time. It’d be nice to maybe get some data.

Dr. Bruce Hoffman: I think I should, yeah.

Dr. Kara Fitzgerald: Yeah, get a student, that good PhD work. Well, Dr. Hoffman. It was just really lovely to connect with you and talk about this. Folks, we will gather as much as we can for the show notes and link over to the site to some of the content that he’s referencing. And if you think of anything else, just let us know. Thanks for joining me today, for this really nice dive into what you’re doing.

Dr. Bruce Hoffman: Thanks, Kara, and nice to speak to you again after all these years.

Dr. Kara Fitzgerald: Right, absolutely. And hopefully, I’ll see you in person at AIC, not this year but next year.

Dr. Bruce Hoffman: Yeah, maybe, who knows? I quite enjoyed this sort of remote telemedicine, teleconference …

Dr. Kara Fitzgerald:  Thank you kindly, for your time. Much appreciated.

The podcast was originally posted on Dr. Kara Fitzgerald’s website here.

Heal Your Chronic Illness and Take Your Life Back

Heal Your Chronic Illness and Take Your Life Back

Mary Vallarta:

Hey everybody. Welcome back to the virtual summit. I’m your host, Mary Vallarta.  As you know, we are here to talk about healing your chronic illness and taking back your life.  Basically how to balance your mind, body, and spirit to restore your health and vitality.

Mary Vallarta:

Today I have Dr. Bruce Hoffman and I am super excited to chat with him. Before I get into the questions, let me tell you a bit about who he is. Dr. Hoffman is board certified in anti-aging medicine, has a master’s degree in clinical nutrition, and is a certified Functional Medicine practitioner. In addition to his clinical training, Dr. Hoffman has studied with many of the leading mind, body, and spiritual healers of our times, including Deepak Chopra, Osho, Ramesh Balsekar, and John Kabat-Zinn. He has shared the stage with Deepak Chopra and Dr. John Demartini, and he continues to spread his inspiring vision of healing and wellness with audiences and patients around the world. Once ensconced in the practice of family medicine, he quickly realized that his interests in medicine were broader than just drugs and surgery. The allopathic medical practice was limited to treating symptoms and illnesses but fell short of restoring the patient’s health entirely. So Dr. Hoffman embarked on a journey to understand what constitutes the human experience and what the triggers and mediators are that perpetuate human suffering.  He wanted to do this not only to help patients be free of disease but to realize their maximum potential.  Dr. Hoffman welcome. That is quite a resume.

Dr. Bruce Hoffman:

Nice to be here.  I’m looking forward to this conversation and seeing what we can come up with.

Mary Vallarta:

Me too. I’ve been looking forward to this conversation. I’m super energized to be speaking with you. Let’s get into it.  Dr. Hoffman, I love how you’ve combined the strengths of Western medicine with the mindful and spirit-centered approach of Eastern medicine. As your bio states, you didn’t actually start out this way. You were practicing Family Medicine. What pushed you to go into the path of functional and integrative medicine that takes mind, body, and spirit into account?

Dr. Bruce Hoffman:

Well, the part leading to where I am now is quite interesting in that when I was a young boy in my teenage years, I went to boarding school and I had a teacher there. My teacher was very interested in not only Western psychology, particularly the work of Carl Jung but also very interested in Eastern mythology and religions, particularly the work of a subset of the Vedantic Hindu medicine called Advaita. Advaita takes the point of view that there is no “there out there”. Everything springs from one source. So there is just one mind, one consciousness, and there is no separation. It’s a very specific way of looking at reality. Many of the quantum physicists who came onto the scene at the turn of the century had a very similar point of view. When they dissolved matter into light, they said, all light is continuous. There is no separation

Dr. Bruce Hoffman:

So this ancient, theological concept, was being married with Western physics. My teacher, Roger, I just hung out with him and we explored all these things and so I became very interested. When I was about 15 years of age, I had what they call a Satori experience, where I directly experienced this One Mind, One Reality. It descends upon you, and you just know that to be true. Before too long, you descend back into your dualistic past, present and future, gain and loss reality and the awareness is lost.  I still remember that. Then I had a second experience like that in my thirties. So having had two experiences of One Mind, One Reality. It sort of cemented, in my body based understanding, that was behind all systems of appearance.

Dr. Bruce Hoffman:

Nonetheless, I continued my high school education. My mother applied for me to go to med school. I had no idea. I find myself in med school. I wanted to be a poet, go hang out with all the beat poets in San Francisco, but my mother thought I should have a more formal education. So she applied for med school and I found myself in med school. Actually, after six years of medical training, I became a Family Physician and fell in love with it. I actually loved what I did. I ended up in Saskatchewan, Canada, practicing Family Medicine. When I got to Canada practicing Family Medicine, it was very apparent that that system of medicine is very limited in terms of what you can offer. We call it the N2 / D2 system of medicine. Name of disease, name of drug. That’s about it.

Dr. Bruce Hoffman:

But what happened was then I also came across a video by Dr. Larry Dossey, one of the great thinkers of the last 50 years in the field of integrative medicine. I watched Larry Dossey sort of draw out this long explanation as to how he combined East and West into his medical practice and his thought process. That triggered another huge explosion of interest and reignited my childhood experiences with my high school teacher and Advaita and psychology. All of a sudden this whole roadmap just opened up and I thought, this is a very interesting possibility. So I then just started learning as much as I could about the human experience. I became a student of as much as I could possibly absorb across all spectrums of human reality from toxicology to illumination. I started to develop a roadmap and with different teachers and different experiences and different ways of seeing and being exposed to different systems of information.  I did Ayurvedic training and they talk about different bodies, different systems of the body.  I spent time with a very well-known doctor from Germany who lives in Seattle by the name of Dr. Dietrich Klinghardt.  I spent years studying with Deepak Chopra and David Simon, et cetera, et cetera. And I just started to develop a roadmap for looking at the human condition from traditional medicine, then expanding it a bit to Functional Medicine and then moving to the brain and then to the emotions, then to the mental field, then to the soul and then to the spirit, which is beyond all confines to space/time. So I developed this roadmap of experiences at each level, diagnosis at each level, potential treatments at each level, because many people will want to go to an acupuncturist, which is at level three in this energy model, but they really should be seeing an oncologist or they’ll go to an oncologist where they really should be doing trauma work.

Dr. Bruce Hoffman:

I tried to sort out all these different possibilities across all layers and levels and help teach/write a new curriculum, really for doctors or healers. Not really doctors. MDs should keep doing what they do. They do it well. Every patient that sits in front of me says well, why doesn’t my doctor know this.  Well,  because it wasn’t his interest and he didn’t train to know this. So give it up. Don’t even ask the question, don’t waste your time. We need a new curriculum for a new expansive model. That’s been my life calling, my life passion, and to which I’m still a student. I mean, I study more now than I did when I was young. I just keep expanding the knowledge base.

Mary Vallarta:

I think that’s what makes your work so fascinating to me. You have sort of like a 360-degree view since you’ve been on the MD side, the family medicine side, and then you’re now continuing to learn more about the Eastern methodologies. So you’re kind of taking everything and putting it all together to make these roadmaps that you’re talking about.

Dr. Bruce Hoffman:

It’s not just Eastern, Mary,  it’s all systems of knowledge, you know, from phenomenology to theology, to psychology East to West, to up and down, it’s all layers, all levels. It’s not only Eastern insights. Some of it is Eastern, but it’s not only Eastern insights.

Mary Vallarta:

I see. Interesting. So integrating all that together is very fascinating and it gives you more of a well-rounded perspective. As you mentioned, MDs aren’t trained to have that type of approach. That’s why there’s a time and place where that’s going to be appropriate. There’s also another time and place where something else might be more appropriate for a patient. So I think that’s important to note. There is a lot of research coming to light on the important role that food plays on one’s ability to prevent disease and sometimes also reverse or heal. As you pointed out, there are such things called trauma. You’ll recommend people see some trauma specialists or stress. What are your thoughts on having more emphasis or focus on things like mindset, changing internal narratives, and healing emotional trauma when it comes to healing?

Dr. Bruce Hoffman:

One of the great challenges of working with patients is when they present with complex multi-system illness, which is the only kind of patient I see these days, they are still very in that diagnostic mindset of “what do I have”? Usually singular, what one thing do I have? Is it mold or Lyme or Mast Cell or whatever? Then they start to think diagnostically and therapeutically in an allopathic way. When you start to have a broad spectrum of understanding the human condition, and you start to understand all the antecedents, mediators, and triggers that eventually ended up in biology and pathology/disease, you can’t stop yourself from taking a far more comprehensive history. So the healer of the future can commit both acts of commission, as well as acts of omission. It’s not what he knows, but it’s also what he doesn’t know.

Dr. Bruce Hoffman:

So if you’re sitting in front of a patient and they are presenting  with symptomatology at this moment in space-time, it behooves you to ask every single possible trigger that may have led up to that presentation. It’s our Western understanding and consensual reality that diseases kind of fall out of the sky. It’s like, Oh, I’ve got rheumatoid arthritis. Then you can go to the doctor and get an immune modulator, or you can go to a naturopath and get an herb, but it’s still that singular mindset. When we look at patients from a more complex model, we have to start looking at not only diagnosis from a Western perspective, because you need to know that, that it’s an inflammatory and immune system-based disease based on autoimmunity, which has its links in leaky gut, et cetera, et cetera, and the genetic predisposition.

Dr. Bruce Hoffman:

You’ve got to know that, but you’ve also got to understand how people arrive at a point in time with a diagnosis. You know, people, they inherit epigenetically the traumas of their forefathers. So if you don’t ask a history of their forefathers and the ancestors you are missing out on a piece. Then they get born into a family system, and whether or not they were adequately seen by the mothers in the first 10 years and by their fathers in the second 10 years and peers, and by the loved ones in the third decade, they don’t adequately myelinate the three different brains that grow up, the reptilian, limbic and adult brains. So if they are not self-regulated by external parental figures, they don’t learn to self-regulate themselves and they have a fragile personality structure very often.

Mary Vallarta:

So how do you help them uncover all of this information?

Dr. Bruce Hoffman:

You’ve got to take a very thorough history. I take a two and a half to three-hour history and ask all of these questions.

Dr. Bruce Hoffman:

Then those experiences, your epigenetic transfer, ancestral trauma, early childhood experiences that all gets then translated into your perception of reality, your internal dialogue, your thoughts, your value systems, your beliefs, and your defenses. So many people stay highly defended from feelings that arose in the first 30 years of life because they are too painful. So they’re defended and they are traumatized. That then translates into electrical messages in the brain, which you can read on a qEEG. I have a brain treatment center, which reads qEEGs. You can see hallmarks of early trauma on the brain. You’ll see the one brainwave, the [1] beta brainwave highly red, highly amplified. That then gets turned into chemical signals. That then starts to interact with your phospholipid cell membranes, which you can measure, which then turn on receptors, which then turn on genes, which then turn on proteins, which then turn on all the biochemistry that runs your life.

Dr. Bruce Hoffman:

So you have this whole cascade of possible antecedents that can set you up for what’s happening at this moment with so-called symptomatology or disease expression, but it’s not just rheumatoid arthritis. It’s way back in the ancestry, trickling all the way down to physiology. And then you have the environment coming in. That plays havoc with your, your detox pathways and sitting on DNA. Sitting as adducts on your DNA and mitochondria affecting their expression of lipids and proteins. So if you don’t ask all these questions, you’ve got a limited roadmap and you got a couple of tools in your toolbox. You’ve got to have a very broad toolbox, and that’s why education becomes important. We have to educate healthcare providers of the future to broaden their toolbox. Not only to broaden their toolbox but also to broaden their self-understanding as well.

Dr. Bruce Hoffman:

If a healer approaches a patient with a hero type approach, I’m all-knowing, and you’re all sick. They also perpetuate a very lopsided point of view. The patient’s well side doesn’t get activated. They don’t activate the healthy part of who they are. They identify with the disease, the doctor as the hero is going to fix them. That’s a very lopsided relationship. Often patients sort of, in order to survive that lopsidedness, they just don’t activate their intent to do what is required for them to activate the healer within. The healing archetype within. Without activating that there’s no outcome.

Mary Vallarta:

Right. So would you say your approach is also about giving power back to the patient? Like letting them realize that they have a big role to play in their healing?

Dr. Bruce Hoffman:

We try to. Some people are highly defended.  People have value systems, a hierarchy of values. People will say that their health is a high value. They come to you to treat their health or help them treat their health. When you start to take a history, you’ll find out, particularly with men, by the way, this is like a big male thing. Their highest value is their career, making money, health is secondary. They often delegate their health to the loved ones, their spouses, or somebody else. They don’t really want to rob Peter, their career-making money, to pay Paul, to invest in their health. So they don’t raise health up as a value. Unless patients are prepared to raise health up as a value and become a participant in their own healing experience, they remain passive and they have what we call “projection of will”.

Dr. Bruce Hoffman:

They project their will to heal onto you. If you rise up in the healing archetype “I’m all-knowing, I’m going to fix you”, you start working harder than the patient. It’s a very lopsided relationship, almost doomed to fail. So you’ve got to try and enter into their system and sort of feel where they are in their own evolution.  Is health a high-value? How healthy is their ego strength? Is it fragile? How much projection of will do they have? Do they have outer resources to assist them or are they without resources? Do they have personality disorders? Do they have what it takes to take on such an extensive journey? And, of course, finances.  Most of this isn’t funded by healthcare systems and nor should it be because it would bankrupt most of them.

Mary Vallarta:

Right. Also, one of the most important questions for them to know the answer to is why do they want to heal? Why do they want to get better?

Dr. Bruce Hoffman:

On the first page of my 70-page questionnaire is “Why are you here, How can we help you, What is it you want to achieve?” and how committed are you to making the changes necessary? It’s interesting when it comes back 50% or 75% committed. Immediately I say we have to have this conversation first and find out what that’s about. Because if people haven’t been seen by their parents, if they haven’t been supported and challenged in a healthy, supportive, challenging way, which is how love evolves and how you develop a concept of self. You only develop a good concept of self, good ego strength if you are both supported and challenged by your parents, not just supported. If they don’t have a healthy sense of self, they can’t take on what is being required of them to sort of move through this experience. They just don’t have the resources to do so.

Mary Vallarta:

Right. That’s very true.

Dr. Bruce Hoffman:

You have to find out where they are with that, you know, and where is health in their value system. You really have to ask that question before you launch into “tell me about your disease”. You have to find out who this person is sitting in front of you and where they are at in their hierarchy of values as to doing what it takes to get better. You know, there are many possibilities for healing. The first possibility is just treating disease. Get this symptom out of me. I want to do it quickly without money and without me being involved, just give me a pill. Mahatma Gandhi said the tragedy of modern medicine is that it works. There’s that possibility. Then the other possibility is they see symptoms as teleological. Those symptoms are actually asking them to enter into their own life, to try and find out why they are this way in space-time. Then they see mind, body connections.  That the way that they construct reality may influence the systems they put in place to support them and the way they perceive things and what they eat, it all plays a role. So they become more conscious of their own advocacy. That’s the second possibility. The third possibility for healing are those people who do not only want to be free of disease, which is sometimes not possible, you’ve always got some symptomatology and, but they want to live at the highest maximum potential. To do that, they have to go through a lot of personal development and personal growth to know their value systems, to know how inspired they are. To find out what wakes them up every morning. Are they called from above by some spiritual purpose or do they just get out of bed and just sort of see what happens?

Mary Vallarta:

Right.  So that brings us back to the why.  Let’s talk more about maximum potential, because I know that’s a big part of your work. Can you describe what maximum potential is?

Dr. Bruce Hoffman:

Well, when a person wakes up in the morning inspired by what they do, that’s living at your maximum potential. They are living at their maximum potential. It’s a vision of what they are here to do on this planet while they’re in a body. In psychology, it was called a daemonic calling. Your inner constellated self calls you from above to become who you’re meant to be. So you’re just inspired to do what you do, and you know what you are meant to do and you throw all your life force into that outcome.

Mary Vallarta:

Which is basically their higher purpose.

Dr. Bruce Hoffman:

Their highest value, their highest purpose. They don’t need to be motivated to get out of bed. They get out of bed and just do what they do. They stay up very late at night trying to manifest it. Their life force is invested in it. There’s that old image that I love, if you will go to a university and you stand outside and you look at the different levels of a university, the undergraduate student’s lights go out at four o’clock, the postgraduate at six o’clock, the doctoral students at 10 o’clock and the Nobel prizewinner’s their lights get switched off at one o’clock in the morning. They are just called into the daemonic calling. They just know who they are and what they meant to do.

Mary Vallarta:

…and that’s what pushes them, yes.

Dr. Bruce Hoffman:

But that’s only the third possibility. The fourth possibility of healing is when you know that you are part of a connected whole. You don’t identify with your body, your emotions, your mind. You identify with that aspect of you that is beyond all of that.  Your deepest self, your soul, which is sort of linked to this one mind, this eternal consciousness. You know you’re not your body, you’re not your mind, you’re not your thoughts, but instead, you’re part of this continuous oneness and you stay connected to that in that field of consciousness that is that. I’ve had patients die, fully healed, connected to that aspect of themselves. They just know who they are. They know they are not their bodies, they’re not their minds,  they’re not their thoughts, they’re not their actions. They are beyond that.

Mary Vallarta:

That reminds me of the concept of  Satva  in Ayurveda.

Dr. Bruce Hoffman:

It’s called Brahmi in the Vedantic model.

Mary Vallarta:

Oh, nice. I’m just getting into more Vedic studies. I’m in Ayurveda right now, which I’m really loving. That’s really what inspired my own healing journey.

Dr. Bruce Hoffman:

I took my model from Ayurveda because I studied it for years and went to India and did an internship there.

Mary Vallarta:

That’s my dream. I want to go to India and study it one day.

Dr. Bruce Hoffman:

But they have these koshas, these bodies. I took that model and added a few and I made the seven stages to health and transformation model based on Ayurvedic and Vedantic scriptures.

Mary Vallarta:

Oh, got it. So what are those seven stages? Can you share them with us?

Dr. Bruce Hoffman:

Yes. Spirit, soul, mind, emotion, energy, physiology and structure, environment.

Mary Vallarta:

Okay. Interesting.

Dr. Bruce Hoffman:

Yeah. They are based on the five koshas from the Vedantic philosophy, the five bodies, the five layers.

Mary Vallarta:

So obviously when your patients are working with you, I can only imagine some of them get challenged. Right? Some of them might get frustrated during this whole process. So how do you go about helping them and supporting them push through or be comfortable with feeling this discomfort? Cause a lot of times people run away from discomfort.

Dr. Bruce Hoffman:

Again, it’s incumbent upon me if I’m doing a reasonable job, not to impose my model on them, but just ask what they want.

Mary Vallarta:

Ok, going back to that.

Dr. Bruce Hoffman:

Some people just want to not have asthma.  They’re not interested in seven levels of healing. I respect that. Then I pull out all my functional medicine, toxicology tricks, and just treat asthma.  Treat triggers of asthma such as mold and food sensitivities and Mast Cell blockade and mitochondrial resuscitation. I do all my functional medicine things. Other people come to me and say, I’ve been sick my whole life and they give you 50 symptoms. And you know, immediately that that person probably has not had the most advantageous experience from either ancestrally or from birth. Almost definitely you can tell that. The adverse childhood experiences studies show that people who’ve had adverse childhood experiences had three to four times increased health disadvantages as they mature.

Dr. Bruce Hoffman:

So you know when people tell you they’ve been sick for as long as they remember. You immediately go into early childhood trauma history and it’s always there. You can always tell. Interrupted bonds with their mothers. They have merged with mothers. They were sent off to boarding schools at young ages. They go to intensive care units and incubators and the mother has problems with the father so the mother takes her eyes off the child and doesn’t myelinate the child’s sense of self. Then mother’s offline. Then they have stillbirths and miscarriages and they’re all there in the history almost every time in a complex illness patient.

Mary Vallarta:

Hmm. So basically you meet them where they’re at.

Dr. Bruce Hoffman:

Yes, I tend to meet them where they’re at. You try and work out each level.  At level one what’s going on? Is it food? Is it mold? You do your normal medicine. Then you ask deeper questions. Are some of these symptoms teleological? Are these symptoms bringing patients to you because they have to heal a part of themselves that they never integrated in their evolution? For instance, I had a patient with MS whose father was a very famous sports coach and she never felt seen by her father, always neglected. She had a superego that is highly punitive, and she didn’t feel ever seen. So she was constantly beating herself up and attempting/strivinh to become more than she could possibly be. She tried and tried and tried, but dad was always coaching the team.

Dr. Bruce Hoffman:

Then the dad, when she was 18 or 19  I believe, her father got fired from the team. The next day she developed MS. The next day. That symptom was saying, dad, you were never there to take care of me. Now, look at me, I’m sick. He rose to the occasion. When he was fired, he was at home and he could be with his daughter. It was set up that way, that the symptoms drew that complexity together for it to be resolved. When she got that installed that she used that to use that in healing. It was very powerful. I have many, many cases and stories like that, where symptoms guide people to heal a part of themselves they’ve left behind.

Mary Vallarta:

Right. That is fascinating.

Dr. Bruce Hoffman:

Symptoms don’t fall out of the sky.  They have intent. In my experience.

Mary Vallarta:

Yeah. I think that the more I speak to all of the experts that I’ve talked to so far, the more I’m realizing that symptoms are really an opportunity for people to get to know themselves on a deeper level.

Dr. Bruce Hoffman:

I did a workshop with Mark Wolynn who is one of the great family constellations authors and workshop leaders out there. Once a year, we’ll do a workshop on illness and your family system and early developmental trauma. Almost to the person, we can link the rising of symptoms to events in the lifespan that needed to be resolved and healed. Once we linked them and made them conscious and gave them the homework to do, there was a vast new release of healing potential because you don’t heal until you have a new internal dialogue, a new story, a new narrative. If you have the old narrative, you create the same biochemistry. People with a new narrative, they have a new insight. It releases a potent internal life force that then constellates the biochemical pathways downstream to advocate healing.

Dr. Bruce Hoffman:

So we would do this workshop. Mark was a master at family constellations. Patients would sit next to him, and we would ask what their problem is and they’d say thyroiditis or leaky gut or Mast Cell, mold, whatever.  Then you’d say, well, tell me about your mother. Tell me about your father. Tell me about your grandparents and your siblings. Then he’d put up people in this constellation and worked with them energetically as to what was going on in the system and how their symptoms correlated with the dynamics of the system, the entanglements of the system. They could see how their symptoms didn’t just arise from nowhere. They were contingent upon some of these entanglements that needed to be healed. Once they saw what they hadn’t perceived before because children will often tell themselves a story that’s not true.

Dr. Bruce Hoffman:

They’ll say their mother was mean and angry, but their mother lost two children before they were born. The mother got very little from her mother. The mother was always bothered about the father who is out doing something or other. So the mother just had a little bit to give and unless the child sees that, and sees the mother through new eyes, the judgment of the mother will be there.  A person is half their mother, half their father. If they start judging half of themselves, guess what? They’re not open to the healing force, which is their whole self.  So everybody ultimately has to realign with their parental mothers and fathers. If you don’t say yes to your mother and father, your healing is going to be limited, no matter what you’ve experienced.

Mary Vallarta:

Because it’s pushing yourself away. They’re half of you like you mentioned.

Dr. Bruce Hoffman:

That’s the setup for auto-immunity by the way.

Mary Vallarta:

Oh yeah, because you’re rejecting yourself and autoimmune, right? Oh my God, that is powerful. I don’t even know what to say right now, but it shows how important it is to really understand yourself, but also understand your parents.  Also understanding your grandparents because your grandparents affected your parents’ psyche. It affected how your parents treated you.

Dr. Bruce Hoffman:

No question. 100%. There’s a one-to-one correlation.

Mary Vallarta:

So Dr. Hoffman, switching gears here a little bit because I’m also quite interested in anti-aging medicine, but I don’t know too much about it. Could you tell us a little bit about what that is?

Dr. Bruce Hoffman:

It’s a myth.  I’ve trained in it but there is no anti-aging medicine. It’s a nice sort of slogan for slowing down the process of aging. Okay. We all age. You’ve got the hormones of youth and you’ve got these drives.  In the first 30 years, you can do no wrong. You just push yourself through everything. Then entropy sets in and you start to sort of come apart slowly but surely.

Mary Vallarta:

You’re noticing it now.

Dr. Bruce Hoffman:

No question. The wrinkles and the skin sags.

Mary Vallarta:

The low back pain

Dr. Bruce Hoffman:

Then you get the inflammatory diseases of aging. Then you get separated into either heart disease or cancer or one of those things. They are all driven by genetics and environment and lifestyle and mind/ body.  The more inflamed you are by your lifestyle, the more unresolved you are with multiple triggers, the more interleukin six and tumor necrosis factor and all the inflammatory signalings are flying around, destroying your mitochondria, which then reduce your ATP, which then reduce your life force. So what we do in anti-aging medicine is try and slow down that trajectory before all is lost.

Mary Vallarta:

Yeah. There’s no way that you can stop yourself from aging. It’s just really about how to stop those symptoms of aging or delay them, right?

Dr. Bruce Hoffman:

Modify it so that your entropy isn’t like this.  Then you drop dead one day because your gene pools run out,  it’s time.

Mary Vallarta:

Yeah. It reminds me of my grandmother. She died, but she didn’t really die of any disease or illness. I think it was just because she was older and her body was just tired.

Dr. Bruce Hoffman:

The genes give up.  Everything ends.

Mary Vallarta:

Yeah. So share some of the most important things you’ve learned from your spiritual teachers. You’ve named a lot of big names, in your bio, like Deepak Chopra and Osho.

Dr. Bruce Hoffman:

So, here’s the answer. You probably won’t want this one.

Mary Vallarta:

Give us the real answer, not what you think we want to hear.

Dr. Bruce Hoffman:

People who’ve had difficult upbringings, who’ve had some complexity in their early developmental years, will often go to find spiritual teachers to take the part of the good parent that they feel they didn’t get. So whenever I have patients come in who have spiritual teachers and gurus, I’m very suspicious. Having had very many spiritual teachers and gurus myself. Having been to India three times and sat on many mountain tops meditating. So that’s the first insight that I really want to emphasize. It’s not wrong. It’s just when people don’t heal with their individual mothers and fathers, they’ll find a great mother and father that will look upon them benignly.

Dr. Bruce Hoffman:

You’ll find a lot of the great spiritual teachers who went to Burma and Thailand and India in the seventies, all of the Western students of spirituality. There are a lot of them. Jon Kabat-Zinn is one of them, Jack Kornfield is another. They all went and meditated for 15, 20 years, put on red robes and then came out of the forest, went back into cities of America, started to see people and all of a sudden realized, hold on a second, we are just performing spiritual bypass. These people have got messed up lives and they all went and became psychologists.  They all needed to heal the early traumas that people were trying to bypass to develop spiritual awakening. So that’s one of the greatest insights I’ve seen over the years. It’s not that spiritual teachers can’t provide some insight, but I always get a little uneasy when I see a guru sitting on a big white pedestal.  Then there are all of these devotees.  And I’ve done that for decades.  I’m judging myself.

Dr. Bruce Hoffman:

Then I just always ask, what is it about this experience that was being bypassed? What is it that they are trying to gain? What, what layer and level is still unfulfilled in their evolution? That’s what my curiosity is because an awakening experience into Satori is a sort of a brief exposure where you go beyond mind/ body and you actually know that everything is unified. There is no past/present/future. There’s nothing to fear and you’re sort of eternal,  immortal and you’re never born and you never die. That is what happens when you awaken.  But to sit in front of a guru to try and get that experience, I’m not sure that’s the best use of your time.

Mary Vallarta:

Yeah. I think it’s just an illustration of how you’re still searching for answers outside of you.

Dr. Bruce Hoffman:

That’s what Advaita says.  The essence of Advaita, which I learned at 15 was the very act of seeking prevents you from being who you are because you are that. So what are you seeking? You are already that thing.

Mary Vallarta:

What are you seeking? Exactly. I get that. That is really good advice when you think about it.  The answers are not out there. They are in here.

Dr. Bruce Hoffman:

Carl Jung said the urge to be whole is evolutionary. You can’t avoid it. Dianne Connelly said all sickness is homesickness. You try to come home to the most integrated aspect of who you are.  You can’t just go and sit with a guru.

Mary Vallarta:

That won’t give you the answers.

Dr. Bruce Hoffman:

It’s fun, and it’s very pleasant for a time. And I’ve done it for a long time, but you still got to go down the chakras and work your way through them. Early developmental trauma.  All of that stuff. You’ve got to heal that stuff.

Mary Vallarta:

If anything, it’s sort of a way where someone could continue resisting actually looking at themselves, getting to know themselves by sitting with a guru, and not ever advancing to internal examination.

Dr. Bruce Hoffman:

Perfect, perfect example you just gave.  It really does, in many cases, exemplify and exaggerate, the very pathology that’s brought them to the guru in the first place, which is resistance and projection. By sitting in front of the guru they are refusing to face the very thing that they need to face, which is themselves and their defenses.

Mary Vallarta:

Yes. Fascinating. So aside from sitting or seeing your patients, one-on-one Dr. Hoffman, you also actually have online programs and courses that people can take. Can you tell us a bit about what those are?

Dr. Bruce Hoffman:

Well, it’s funny, I used to do weekend workshops and all sorts of things. Then I condensed it all into a Friday afternoon lecture, a one-hour lecture for my new patients. Then the one-hour lecture became seven hours. I felt sorry for my patients. So then I took that lecture and made it into a book. So that book and those videos are available.

Mary Vallarta:

Nice.

Dr. Bruce Hoffman:

Yeah. So if you want to learn Seven Stages to Health and Transformation, I have a video and I have a PowerPoint explanation of it all, but I no longer lecture to that degree. I’m going back and starting to do lectures on different topics like Alzheimer’s disease and Mast Cell Activation and mold exposure and various aspects of mind-body healing. Those are in development. Most of the time now I’m helping other practitioners. Guiding them through this new curriculum of Seven Stages to Health and Transformation where not only do they learn new skills, but they learn about themselves.

Dr. Bruce Hoffman:

They have to stay congruent, they have to be present in that experience. I forgot to mention as part of my explanation, I went off at a tangent, that patients who don’t have good relationships with their parents have low trust. If they have medical PTSD or trauma from the medical system, that gets projected on you as a healer because all medical systems are very patriarchal and you are a parental figure. So if you’re sitting in front of a patient and there’s no trust established, there’s nothing you can do. So you have to ask that question first. You know I’m trying to teach people, other practitioners, how to be present with patients before they get more tools in their toolbox and go into courses and learn things.

Mary Vallarta:

That is so important.

Dr. Bruce Hoffman:

How to develop trust with a patient. Sometimes you can’t, they’re too traumatized and you try your best, but it’s just not possible.

Mary Vallarta:

But that just shows the role that each person plays. The role that the practitioner plays and also the role that the patient plays. If either one of them is not invested, it’s not going to yield the highest potential outcome.

Dr. Bruce Hoffman:

It won’t. Some people are too traumatized with too much mental health illness that they just can’t do what it takes to show up in that experience. Then you just have to admit that it’s not going to work out. You have to learn who is sitting in front of you. Also, know yourself through your own Myers – Briggs typology, through your own Ayurvedic typology,  you have to know if you’re Vata, Pitta, Kapha. Is that patient Vata, Pitta, Kapha because the Vata patient is not going to do what the Kapha patient does. They are an entirely different person.

Mary Vallarta:

Yeah. And then honoring and accepting that type of person and not projecting another type of person in that chair.

Dr. Bruce Hoffman:

If I’m a Pitta practitioner in my hero archetype and I know everything, I’m going to tell you what to do. And the Vatta patient walks in and is very sort of inspired for like three days and then they lose interest. If you impose your value system and your Ayurvedic typology or dosha onto them, and you don’t resonate and know how to treat Vata patients, you will lose them and you’ll feel frustrated.  Like a Kapha patient, they always show up, they never do what you asked them to do, or they do very little, but they’re always very loyal.

Mary Vallarta:

Very loyal. And we’re talking about Kapha, Vatta, Pitta. Those are the different dosha constitutions, that we talk about in Ayurveda.

Dr. Bruce Hoffman:

Then the Pitta patient, if you’re not the best in the city, they’ll leave you and go find the best.

Mary Vallarta:

They are looking for the facts. They’re like the fact-finder.

Dr. Bruce Hoffman:

You’re not sharp enough and don’t have the best office and are always on time….

Mary Vallarta:

You gotta check all the boxes for the Pitta patients.

Dr. Bruce Hoffman:

But as a practitioner, you’ve got to know who’s coming in the door because you’ve got to adjust the way you interact with them.  Knowing your Myers-Briggs typology as well, thinking people are not the same as feeling people. You’ve got to know that.

Mary Vallarta:

That’s very true. It’s sort of like detective work that you have to do when you work with your patients. Well, Dr. Hoffman, I can talk to you for hours. There are so many different questions that I can keep asking you, but for the sake of this particular interview, I’d like to ask if there’s anything else, one thing that you can leave us with here today that you didn’t get a chance to cover.

Dr. Bruce Hoffman:

In regards to talking to well people? Or people with complex illnesses? Or could you give you more direction?

Mary Vallarta:

Yeah. Well, the title of the summit is Healing Your Chronic Illness and Taking Your Life Back, meaning taking control of your health, right? Being the person and seeing the power that you have to own your life, to own your health. And so what would be the last thing that you’d want to leave us with here today?

Dr. Bruce Hoffman:

I think what’s most important is that people have to understand that if they present with chronic ill health or chronic complex illness, they have to try and find a practitioner who has a broad range of experience with multiple tools in their toolbox. They can’t just do one stool test and hope to heal. That’s number one.

Number two, they have to become their own patient advocates. If they are not invested in advocacy, there is very little that you can do.

Number three, they can’t project all the will to heal on the practitioner. They have to take some of that responsibility themselves.

Number four, they have to raise health up as a value. If the health isn’t one of the first or second values, it will default to number four or five, wherever you have your highest value, you will have your most order. Wherever you  have your lowest value you will have your most chaos. If health truly isn’t your highest value, be honest with yourself. Then look at it and say in the future, I will make it my high-value but right now I want to keep working and eating poorly and making money because that’s where my highest value is. Not wrong or right.  Just be honest and truthful and know your value system.

Mary Vallarta:

Wow. That is a great way to end the discussion. I feel like you beautifully summarized our conversation and added new thoughts to it. So I appreciate that. I will go ahead and make sure that I link Dr. Hoffman’s website, where some of his writings and programs are, so you all can take a look. I’ll also include that in the post-summit email. Dr. Hoffman, you’re also on social media. So what is your handle where people can find you and possibly connect with you there?

Dr. Bruce Hoffman:

So Instagram. My staff said, “make sure you say this at the end”.

So Instagram is www.instagram.com/drbrucehoffman/

Facebook is www.facebook.com/TheHoffmanCentreforIntegrativeMedicine/

and then the website is www.hoffmancentre.com.

I also have a brain treatment center, www.braintreatmentcentreofalberta.com I think those are all the handles.

Mary Vallarta:

Yeah. I mean, there are more.  Do you have a Tik Tok? Do you have a Twitter?

Dr. Bruce Hoffman:

Yeah. Yeah. Yesterday my Twitter account was activated by an assistant. I have no clue.

Mary Vallarta:

There you go. Well, Dr. Hoffman is on Instagram, so you can catch him there. I think that everyone’s on Instagram. So find him on IG. You should see the links in the handles below. Look at his website. There are a lot of resources there where you can get started if you are interested in everything that we’ve talked about. As Dr. Hoffman said, be truthful to yourself and meet yourself where you are. Stop, resisting, and meet yourself where you are, because that is an integral part of starting and continuing the healing journey.

Dr. Bruce Hoffman:

Also, the outer aspects of healing often in complex illness have to be congruent with inner healing too. You can’t just take a potion or herb. It’s much more complex than that. You’ve got to take a full system approach. There is a lecture being posted on my website soon on YouTube, where I give a 1 ½ hour lecture on the Seven Stages of Healing which will summarize some of the things we’ve mentioned.

Mary Vallarta:

Ooh, yes. I’m gonna watch that for sure. Okay. Thank you so much for joining us today. Hope you got a lot out of this.  Dr. Hoffman, you are amazing. Thank you for speaking with me.

Dr. Bruce Hoffman:

Yeah. It was nice talking with you.

Integration of Complex Systems into a Structured and Staged Diagnostic and Treatment Approach

Integration of Complex Systems into a Structured and Staged Diagnostic and Treatment Approach

Good morning everybody.

I’m the last speaker of the conference, and I’m going to try and tie up some of the concepts we’ve learned into a comprehensive diagnostic and treatment protocol specific to the theme of the conference One People, One Planet, One Health.  I want to provide some idea of how I approach patients with complex issues and attempt to make sense, if you will, of some of the complexities and some of the multiple incoming bits of data and information that we often are asked to sort through.

So, this is a very common scenario. The patient presents at your office having seen many people, having tried many things, having researched, having been on the internet, and is up-to-date with all the latest treatments and then asks a few things that you may or may not be familiar with. You are left wanting to know or thinking, how do I approach this patient, and what systems of inquiry do I use, what diagnostic protocols can I think of? How do you proceed to make sense of this? It’s very challenging.

Where do we begin? The amount of misinformation out there is huge, patient advocacy is welcomed, but often misdirected. There’s often lots of single point causation. People think it’s Lyme or mold or mast cell activation syndrome. It’s often all those things and much more. It’s very difficult to penetrate and get into a patient’s system of inquiry without sometimes ruffling feathers or offending people’s points of view.  It is sometimes a minefield, not always but sometimes. Sometimes it’s very pleasurable and it fills you with hope and it sort of makes you realign with why you started to do this work in the first place. Other times, it’s very challenging. The question that arises often is – is the functional medicine integrated model adequate, does it leave things out? What else can be considered? What other considerations can we bring into account when we’re dealing with complex patients? And I hope to go over some of those today by presenting this data.

By way of background, I was talking to Werner Vosloo, a member of the ISEAI board one day about complex patients and had approached him and he said, well didn’t you just present it and show us what you do. So that is the basis of this presentation.  Just a little bit by way of background because it would make sense at the end, why I chose to introduce some biographical information about how I arrived at this system.

I had a rather complex childhood, but I was fortunate when as a teenager. I was sent to boarding school and had this high school teacher by the name of Roger. He introduced me to many things, including the philosophical system of Vedanta and a particular subset of Vedanta called Advaita. The relevance of this will be made clear a bit later. He also introduced me to the writings and work of Carl Jung, whose book, Memory, Dreams, and Reflections was a seminal piece of work in my early exposure to philosophical systems.

Carl Jung was the first person to draw out the cartography of the psyche as told through his autobiographical narrative, which is a very fascinating read. He was also the first person to really say that the psyche, the inner world of people, has an objective reality. Although it’s subtle and unseen, there are aspects to it that can be used and taken to be somewhat fixed and relied upon as a roadmap when you’re working with people’s unconscious material. He also said, along with many others, that the desire to be whole, or what he called” individuated”, or to be integrated, to be healed if you will, to know yourself. In the East, they call it enlightened, Maslow called it self-actualized. He said that this was an evolutionary urge. Everybody desires to be the best they can be in the most integrated way.

This is evolutionary. So patients, although they may present with sickness and disease, there may be another directive that they are asking. The question is, as medical practitioners, is this our responsibility?  Where do we enter into these complex systems and what are our responsibilities? I’ll address these a bit later. So, he (Jung) said that the urge to be whole, to be healed is evolutionary.  Advaita, within this Hindu system or the Vedantic system, is often translated as non-duality.  A more apt translation is non-secondness, meaning that there is no other reality other than what they call Brahman in Hindu terms.  That the reality as we see it through the five senses is not ultimately, at its deepest core, constituted by bits and pieces, by parts. That is, everything that’s always changing in the universe, all these changing things have no existence of their own, but they are all appearances of what they call The One, Brahman, the Unmanifest Field. This is not that different from what the great quantum theorists of the last 150 years have said. They’ve all said that behind this vast appearance of matter, is this unified field of information and intelligence, which they call a quantum field or light if you will, which is infinite, eternal, and never changes. It’s not subject to space-time and present moment awareness.

Advaita says that there is nothing to be made whole, as Jung said, because you already are whole, you just don’t know it. You don’t just wake up to that reality. It’s a philosophical concept which we’ll address and come back to. Now, ironically, the title of this conference is One People, One Planet, One Health, the very essence of Advaita. One mind, one manifestation, everything is connected with everything else.

Another bit of biographical data, which I introduce in order to elaborate on why I use the system. When I was younger, I had two major experiences of what they call satori in Zen Buddhism or Christ consciousness in Christianity, Fana in Sufism, Samadhi in yoga whereby you directly experience this reality. When you directly experience this oneness, it’s a very peculiar experience. It’s not psychotic. You are very much in your body, but you really do see this unified field that underlies all matter. You really do see that past, present, and future are continuous. You really have no fear because you understand yourself to not be your ego squeezed into the confines of a body through space-time. You just experience this expanded state of awareness. Literally, everything does appear to glow with a certain light. Quantum theorists will tell us that matter is nothing other than light squeezed down into matter. That’s the basis of quantum theory.

So when you have these awakenings and these experiences, which many people have had through near-death experiences and precognitive dreams and synchronicities etc., you definitely do experience that oneness that underlies all appearances of matter.  It really is a different state of consciousness, but it actually, you resonate with it and believe it and know it to be true.

After high school, I found myself in medical school and became a family physician in Saskatchewan,Canada and then started to be curious as to what other methods of healing and methods of inquiry could help patients when they presented to the office with symptoms.

I was then exposed to a video by Larry Dossey, who you all may know, and he incorporated aspects of Eastern and Western medicine into his approach. This approach evoked in me a memory of my childhood exposures to Eastern thought, and then launched a massive search for whatever it was that could assist patients to live at their maximum potential, not just treat symptoms, but to live more fully. So, using my allopathic training as a basis, I then, like many of you, became curious and started to study beyond that allopathic model.  I studied TCM and acupuncture. I spent years with Deepak Chopra and David Simon studying Ayurvedic medicine. Went to India and did an Ayurvedic internship in Poona. Did IFM training and A4M training, spent years with and still do, listen and study with some of the great leaders in biological medicine, Dr. Dietrich Klinghardt, many others in the field.  I’ve studied with Lawrence Afrin and Shoemaker like many of you, Dr Horowitz in the Lyme world, William Walsh in the mental health field.

But I was ultimately provoked into thinking about integral theories by the works of Ken Wilber and his so-called integral theory of everything. He combines all these areas of thought, and philosophical systems into one unified system. It’s theoretical, but not practical. So, what I did was make practical these theoretical systems. This is the seven-level model that I’m proposing today.

The title of the conference is One Health. One Health is a big movement of trying to integrate different aspects of our reality, including animal health, human health, and environmental health.  Even though Advaita and the One Health concept have different epistemological origins, one is more of a different state of consciousness whereas the other is more linear in space/time. They both embrace an attempt to unify different aspects of separateness.

This unification of systems is not new. We know from antiquity that many of the old traditional systems of medicine, which were not alternative, they were the traditional systems, were very integrative. They weren’t like traditional medicine as we know it now. Allopathic medicine is the new kid on the block. More integrative systems have always been there. We know from the ancient temples of Asclepius, which were scattered around Greece and Turkey, that people would travel very long distances to go to these temples. They would spend time in the outer sanctums getting all the purification rituals. These are the outer therapies.  They also had to travel long distances.  It has been shown that if people go through some sort of hardship to get to a healing center, there’s a much greater prognosis. This has been replicated with studies with cancer patients showing the further they travel, the better the outcomes.

So, people had to give up something to get something. They had to have intent. They have to mobilize themselves.  This is something we know.  When we’ve tried treating patients, if there’s no true intent, if they don’t mobilize the inner resources to get what they need and want, if they stay passive, it’s very difficult to treat people. We call that “projection of will” or “high resistance”, if you will, in psychological terms, but when patients present in that mode and you start working harder than the patient, you all know this, it becomes very difficult to help them. And so, the practitioners at ancient temples knew this, that people would travel long distances to come to these temples. They would go to the outer sanctums where they are getting the outer treatments, much like today, where you get your pills and potions. They go through purification, rites, and rituals, which is similar to the nutrition and detoxification protocols of more integrative practices today.

Then they would be shifted or moved into the inner sanctum where the abaton was, where the dream sanctuary was, where they were required to have some inner experience, some inner signal from the unconscious that they were on a healing sort of path. After that was over, they would go outside the inner sanctum and move into the theaters or amphitheatres where great Greek tragedies and plays were enacted.  These were to show people that these dramas of health, healing, and transformation were archetypal.  Players would re-enact the great human dramas of evolution in life and show people the archetypal description of how life unfolds. So, these traditional integral systems have always been around.

Larry Dossey, through his book Reinventing Medicine showed that modern medicine has started to embrace more integral concepts, as we all know.

He called Era One medicine, physical medicine – existing from 1850 to the present day.  Actually, through Paracelsus, we know that the application of outer remedies has been around somewhat for 500 years or so.  But our true allopathic paradigm exists from about 1850 to now. Then Era 2 medicine, when mind/body medicine systems were integrated. Then Era 3, what he calls “non-local” medicine where spiritual practices and spiritual insights were added to the paradigm and somewhat integrated into therapies that exist to this day.

At a recent Lyme conference, an ILADS conference, there was a presenter who showed that there are many research systems now trying to integrate a lot of these different, disparate aspects of reality into a sort of a research mode or research vehicle so they can try and look at different systems as to how they interrelate and what the additive effect of different systems are. So, there’s lots of research going on in integration.

But, all of you know, when we approach patients with our old allopathic mindset or what we call Era 1 Medicine, well, the reason you are at the ISEAI conference is that we know that the system has its limits, but it also has its great virtues. These are just some of the reasons why we’ve moved beyond that model alone. We know about all the research articles that have shed some doubt on some of the previous findings and how editors of journals are highly compromised and how research often hides the negative data and promotes the positive data. We also know that you can’t really treat patients just through physical interventions. We can’t treat people as machines. We do. Sometimes very effectively.  But when you’re treating complex patients, you can’t separate consciousness, environment, culture, emotions, and the sort of inner core workings of the patient as they relate to their society and their culture and the world at large. You just can’t isolate it.

Then the allopathic model, as we all know, limits treatment to drugs and surgery. We’ve got to expand our model. Majid Ali coined the phrase N squared, D squared medicine. Meaning name of disease, name of drug. This is what we spend a lot of time doing in allopathic medicine. The other aspect that is interesting is that when you name a disease it often limits the involvement of the patient. It often tends to shut down further inquiry and that in itself can be problematic.  When a patient has lupus, for instance, it just brings together a whole mental minefield. “Oh, I have lupus, what now?” It shuts down further inquiry into the antecedents, mediators, and triggers in the functional medicine world. It also isolates the inner reality of the patient from the outer disease. The inner healer, the inner intent sometimes just goes down, goes quiet. They simply focus on the diagnosis.  I have lupus now let’s deal with lupus.” I think this is a great tragedy, which I will explain a bit later.

Why? It separates cause and effect. Patients present with say Mast Cell Activation Syndrome and yes, they identify some triggers and they go on all the mast cell blockers, but it doesn’t really take into account building biology and EMFs and other things that may be playing a role.

Then one of the great tragedies and often experienced with that is when the disease or symptom cluster can’t be named, it is dismissed as all in your head. This is a great tragedy. More and more practitioners are being made aware of this great tragedy. When allopathy runs out of diagnostic options, very often these simplistic interpretations get placed on the patient.  Instead of the provider saying I don’t know, what other methods of inquiry should we open up? Who should we refer to in order to get more insight into this case? As we all know, allopathy has a tendency to be quite arrogant in terms of its understanding of mechanistic disease. If it can’t be explained through Newtonian mechanisms, it often is said to not exist, and we all know this not to always be true.

I was listening to a talk by Dr. Klinghardt and he brought forward this insight, which I thought was fabulous. He said when he was exposed to his early medical training, he was primarily exposed to the regulatory forces in health and healing. His teachers told him that there were three classes of medicine: regulation, substitution, or suppressive. Suppressive, or what we know as antibiotics, et cetera. Substitution is when something is deficient, you give something to replace it.  Regulation is the idea that the body is a self-regulating system. You just have to find ways to assist the patient in self-regulation or to optimize function. We know that the mind, through intent, has a tremendous capacity to self-regulate as well. So, I thought this was worthwhile introducing.

The other thing about our model is that it ignores different stages and states of consciousness. It just treats mechanistic, Newtonian models of space and time. The body as a machine that’s broken down and needs fixing.  This doesn’t really take into account the different stages of people’s lives and different states and stages of consciousness, and what can be called diseases of the soul.

That’s a broad concept, but sometimes the patient needs another input other than what we have in our arsenal.  Like Prozac or Abilify or something like that, then they have a true crisis of the soul, a spiritual crisis if you will. An integral physician, a person who practices a more complete model, becomes aware of these dimensions of being in consciousness.  They will be able to determine through their own internal sort of system of knowing, which one it is and whether to prescribe Prozac or meditation or send them to a spiritual crisis therapist, et cetera.

Another aspect that I find quite challenging is this patient/doctor relationship. You know, we all go to med school, naturopathic school, a chiropractic college, and we accumulate this huge body of knowledge. In the first half of life, when we are accumulating all this knowledge, there is this tendency to occupy what can be called the hero archetype.

It is this all-knowing archetype that we  assume that we know more than what the patient knows. The patient is seen as an object, a closed materialistic system, unknowing and sick. It ignores very often when the doctor is in the hero archetype, the part of the patient that is not sick, the healthy aspects of the patient, their value systems, their choices, their intent, and the fact that they have the capacity to demand quite a significant healing response within themselves. When the doctor is the hero archetype, the patient assumes the “sick” role and becomes passive.  Often, they sort of learn this passive role in order to survive this one-sided relationship. How often have you heard our patients say, “I tried to tell him, I wanted to ask him questions and I was just shut down and I had five minutes and they walked out the room.”

This is very common. We’ve all experienced it and it’s ubiquitous in our field. But the thing that’s really interesting is that the doctor in the hero archetype remains blind to their own vulnerability and their own cycle of woundedness if you will. So being a doctor as a hero is one archetype. 

The doctor as a healer is a very different archetype. The wounded healer, if you will. I don’t really like that word, but it’s just the doctor being vulnerable.  They see both sides, the sick and the healthy parts, and they stay related to both within themselves and the patient. They don’t just see organs, hormones, neurotransmitters, and psychopathology.  Not just a body of overactive muscles and neurotransmitters. Not a soulless body, but the whole being of the patient. Now the healer archetype is embodied more by who the doctor is than what they know.

And we have to stay humble to that and stay related to those two archetypes. Who are we? What do we know and how do we stay related to the patient? So, there’s just a diagram explaining the difference.

This brings me to the point that the inner world of the physician becomes paramount. How much inner work has the physician done on himself to know what he knows or doesn’t know. How much does the physician actually embody that outer symbol? The caduceus, if you look at the symbol of the caduceus,   the caduceus is actually the staff of Hermes, the Greek version of the Egyptian God. He is the God with a man’s body and the head of a bird.

He was worshiped as the creator of the arts and sciences and music and medicine. Greek legend has it that one day Hermes was walking along and saw two snakes that were fighting and he took his staff and he struck it down between the two snakes. They curled themselves around this staff, forever in contention, but held in mutuality of power by the staff.  This was written by Robertson Davies. Now the symbol of modern medicine is the staff of Hermes separating these two opposing forces, not letting one outshine the other or align to win the battle and the struggle for supremacy. These two opposing forces are wisdom and knowledge.  The caduceus is a reminder that medical practitioners must maintain a balance between the two. Knowledge is what we learn in our toolkit, all that we learned from the outside. We bring many years of training to bear on the diagnosis.

Wisdom is what comes from within. Where the doctor looks not at the disease, but at the bearer of the disease, the person who’s sitting in front of you. That is what creates a link, or unites the healer and the patient. This exercise makes him the true physician, a true healer, or what Robertson Davies called a true child of Hermes. The book is called The Merry Heart – How a doctor can also be a humanist. It’s the wisdom that tells a physician how to relate to the patient and to make them a partner in their own evolution and cure. Both of these sources of wisdom must be accessed, not only by healthcare providers but also by the patient. The patient themselves must apply as much external knowledge as they possibly can if they’re not too ill.

It’s from as many different sources as they can. While also being cognizant of the fact that not all healing is about applying an external remedy, an inner journey is required.

Then another issue about the loss of competence in our model is that it emphasizes this disease-based model. We are asked to treat one small link in a sometimes thoroughly diseased chain of events. We patch people up and send them back into the same environment. The model has very few directives for wellness, let alone directives for living at one’s maximum potential across all spectrums of the body, mind, spirit axis.

This has been known for a long time, 2012, New England Journal of Medicine quote “We must teach aspiring physicians about system science. We should emphasize homeostasis and health, rather than only disease and diagnosis.” We’ve paid lip service to this, but it’s really not organized into any roadmap or system of approach.  IFM and functional medicine do a very good job, but is there more?

Then we come to the question, how do we even define health? We understand that human beings are these assemblages of molecules. But we know as humanists that they contain much more and we’ve kind of just reduced them to materialistic bodies. So, what does health mean in a multidimensional being?  Interesting question.  Can I be healthy if I’m spiritually malnourished?

If a white supremacist’s blood work comes back normal, is he healthy? How many levels should a physician actually treat? Is this even our task? As a physician, we can compartmentalize and treat one area, but as a human being, we face a painful dilemma. We just can’t do that. We know the patient comes in with complexity.  The more I become a doctor treating one little piece, the less I become a humanist, aware of all the interconnections. Traditional medicine, as we know, treats the illness. Integrative medicine has more of a patient systems approach but a more complete model includes the physician’s own role in terms of wisdom and knowledge, both internal and external ways of knowing as they relate to this complex human being. The Hippocratic Oath is “First, do no harm”, but remember there are two ways to harm. Errors of commission, but also errors of omission. By what we know, but also by what we don’t know.

So, what do we do practically in the office when we know everything is connected to everything else? What do we do when we know all illness is embedded in larger network systems and chains of pathology? How can we approach people from this perspective?

The first possibility is viewing suffering, physical or emotional, as unwanted. We suppress it and we treat it and we say illnesses have no causation, they just fall out of the sky and we get a diagnostic code and we go and find a remedy. We subscribe to the consensual reality of our culture that just perpetuates this cycle. This is symptom treatment and has nothing to do with healing. You’ve all heard that the original definition of a quack is someone who treats symptoms.  This is true. This is from antiquity. So that’s one possibility.

The second possibility is working with patients who began to look at physical symptoms as a larger inquiry.  Symptoms, as teleological, more as entry points into something that they need to transform. I have observed this over years of working with patients. Yes, you may present with a diagnosis, but are these symptoms pointing to something deeper in the patient’s complexity that’s asking to be made conscious, is it giving voice to silence in a system? I can quite categorically state in many cases, yes, a cold is sometimes just a cold, nothing further is required. Or pneumonia is pneumonia, but very often symptoms are teleological. They point towards something that needs to be made conscious and worked with.

I remember a patient recently just last week presented with multiple sclerosis (MS). She had a very difficult relationship with her father, her whole life. She was never seen by her father. Her father was a very famous coach in the national sport in Canada. He spent all his time working with his team and was never at home. This patient was extremely, extremely bitter, and angry about this relationship. She felt she was never seen and never fully taken into the father’s confidentialities and mentored and parented by the father as she should have been. This was part of her whole life. This is where it becomes interesting. She presented with MS. So, we asked a little bit more as to when the MS appeared? And she gave me the exact date. Then I asked her, and where was your father at the time? She suddenly just broke down in tears. She said you know what? I developed MS the day after my father was fired from the team.

It was immediately apparent to her that she’d been ignored and neglected her whole life by her father. The day after her father no longer had the obligation to leave home and be out of the home most of the time. He was fired, he was now at home. She showed the symptomatology of MS the day after he was fired. She connected the two. She said, finally, he saw me and started to take care of me. One day, 24 hours. That is a symptom that I think is teleological. I don’t know what else to call it.

Patients who fall under the second possibility often start to ask much deeper questions and use symptoms as allies. They ask themselves questions. We all have these patients, and they are a delight to work with if their reasoning is rational. Sometimes we get people who, as we know, don’t have the capacity to integrate knowledge in a way that is coherently helpful to them. That becomes problematic. But many people are excellent self-advocates and have deep intuitions as to meaning and purposes as to the possible teleology of symptoms. They use a much more conscious approach and they recognize patterns and they approach their healing, not just with physical interventions, but with a much wider array.

Then you get the third possibility, that others seek a state of health motivated by aspiration or something more than just an absence of symptoms, but a positive state of wellbeing. As much as they’ve learned about illness, they now look at what it is to be healthy and well. This includes a sense of inner self-regulation. Competence, self-competence, not hubris or arrogance, but they just know themselves. They have a core self that is self-regulated. They really are called from above. They are inspired.  They have a sense of meaning and purpose. They know why they get up every day and they know they have a destiny to fulfill. They are inspired from within. They are also aware of parts of themselves, this part of themselves they don’t want to own, shadow, and how they project that shadow onto others. They also know that the ultimate desire is to know themselves as much as they are capable of.

They stay in their core, without too many emotional fluctuations. They see crises as blessings. They are inspired by a mission and vision bigger than themselves to which they stay aligned. These patients are delightful to work with, as we all can attest.

Alastair Cunningham, in his book, Bringing Spirituality into Your Healing Journey said the qualities of cancer survivors that best predict spontaneous remissions are those who are open to change. Those who have a commitment to daily practices, have a deep sense of themselves, and have achieved a level of autonomy integration and inner authority, as opposed to those who have what has been turned into type C patients. Type C patients, as we know, are less able to summon the strength within themselves. They suppress emotions and tend to have “projection of will,”where their desire to be healed is all placed in your hands.  They tend to defer their own needs to the needs of others. They don’t tend to practice a healthy balance of narcissism and altruism. Everything is about the other.

Then is the fourth possibility. Those who seek a level of health that is fundamentally and radically different. These are the people who have what we call an expanded level of consciousness. Self-transformation rather than self-regulation. This viewpoint embraces all the previous perspectives and approaches to health while simultaneously transcending them in the creation of a fundamentally new vision. Here people start to identify themselves with an aspect of themselves that is not only their bodies, their emotions, and their mind. If you think about it for a moment, our bodies change, our emotions come and go, our mental field changes, but to whom are those changes taking place? The answer is you, the deepest sense of who you are.

That is a sort of subjective experience which you can align with. They define themselves by attention to an inner, more spiritual process, rather than something outside of itself. They become attuned and surrendered to something, to an intelligence that’s greater than their own ego. They know that their ego is not the center of the universe. The evidence for ourselves not being at the center of the universe against the backdrop of infinity is rather overwhelming. People who surrender to that awareness know that they are just one small cog in a very large wheel and against the backdrop of infinity. They don’t take themselves too seriously, but they stay aligned to what they are called to do in this incarnation.  But they surrender to something bigger than themselves. That’s why the ancient Greek temples often had open roofs. Peoplewere open to something, some intelligence that is more than just themselves. This is very similar to what happens when I had that satori experience, you stay open to something bigger than yourself. What happens is when that comes through, fear completely disappears. It really does. You just have no fear of death, because you really know that we are not our bodies, emotions, or thoughts. You just know that to be true. This is the deepest possibility of a transformed individual, from illness to illumination. Hence the nature of my talk.  Very often, when we have these awakenings and satori, they are fleeting. My first one lasted a few hours and the second one lasted a few days. So, you have this awareness and then you come back into your body and space-time, and the duality of being in the emotional body, but you still carry that awareness in you, that there is this possibility beyond your ego-based experience.

All the great wisdom traditions teach that is the true state of who you are. That’s the essence of Advaita. That’s the essence of many of these inner esoteric traditions of spiritual practice.

This can be felt and experienced and be part of your healing journey. So, we move then from the relative purpose of medicine to the ultimate purpose and possibility of healing when we start to incorporate this deeper aspect, this sort of shifting consciousness if you will.

So, a more complete roadmap doesn’t look at treatments but looks at how all these approaches can be applied. The doctor, the patient, the individual, the collective unconscious, the unconscious states, and stages of consciousness, sickness, and wellness. The healer and the patient have that roadmap. They are aware there’ll be multiple risk factors at all layers and all levels. There will be many different diagnostic and therapeutic options at all layers and all levels.

As I mentioned, I use Ken Wilber’s integral medicine model, but it’s not practical. It’s theoretical. Ken Wilber incorporated many paradigms into his system of human inquiry. All the ancient sciences, physics, chemistry systems, theories. It is a system of individual outer and inner reality and collective outer and inner realities. He calls it the Integral Theory of Everything.

One of his statements in the forward to the book, Consciousness and Healing, which I recommend everybody read, says “In the black bag will not be just 20 pills, two scalpels, and an orthopedic hammer, but all layers, all quadrants, all states and all stages of consciousness. The crucial ingredient isn’t all the ingredients, but the holder of the bag. The integrally informed practitioner opened to their entire spectrum of consciousness who can acknowledge what is occurring in all levels internally, as well as externally. Who have an expanded map – from dust to deity, from dirt to divinity, and from agony to ecstasy. Only then the treatment.” I think it’s a wonderful insight into what’s possible. How to practically apply that in insurance-based medicine, in a short appointment, well that is another thing.  That’s the logistics of how to practice in this model.

So, is there some way to practice medicine that surrenders not one ounce of the rigorously scientific, empirical, and clinical dimensions that are the cornerstone of any modern scientific system of healthcare, but also make room for other dimensions of being in the world that if ignored, subtract from one’s humanity and effectiveness as a physician? This was the great question that arose in my evolution as a doctor/physician. I was likely to be exposed to many great thinkers and read many books and visit many clinics and ashrams and so forth.

The origination of the model, I’m now going to teach you and show you just briefly. It was based on original Vedantic awareness.  When you look at the literature, they talk about these layers and levels of the human experience, and they step them down. They call them Koshas. It’s an Ayurvedic or Vedantic map of the human experience. At the time I was studying Ayurveda, I happened to meet Dr. Klinghardt, who has his Five Levels of Healing. I looked at his five levels and I looked at the Koshas, the bodies that I was learning and studying with Ayurveda, and I created a few more divisions. With Dr. Klinghardt’s permission, I created subdivisions of the five and made them seven. He allowed me to use his map, but I took the level one and made it it’s own.  Stage One, or the environment. Then in Stage Four, I separated the mind, the intellect, and created another subsection called emotion. You’ll see why in a moment. I separated them out into seven instead of five.

This model, if you look at it. Stage One.  When you are sitting in front of a patient and you’re trying to look at them through a certain lens of how you’re going to appreciate what they’re presenting with, this is the lens I use. I can’t think any other way now.  I think of what stage is being asked to be interpreted and covered. Stage One is all about the external body, the environment. Stage Two is all about physical, biochemical, and structural. Stage Three is all about energy, the autonomic nervous system. Stage Four is about emotion. Stage Five is about intellect, ego, and defenses. Stage Six is about the unknown aspects, the hidden aspects of our reality, which is called, for want of a better word, soul. I like the word authentic self as opposed to the persona, and then the family systems that we inherit, and then there’s a sort of archetypal, mythical dimension underneath that too.

Then Stage Seven is this expanded state of consciousness, the so-called unified field, or the Grand Organized Design, (G.O.D.)which is this nature of reality behind our space, time, physical existence. Now Ayurveda recognizes that health is more than just the absence of diseases. They call it a vibrant state in which your mind, your body, and environment are intimately connected and functioning in a healthy, nurturing, and supportive way. It’s a harmonious relationship between all these levels, the mind, the body, and the environment at the highest level of joy.  The mind is clear and creative, the body’s healthy, vibrant, and strong, the air is clean and fresh, the food is nourishing and clean and relationships are loving, communicative, and nourishing. Well, this is an idealism. We know that. But it’s an idealism that can be entertained when you’re working through space-time reality.

This is the model we all bring to our rooms when we see patients. At the highest level of healing, none of that matters because at our deepest sense of who we are, we are beyond all of that. That is what you do invoke when you have this awakening into another level, at Stage Seven, if you will. So, at the deepest level of Stage Seven, none of that will matter because that’s not who you are. So that’s the roadmap.

 On the screen, I know this is going to make you annoyed because I put everything into this map, but you can’t read it because it is too small.  There is no way to make this map readable on a computer screen, but I’m going to break it down. So here are the Seven Stages to Health and Transformation.  At the bottom, I’ve acknowledged the contribution of Dr. Klinghardt who has five levels and I’ve incorporated some of his concepts as well. But as I said, I’ve expanded them and added many, many other dimensions. So, I’m going to break them down and you’ll be able to read the breakdowns for each level.

So, here’s a patient in his fifties presenting with marital conflict, alcohol abuse, and depression. You’ve got to think of this patient through the seven-level model.

Stage One – environment. He’s got mercury toxicity, organophosphate exposures, biotoxins, root canal issues, tick bite history, et cetera, et cetera, everything to do with the environment.

Stage Two – looking through the functional medicine lens, everything we know, the genetics, the food sensitivities, the permeability, the Mast Cell, it’s all there and we do our appropriate workup. We find out that he’s in the cell danger response, his mitochondria were low, et cetera, et cetera.

Stage Three – we look at his electromagnetic body if you will.  We see that he is exposed to computers all day, he has had head injuries, his NeuroQuant MRI shows certain things like asymmetry from a head injury, he’s got high thalamus and amygdala in his NeuroQuant at 99% percentile.  Knowing that this person probably has mast cell activation and the limbic looping through either PTSD or early childhood trauma.

Stage Four – here we have it.  Sexually abused as a child, beaten by dad as a child, dad was an alcoholic, brother died when he was 12. His own son died when he was 17. This is a highly traumatized individual. This is a very difficult case to work with because of the complexity and the defenses this person is going to bring to the interaction, especially in terms of trust.

Stage Fivev–one could say he has a narcissistic personality disorder, major depression. He has a personality disorder and a mood disorder.

Stage Six – from the family. There were all sorts of inherited trauma that was brought through. 

Stage Seven – he had no connection to anything other than his own suffering.

This patient is complex and difficult to treat. But if we have a roadmap, we can sort of orientate ourselves to each layer and each level and then work accordingly. Give ourselves a year to sort through a lot, if the patient has the ego strength to survive that level of complexity. We have to often modulate our own knowledge of this individual where their weaknesses and strengths lie and then adjust ourselves accordingly.

So, when patients like this walk in, we take the history, we look for the antecedents, mediators, and triggers. We create timelines, we posit a working hypothesis. We do all the tests and we jump into treatment. I’m just going to suggest before we take this approach, before you rush into treat these specific symptoms, clusters, or diagnoses across all layers and levels, step back and ask a couple of questions of ourselves.  When we go to look through this much larger lens there are certain things that I think we should bring to the dynamic in the room with the patient.

So here are the things that I sort of need to remind myself of many times a day, and sometimes forget when I’m in the doctor as hero archetype, which is not difficult to do. You get humbled.  You’ll often get patients who humble you.  You get challenged, and then you drop back into the awareness that yes, we can occupy doctor as hero but we also need to be doctor as patient.  We have to be aware of our own hubris and our humility when you are dealing with complex patients.  You will be pulled back and forth by so many dynamics that are being thrown at you.

Here are some of the things I think are important. Are you present, related, listening, resonant, embodied, and attuned?  This is Porges social engagement theory. Does your face reflect that you are listening to that patient? Is there trust established? Are these patients being seen by you? Were they ever seen by anybody? The patient I mentioned before, was never seen by his father, his brother died, he got lost. His mother was so traumatized. Then his own son died. Can you imagine the level of trust he has in outer parental or in external authority figures? Not much. You’ve got to be aware of the projection of these unresolved early developmental issues of patients.

The patient, as I mentioned, had so many unresolved complexes that he projected onto the exchange it was very difficult to negotiate in some of these complexities. How many layers and how many levels are needing your attention? Are symptoms Teleological? Do they point to something in the system as I mentioned before?

Then what stage of life are they in? The first half or second half? This is a very important question that comes up a lot.  If you look at the trajectory of life, the first half of life is very different from the second half of life. In the first half of life, you’ve got this developmental brain, you’ve got the so-called triune brain, the reptilian brain which is fight/flight, you’ve got the limbic brain which is emotional and then you’ve got the mammalian brain, the prefrontal cortex, which is the inhibitory brain.

If you look at the trajectory of patients, attachments, and needs in the first 10 years the child needs to be seen by the mother in particular, not so much the father although the father does play a role.  The child attunes to the gaze of the mother. The mother’s right prefrontal cortex tunes and attunes with the child’s right prefrontal cortex, and a sense of attachment and safety is created.   Sebern Fisher showed in her fabulous book about neurofeedback development that if the mother and the child attune in the first 10 years of life, and there are no breaks in the bond, that creates, in the child, right prefrontal cortex maturity, and they develop a sense of self. Now, if the mother’s present and it tunes with the child, because the child looks to the mother, attunes with the mother, feels safe, looks away, self soothes, self regulates then looks back to the mother.  This goes on for years. In a daughter, up to 30 years. In a son, later, up to 35 years. That child is always trying to attune to the parental expectation. Now, if the mother is present and the mother is attuned, the child feels safe. So, the first 10 years of life is all about fight/ flight and safety. If the child is safe in themselves, they then start to develop core strength and a stable sense of self, which they then take into the next 10 years, which is developing an identity and a sense of self with peer groups. Now, the father’s often responsible for tuning the child into the second half, the second decade of life when the limbic brain becomes attuned. If that child then gets exposed to bullying and ridicule, that limbic brain is highly traumatized and that’s when you get all these anxiety states and OCD states because there’s no self-regulation at that level of development.

Then in the third decade of life, you achieve a certain sense of autonomy. You’re starting to lay down your prefrontal cortex, your inhibitory brain, where you inhibit the fight/flight of the first 10 years. You inhibit the fears of the second decade, and you start to develop a sense of autonomy and independence, where you’re no longer looking for parental guidance. The parent is the external prefrontal cortex for 30 years. The child’s always looking for (external) self-regulation. But then as the child develops and leaves the father’s or mother’s house, they have their own prefrontal cortex to inhibit their fears and their emotional fluctuations, and their fight/flight responses. That’s a healthy developing ego. Patients in the first half of life are often taken up by these biological imperatives. They are very different. It’s the ego development of the child to develop a coherent sense of self. It’s very different from the second half of life, which we call more of a soul part of a person’s life. Whatever develops in the first half of life, particularly if there was high drama and trauma, the child will often develop what’s called a provisional sense of self, where they leave their authentic self behind. They make themselves adjust to cope and survive. That is what we call the provisional self, and that becomes the ego, the operational sense of self that takes them through life, which can be very highly developed. But the core instinctual self often gets left behind. It’s been my experience that in the second half of life symptoms will often bring a patient back to re-examine that part of themselves that they left behind in order to develop a provisional operational sense of self.

This happens all the time when I take histories and look at the teleological impact of symptoms. I think we need to, as practitioners, be aware that treating a patient in the first half of life, I’m talking about patients with complex mind-body type illnesses, not just bronchitis, but I’m talking about complex patients. Patients in the first half of life are called, driven by biological imperatives. You know, Freud talked about libidinous drives, Dr. Adler talked about power drives.  Jung was the only one to talk about the drives of the soul. Jung would not see a patient psychologically until the second half of life, because he said there was nobody home. He said that in the first half of life, you’re just driven to become something. So, you’ve got hormones at your disposal and there is no true consciousness to work with.

I’m not saying that younger people aren’t conscious, of course they are. But you are being driven to become something and succeed in life, it’s only in the second half of life when we are naturally drawn to become more aware of your true, authentic self, that we can really start to do more of the inner work because we’re not being driven to succeed in the outer world. This changed my practice when I started to look through that lens. I think it’s an important lens. We can’t ignore it.

So, this series of questions. What is the strength of that person? What ego strength? Are they fragile? Do they project their will? Are they highly resistant? These patients are different. You’ve got to be aware of them. How defended are they?

What unconscious dynamics are they wanting to be made conscious of? Are they ego defended or soul defended? There’s a difference, which I don’t have time to go into.  The soul defended people are far more traumatized.  Are they able to self-regulate or are they in their core or do they fragment into different ego states? Do they freeze or disassociate? Are there personality disorders?  Then asking other questions. What is the actual content of the internal dialogue? How polarized are they into black and white thinking? Is there a need for a new narrative, a new story that needs to be told? I often see complex patients and they often don’t heal unless they have a new image, a new story, a new internal dialogue, even sometimes an awakening that is physiologically experienced. Not cognitive, but a true awakening to a new reality.  That’s not a fragmented ego state or dissociative ego state. It’s truly a transcendent experience.

What is their capacity for self-advocacy? How well-informed is it? Is it rational? Is it magical? Wishful thinking? Are you, as a medical provider able to create salience and relevance? Do you educate your patients as to the complexity of their presentation? Or you just tell them what to do? There is a difference. We all know that education goes a long way in creating so-called compliance because there is salience, there is relevance. What are they asking of you? To treat disease, to make symptoms go away? Or are they asking to be assisted in their quest for full human flourishing? It’s important to know. What archetype do you occupy? Are you in your doctor as hero or doctor as healer mode? Do you stay in your core? Are you able to take no credit, take no blame, stay true to your own chief aim, vision, destiny? Are you able to keep loving what you do and not get too elated when people praise you or depressed when people damn you?

Doctors are subject to lots of projection, lots. A patient comes in the door and praises you.  I know to keep yourself in your core because the next one’s going to come and damn you. So, you just don’t oscillate between seeking praise and getting too upset when people go at you.  Which they do. On social media. On rate MD. You know, people can project all of the unresolved parental conflicts onto authority figures. Don’t forget we as MDs or naturopaths or chiropractors, carry a big potential for large parental projections onto us. These are unconscious projections by patients, that which they haven’t resolved with their parents. One of the great questions I always ask a patient is how are you related to your mother and father? If there is a complexity there or they’ve never seen their mother, never seen their father, that’s a different patient than one who’s been seen, loved, and nourished by patients. We know that through attachment theory and early trauma.

The last question is where do we enter into this complex system when patients present with this kind of complexity, where do we enter? What level?  Do we enter at the level of toxicology?  Do we enter at the level of the soul? Do we enter at the level of ego development? This is what we need to ask ourselves. Often when you sit enough in the field of a patient it becomes clear. It sort of unravels itself. It’s only through a phenomenological inquiry that the answers will emerge. You kind of walk in with a plan. You’ve got to stay related. You’ve got to look the patient in the eyes and you’ve got to listen and then see what emerges phenomenologically in the field as to where this system is asking to be unraveled or order created out of some chaos.

Here’s what we do. The first level is the Extended Body. You know, the river is my blood, the rainforest produces oxygen- is my lungs, the earth is my body. Every time we breathe in and out, we exchange tons of information with the environment. Just look at COVID. See how much gets exchanged through droplets, etcetera. Someone calculated with every breath we exchange 10 billion trillion atoms. That’s remarkable. Where were those atoms before I breathed them out? They were in my liver, my kidney, my spleen, my bones, my brain.  Deepak used to talk about the fact we are always in an involuntary organ transplantation program. COVID has brought us this awareness. It’s too close to home. It has been calculated, do the math, that by the time you leave a room, we walk out with at least a million atoms that came into the room with somebody else. We’re constantly exchanging our bodies with each other and with the environment at large. Everybody here has atoms that were once in the body of Jesus Christ or Mahatma Gandhi or Saddam Hussein or the lion in the Kalahari Desert or Donald Trump for that matter or the notorious RBG if you will. So, when you say “this is my body”, it’s somewhat of a delusion. It’s a limited perspective of who we are. So, the air we breathe, the food we eat, the water we drink is densely packed with a multitude of potentially carcinogenic and immune system depleting toxins. We know that. I mean, fabulous lectures this weekend on that from some of the world’s authorities.

The great teachings of Ayurveda say “I’m not in this world, the world is in me”. It’s not metaphysics, it’s science. We are continuously in exchange. We have a responsibility as well, to know that there is no “out there”.  Us and “out there” are one and the same. It is incumbent upon us in this field to be environmental activists. In the highest sense, we have a responsibility because we know this to be true. Every time we drive our car when we could be walking. Every time we throw away a bottle and we could be recycling. We should be and must be at the forefront of the environmental movement.  I do believe ISEAI is really carrying that mantle, of course. Mark Hyman’s new bookFood Fix was fabulous when he outlined how our food supply is in the hands of our 12 CEOs of big companies. Very sobering.  We have a need for this regenerative farming, et cetera. So that’s the Extended Body, the world outside of ourselves. I just put together this quick slide. These are some of the toxicology environmental labs that I use. Some of the treatments I’ve found helpful. We are all familiar with these, you know these, I just wrote this down for quick reference.   I originally had much more time to speak and I was going to go into more detail, but unfortunately, that can’t happen today.

The second level is the level of the Physical Body. We know that our body is nothing other than DNA wrapped in food with some structure. We know that macro and micronutrients influence this dramatically.  When we look at the physical body as such, there are certain things that really have emerged in my practices. At the core of this awareness, because this is where most people will enter. They enter into at Stage Two, the physical symptomatology and biochemistry. We do our allopathic history and functional medicine history. We do a complete functional medicine workup with all the tests we can. That stupid saying that we all are aware of, “you can’t manage what you can’t measure”, it’s so true.  Some practitioners are excellent at what’s called ART, autonomic response testing, and don’t test as much. I personally am more familiar and more skilled at test interpretation. I try and get as many tests as I possibly can so as to explore the cartography of what’s being presented. People often, and budgets are limited, of course, so you have to adjust accordingly, but if you can test it really helps you pull in all these disparate parts and create a more cohesive roadmap for helping patients. So the complete functional medicine workup, we’re all familiar with it. I do feel that the different diets, you need to know all of them. You need to know about fasting, mimicking, intermittent fasting. I personally find the paleo autoimmune low histamine diet to be the bedrock of trying to get people to downregulate the inflammatory issues they usually come up with.  You have to be familiar with the histamine diet, the oxalate diet, the SCD, the Ayurvedic diet.  A Vata person’s diet in Ayurveda is very different from a Pita person’s diet. You’ve got to know the different tastes and flavors that these different Ayurvedic doshas if you will, do better with.  I do think it’s important.

Mitochondrial medicine, the cell danger response, membrane medicine, Robert Naviaux’ s theory is unbelievable.  It changed the way our practice works. We are now able to do the labs that look at some of these markers. I do them on every patient, almost. Working with Dr. Afrin and Mast Cell patients, we now start talking about Pentad and recently Septads.  Pentad patients are patients with Ehlers-Danlos,   POTS and dysautonomia and auto-immunity with chronic infections and cranial, cervical instabilities. This is important. Many POTS patients go undiagnosed. You’ve got to take the blood pressures, lying and standing. You’ve got to ask about Ehlers-Danlos and do Beighton scores. These are very important, little bits and pieces I’ve picked up over time that I’ve put into my toolbox. Sleep and exercise medicine, we all know that. Peptides, exosomes, stem cells are new kids on the block, and there’s even more now. We’ve got psychedelics in there too. There’s so much going on, unbelievable. Ketamine, et cetera. Dentistry, you’ve got to know dentistry. You got to start learning about dentistry and how to read a two-dimensional panorex and maybe 3D cone-beam CT scan, but best to work with a biological dentist, you’ve got to know a lot. Lots about Nucca chiropractic, craniosacral vision therapy, and know your immune system basics.  It is very important to know how to down or up-regulate accordingly.

Then Stage Three is the Electromagnetic Body. We all have this layer of Prana according to Ayurveda, this level of energy and vitality. There’s a difference between a corpse and a human being.  With a human being, there is some intelligence flowing through which needs to be nourished and interacted with in every way. Just as we are metabolizing food, we metabolize with sight and touch and smell, et cetera.

We have to know some of these theories and some of these insights. These energy fields that come from the body that works in concert, and it’s been shown that they actually govern biological processes. We know from the work of Dr. Albert Popp that there’s a biofield around in the body. It’s coming from what they believe to be DNA. This whole concept of the aura is actually real. Local fields, meridians, regulate the flow of energy within the body.  These fields operate as a spectrum. They can include electrical, electric, magnetic, and subtle energies. These do correspond with a wide range of scientific data and field reports. I learned from Dr. Klinghardt from his work with Dr. Popp and others that our matter, our actual biochemical reactions are controlled by this energy component, which shapes matter. Apparently, there’s an electromagnetic sort of field that stands as a standing wave outside of your body. Where they intersect it actually is where the control of biochemical reactions occur. We know from Harold Burr in the nineties, he measured these electrical fields around an unfertilized, salamander egg, and found it was shaped like a mature salamander. He showed that often these electromagnetic patterns often undergo destruction before the physical body, before physical illness follows.  When we look at this electromagnetic field, we have to know about the brain. We have to know about the autonomic nervous system. We’ve got to know about NeuroQuant MRIs, heart rate variability.  The QEG work that we do here at the clinic is extremely important. I love to correlate NeuroQuant MRIs with QEEGs. You can often tell the biography of a patient just by looking at what’s showing up in the NeuroQuant MRI and what’s showing up in the QEEG. We also have to know about interference fields, scars, tonsillectomies, tissues that have damage to them, which can actually interfere with some of these fields. We have to know about man-made electromagnetic fields. This becomes part of our workup. Getting a building biologist to go into a home and measure electrical fields, magnetic fields, EMF’S, and dirty electricity.

We also have to know about the mind because the mind through the stress response or through intention can sort of change the electrical field.

Upregulation of the HPA access, for instance, can cause cortisol to cause a leaky gut, leaky brain, leaky mitochondria. So we have to know about stress responses, mental fields, and the downstream effects on the electromagnetic body. This is the so-called regulatory medicine that Dr. Klinghardt mentioned where we use interventions, homeopathy, acupuncture, all forms of regulatory medicine of which we learned, not through allopathic medicine, but through other studies. Sometimes with brain injury, we do need to do neurocognitive testing. I do quite a bit of this, particularly with traumatic brain injuries.

Now we switch from the outer world to the inner world. We start looking at the emotional fields of the body. And Candace Pert was the first to show that thoughts create our physiology through first electrical and then chemical signals on neural peptides.

Every time we think a thought it’s turned into a chemical.  The Ayurvedic saying is if you wanted to look at what your experiences were like in the past, look at your body now. There is a blueprint. If you want to know what your body’s going to look like in the future, look at your experiences now.  Traditional Chinese medicine teaches us that emotions are linked to specific organs. You know that a patient who’s been sexually abused, particularly females, often have a lot of pelvic symptomatology. Anger and the liver are very much linked. You’ll see this a lot. Also, grief. I had a woman who gave up a baby for adoption and she presented with asthma. She dealt with the adoption guilt and her asthma cleared. Nothing else. It’s just linking emotion to organs. This is a real thing. It’s not just speculative on the part of traditional Chinese medicine. Many studies have been done showing how emotions are linked to biochemistry. Anger has specific upregulation of inflammatory cytokines, laughter downregulation, et cetera, et cetera.

We know from this world of the emotional body we’ve got to start looking at early developmental traumas, the adverse childhood effects of trauma, and what effect they have on the body. We know that there’s an increased incidence of all sorts of diseases with adverse childhood experiences and early trauma. We’ve had to learn about trauma-based therapies, integrated body psychotherapy, somatic experiencing, family constellation work, early developmental trauma work. We use a wide array of therapeutics in this domain. We can’t ignore the level of complexity that dysregulated emotions bring into the interview.

Level Five is everything to do with the Intellectual Body or the so-called individual mind and ego development, the operational sense of the self. We have this individual ”I”, which is interrelated to bio-social networks. This is a very important part of how we interrelate.  Is the person’s ego-sense of self strongly developed? Is it fragile? Because it depends on how you interrelate with a person as to whether this is true.

Everybody has a value system. You need to know your patients’ value systems. Every person has different personality types. Every person has different constitutional types. I find it quite important to know about Ayurvedic types.  The Vata patient is very different from the Kapha patient who is very different from the Pitta patient as to how you interrelate with them. With Myers Briggs typology, a person who’s an introvert is very different from an extrovert. A person who is judging is very different from somebody who’s perceiving and so forth and so on. A feeling type is very different from a thinking type. It’s important when you start to work with patients to know some of these typologies in order to work with them accordingly.

So, the individual mind, which is located to the body, takes in information through the five senses, transforms that through the filters of values and core beliefs, morals, ethics, and culture, and then in the step-down transformer, the brain, transforms that into reality.  Also, the individual mind or ego takes in information, if you will, from above, from internal images that it has created and stories, we’ve told ourselves about early developmental experiences. Then we filter that through our personalities, our constitutional types, and provisional selves. Our ego states are usually provisional selves. Then we translate that into reality and thus physiology. Our conscious core beliefs about our ego selves mobilize biochemistry, causing neurons to fire together. We often have unconscious core beliefs, unconscious  complexes that come up from below, and then these then create our outer reality.

We have to know how to work with this intellectual body through different interventions. ISTDP is a form of psychotherapy that I respect and refer out to other people to use. ISTDP looks at the defenses of a patient. Patients are often presented with a cluster of symptomatologies, which are masking the inability to feel deeper emotion. For instance, anxiety. Anxiety is not an emotion. It’s a defense against feeling deeper emotions like shame, guilt, anger, rage. So, an ISTDP practitioner will ask patients certain questions and work with them in the transference and countertransference of the relationship to try and see how symptoms may be presenting based on defenses that are being crystallized, preventing them from uncovering what they really are trying to feel. I find ISTDP a fascinating and very deep form of therapy, but difficult to do. I use other methods, the Demartini method, and others.

So, individuals who have truly miraculous responses to healing in their physiology are the ones who have a shift in perception, in consciousness. They extract a new set of information from their perceptions. They change their beliefs about their perceptions and hence radically reorganize their downstream physiology as a consequence.

At the level of the soul, we have to know about the cartography of the soul. The objective reality of the soul that Jung talked about. We have the outer ego that orientates itself to space-time, and we have the deeper unconscious aspects of the shadow in the self. It’s only in midlife that often the soul body or the authentic self wants to emerge.  Very often in a therapeutic encounter, you’ve got to know the difference. Symptoms will often present themselves at this midlife stage, as I mentioned, in order for a person to transition from the first half to the second half. If they hold on too tight to the first half of life ego-based demands, they will often attract challenges in their physiology in order to draw attention to the fact that transition is needed. You know, in Greek mythology, the seat of the soul is on your knees. You will often see this. People who attract tragedies, will attract physical ill health, they’ll attract divorces, they’ll attract bankruptcies. They’ll be challenged, forced to change the trajectory of their life from the first half to the second half, because if they continue on the first half of life endeavors, as the hormones retreat, they will fail to recognize the calling of the soul to become more whole and more developed. We naturally evolve as we mature to integrate parts of ourselves that we left behind. Our provisional selves get made conscious and we start to integrate parts of ourselves that we previously were not aware of. We become more authentically ourselves. We start to deal with something called shadow projections, parts of ourselves that we don’t necessarily like. Those parts of ourselves that we don’t necessarily like, we often attract on the outside.  We have to deal with them until we learn to integrate them. We have 4,500 traits. Every trait serves a purpose. Until we can learn to integrate all traits, we’re not really able to be authentically ourselves.  That’s a methodology and that’s something we have to learn.

The other thing at the level of the soul is the family soul. We often inherit this.  We have to take a multi-generational history to determine neuro-psychiatric conditions. The experience of a parent before conceiving markedly influences both the structure and function and nervous system of subsequent generations. So, at level six, this is one of the most profound insights I’ve ever sort of experienced, what the ancestors bring to the table will often be expressed in the individual, but it has nothing to do with them. It is in their system.  They inherit epigenetically trauma in the system.

Sometimes when you start to see the dynamics and the entanglements of the family system, and the patient is made conscious through family constellation therapy, of these entanglements, and they get an entirely new insight into what preceded them, it entirely rewrites their story and their personal dialogue and their beliefs about themselves. They’re able to really let go of the narrative that they brought into the treatment room. This has been very profound. I used to do a workshop every year with Mark Wolynn who is one of the masters at this work. Whereby we would look at illness and inherited family trauma. Very often we could see how illnesses have their origin in inherited entanglements and family systems. I encourage all of you if you’re fascinated by this to not ignore inherited epigenetic family trauma.

Bert Hellinger was of course the great pioneer of this work. His work is immensely helpful and worth reading.

When a patient shifts their judgment, criticism, and projections, to understanding and see their parents, for instance, in a greater light, something profound happens. They may have hated their mother, but when they start to see how their mother got very little from her mother, something opens in them and they stop telling the same story. They see their mother with more compassion. So, when a parent or individual is placed in a much larger family system, a new image is created, and it absolutely changes downstream metabolites, it really does work that way. These trickle-down effects do go down into physicality and to biochemistry and a whole new healing potential is set in motion.

This summary slide sort of summarizes what I’ve said. When we work at all layers or levels from our family system, from our ancestors, we may inherit events. As well, when we are born, we inherit early childhood bonding experiences either positive and negative, which then influence our beliefs, our values, our internal dialogue. We have 60,000 thoughts a day. Most of them are the same as the day before. When those change, it creates a different downstream metabolism. Then our defenses, that then influences the content of our thoughts, which creates a specific image and a narrative, a so-called internal dialogue, which then alters the autonomic nervous system, peripheral and central nervous system, and the HPA axis immune system. In the brain that then transforms first into electrical signals, then chemical messages in the form of neuropeptides, neurohormones, that then interface with protein receptors in the nucleus of the cell mitochondria.  That is then encoded in specific genes to translate proteins that transform into enzymes, neuropeptides, immunoglobulins, hormones, connective tissue.  That then becomes you, that beat your heart, breathe your lungs, procreate your off-spring and heal.

Or, if you further increase your allostatic load, triggers from the environment, et cetera, creating further cell danger response or hyper-freeze in Porges dorsal vagal theory, that then creates more symptoms of diseases. So, in the middle of this, we’ve got to enter into the system and start to unpack and uncover what’s going on at all layers and all levels that could create either health, healing and a sense of living at one’s maximum potential. Or, further increase and down-regulate the cell danger response and the hyper freeze response and make things sicker and worse. We have to enter into this system and try to unravel what’s going on and what to do. This is the skill of a fully informed practitioner who has a bigger roadmap than just the functional medicine roadmap.

This is a patient who presented, for instance, just looking at the family systems issues.  She presented with all the symptoms that we know many people present with. She was Vata imbalanced. She had POTS, she had chronic pain. She had worked with everybody and still remained very symptomatic. She had an MSQ of 102.  The family story was that her dad was a drug addict. He used drugs, the parents weren’t happy, dad left when she was two and then died from drugs when she was 10. The story in the system was that dad was useless.  Was a drug addict. Killed himself, she seldom thought of him when she did it was very negative. She had a break in attachment with her mom because her mom was always busy with her father and took her eyes off the patient.

She was merged and identified with the deceased father. She could not love him overtly because he was terrible, that was the family myth. He was a no-good drug addict. So, she loved him covertly, but by becoming sick like him.  Children have a massive unconscious loyalty to their parents. No matter what the parents do. She would say to herself unconsciously, (this was not conscious), dad you didn’t live a full life, I won’t either.  I’ll suffer like you, so you won’t have to do it alone. This is the unconscious loyalty of the child to a parent. So, when this was uncovered in a history taking, she tuned in to the sensations of her body, she felt more cohesive. She was able to feel more integration. She felt the vibration, and this became her sense of self. This became a daily practice and she started to then visualize attachment to the mother appropriately and started to bring her father back into her life.

She placed a photo of her dad on her desk as an altar to him, inviting him in. She went to his grave. She visited his family.  Now remember she’s half her father. So, this half of herself which she’d cut off and ignored now, all of a sudden, came up alive and introduced energetically into her system, the part of herself that she had ignored and rejected and was in pain. She then did, level three or stage three work. She did emWave to develop coherence, saw a somatic experiencing practitioner. She developed a stable sense of self and developed the so-called “window of tolerance”. She said, you know, these insights have changed my life. I’m asking dad to guide me. She just started to develop a core self, an increased window of tolerance. Her symptoms calmed down; her POTS was under control. Of course, we did all the biological functional medicine, you know, salt and stockings and Florinef and everything we do at level two. But it was this insight that really had a trickle-down effect. After a certain period of time, her MSQ had come down to 30.

Level Seven – Spiritual Body.  About a hundred years ago, there was, as I said, this infusion of ancient souls.  They said things were not really physical. Behind this mask of molecules behind this facade of materialism, there’s this vast domain of energy and information.  We can relate to it.  It beats your heart, it breathes your lungs, it moves birds’ wings, it creates black holes and supernovas. This intelligence underlies all matter. It has no limits. Larry Dossey’s, his new book is called One Mind. It says that everything behind the appearances of separateness is this One Mind. It is connected in infinity in all directions.

And you can experience it directly through these Satori’s or awakenings or precognition as mentioned. It’s not located within my mind or my body. It is not limited to my brain or my body. It’s the umbrella to all individual minds. This is a level of transcendence that can be experienced. Once it is experienced, it’s the ultimate healing because there’s no fear of anything because you realize that is all there is. We manifest from that. Our separateness is somewhat an illusion of the five senses. This can’t be cognitively felt, it has to be transcendentally experienced.

In summary, in the Seven Stages to Health and Transformation, Stages 1-5: Conscious / Space-Time / Ego.  Stages 6-7: Unconscious / Systemic / Soul. Each level has its own order and its own laws, which need to be understood. The lower five levels belong to the personal realm, the conscious ego-self.  The sixth and seventh to the systemic and transpersonal realms, unconscious. The higher levels have an organizing influence on the lower level.  It is very important to realize that the lower level supplies the energy to the higher levels and creates boundaries for the individual to exist in. Resolution of issues at the higher levels, trickle down to the lower levels. This is so true. You can’t treat POTS and hope for family system trauma to be healed. But if you heal family system trauma, POTS may resolve.

This is very much a rule that I was taught by Dr. Klinghardt and which exists to this day. So, the Seven Stages to Health andTtransformation.  The purpose of an inclusive model is not to create a larger tool bag of treatment strategies, whether they’re allopathic or integrated. The purpose is not to add 10 minutes of prayer to radiation treatment, and believe we are filling a more holistic imperative. We don’t necessarily need more tools and hammers in our toolkit. The purpose is to create as large as possible a diagnostic and therapeutic roadmap that relates directly to the patient’s experience and request and ask, what is it about all the approaches that can be applied to healing? Where both the doctor and the patient, the individual, and the collective, both sickness and wellness are considered and included.

The crucial ingredient isn’t all the ingredients, but the holder of the bag. A transformation in the practitioner. The integrally informed practitioner who is open to the entire spectrum of consciousness. They can acknowledge what is occurring at all levels and all layers, internally as well as externally, as much as is possible. With both confidence and humility, be aware within themselves, of the doctor as hero, as well as the wounded healer, and be aware of projection of this and the patient’s complexes. And attempt to lower as much as possible errors of commission, as well as errors of omission.

“In the black bag there will not be one mechanic to one machine, one plumber to one broken faucet, but one human being to another.  Not just 20 pills, two scalpels, and an orthopedic hammer, but all layers, all quadrants, all states, and all stages of consciousness. They will have an expanded map from dust to deity, from dirt to divinity and from agony to ecstasy – only then the treatment”. That’s Ken Wilber. 

What is most obvious is that this does not happen without a profound inner shift in consciousness and a radical shift in the beliefs of the patient about what is humanly possible.

These beliefs are contained in the internal dialogue at Stage Five. This is accompanied by an entirely new narrative and image, replacing the one from the past and what is possible for the future.  Rewiring through new neurocircuitry a different set of downstream metabolic modulators.

I remember Debra, a dear patient who died from stage four breast cancer after seven years of treatment. She had achieved a profound sense of health and healing in all areas of her life at the moment of her death. She had experienced this shift in consciousness: One mind, and I believe she died fully healed.

This is completely possible. So, we moved from the relative purpose of medicine to relieve symptoms and to cure disease, to fix people, to eradicate tumors, to normalize blood tests, alleviate pain, create clear CT scans and prolong life. These are the culturally sanctioned notions of what physicians are supposed to do. We all asked to do this with the least amount of effort, expense, and sense of personal responsibility. This is compounded by the consensual reality that all illnesses are negative and should be eradicated. Illness is not being used as information for self-transformation.

We then move from the relative to the absolute purpose, to assist in healing the physical body so that people can live out their lives in a state of maximum potential, in the fulfillment of love and purpose, and feel the love, joy, wisdom, and compassion in their lives more fully.  We achieve this, not by medicating a symptom away, but by using it as a feedback mechanism. To let us know where we need to become more conscious, we lean into the sharp points of our lives, and we assist in creating a culture in which spirit and energy have equal priority over matter and the body. We assist in cleaning our connection to this infinite field. One Mind – to which we are all connected. If we fail and people die from physical diseases, there is no tragedy because we can die fully healed with an open heart and a state of present moment awareness with the realization that our true self, our One Mind is connected to something greater than our individual self. It’s non-local, it’s outside of space/time. It’s immortal, and eternal and therefore incapable of death.

 I apologize for going overtime. Thank you for your attention.

If you’re interested in learning more, then please don’t hesitate to read the other posts on the Hoffman Centre blog or contact my office to set up an appointment.

How a Multi-Level Approach to Medicine Can Augment a Cancer Patient’s Treatment

How a Multi-Level Approach to Medicine Can Augment a Cancer Patient’s Treatment

Contrary to mainstream rhetoric, the treatment and prevention of cancer in patients is much more layered than a simple diagnosis and chemo, for example. Things such as past trauma, mold exposure, allergies, and metal toxicity exposure can truly impact how one recovers and even how one reacts to chemo. 

Watch the full video as Dr. Hoffman dives into some of the complexities of a multi-level approach to treatment of cancer in patients. 

Watch the Video

How a Multi-Level Approach to Medicine Can Augment a Cancer Patient’s Treatment

Reference Links

Transcript

Hi everybody. I received an email today from a colleague who is posting his case history on a cancer patient. He detailed the specific oncology issues that had arisen, his approach, and what he believed to be the correct treatment. I was thinking as I was reading this report from an integrative medicine physician about how far integrated medicine, medicine that incorporates many different layers and levels and dimensions of a personal experience, has come. This patient was managed impeccably by her oncologists. Insights were derived from post oncology or peri oncology type issues. When I read through the presentation of my colleague, I was struck by how we can bring so many more diagnostic and therapeutic features to the patient’s experience. When we consider the layers and levels that any individual person brings to the consultation, the history given by my colleague on this patient just touched on a few issues and could have been further expanded upon. I’d like to expand upon the history to provide a road map of how the seven levels, or the seven stages, to health and transformation can be incorporated when thinking of strictly biologically-based medicine.

In his history, he mentioned that this patient had breast cancer. She was treated with chemo and radiation and developed side effects. He went on to mention a few things, such as that she was sensitive, that she had experienced early developmental trauma, that she was a poet and artist, and that she had post chemo fatigue. He also happened to mention that she had a supportive framework, a loving husband, and was very involved in her own patient advocacy. In addition to everything else that he was bringing to the table, he wanted to treat her mast cell activation syndrome. He was looking for further triggers as to why she was still fatigued and anxious, things such as mold exposures or possible Lyme disease. 

In looking through this history, things came to my mind. Whenever there’s a history of early trauma, you have to look upstream to ancestral Inheritance. We know now that individuals carry the experiences of their forefathers. This is well researched and well studied and is now being incorporated into clinical medicine. Whatever the ancestors, particularly the mother, father, and grandparents had emotionally experienced gets epigenetically transferred into the proteomics and metabolomics. This is the cellular expression of that patient’s life that can’t be ignored. Secondly, when a person is born into a dramatic scenario, when they have interrupted bonds between them and their mothers, particularly their mothers in the first ten, twenty even thirty years, there’s a price that’s paid. Particularly if the patient isn’t entrained with the mother’s right prefrontal cortex in an empathic entrainment, one sense of self that inhibits early anxiety and stress or fear doesn’t develop a robust mechanism or the ability to inhibit should anxiety and stressful events arise in the future. So in early developmental trauma, when the child’s developing brain doesn’t entrain with the mother’s development, the mother’s external prefrontal cortex and just a side note, the mother may not have a very robust right prefrontal cortex either, but the child pays a price. They pay a price of potentially a fragile sense of self or even a very undeveloped sense of self and an inability to self regulate.

This is very obviously seen when you do NeuroQuant MRIs or qEEGs. You can see these fingerprints on the qEEG and on the NeuroQuant MRI in the form of increased amygdala size and increased thalamus size. The evidence is there. On a qEEG you can see heightened amplitude of the beta brainwaves, what’s called the anterior cingulate area, and you can see diminished alpha brain waves. You can see these fingerprints of biographical data on biomedical equipment. It’s important to know that. So if somebody has cancer and he’s had a very bad chemo experience with many symptoms post chemo, one does look upstream to any possible inherited trauma from the ancestral realm. One looks at early developmental trauma because all of these get affected through what’s called the HPA axis, the hypothalamic pituitary adrenal axis, in the form of a heightened stress response. The height and stress response can create permeability of gut membranes, mitochondrial membranes, and blood-brain barrier membranes, leading to a flood of potential autoimmune disease and/or inflammatory compounds. So it’s important to take that particular history to look at the brain through a NeuroQuant MRI and to look at the qEEG to see if there are any fingerprints and then therapeutically to assist that individual in self-regulation through various techniques, whether they be inside therapy, m-wave training, vehicle tone stimulators. I always recommend that people get an insight into the underlying dynamics, not just downregulate the biochemical or physiological pathway. 

When there’s early trauma and when there’s early developmental trauma we usually suggest family constellation therapy insight or family constellation workshop to look at the unconscious dynamics of that inheritance. For early developmental trauma, again we use family constellation therapy but sometimes we have to be more advanced. In those cases instead of doing a technique like DNRS, which just downregulates the expression of the anxiety that’s being felt, you need to do more advanced psychological techniques like ISDP. This looks at the defenses the individual developed as a child who wasn’t safe in their environment. They’ve developed the provisional self in order to cope with the slings and arrows of modern life, or just their early life.  So you’ve got to look at the family system that’s inherited, look at early developmental trauma, and the defenses that were developed by that person. Then you’ve got to look at the ego strength and structure of that individual to see if they have a robust sense of self. This determines if they can cope with sometimes what’s required of them to get their physiology and their health back online.

So with oncology and cancer, yes we can give chemo, we do radiation. We do those plus all the natural therapies but if you don’t look further upstream to all these potential mediators that keep a person somewhat off kilter, you don’t complete your healing interrogation and your diagnostic interrogation. So it’s very important to shine your light upstream to look at these potential inherited issues. We know from clinical experience that when you heal at a deeper level, the downstream metabolites and the downstream effects are profound. The body tends to express those consequences of the new images and the new insights and the new narratives in a more cohesive fashion. We say in this work that nobody truly heals until they have a new image or a new narrative or a new story to tell about their past and their present. This is vitally true to understand people who present with extreme complex multi-system illness. It’s never only at level two,which is the physical level. You can do all the most sophisticated functional medicine workups, you can give them every supplement in the book, you can send them to wherever you want to detoxify, or you can do bioidentical hormone therapy. But it doesn’t land in a robust place if that sense of self is fragile, if the ability to self-regulate is poor, if the defenses of the individual are too fortified and won’t allow you in. If a child has had an early experience that keeps them from trusting parental figures, do you think they’re going to trust medical authorities? Unlikely since we’re just external representations of parental figures. No healing occurs without a deep sense of trust. This is deeply profound. I’ve been called out over the years for not taking this seriously and developing an empathic trusting relationship with the patient because if that’s not established you might as well give up the rest of it. It’s not going to occur. Patients will resist your efforts to help them if there’s not an empathic relatedness between you and them whereby you understand their dynamics, you understand the fortifications of the psyche that prevent healing from occurring, and you relate subtly to what they’re asking you to do. Sometimes it takes time to establish a therapeutic alliance and a trusting relationship. If you bulldoze your way in and try to tell somebody what to do who has high resistance, something called projection of will, which means they’re asking you to fix them without any advocacy of their own, you’re in a precarious position and success is very limited.

So in this particular case I was struck by the fact that:

A) she had early trauma 

B) she had heightened anxiety

C) she had post chemo fatigue

And the whole world of post chemo fatigue of course has lots to do with mitochondrial dysfunction. In traditional medicine we’re not taught anything about mitochondrial dysfunction unless it’s a genetically inherited mitochondrial disease. Even in functional medicine you know mitochondrial dysfunction is paid lip service and people are given you know coenzyme q10, carnitine, lipoic acid, vitamin C, magnesium, and so on. But through the work of Robert Naviaux and the cell danger response we know that the mitochondria also need to be approached with a certain elegance, a certain sophistication, a certain patience because you can’t coax a mitochondria back to health by just throwing everything in the kitchen sink at it, hoping it’s going to recover. You have to understand the timelines and the movement through what they call the cell danger response, where there’s an inflammatory response and the mitochondria shut down

to protect the host. Then there’s moving through a healing response, which takes time. Our bone marrow turns over every four months and the mitochondria too have their own timeline, their own seasons so to speak. If you’re interested in the subject I’d suggest you read anything by Robert Naviaux. 

So this patient needed chemo, she had post radiation, post chemo fatigue, she was highly anxious, and wasn’t sleeping but she also had resources and she had some insight into her case. With these issues in mind it’s always important to expand our diagnostic and therapeutic base and try and bring everything to the table, to assist that person moving through their present symptomatology of anxiety fatigue and gut issues. This particular individual had gut issues. You have to do a full functional medicine workup with food sensitivities, gut permeability, hormonal HPA axis assessment, and methylation micelle detoxification. That’s just a given, a basement workup. I was struck by how far we’ve come in the understanding of illness and the fact that illness isn’t something that just requires a therapeutic drug. That concept of n squared, d squared, name of disease, name of drug, is so far advanced. We’ve come so far over the last thirty years in this understanding. Unfortunately the healthcare systems that exist are still very mechanistically based, disease based, which is fine. But when it comes to a true transformative healing experience, all layers, all levels, and interpersonal relatedness with trust are now available to us. It behooves us as therapists and medical personnel and healers if you wish to use that word. We have to do our own work and we have to know how to navigate the nuances and subtleties and levels and layers of a person’s experience and how to read the hidden signs. How to access unconscious dynamics and how to make conscious that which is being asked to be made conscious. Symptoms are often in a person’s life in order to bring to consciousness that which is hidden. It’s been said before that all sickness is homesickness. Even though this could be considered a sort of glib metaphor, especially when somebody’s suffering severely.  It’s been my experience that if you really lean into that possibility, the full potential of the person’s self-expression can be realized through a sensitive, insightful and broad palette of diagnostic and therapeutic insights. So these were my musings on a Sunday afternoon and I just wanted to share those with you. Thank You.

A Discussion About Mold and Mold Exposure with Dr. Bruce Hoffman

A Discussion About Mold and Mold Exposure with Dr. Bruce Hoffman

We discuss how mold and mold exposure can be a trigger for Chronic Inflammatory Response Syndrome (CIRS), and Mast Cell Activation Syndrome (MCAS). We discuss ways to investigate and determine if you have been exposed to mold and what you should do if you suspect mold exposure is affecting your overall health.

To learn more about mold treatment, prevention, and recommendations, visit the Mold Illness section of our Hoffman Centre website.

Watch the Video

A Discussion About Mold and Mold Exposure with Dr. Bruce Hoffman

Reference Links

Transcript

I wanted to talk a bit about mold and mold exposure as a potential cause for chronic ill health. Mold is ubiquitous and, without question, many people are suffering from the effects of mold. Mold triggers Mast Cell Activation Syndrome (MCAS), and many people are suffering from that, which is why I feel that it has to be part of a differential diagnosis for chronic ill health.  

It’s shocking how many people have mold exposure as a trigger and as an ongoing mediator, keeping them in an inflamed state resulting in Chronic Inflammatory Response Syndrome or CIRS. There is a 34-page article on my website describing the diagnosis and treatment of mold illness or CIRS.  

I would recommend the following steps to people who feel they have mold exposure.

Do the CIRS questionnaire found on page 9 of the aforementioned article. You can see if you fulfill the criteria for the potential diagnosis of mold illness. Some of those symptoms are not just for mold illness. Some are more psychiatric based questions that can arise from mold. So, the questionnaire itself isn’t enough but it’s a good start. If you have more than eight symptoms in more than six of the subtypes on the questionnaire, consider mold as a potential differential diagnosis.

The second thing you can do is a visual contrast test. This too can be googled. Dr. Shoemaker’s website has access to a computerized VCS test. Take the test and if you fail it, consider mold as a potential illness or reason for feeling unwell.

Then, of course, the most important consideration is exposure. If you know that you’ve got a basement full of mold or your bathroom or your bedroom has mold on the windows from condensation, you have to consider that in your differential.

Not everybody gets sick from mold. Some people simply get allergy type symptoms,  but some people get true inflammatory response illness (CIRS). It’s been estimated that only 25% of people will have significant illness from mold. However, in my experience it’s more than that. People often downplay how important mold and the mycotoxins produced by mold are in influencing your health. 

So, what is important? Your exposure and your history. Is what you are exposed to visible mold? If it’s not visible, it could be hidden and so you often have to do your own homework and call in a mold inspector to look for the potential sources of mold. So, what can you do to potentially identify a problem? Look up at your pot lights. Is there a brown ring around your pot lights? Do you have buckled baseboards? Do you have black mold on your window frames? Is there mold in the grout in your shower? Do you have a front-end loading washing machine that smells musty? Does your house smell musty? Is there any potential mold in your air-conditioning system? Do you have a food composter in your kitchen? Because a lot of mold grows there. If you aren’t sure, it’s important that you call in a mold inspector, someone who will do a visual inspection and is armed with specific tools such as an infrared camera. Someone who is able to actually measure the dryness or wetness of drywall and put a small hole through drywall if you suspect mold or moisture behind the wall. The inspector will begin the examination of your home in the attic, looking at the insulation and at the condensation potential. Is your upstairs attic vented? A lot of the homes that we built in the Calgary building boom in 2009-2010, including my own by the way, didn’t have venting.  Condensation and wetness were ubiquitous and many people didn’t discover the mold until many years later, so get a good visual inspection. Find somebody to come in and inspect from the attic to the basement, someone who goes inside and outside and looks in multiple areas. If you go online, you’ll see how to do a visual inspection and a lot of it you can do yourself.   

Then you want somebody to do what’s called an ERMI test, which is a mold spore count. You want to do it either through a vacuum collecting dust from carpets or a swiffer cloth collecting dust off the floors. We recommend living rooms and bedrooms first. Some people do it in the basements although it’s not often recommended because a lot of basements are moldy. In my personal experience it’s important to know if your basement is moldy because through your furnace you’ll be pulling in mold through the furnace and pushing it throughout the house. Molds have also traveled from the basement through convection currents when your home heats up and so if the basement is a source, you want to know exactly how bad it is.  

Once you’ve done the visual inspection, once you’ve done ERMI testing looking for mold spores, once you’ve found mold (or not), the next step in the diagnosis is to do what we call the cytokine testing. Those aren’t done in Canadian labs, so we have to send them out. We call them the Shoemaker panel and we measure things like C4a, TGF Beta-1, MMP-9, VEGF, MSH and we do a nasal swab for something called MARCoNS, a coagulase negative staph. Basically, it’s a staph that lives in your nasal passages. It doesn’t produce overt nasal symptoms but can have significant cognitive effects and mitochondrial effects on your symptoms. So, we do those inflammatory markers.  

Recent advances have been very controversial regarding the use of urinary mycotoxin testing. In the original workup by Dr. Shoemaker didn’t believe that urea mycotoxin testing had any role to play in the diagnosis of mold illness. He has personally moved on to transcriptomic testing for definitive diagnosis but many other clinicians do urine mycotoxin testing to determine if there are any toxic mycotoxins of mold in the urine.  This is used quite extensively by the breakaway group that doesn’t adhere strictly to the Shoemaker protocol. There are two schools, which are the Shoemaker purists and then the group that has broken away. Like any good movement, there are always two camps, we can’t get away from that. Support and challenge exists throughout nature, exists throughout medicine, exists throughout clinical diagnosis and treatment.   

So, if you have a symptom profile that was suggested by the questionnaire, if you have a positive VCS test, if you have any signs of mold in your home, if the testing for mold spores in your home is positive, if your urine mycotoxin tests are positive and your Shoemaker labs are very positive, it’s highly likely that mold is playing a role in your illness. You need to find a practitioner who knows how to treat it. The treatment is extensive, requires lots of steps, and has to be followed in a specific sequence otherwise you can overload the detox pathways and get into increased symptom expression and feeling worse, not better.

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A Discussion About Lyme Disease with Dr. Bruce Hoffman

A Discussion About Lyme Disease with Dr. Bruce Hoffman

The diagnosis and care of a patient with Lyme Disease is multifaceted and can be approached from more than one angle. It likely goes without saying that mainstream medicine is taking a much different approach than those in the functional and integrative space. 

In this video, I discuss the importance of looking at the larger history of said patient and how lab testing plays a role in proper diagnosis of Lyme Disease. 

If you are looking for answers regarding your situation, please contact our office today for more information. 

Watch the Video

A Discussion About Lyme Disease, with Dr. Bruce Hoffman

Reference Links

https://hoffmancentre.com/podcast-understanding-symptoms-and-treating-the-whole-person/

Transcript

Good afternoon everybody. I just finished an interview with the CBC (Canadian Broadcasting Corporation) and they wanted to talk about Lyme disease in Canada. We had a good, 20-minute chat that will probably be aired on some CBC broadcast in the fall. 

I was struck by one of the issues that often arises in my practice when I’m asked to treat complex multi-system, multi-symptom patients. They often come in and say, “I’ve got Lyme disease can you help me?” or “I’ve seen five doctors, naturopaths, et cetera, but I’m not better”.  

One of the biggest frustrations has been people believing that there’s one single trigger for their presentation of symptoms. They have one or two positive antibodies on their lab test, are told that’s a positive Lyme marker, and then are told by their medical provider that they should be on a full treatment program. I think that it’s medical malpractice to jump into the diagnosis and treatment of Lyme disease without a considered approach. 

We do know that there are two schools of thought in the standard of Lyme diagnosis. There are the traditional infectious disease specialists, who have very strict criteria for the diagnosis of Lyme disease, rightfully or wrongfully. Then there is a more broad approach to the understanding, diagnosis, and treatment of Lyme disease, which is purported and put forth by a group called ILADS, to which I happen to belong. 

The two schools of thought do not see eye to eye and that continual friction places the patient in the middle, trying to work out what is the best approach. 

Often patients get a diagnosis of Lyme disease from a provider they’ve seen based on the US test. They then get sent by their family doctor to an infectious disease specialist who reads them the riot act and lets them know that the tests are recording too many false positives, that they are irrelevant, that the lab is just trying to make money, or that the labs aren’t standardized. This battle goes back and forth, causes frustration for everyone, and the poor patient sits in the middle, trying to make sense of it all. 

Our aim is to talk about the differences between the two approaches, address the specifics as to why one group is vehemently certain of their position and the other group contests that position and has their own set of criteria for diagnosing and treating, which, based on the data, can’t be invalidated and has to be taken into account.

So here’s my take on patients who believe Lyme may be a trigger without a thorough health history. Lyme disease and co-infections are based on a very thorough clinical history.

I’m not going to go into the specifics of that clinical history, but the doctor or healthcare professional interviewing you must spend a lot of time taking a very specific history as to what symptoms you’re presenting and how you came to this diagnosis.

Just walking in with a positive lab test, whether it be US based or even Canadian based, isn’t good enough. Although with the Canadian test, if it’s positive, there’s a strong likelihood that Lyme disease is playing a role.

The Canadian test has very strict criteria for false positives and negatives, so if you have a positive test in the Canadian lab, it’s very likely that Lyme is an issue. So, I suggest that your practitioner takes a very thorough history and starts to use certain criteria to make the diagnosis.

One, is there history of a visit to an endemic area? Secondly, is there a history of tick bites?  Third, is there history of rashes? The problem is that many times, in fact most times, that history isn’t obtained. But if the history is there, that guides you in a certain direction. Those questions must be asked. Then a full list of symptoms must be taken, to try and differentiate whether your symptoms are specific to Lyme and related co-infections or whether they cross over with other conflicting or added potential causes for illness.

For instance, we know that in Lyme disease patients, after the first thirty days, the disease is characterized particularly in the later stages by migratory polyarthritis, which is joint pain or muscle pain that goes from joint to joint or muscle to muscle. These sorts of symptoms are very diagnostic. There are other things that cause this, but in the context of exposure to tick-borne illness, if those symptoms exist, you want to dig deeper.   

So migratory polyarthritis or muscle pain, those are very big symptoms for Lyme disease. Now for the co-infections, you want to ask very specific things. Do you have night sweats? Do you have day sweats? These occurrences are very specific for Babesia symptomatology. Do you have shortness of breath or “air hunger”? Do your symptoms come and go? Are there a lot of emotionally based symptoms, particularly anxiety as this has been associated with Babesia. You want to ask these very specific things.

Bartonella tends to be more peripheral so you tend to get a lot of pain syndromes such as Neuritis, which is pain in the peripheral nerves. Painful soles of the feet, particularly when you get out of bed in the morning. This is why the history is so important.

Lyme disease is now considered to be a clinical diagnosis based on history and physical examination, not based on a positive lab test. Why? Because you do get false positives and depending on which tests you run, the interpretation of results is highly complex. Unfortunately, due to cost we have the Canadian tests, which are elementary and introductory at best. 

Infectious disease specialists will say that they’re good enough, however, I disagree. When you want to look further and beyond you do have to look at more advanced testing which is, unfortunately, cost prohibitive. Most people can’t afford what’s really needed. I do try and get as many tests as I can across the spectrum of different testing types, including B-cell antibody testing, T-cell testing, PCR testing, plasma testing, and FISH testing. The more tests you can get, and the more that you correlate those tests with the clinical diagnosis in the symptom profile picture, the more you can hone in on the diagnosis of potential Lyme disease.

In Canada, Lyme disease is rising at a very alarming rate due to the migration of ticks and songbirds to the North. There was a study done showing that there are 32 million South American ticks brought north by South American birds every year. That’s a pretty alarming statistic. We know that songbirds are migrating to the North due to global warming and spreading their tick-borne load further and further North, hence the rise in tick-borne illness in Canada.

So, be cautious. Don’t jump to a diagnosis of Lyme disease because you have a positive test. Make sure that you have a very thorough history taken and make sure that the person who’s interviewing you has experience in the diagnosis and in interpreting lab data. The more lab data you have, the better.

Don’t rush ahead and treat yourself for Lyme disease without due caution. It can lead you into the wrong direction and make your immune system and your gut microbiome quite compromised if you treat inappropriately with some of the drugs out there that are available. Just a word of caution. This was covered in a podcast that you can listen to here.

Inflammatory Bowel Disease – Crohn’s Disease and Ulcerative Colitis, Part 1

Inflammatory Bowel Disease – Crohn’s Disease and Ulcerative Colitis

In anticipation of the upcoming Crohn’s and Colitis Summit, I want to share more about inflammatory bowel disease, Crohn’s disease, and ulcerative colitis. This two-part series will be a deep-dive into the root cause of inflammatory bowel disease, along with a comprehensive look at lifestyle changes and functional therapies that may provide relief. This free summit, hosted by Ravi Jandhyala and Mallika Allu of Gut Heal Protocol, will be held September 21st-27th. I will be speaking at the summit, and I encourage you to sign up if you or a loved one has Crohn’s disease or ulcerative colitis. Please note this summit has already taken place.

Inflammatory bowel disease (IBD) comprises a number of different medical conditions. The most significant of these are Crohn’s disease (CD) and ulcerative colitis (UC). These are chronic, immunologically mediated diseases with periods of relapse and remission, in addition to marked variations in mucosal inflammation from near normal in remission to severe ulceration in relapse.

UC affects only the colon with superficial inflammation, whereas CD affects the entire gastrointestinal tract and leads to transmural inflammation, strictures, fistulas, and abscess formation. 

The etiology of IBD is complex, but intricate dynamic interactions between the intestinal microbiome, host genetics, and external environmental factors all play an interrelated role in the development of IBD and its subsequent outcomes. 

The key mechanisms underlying the pathogenesis of these diseases are a genetically susceptible host exposed to external environmental factors, affecting gut microbiome and commensal flora. This results in a dysregulated immune response to different aspects of the gut microflora and increased intestinal permeability.

In this article, you will learn:

  • The etiology (root causes) of IBD, CD, and UC,
  • How the intestinal microbiome and your body’s immune response lead to IBD,
  • And the risk factors that may make you more susceptible to developing CD or UC, or having more severe flare-ups.

In Part 2, I will discuss our current strategies for diagnosing and treating CD and UC.

What causes IBD?


The health of the intestinal microbiome plays a key role in the pathogenesis of CD and UC. In particular, this is related to dysbiosis and reduced diversity of the gut microbiome. It also relates to protective bacteria subpopulations, such as Firmicutes, and an increased representation of potentially pathogenic bacteria, such as enteroinvasive Escherichia coli in subsets of ileal CD. In these conditions, species richness decreases, although some species seem to overgrow and increase in number. 

Both CD and UC are defined by an abnormal immune response, in which the immune system mistakes benign or beneficial cells and bacteria for harmful foreign substances. When this happens, the immune system, through a process known as molecular mimicry, can damage the gastrointestinal tract and produce symptoms of IBD.  UC is primarily a T-helper 2 (Th2) immune cell response, while CD is primarily T-helper 1 (Th1) cell mediated. 

Starting at birth, the cumulative effects of different environmental exposures, combined with a predetermined genetic susceptibility, is thought to cause IBD. It appears that continuous exposure to the collective effect of dynamic environmental factors, referred to as ‘exposome’ by Christopher Wild, affects the incidence of IBD.  Infancy and early childhood influence the formation of the immune system, whereas adult exposures to environmental factors alter established pathways.

Western lifestyles also seem to play a role, indicated by higher number of cases of IBD in Europe and the USA. The condition affects 1.5 million US citizens and 2.2 million people in Europe. There has been a significant increase in the last five years that’s consistent across several distinct ethnic groups and geographic locations. This increase parallels the Westernization or industrialization of an area’s lifestyle

Immigrants moving from low risk to high risk areas tend to assume the qualities of the high-risk areas within a generation or two. In their new location, the risks are much higher than in their low-risk country of origin. There has also been an increase in the number of cases in developing countries in Asia, Eastern Europe, and Northern Africa, as their lifestyles and living environments change. Onset of IBD in young adulthood is characterized by a relapsing and remitting course with frequent hospitalizations or surgery.

  1. Is irritable bowel syndrome a type of IBD?

Irritable Bowel Syndrome (IBS) is considered non-inflammatory and a syndrome, or a group of symptoms, rather than a specific disease. Symptoms of IBS typically include chronic abdominal pain, diarrhea, constipation, or alternating bouts of both of these. People with IBS are also more likely to have other functional disorders such as fibromyalgia and chronic fatigue syndrome (CFS). IBS doesn’t produce the destructive inflammation found in IBD, so it may be considered a less serious condition. However, it can still cause chronic discomfort and affect quality of life. Research suggests that IBS can be caused by stress and the manner in which the brain and gut interact.

Risk factors of IBD


Well known risk factors for IBD include:

  1. Cigarette smoking: reduced risk of UC, increased risk of CD
  2. Appendectomy: reduced risk 
  3. Western diet: increased risk
  4. Stress: increased risk 
  5. Depression: increased risk 
  6. Low vitamin D levels: increased risk
  7. Estrogen replacement therapy: increased risk of UC
  8. Left-handedness: increased risk
  9. Mycobacterium paratuberculosis infection: increased risk of CD

Breast-feeding, appendectomy, and smoking, surprisingly, are all associated with reduced risk of UC. 

The effects of some of the risk factors outlined above appear to differ between CD and UC. Despite shared genetic and immunologic mechanisms, distinct pathways of pathogenesis exist.

There’s a substantial body of research that’s available regarding risk factors, but limited evidence for the treatment of these environmental triggers to modify disease outcomes or prevent relapse. There have only been a few controlled clinical trials for modification of risk factors resulting in an improvement in patient outcomes.

Risk loci, or specific gene locations within your chromosomes that appear to alter IBD risk, highlight several key pathways in pathogenesis. These include the following:

  • Innate immunity
  • Adaptive immune responses
  • Abnormal glycosaminoglycan (GAG) content of the mucosa
  • Maintenance of intestinal barrier function with increased intestinal permeability
  • Pathogen sensing 
  • Endoplasmic reticulum stress
  • Response to oxidative stress
  • Decreased oxidation of short chain fatty acids  
  • Increased inflammatory mediators 
  • Increased sulfide production
  • Decreased methylation
  1. Genetics

Everyone is born with a certain genetic susceptibility to IBD. Following exposure to a Western lifestyle, diet, and certain environmental triggers, a specific threshold is reached and IBD may develop. This explains the low concordance rate in twins, suggesting that genetic influence, while important, is only one piece of the IBD puzzle. The exposome, or the total coherent effect of all environmental factors from birth to death, plays the determining role.  

A positive family history of IBD is the most important risk factor for the development of the condition. Whole genome scans have found susceptibility genes for UC on chromosomes 1 and 4. A concordance rate of 19 percent for UC and 50 percent for CD in monozygotic twins has also been established. 

Genetics have shown 204 distinct genetic risk loci for IBD, with the majority of risk alleles being shared between both diseases. However, 37 CD-specific and 27 UC-specific loci have been identified. Known loci account for only a third of the risk for either disease. 

  1. Childhood exposures

Breast-feeding appears to confer a protective effect on both UC (1.8-fold) and CD (2.2-fold), in keeping with known protective effects for other immune-mediated diseases such as eczema and asthma, allergic rhinitis, and type 1 diabetes. This is thought to be due to protective maternal antibodies and the induction of immune tolerance to specific food antigens and gut microbes.

Antibiotic exposure is associated with an increased risk of adult and pediatric-onset IBD. Exposure during infancy or early childhood is associated with the greatest increase in risk. Use of antibiotics between the ages of five and sixteen, through the effect on the microbiome, appears to increase the incidence 1.6-fold. If antibiotics are used in the first year of life, the risk of CD increases 5.3-fold. 

The strongest risk increase is linked to the use of broad-spectrum penicillin (3.1-fold), pen V (2.9-fold), then cephalosporin (1.9-fold).

It’s been hypothesized that by altering the gut microbiome composition, pathogenic bacteria colonize while the normal process of tolerance, which is crucial for immune development, is disrupted. This leads to an aberrant response of the host immune system to its microflora.

On the other hand, early childhood Helicobacter pylori infection is associated with a decreased risk of CD of 1.7-fold and UC of 1.3-fold. H. pylori increases Fox-3, the transcription factor of T-regulatory cells, which down-regulates the inflammatory response. 

  1. Hygiene

A high hygiene level increases the risk of IBD. Living in an urban environment increases risk by 1.2-fold.

Having a smaller number of siblings increases risk 2.6-fold. The more siblings you have, the lower your risk for IBD.

Sharing a bedroom decreases risk of UC by 2.1-fold and CD by 2.3-fold, while a hot water tap in the home increases the risk of CD by 5-fold.

Animal contact decreases risk of UC and CD, with similar effects seen regarding asthma and eczema.

The implication is that the more hygiene measures employed, the fewer helminths (worms and parasites) you’re exposed to, and therefore less induction of dendritic cells maturation and ability to drive the T-cell immune system occurs. This results in decreased protection against autoimmunity. 

In simpler terms, “germophobes” may be at an increased risk of developing IBD.

  1. Autism

There have been several reports of a link between autism spectrum disorder (ASD) and chronic gastrointestinal (GI) symptoms. Endoscopy trials have demonstrated a higher prevalence of nonspecific colitis, lymphoid hyperplasia, and focally enhanced gastritis in people with ASD compared with controls. Postulated mechanisms include aberrant immune responses to some dietary proteins, abnormal intestinal permeability, and unfavourable gut microflora. 

Wakefield et al conducted one of the earliest studies investigating gastrointestinal anomalies in autistic children in 1998. In this study, twelve children with regressive developmental disorders, nine of whom were autistic, were all reported to have abnormal colonoscopies. The most consistent finding was lymphoid nodular hyperplasia (LNH), which was present in nine of the twelve children. This mild to moderate colitis was deemed nonspecific on the basis of not fulfilling criteria for either Crohn’s disease or ulcerative colitis.

Criticism regarding the ‘normalcy’ of LNH in children prompted Wakefield, et al. to perform ileocolonoscopies in 60 children with regressive developmental disorders and compare them with 37 developmentally normal controls. In this trial, ileal LNH was present in 93 percent of affected children in comparison to 14.3 percent of controls (P<0.001). Chronic colitis was detected in 88% of affected children compared with 4.5% of controls. 

Torrente et al. compared the gastric biopsies of 25 autistic children with those of ten normal controls, ten CD patients, and ten children with H. pylori infection. Eleven of the 25 autistic children had a focally enhanced gastritis, while two had mild diffuse gastritis. Immunohistochemistry results demonstrated the pattern of lymphocyte infiltration was most similar to Crohn’s disease, with the exception of a striking predominance of CD8-positive over CD4-positive cells and a marked increase in intra-epithelial lymphocytes. Another highly specific finding among autistic children was a dense, sub-epithelial basement membrane immunoglobulin G deposition, which was absent in the other subgroups.

ASD patients and their caregivers often report improvement in the patient’s condition after following elimination diets. Improvements occur not only in the GI symptoms, but also in behavioural and cognitive problems such as hyperactivity, communication skills, and attentiveness. Interestingly, 36% of children with ASD have a history of cow’s milk and/or soy protein intolerance in infancy. In addition, while studies haven’t indicated an increased incidence of Celiac disease in these individuals, parents have often reported an improvement in their child’s behavioural disturbances when following a gluten-free diet. These benefits haven’t been seen consistently in randomized trials, although a Cochrane review did report a significant reduction in autistic traits on a gluten-free, casein-free diet.

One hypothesis is that ASD may be accompanied by aberrant innate immune responses to dietary proteins, leading to GI inflammation and aggravation of behavioural problems. One study, measuring pro-inflammatory cytokines in response to common dietary proteins, showed a greater than two standard deviations (SD) excess in tumour necrosis factor-alpha and interferon-gamma production in response to gluten and cow’s milk protein among ASD children, when compared with controls. 

A subsequent study confirmed a higher prevalence of elevated tumour necrosis factor-alpha and interleukin-12 production with beta-lactoglobin and alpha-lactoglobin, but not casein, in autistic children and children with non-allergic food hypersensitivity, compared with normal controls. 

Another theory suggests that abnormal intestinal permeability in children with ASD causes them to absorb fragments of incompletely broken-down peptides such as gluten or casein, which cross the blood-brain barrier and act as endogenous opioids. 

The gut microflora has also been targeted as a potential player. There have been anecdotal reports of the onset of autism following broad-spectrum antibiotics, suggesting that disruption of the indigenous flora may lead to colonization by neurotoxin-producing bacteria. Autistic children have been shown to have higher counts and more species of Clostridia than controls matched by age or gender. A small prospective trial demonstrated a significant but transient improvement in autistic features following a course of vancomycin (antibiotic) therapy, with relapses presumed to occur because of persistent spores that proliferate upon discontinuing the medication.

  1. Yeast

The ratios of yeasts in the gut, such as Saccharomyces cerevisiae and Candida albicans, may be significantly altered by IBD. Normally, yeasts and fungi account for less than 0.1% of the total microbiota population. However, there is often a decreased population of S. cerevisiae and increased populations of C. albicans and other Candida yeasts in the guts of people with IBD.

Antibiotic use can result in fungal overgrowth, especially of the Candida yeasts, which may then compete with the bacteria in the gut for survival and growth. This fungal overgrowth can make the host more susceptible to mold illness, paving the way for an immune response that may invoke chronic inflammation, autoimmunity, or IBD.

It appears also that certain components of the cell walls of fungi can trigger immune responses, which may add to the overall exposomeXI.

  1. Gut microbiome

Recent studies have highlighted the association between the gut microbiome and the pathogenesis of IBD. 

Reduced biodiversity of the gut microbiome is apparent even at the onset of diagnosis, before treatment is initiated. CD, especially ileal CD, has been associated with increased frequency of pathogenic bacteria such as enteroinvasive E. coli. There can also be a reduction in the frequency of anti-inflammatory bacterial subgroups, particularly Faecalibacterium prausnitzii. Giving strains of this specific bacteria has resulted in improved outcomes and amelioration of colitis in animal models.

By the time someone reaches adulthood, the immune system has matured and lifestyle factors become more apparent as choices are increased. Adult exposures seem to be involved in changing the already developed immune system. Several environmental factors have been identified as playing a role in IBD development independent of stage of life, previous development of acute bacterial gastroenteritis, geographical location, and vitamin D. 

Bacterial gastroenteritis as a result of Clostridium difficile, Campylobacter, and/or Salmonella infections can increase risk of IBD. The risk of developing IBD increases significantly after bacterial gastroenteritis, especially within the first year. The largest effect is seen with CD, for which there is a 2.9-fold increase, rather than the 2.1-fold for UC. This may be explained by the increase in interleukin-6 (IL6), blockage of T-reg cells, and the activation of self-reactive T-cells, leading to a chronic inflammatory response.

  1. Mycobacterium avium infection

M. avium subspecies paratuberculosis (MAP) infection rates are higher in CD, although a causative link hasn’t been established. Meta-analysis has shown a 7-fold increase in CD in MAP infections, but the timing of this infection couldn’t be ascertained to be a cause of CD and is perhaps merely a bystander. 

  1. Tap water

Drinking tap water lowers the risk of CD 2-fold. It’s been proposed that this might be due to harmless microorganisms triggering regulatory T-cells.  

  1. Flying

Individuals have an increased risk of disease flare following high-altitude flights or after travelling more than 2,000 metres above sea level. Mild hypoxia leads to an increase in IL6 and C-reactive protein (CRP), which are markers of inflammation.

  1. Obesity

An American cohort study showed a 2.5-fold increase in CD in obese women with a body mass index (BMI) greater than 30 kg/m2. 

  1. Smoking 

Smoking confers a 2-fold increase in risk of CD, which is somewhat lessened when stopping smoking, although the pathogenic mechanism remains unknown. 

Smoking is associated with a more aggressive form of CD, more surgery, and an earlier risk of recurrence and re-operation following a bowel resection. Stopping smoking prior to the diagnosis can result in a reduced likelihood of progressing to complicated disease behaviour or the need for surgery. Smoking cessation is also associated with a reduced rate of relapse regarding CD.

With UC, current but not former smokers appear to have some protection, with half the risk of UC in current smokers compared to individuals that have never smoked. Smoking confers a 1.7-fold reduction in risk for UC. 

For former smokers, the risk for both UC and for CD increases by the same amount.

For patients with UC, smoking leads to a more benign disease course with fewer flares, a reduced need for steroids, and lower colectomy rates. Smoking cessation increases the risk, with the effect lasting for up to ten years after quitting smoking. This suggests that smoking only defers the development of UC. Quitting smoking is also associated with flare-ups.

Passive, or second-hand, smoking has a weaker beneficial effect. The mechanism of this different effect between CD and UC is unknown, but is thought to be influenced by the constituents of cigarette smoke having different effects on oxidative stress in mononuclear cells.

Smoking is known to affect the immune system through both cellular and humeral pathways by transforming the synthesis of pro-inflammatory cytokines, altering gut permeability, reducing smooth muscle tone and contractility due to nitrous oxide, and effecting changes in the gut microflora. 

There’s also an interaction between smoking and genetic variants in the CYP2A6/EGLN 2 locus and glutathione transferase enzymes (GSTP1) and risk of CD and UC. Snips in these genes showed significantly different outcomes. 

  1. Appendectomy

There are divergent effects between UC and CD following appendectomy.

When performed before the age of twenty, there’s an increased risk of UC with no effect or only a slightly increased risk of CD. The mechanisms remain unclear, and appendectomy may result in intestinal microbiome alteration with a protective effect on UC. The microbiome composition in the appendix also appears to confer protective effects against UC

  1. Diet 

The role of diet has been problematic to determine. This is due to difficulty in tracking it through the course of a lifetime, different recall between controls and cases, and potential restrictions on diet choices pre-diagnosis based on the nature of the disease. 

Increased fibre of approximately 24 grams was associated with a significant reduction in risk of CD but not UC.   This was related to fruit fibre and not that of vegetables, including cruciferous ones. No association was found between fibre from cereals, whole grains, or legumes. 

Fibre may confer epithelial integrity and reduce translocation of potentially pathogenic bacteria such as enterovirus E. Coli, which may play a role in CD. Fibre activates the aryl hydrocarbon receptor (AhR) expressed in intestinal lymphocytes, which offers protection against environmental antigens.  

A diet high in long-chain n-3 polyunsaturated fatty acids (PUFA) was associated with a reduced risk of UC. CD had no modifiable fat intake risk factors for CD. One large study found omega-3 supplements had no beneficial effects, while a high intake of animal protein revealed a potential association with IBD. Sugar and a high-carbohydrate diet are associated with an increased risk of IBD, while fruits and vegetables seem to have a protective effect.

Alteration of diet can trigger flares in many different types of disease. High fat diets result in expansion of specific bacterial subpopulations that are associated with a pro-inflammatory response, particularly diets high in meats, as well as polyunsaturated omega-6 fats (like those found in industrial seed oils such as soybean oil, corn oil, and canola oil).XVI Elemental diets show improved outcomes in CD, whereas partial and complete enteral nutrition show effects superior to placebo but lower than steroids. 

Elimination diets, such as the specific carbohydrate diet, lectin-free diet, autoimmune paleo, and Whole30, are of particular interest as well, but there is still a lack of strong evidence regarding their efficacy for IBD treatment.

Childhood diet and antibiotic exposure is an important determinant of microbiome composition. Breastfeeding appears to reduce UC risk, but it doesn’t appear that formula-feeding necessarily increases UC risk. Researchers have found that the gut microbiome of both breastfed and formula-fed children changes significantly after the introduction of foods. Therefore, the first foods a child receives (other than breastmilk or formula), and the foods they eat throughout their early childhood, may profoundly affect their gut microbiota composition and affect their IBD risk level.

  1. Glyphosate

Glyphosate is the world’s most widely produced herbicide. It’s the primary toxic chemical in Roundup™ and many other herbicides. As a broad-spectrum herbicide, glyphosate is present in more than 700 different products and used in industries such as agriculture and forestry, and even in the home. 

Glyphosate was introduced in the 1970s to kill weeds by targeting the enzymes that produce the amino acids tyrosine, tryptophan, and phenylalanine. However, the enzymes of many bacteria are susceptible to inhibition by this chemical, so it can also alter the gut flora of many animals. 

Usage of glyphosate significantly increased after the introduction of genetically modified (GMO), glyphosate-resistant crops that grow well despite the presence of this chemical in the soil. In addition, the toxicity of the surfactant polyoxyethyleneamine (POEA), which is commonly mixed with glyphosate, is greater than the toxicity of glyphosate alone. 

In addition, Enlist Duo™, a herbicide product containing a 2,4-dichlorophenoxyacetic acid (2,4-D) salt and glyphosate, was approved for use in Canada and the United States in 2014. This was for use on GMO soybeans and maize, both of which were designed to be resistant to both 2,4-D and glyphosate. 2,4-D has many toxic effects of its own. 

Research has shown that glyphosate disrupts the microbiome in the intestine, causing a decrease in the ratio of beneficial to harmful bacteria. Highly pathogenic bacteria such as Salmonella entritidis, Salmonella gallinarum, Salmonella typhimurium, Clostridium perfringens, and Clostridium botulinum are highly resistant to glyphosate. Unfortunately, however, most beneficial bacteria such as Enterococcus faecalis, Enterococcus faecium, Bacillus badius, Bifidobacterium adolescentis, and Lactobacillus ssp. were found to be moderately to highly susceptible. 

The relationship between the microbiome of the intestine and overall human health is still unclear.

 However, current research indicates that disruption of the microbiome could lead to conditions such as metabolic disorder, diabetes, depression, autism, cardiovascular disease, and autoimmune diseases such as IBD. 

  1. Celiac disease, IBD, and the glyphosate connection

Researchers have found that people with Celiac disease are about 10 times as likely as a control group to have IBD. Conversely, the prevalence of Celiac disease in IBD appears to be comparable with that indicated in controls.

Celiac disease, and more generally, gluten intolerance, is a growing problem worldwide. It’s particularly serious in North America and Europe, where an estimated 5% of the population now suffers from this condition. It’s a multi-factorial disease associated with numerous nutritional deficiencies, as well as reproductive issues and an increased risk of thyroid disease, kidney failure, and cancer. 

It has been proposed by researchers Samsel and Seneff that glyphosate is the most important causal factor in this epidemic. Fish exposed to glyphosate develop digestive problems that are reminiscent of Celiac disease. The condition is associated with imbalances in gut bacteria that can be fully explained by the known effects of glyphosate on these particular types of bacteria. 

Characteristics of celiac disease point to impairment in many cytochrome P450 (CYP450) enzymes, which are involved with detoxifying environmental toxins, activating vitamin D3, catabolizing vitamin A, and maintaining bile acid production and sulfate supplies to the gut. Glyphosate is known to inhibit CYP450 enzymes. 

Deficiencies in iron, cobalt, molybdenum, copper, and other rare metals associated with Celiac disease can also be attributed to glyphosate’s strong ability to chelate these elements. Deficiencies in tryptophan, tyrosine, methionine, and selenomethionine associated with Celiac disease also match glyphosate’s known depletion of these amino acids. 

Celiac disease patients have an increased risk of developing non-Hodgkin’s lymphoma, which has also been implicated in glyphosate exposure. Reproductive issues associated with Celiac disease, such as infertility, miscarriages, and birth defects, can similarly be linked to glyphosate. 

Glyphosate residues in wheat and other crops have been increasing recently due to the growing practice of crop desiccation just prior to the harvest. The practice of ‘ripening’ sugar cane with glyphosate may also explain the recent surge in cases of kidney failure among agricultural workers in Central America. 

  1. Mast Cell Activation Syndrome (MCAS)

As early as 1980, Dvorak and colleagues reported that mast cells were markedly increased in the ileum of patients with CD. In 1990, Nolte et al. showed the same findings in patients with UC. There were increased numbers of mast cells with associated degranulation products of histamine and tryptase, along with associated increases in cytokines and leukotrienes IL-16. TNF-alpha and substance P have also been found in the mucosa of patients with IBD, particularly when stained with the CD 117 stain. 

According to the latest literature research conducted by Dr. Lawrence Afrin, one of the key researchers in MCAS, mast cells release at least 1,000 mediators of inflammation. This includes, but isn’t limited, to histamine, proteoglycans (heparin and chondroitin sulfate), proteases (tryptase, chymase and carboxypeptidase), eicosanoids, and platelet activating factor (PAF).

Activation of mast cells leads to the release of the eicosanoid arachidonic acid from the phospholipids on the cell membrane. This 20-carbon fatty acid is then rapidly oxidised, along either the cyclooxygenase pathway to form prostaglandin D2 (PGD2) or the lipoxygenase pathway to form leukotriene C4 (LTC4). Histamine triggers the histamine H1 receptor and tryptase, the protease-activated receptor 2 (PAR2).

Therapies aimed at down-regulation of mast cell activity may be important in the treatment of IBD. 

Mast cell cytokines constitute a third category in that they may be both preformed and newly synthesized. These include IL-4, IL-5, IL-6 and TNF-alpha in the nasal mucosa and bronchi, as well as IL-1B, IL-3, IL-8, IL-9, IL-10, IL-13, IL-16, IL-18, IL-25, granulocyte -macrophage colony stimulating factor (GM-CSF), and stem cell factor macrophage chemotactic peptide (MCP)-1, MCP-3, and MCP-4. 

Many factors are known to activate mast cells, and their activation is a crucial step involving pathophysiological changes. These factors include antigens, anti-IgE, substance P, VIP, C5a, C3a, somatostatin, morphine, very low-density lipoprotein, stem cell factor, tryptase, and eosinophil cationic protein, all of which are known to activate mast cells. 

It should be noted that mechanisms of mast cell activation differ with different classes of triggers.

  1. Nutrient deficiencies 

UC patients were found to have lower levels of vitamin A, vitamin E, and carotenoids than those in  controls. This implies that certain nutrient deficiencies may either play a role in the development of UC, or, conversely, are a complication of UC. 

  1. Vitamin D

Vitamin D intake is inversely associated with UC risk, meaning that higher vitamin D intake is linked to a lower UC risk.  Additionally, higher blood levels of vitamin D are associated with reduced risk of CD.

 Patients who increased their blood vitamin D levels had a 1.9-fold protective effect for CD, but not for UC. They also had a lower risk of surgery compared to those who remained vitamin D deficient. Low vitamin D levels are also associated with a higher rate of colon cancer and C. difficile infections.

Vitamin D administration may reduce the risk of IBD relapses. Vitamin D is also known to play a role in the regulation of the innate immune system by activating the TH1 lymphocytes and monocytes. This causes the inflammatory response to be down-regulated. 

  1. Weather and latitude

Incidence of IBD is higher in northern latitudes where people have reduced exposure to ultraviolet (UV) light. The Women’s Health Initiative (WHI) study noted a lower risk for both UC and CD in women in southern latitudes (1.6-fold for UC) compared to those at higher latitudes. Living in southern latitudes appears to be protective, likely due to increased UV light and subsequently higher vitamin D levels.

Warm summers have a protective effect for UC and possibly for CD as well. This is also the case for other inflammatory diseases such as multiple sclerosis (MS), rheumatoid arthritis (RA), and systemic lupus erythematosus (SLE). This is thought to be due to an increase in microbial diversity, which in turn confers benefit.

  1. Psychological behaviours

IBD has long been associated with neuroticism, dependency, anxiety, and perfectionism. Recent well-designed studies have confirmed that adverse life events, chronic stress, and depression increase the likelihood of relapse in patients with quiescent (dormant) IBD.

The evolving science of psychoneuroimmunology has outlined the mechanisms by which the nervous system can affect immune function at both the systemic and gut mucosal levels. These mechanisms are thought to be due to changes in the hypothalamic-pituitary-adrenal (HPA) axis and alterations in the bacterial mucosal barrier. These occur via mucosal mast cells and mediators, such as corticotrophin releasing factor (CRF). 

To maintain homeostasis, a living organism must constantly adapt at a mental, emotional, molecular, cellular, physiological, and environmental level. Stress is defined as a threat to an organism’s homeostasis. The function of the stress response is to maintain homeostasis through behavioural and biological or physiological adaptations. The stress response involves the complex integration between a series of interconnected regions within the brain. These are the hypothalamus, the amygdala, and the hippocampus. This hub receives inputs from viscera and somatic afferents and from higher cortical structures, including the internal dialogue and mental perceptions of the patient. This in turn, affects the neuroendocrine stress response via two interconnected effector pathways, namely the HPA axis and the autonomic nervous system (ANS).  

Stress stimulates the release of CRF from the hypothalamus, causing the release of adrenocorticotrophic hormone (ACTH) from the anterior pituitary. This in turn causes the release of cortisol from the adrenal cortex. Stress also activates the descending neural pathways from the hypothalamus to pontomedullary nuclei, which control the autonomic nervous system response. Stimulation of the sympathetic nervous system (fight/flight) causes the release of adrenaline and noradrenaline from the adrenal medulla. This is in addition to supplying the entire gut directly. The parasympathetic vagus nerve and sacral nerves provide parasympathetic input to the upper gut and to the distal colon and rectum. 

The gut has its own nervous supply called the enteric nervous system (ENS), which is innervated by both sympathetic and parasympathetic fibres. This network has been termed the gut-brain axis. The ENS contains 100 million neurons and regulates the motility, the exocrine and endocrine functions, and the microcirculation of the gut. These axes (HPA, ANS, ENS) can then interact directly with the immune system. Psychoneuroimmunology is the study of how behavioural factors and CNS function can influence the immune system, and hence inflammation, at both systemic and local tissue levels.

Nerve fibres of the ANS form close effector junctions with lymphocytes and macrophages in lymph glands, bone marrow, the thymus, the spleen, and mucosa associated lymph tissue. These nerve fibres also release a number of chemicals called neurotransmitters, such as catecholamines, vasoactive intestinal peptides, angiotensin II, neurotensin, somatostatin, and substance P. These are capable of affecting lymphocytes, macrophages, neutrophils, and other inflammatory cells at the neuro-immune cell junction. Lymphocytes and other inflammatory cells also carry receptors for the hormones and neuropeptides of the HPA axis, such as growth hormone, ACTH, corticosteroids, and CRF. 

At high concentrations, cortisol has an immunosuppressive effect, increasing the release of anti-inflammatory proteins and IL-10. Transcription of inflammatory signalling molecules such as IL-6, IL-1, and TNF-α are reduced through transcription factors AP-1 and nuclear factor kappa beta. At lower doses, cortisol has an immune stimulating effect.

Similarly, adrenaline and noradrenaline have mixed effects at different doses on immunity and inflammation. Adrenaline causes an increase in serum IL-6, an increase in lipopolysaccharide (LPS) induced IL-8 and IL-10, and an increase in cytotoxic (cell-killing) T-cells and natural killer (NK) cells.

Chronic sustained stress due to adverse life events, such as bereavement, divorce, and depression, have been shown to reduce the numbers of cluster of differentiation 8 (CD8, a glycoprotein) lymphocytes, NK cells, and macrophages in the blood. However, in addition to immunosuppression, chronic stress with reduced heart rate variability, which is a sign of increased sympathetic tone, has been shown to increase inflammation, showing raised CRP.  

Acute stress causes stimulation of the sympathetic nervous system with a rise in adrenaline and noradrenaline, followed a little later by a rise in cortisol. This leads to an acute episode of immune enhancement with an increase in inflammatory cytokines that are known to be associated with flares of IBD. This includes a rise in cytotoxic CD8 T lymphocytes and NK cells and an increase in their cytolytic activity, in addition to platelet activation and thrombin generation, producing effects of microcirculation ischemia causing thrombosis and microinfarction. This effect is lowered with beta blockers rather than aspirin, suggesting that a stress response or sympathetic activation is at the root of it. 

Psycho-social stressors have long been associated with triggers. Recent and remote stress is associated with an increased incidence of IBD, with recent stress being more significant. When questioned, patients indicated that stress was the trigger for 70% of their flares. Depression feelings were associated with a 2.4-fold increased risk of CD, but not UC. Depression, anxiety, and stress are also associated with increased rates of relapse and surgery for IBD.

The inflammatory response to stress through elevation of IL-6 levels can be changed in mice by administrating antibiotics, suggesting antibiotics exerts their effects through changes in the gut microbiota.

Using medications to treat these conditions appears to have variable effects. People referred for therapy following increased stress due to the diagnosis have reduced rates of relapse, outpatient attendance, and use of steroids or other medications for IBD. 

In summary, stress can play a significant role in immune system dysfunction leading to an inflammatory response, which may trigger new-onset IBD or a flare of existing disease.

  1. Sleep

Both increased and reduced amounts of sleep have been associated with negative health outcomes. Reduced sleep quality was associated with an increased risk of relapse at six months post-remission in CD, supporting an association between poor sleep and gut inflammation. Sleep disturbances in IBD may lead to a 2-fold increase of disease flare. Sleep deprivation also leads to activation of the immune cascade.

  1. Nonsteroidal anti-inflammatory drugs

The use of nonsteroidal anti-inflammatory drugs (NSAIDS) for fifteen days per month increases the risk of UC 1.9-fold and CD 1.6-fold. These figures are increased by greater weekly dosage, and a higher frequency or longer duration of use. NSAIDS lead to inhibition of cyclooxygenase (COX), resulting in a decrease in protective prostaglandins in the gut mucosa, increasing gut permeability. 

  1. Oral contraceptives

Current use of oral contraceptives (OCP) leads to 1.3-fold increased risk of UC. The risk of developing CD with current use of OCP is increased by 1.5-fold. 

  1. Post -menopausal HRT

Post menopausal HRT increases the risk of UC by 1.7-fold, but not CD. It’s been proposed that estrogen modulates gut inflammation by acting on estrogen receptors that are found on gastrointestinal epithelial and immune cells. 

UC is a Th2 mediated illness, and estrogen promotes Th2 cytokines. The same holds true for other Th2 mediated diseases, such as RA and SLE. However, this is not the case with CD, which is a Th1 mediated illness. 

A prospective cohort study (the Women’s Health Study) followed 108,844 postmenopausal American women, with a median age of 54, without a prior history of CD or UC in 1976. The risk of UC appeared to increase with longer duration of hormone use and decrease depending on the time since discontinuation. There was no difference in risk according to the type of hormone therapy used, such as estrogen as opposed to estrogen and progestin. No association was noted between the current use of hormones and the risk of CD. The effect of hormones on the risk of UC and CD was also not modified by age, BMI, or smoking.

  1. Ambient air pollution

On the whole, air pollution exposure wasn’t associated with the incidence of IBD. However, residential exposure to sulfur dioxide and nitrous dioxide gases found in industrialized regions may increase the risk of early-onset UC and CD respectively. 

Living in regions with high sulfur dioxide emissions before the age of 25 increases the chances of UC 2-fold. A high nitrogen dioxide exposure before the age of 23 increases the chance of CD 2.3-fold. Total pollutant emissions correlate significantly with an increased risk of hospitalization in established IBD. Pollutants may also be absorbed and incite the inflammatory process that’s characteristic of IBD.

  1. Physical activity

Researchers have found that women engaging in active physical activity have a 44% reduction in CD risk compared with sedentary women. Physical activity was not associated with risk of UC.

The absolute risk of UC and CD among women in the highest fifth of physical activity levels was at just 8 and 6 events per 100,000 person years. This compares to 11 and 16 events per 100,000 person years among women in the lowest fifth of physical activity. 

Age, smoking, BMI, and cohort didn’t significantly modify the association between physical activity and the risk of UC or CD in these findings. The pathway appears to be mediated through the autophagy (clearing out or recycling of damaged cells) pathway or cell senescence (cell aging).

Summary

There’s a rich body of research showing potential environmental risk factors for the development of IBD. However, there aren’t many high-quality studies showing that environmental changes may have a large effect on disease outcomes. For a large number of possible environmental factors, meta-analyses are not yet available.

Many novel factors are identified by large cohort or case-control studies, but are yet to be reproduced by and validated by independent research groups. Consequently, the level of evidence is somewhat low and caution should be exercised when drawing firm conclusions or making recommendations.

However, individuals with a genetic susceptibility can be cognisant of environmental factors and do their best to lower or delay their genetic expression, as their exposure threshold may not be reached. Being aware of which environmental factors are involved in developmental phases as well as along the course of the disease to increase flares and development of complications, gives the treating physician and patient as advocate the opportunity to make the necessary adjustments along the patient’s timeline.

 This has the effect of lowering the risk of disease expression with a more personalized treatment plan.

In Part 2, I will be reviewing the lab tests that are used to diagnose CD and UC, along with lifestyle changes and treatment options that are often successfully employed in IBD care.

In the meantime, I encourage you to contact my office if you are seeking functional and integrative care for your IBD. 

Podcast: Looking at Lyme: Understanding Symptoms and Treating the Whole Person

Looking at Lyme

I was recently interviewed by Sarah Cormode for an episode of Looking at Lyme, an educational podcast created by the Canadian Lyme Disease Foundation, where I highlight the importance of taking an in-depth patient history to understand and document Lyme disease symptoms.

I also discuss several approaches to treating Lyme disease and explain why such a variety of symptoms amongst patients with Lyme disease exists.

Take a listen below.

I was recently interviewed by Sarah Cormode for an episode of Looking at Lyme, an educational podcast created by the Canadian Lyme Disease Foundation, where I highlight the importance of taking an in-depth patient history to understand and document symptoms.

I also discuss several approaches to treating Lyme disease and explain why such a variety of symptoms amongst patients with Lyme disease exists.

People with Lyme disease have a lot of different symptoms, the bacteria attacks the body in so many different ways. Sometimes it attacks the brain, the heart, the joints, you name it. Today I'm looking at Lyme, we're going to dive into functional medicine, we'll look at the body from a holistic perspective and meet a doctor who treats the whole body and the mind.

Getting treated early for acute Lyme disease is critical. Some people find the attach ticks and others might get a bull's eye rash. But that's not always the case. And without these telltale signs, people might not get diagnosed. The longer that you have the disease, the worse it gets, and the harder it is to treat. That's when we need to go to the doctor. So, let's do that. There are very few medical doctors with the expertise of Dr. Bruce Hoffman. He practices functional medicine, and we'll get him to tell us more about that. We reached him at his Calgary clinic. Good morning, Dr. Hoffman.

Good morning to you.

What's the first thing that you look for in a patient who potentially has Lyme disease?

Your patients present to a doctor's office with many symptoms and many complex, interlocking possible what we call in medicine, differential diagnosis. So, they present with a whole host of symptoms. And it's the task of the doctor taking the history to try and work out what may or may not be Lyme disease. And sometimes patients come in with some Lyme test and say they definitively have Lyme disease, or they have positive biomarkers for Lyme disease on some of the tests they've done. But when a closer history is taken, that may not be the case. So, there's quite a lot to really sift through when you're trying to differentiate whether somebody has Lyme disease or not. The most important thing is the symptomatology. You want to take a very definitive history. In my clinic, we use different types of questionnaires to try and determine whether or not Lyme may be a diagnosis. And we also then start to take a very specific history about whether they visited endemic areas, which is somewhat a moot point because Lyme disease is somewhat, you know, it's specific, it's everywhere. If they visit an endemic area, if they've been bitten by a tick, if they've had the rash, which is very uncommon, by the way. But we start to ask the history of exposure, history of tick bite, history of rashes and in a symptom history, looking over the variable symptoms that present with Lyme disease and/or co-infections that come along with Lyme disease. A lot of questions need to be asked, and you've got to sift through them and try and determine if Lyme disease is the primary presenting feature or are there any other coexisting disorders that interlock, like mold exposure, or heavy metal toxicity or food sensitivities? And there's many of them that may interlock with a symptom presentation. So, there's a lot to ask.

Yeah, it sounds like getting that patient history is just so critical. 

History is everything. You know, you've got to take a good history. You can’t have a patient walk in and say I've got Lyme disease, and I go, okay, let's treat you. No, no, you have to stop and really ask very specific questions.

And it also sounds like you mentioned that most of your patients don't ever remember having a tick attached or getting a rash.

You know, the majority don't. I do have a number of patients who went to college in northeast in the United States, and they were out in the fields and in the forests, have a history of tick bite and rash exposure. But I would say that's probably 5% of my population. My patient population, it's very low.

Guess when we spend time in the outdoors, if we check for ticks and do a tick check and actually found one attached, we have something to at least document or same with a rash. If you found one, it'd be a good idea to get a photo of that to share with your doctor.

Absolutely. It would be lovely if we had that cookie cutter you know, clear cut, walked in the woods, got a tick, notices for within three days a high fever, headache, and then the Lyme disease rash. That's so seldom.

It's never that that clear? Is it?

Never. I wish it was easier.

So how critical is it then for people to get diagnosed and treated early?

Oh, if they've been exposed and there's definitely a tick bite. And the symptomatology of high fever, sore neck, chills and joints. If that occurs, you get them on antibiotics while waiting for lab data or getting the tick, if it's discovered, sent off to the lab for analysis. Definitely, I’ll put them on treatment right away. And there's different standards of Lyme disease treatment, depending on which school of thought you belong to. Some schools of thought say, you just need like a brief dose of doxycycline. And others say at least four to six weeks of treatment. It depends on your approach.

Do you have a preference?

Longer term antibiotics, definitely not a short term

Yeah, that was certainly my experience, I had about 10 days of antibiotics, and then all of my symptoms came back afterwards.

Absolutely. If patients have an acute exposure, and they have symptomatology, we do have a baseline laboratory test. And then we repeat it four to eight weeks later to see if there's any rising titers. And we send the tick off for analysis. I usually cover them with antibiotics for at least six weeks. 

Wow. That's great to hear. And so, what is functional medicine?

Well, functional medicine is this emergent system of approaching a patient from a very different point of view. Like my medical training is what we, I don't mean to be derogatory, but it's called the N2D2 method of diagnosis and treatment; name the disease, name the drug. You know, that's how we learned in medical school, we just look at differential diagnoses, what disease or symptom cluster does this person have, and what drug can I pull out to help them. That's the specific training, highly relevant, nothing wrong with it. But now we have this emerging cohort of patients who have this chronic multi system, multi symptom disease profiles, with many interlocking issues. And that model doesn't work. And I tend to see and many people who are outside of the so-called traditional healthcare system tend to see that cohort of patients. Functional medicine attempts to take an upstream history back to what we call antecedents, mediators, and triggers. We go and look upstream to see, first of all, what's your symptom profile now? But, when did you start to feel unwell? One of the most relevant questions I ask a patient is; when did you last feel well, and then you want to take it from there, backwards and forwards. So functional medicine looks backwards as to the timeline, or the potential triggers and inherited factors which may play a role, the triggers what may have triggered the illness, and then what we call mediators, what may be keeping that symptom cluster alive. In conjunction with that we look at, not so much as pathology and disease laboratory tests, but we look at functional laboratory tests. How is the biochemistry and the metabolomics? How are they functioning? Are they optimized? Or are they deficient within a spectrum? Traditional Medicine has a reference range of, you know, negative or positive. Functional medicine optimizes function based on individual susceptibility and genetics. It's a very elegant form of practicing medicine within chemical principles. Just old school sort of, you know, when did you last feel well; what happened and what may have been playing a role. No longer looking at single factors, instead, looking at multiple causative factors as to what keeps this patient still symptomatic. And I can tell you, from my experience, that there is never one reason why a person is not feeling well. There's usually a whole myriad and host of issues from poor sleep, poor diet, early childhood trauma, dental issues, food and gut sensitivities. It is complex, long list of what made you unwell. 

Yeah, absolutely. Why do the symptoms vary so much from one patient to the other?

You mean with Lyme disease specifically?

Yes. with Lyme disease specifically?

Well, while it depends on a whole host of factors, it depends on the individual immune response of the person, the total toxic load, the infectious load, the expression of the Lyme disease spirochaete, with or without co infections, the metabolic and nutritional strength of the individual, the immune competencies, the presence of natural killer cell functions, whether they can suppress the immune response. The fact that Lyme disease goes from different forms; the cellular form to an intracellular form, to a cystic form to a biofilm form then it comes and goes depending on your immune surveillance. There's a lot of reasons why somebody has waxing and waning of symptoms and feels variations in their symptom profile.

Is it possible for someone to have Lyme but not have any symptoms?

You can have positive laboratory testing for Lyme and be asymptomatic. Absolutely, absolutely. But you don't see those people because they feel good.

Yeah, definitely. Do symptoms flare and go dormant normally for some of your patients?

They do. They wax and wane depending on stressors, diet, travel and multiple factors affect the expression of symptomatology. Treatment or no treatment. Some treatments exacerbate the symptomatology quite dramatically. They get what they call the Jarisch Herxheimer reaction (JHR) where you put in a treatment and the patient's symptoms just go through the roof. And so, there's all these variations as to why people wax and wane and get increased symptoms at times. But yeah, we certainly have people with, with no symptoms, who have positive laboratory tests as well.

Dr. Hoffman, are you seeing a larger increase in the number of patients that you suspect to have Lyme disease and other co infections?

Absolutely. Yeah. As you know that the Lyme disease diagnosis is highly controversial, depending on which school of thought you belong to. Whether you belong to the sort of infectious disease society, the infectious disease group of medicine, or whether you follow the ILADS criteria for the diagnosis and treatment. Those are these two different schools of thought. Now you know, even with that, there's been a tremendous uptake in the Lyme disease diagnosis and co-infections due to global warming. The migration of songbirds further north and the spread of ticks deeper into the north because of global warming. It's been estimated, one study showed that the songbird flight path from South America to North America brought up to 32 million tick species. In the yearly migration just northwards from South America. So, there's a there's a huge increase in the diagnosis. For sure.

Yeah, especially for anyone who's living along any kind of migratory bird path.

Absolutely. Yeah, absolutely. And there’s this great Canadian researcher, John Scott, showing us published papers on this issue.

Yes, hopefully, we'll get him on a future podcast as well. I'd love to hear more about his research

Absolutely. Yeah.

So I was fortunate to go to the ILADS conference last year in Boston, and I learned about mast cell activation. And I was just wondering if you could tell me a little bit about that disorder.

Well, Mast Cell Activation Syndrome (MCAS) is a relatively new diagnosis. It's been around for a while. Dr. Lawrence Afrin is one of the leaders in the diagnosis and treatment. He's just recently published, which I co-authored, a criteria for the diagnosis. And the reason why that has been important is because previously at medical school, we learned about systemic mastocytosis, which is an increase in the number of mast cells that create disease processes. But mast cell activation syndrome is an increase in activity without an increase in number. And there are different criteria for the diagnosis. Mast cell activation syndrome is a very, very important concept to keep in mind when seeing patients with chronic systemic illness because you'll see it a lot. I see it a lot. Mast cells or white cells act as vigilante cells to try and protect you from incoming stressors. Whatever they may be, whether it's mental, chemical, environmental, infections or food, they spew out at least 1000, not 200 as one's thought, but more than 1000 mediators of inflammation. One of them is histamines. Everybody knows the histamine is a sort of allergy hive reaction. There are many other mediators of inflammation. People with mast cell activation syndrome have this heightened inflammatory response to ongoing day to day environmental exposures and present with a multitude of symptoms in multiple organ systems. And they travel from doctor to doctor you know, they go to the allergist and the rheumatologist and to the neurologists, but nobody ties the systemic nature of this condition together. So, it's important again to take a thorough history and elicit whether somebody may be presenting with mast cell activation syndrome. Now, interestingly, mold exposures and Lyme disease trigger mast cell activation syndrome. So you often get a cross mapping of symptomatology.

Well, what would be your best advice for someone who suspects that they might have Lyme disease?

Well, it's a very tricky one. Because here's my experience. People often want to believe in a one diagnosis - one treatment approach when they present with complex illness. And it's really doesn't do them any favors to adopt that attitude. Yes, you may have a classic exposure and symptom profile, no question about that. But when you've got chronic illness, and chronic multi system, multi symptom exposures, and you go into a Lyme test with a naturopath or an MD, they send it to the states or even they send it to the Canadian Winnipeg group. And you come back with a positive test, it doesn't mean that the reason for your symptom profile is Lyme. Lyme may be the trigger, but you may have a whole host of underlying issues that are playing a role in your symptom profile. And one of the great tragedies that I see in my practice is people who come to see me, they've got a positive Lyme test and they've been treated for Lyme. But it's really not the key diagnosis, there are 70 other underlying factors that are far more relevant than that positive laboratory test. So, in response to your question is just be extremely discriminatory, when you jump to the diagnosis of Lyme disease as causing your symptoms, it may not be that. It may be there, you may have a positive test. But it doesn't mean that Lyme disease is at the root of it. It may be that it is. But you can't just take a positive test and treat it as if that's it. And I see that 90-95% of the time. They just go get treated for Lyme, but it's not really Lyme that's causing a symptom profile. Sometimes it is, of course it is, but you've got to discriminate.

So it's that combination of diagnostic testing and patient history,

History, history, history. If you're not taking a two-hour history with your patient, a timeline from conception to present, plus even intergenerational issues because we know that you inherit epigenetically family trauma. It is very well studied and well researched. Now, if you're not taking a thorough history, and following the timeline and symptom presentation of that patient, at least a two-hour history, you can't really discriminate on a history basis, whether this patient is suffering from one illness or 15 possible comorbid conditions. You have to take that history, then you back it up with laboratory data. The more laboratory data, the better, which unfortunately and again, with our healthcare system, that sort of privilege and that sort of luxury of a two-hour interview with extensive lab data. It doesn't exist. You have to go outside the healthcare system to get that service, you know, which is a tragedy, but it's the truth.

I couldn't agree more. Thank you so much for your time, Dr. Hoffman.

Thank you so much.

My key takeaway from that conversation was just how important it is that a doctor gets a full patient history. I know that in my case, I had a lot of symptoms and it was really confusing to understand what was going on in my body. That wraps up another podcast. Thank you so much for listening. Stay safe in the outdoors.

Lecture: 11th Annual CHNC, Mild Cognitive Impairment

Since 2000, deaths from heart disease have decreased by 14%, while deaths from Alzheimer’s disease have increased by 89%. Alzheimer’s disease is the third-leading cause of death in the USA. There is a major distinction between just memory loss and a wider range of cognitive abilities and decline.

In this lecture, Dr. Hoffman discusses how to differentiate between mild symptoms of cognitive decline versus those of advancing Alzheimer’s dementia. Only 5% of all incidents of Alzheimer’s disease are considered genetic in origin; the rest are caused by lifestyle factors over which we can exert significant control.

Dr. Hoffman also talks about the different subtypes of Alzheimer’s disease, many of the 150 potential risk factors for their development and the lifestyle, nutritional, hormonal and medication interventions that can make a marked difference in patient outcomes.

Mild Cognitive Impairment 11th Annual CHNC Part 1

Dr Bruce Hoffman

Mild Cognitive Impairment 11th Annual CHNC Part 2

Dr Bruce Hoffman

Transcript

Dr. Bruce Hoffman:

And so, I look at the broader model, the seven levels of healing, I look upstream, I look at the family system. Epigenetically, you don’t escape the fate of your forefathers. Whatever fate your forefathers went through, you don’t escape it, you epigenetically manifest their experiences and if they have unresolved experiences, traumas, murders, deaths, you do not escape the effects. It has been studied extensively, many studies now, mainstream research, this is not esoteric research, with children that have been born since the world trade centres went down- higher incidence of PTSD even though they weren’t there. These events were just epigenetically transmitted.  

We know through cognitive behavior therapy that if you don’t change the way you interpret reality, you can release a whole storm of inflammatory and toxic neurochemistry which then influences your cellular expression of micro RNA, which then influences metabolic cellular outcomes; so your very thoughts, every single thought you think, 60,000 thoughts a day depending on how you bias those thoughts, determines physiological outcomes. That’s what CBT is all about. Those of you know about CBT- (cognitive behavioral therapy) – is all about changing the way you interpret reality, based on a new world view or interpretation. We have a saying in this work that we don’t heal until we actually have a new image, a new way of interpretation, a new way of looking at the world, a new story. Also, we don’t heal until we align ourselves in an accepting if not loving way with our mothers and fathers, and our ancestors. Those of you who hate your mothers and fathers. Those of you who cut off from your mothers and fathers. Those of you who judge your mothers and fathers for not having given you enough. You need to maybe open that up and look a bit closer because you are half your mother and you are half your father. How are you going to heal and cut off half your lifeforce? You can’t do it.  I tell my kids, when they need new partners, I say to them, here’s your screening tool, the one question to ask the person in front of you to whom you are potentially attracted to, “how are you with your mother and father”? Just ask the question. If they tell you that they hate their mother and father, and that they never want to see them again, run like hell. It’s not going to go well. And I tell you that’s a very reliable indicator for how people are in the world. So we use a much larger, larger model to view and interpret people’s health.

Just by way of some definitions. Dementia is when cognition fails, but Alzheimer’s is characterized by particular findings that you find in the brain. The tangles, and the amyloid plaque that defines Alzheimer’s and although it starts with memory loss, it very soon ends up in the inability to formulate language, and then socialize, and then eventually end up in the with the reptilian brain expression where you barely function. You can eat, you can sleep, but your whole orientation to the world outside of you is shut down. 

There are different types of dementia. Alzheimer’s is the most common, but there are other types. Neurologists are extraordinarily good diagnosticians. So, if anybody has a dementing process, or cognitive decline, you really do want to see your neurologist because they have the ability to really discern the subtleties of different types of dementia, and what differentiates Alzheimer’s disease from other forms of dementia. As I said there is the APOE4 gene- if you have the APOE  3/3 gene, you have a 9% risk of Alzheimer’s. If you have the 3/4 gene you have a 30% three times increased risk, and if you have the 4/4 gene you have a 50-90% risk potential for developing Alzheimer’s disease as you age if you don’t do something to change the inputs. There is a website https://www.apoe4.info/wp/ for carriers of these genes because the people who run this website are aware now of how profound this gene is. This website is dedicated to informing individuals with the gene and what can be done to down-regulate the potentially negative outcomes of disease expression. 

I’m going to skip some of the basics because I know I’m going to run out of time but here’s the hallmark of Alzheimer’s, these tau tangles which are in the neurofibrillary and the amyloid plaque. This creates an inflammatory response which shuts down neuronal synaptic communication, which kills neurons so as your synapses die from these tangles, neurons die. Your brain atrophies and dementia can ensue, and if you had to look at what in at the most minute level- what’s really going on in Alzheimer’s disease. It has everything to do with the interplay between trophic factors and blastic factors, growth factors and destructive factors that influence one particular protein called the amyloid precursor protein. This is where amyloid plaque comes from, it comes from this protein. It’s a subset of it and you have what are called molecular scissors, or proteases that come along and they snip through this amyloid precursor protein. If it makes one snip, you get the anti-Alzheimer’s outcome. If it makes four snips, you get the pro Alzheimer’s outcome, so the entire Bredesen protocol is everything to do with how you influence these molecular scissors to favorably produce the two pieces of amyloid precursor protein, as opposed to the four. That’s what it is, what you can do to drive support for neurons, as opposed to destruction of neurons by influencing these molecular switches. That’s it at the molecular level anyway. 

So, we don’t go progress straight to Alzheimer’s disease. Before Alzheimer’s occurs, there’s a subjective cognitive decline that can occur, for people 10-15 years before where people may say “I’m just off my game, I’m not as smart as I used to be now.” Normal aging produces this, our brains slow down but if you are going down the dementing routes- if you’re going down the Alzheimer’s route, you may start in a preclinical way. Some of your tests may be already positive before you actually pick it up. It’s subjective decline. Then you actually start to get mild cognitive decline where you actually objectively starting to register negatively with specific testing. I can’t tell you how many people come to my office who are running corporations, CEOs, with mild cognitive decline. Their biochemistry, their markers of cognition, they fail, but they’re still operational but they’ve got objective signs of decline. After that is when you lose tasks of daily living and you start to go down the dementing path. There is a difference between dementia and normal aging with statements like “I forgot my keys.” People with just normal aging usually remember where they parked. They can retrace their movements and realize, “Ah that’s where I left them.” So, these are some differences, but it’s a bit of a fuzzy line in the beginning. As I said those of you on the right side of your biological drives when your brains speed is still travelling at 300 milliseconds. You still got a good brain speed, so you’re not so concerned about this but I’m personally on the other side of that curve and I’m very concerned about things like this. That’s why I started the brain treatment centre, not only to help patients. I had a selfish interest; I want to keep my brain moving at 300 milliseconds for as long as I can. Okay so this is the difference. Everything has to do with brain speed. Our brains move at 300 milliseconds per second. After age 20, and every decade thereafter, 10 milliseconds are lost just through normal aging. That’s profound, you know when your brain speed slows down you literally slow down. When your brain slows down, neurons and synapses die and there may be a bad outcome if you don’t do something about it. There’s a separation, a gap, between thinking a thought and executing the thought, by doing. 

There’s many reasons why people’s brains slow down or are exacerbated by lifestyle issues that don’t lead to necessarily dementing Alzheimer’s illness. The aging is the number one cause of brain slowing down but then you may have strokes and stress. People also drink far too much, it’s a neurotoxin they get addicted to. Certain things, prescription medications, can have profound effects. I mean you have no idea how many statins are given out like candy. Some of them cross the blood-brain barrier and shut down cholesterol metabolism. Cholesterol is a building block of brain neurons and myelin. You have got to think before people start taking these drugs. Some people come into the office and we suggest they go through something called the Cognoscopy. Everybody at age 50 gets a free colonoscopy, free under health care. Now, in terms of the future, start spreading the word, ask you friends, ask your parents, mom have you undergone a cognoscopy? A cognoscopy is a brain evaluation. Now your mother will say no because it doesn’t exist in the healthcare system. We can plant the seed; we can start thinking about it. It will happen because as I said in the beginning, try living one day without a functional brain. You know, it’s awful.

At the clinic we do questionnaires. Any of you recognize this MoCA (Montreal Cognitive Assessment)? You recognize it? Do you remember Donald Trump 2 months ago flashed this test and said “I’m brilliant, I’m a genius.” No, I’m serious he did pass the most elementary of cognition testing called the MoCA- and this is a five-minute test. He got 30 out of 30 apparently, but people with dementia they fail it. If you know anybody with a score less than 19, you’re on the wrong side of your MoCA. Your MoCA score for the average Alzheimer’s patient is around 16, 16.2. If the score is 19 to 22 those people with dementia will, if they can’t you now- they can’t take care of the daily tasks of living.  That’s a serious pattern. People with a mild cognitive impairment they have a MoCA score between 22 to 25. People who passed had a score of 26 or up. If you want to be in that range, I suggest that you get your brains assessed even if you do this online. It takes five minutes. We also have at our center the computerized CNS vital signs tool which is a computerized measurement of cognition. With this slide you can see this is one of our Alzheimer’s patients. They can’t perform the tasks of executive functioning which the frontal lobe performs. What we take for granted they completely failed as opposed to somebody with a relatively normal executive functioning. You see how the brain atrophies and the brain atrophy starts in this part of the brain called the medial temporal cortex; that’s the hippocampus. The hippocampus is where we lay down new memories. It has limited capacity but we lay down our new memories in the hippocampus and as the dementing process spreads, it reduces the hippocampal neurogenesis and the nerves start to die but then it’s spread throughout the brain and this is a typical brain with Alzheimer’s. It really is shrunk, it’s quite remarkable, when you see it on MRI and there’s many imaging techniques which are used, MRIs, FDG-PET scans, amyloid PET scans, there’s all kinds of diagnostic tests. We’ve recently introduced in Canada software called the NeuroQuant MRI and this has to be privately ordered. You can’t get this from healthcare, I’ve asked, they won’t do it. But this NeuroQuant MRI actually measures objectively the size of each different area of your brain and compares you to a normative database of particularly the hippocampus and the frontal cortex. These are the two parts that go first, they shrink and we can objectively measure and compare these to other people’s brains. A normal MRI doesn’t do this. Here you can see the hippocampus is reduced. We also do QEEGs, and we can see the brain slowing down, that’s a slowed brainwave that we measure through a QEEG. 

Then we get to Dr. Bresden’s six subtypes of Alzheimer’s disease. Here we really have to understand the different six subtypes to learn how to work them up and how to treat them. If we don’t understand them according to this model, we can’t treat themand so the subtypes are: 

A) Inflammation. Here inflammation is at the root cause of the Alzheimer’s expression, Here, all these inflammatory markers get expressed in APOE4 subtypes. Inflammation is the most important risk factor for that subtype. Here you can see the hippocampus atrophied. We then have to seek out all the causes of that inflammation and all of you know the following triggers very well. Food, gut health, leaky gut, this is at the basis of this inflammatory subtype. We look at the causes of leaky gut, these are all lifestyle issues and we can actually measure how leaky your gut is and how leaky your brain is. You can actually measure now with specific labs the leakiness of your barrier functions and you can measure gut ecology and look at inflammatory factors. You can measure and look at zonulin – the protein that causes leakiness and histamine that makes it worse and then you can actually measure the protein in the lipopolysaccharide coating of bacteria that leak across the gut and cause bacterial endotoxemia and an inflammatory response. These are called LPS lipopolysaccharides. This is the root of many inflammatory brain disorders. Look at all the diseases that get expressed when lipopolysaccharides get expressed.

Then you look at food sensitivities. There are many different ways to look at food sensitivities. Many people come and see me and they have done one IgG test. That’s not it, you have to look at different immunological pathways to look at food expression. One test at our local private lab for IgG foods is not how you work up food sensitivity. You must learn about the other methodologies because they are extremely relevant. One may be positive may be negative in the next test. We also do a whole ton of work around gluten. Gluten as you know, nobody processes gluten well, even if you have or don’t have celiac disease. Even if you have or don’t have gluten sensitivity, nobody has the enzymes to break down the gluten molecule. Nobody. Dr. Fasano the great gluten researcher has said this for 10 years. You get a leaky gut from gluten, now those of you without the bad genes can repair it within hours. But every time you have gluten, you have a leaky gut- quick repair- ok. We measure the gluten molecule in all of its subsets with specialized labs and we measure antibodies to cross-reactive foods. Gluten cross-reacts with different foods. How many of you like coffee? How many of you like coffee and are gluten sensitive? How many of you knew (instant) coffee performs molecular mimicry and ignites the same pathways as gluten may? Just a thought. A particularly horrible thought. And then we can measure antibodies to specific tissue. We can measure antibodies against all of our organs and particularly we can actually measure immune systems attacking of core neurological structures, synapses, tubulins, myelin. You can see how under attack your brain is when you start doing these tests. 

Dentistry. How many of you lump dentistry and health together? How many of you lump dentistry and medicine together? It’s a separated discipline in present ways it is practiced. We can’t work up an Alzheimer’s patient without doing an extensive dental work-up. I do a panorex x-ray and a 3D cone beam CT, looking for periodontal disease, root canals, mercury fillings, dissimilar metals, implants, cavitations. There’s a whole slew of potential toxicity existing in the mouth. Multiple studies show the link between periodontal disease and the risk of Alzheimer’s disease. We do peridontal workups.

B). The second subtype is the glycotoxic, the type that causes too much sugar. Sugar as you all know is a potent, potent toxin. It should be a classified substance. 300 years ago, it was sought after like cocaine is today, people would seek it out because they knew how it made you feel- temporarily. Our bodies can’t cope with more than 15 grams of sugar a day. What is in one  sugar soda contain -4200 grams of sugar (not diet). We can’t cope with this huge input of sugar, I mean I know you know formulas but this is the second subtype that causes neurological causes, dementing processes.

C) And then we get the atrophic type, the atrophic type is the type that as the brain ages, it loses neurotropic support, vitamin D, zinc, estrogen, testosterone, pregnenolone, DHEA, all of it gets withdrawn as we age. If there’s one thing in my practice that I enjoy the most, is to see a postmenopausal woman who’s not dementing but she has cognitive decline, go back onto bioidentical hormones and they are so happy. Three months later they come in and the first thing they’ll say, I can’t believe it, I’ve got my brain back. Why? Estrogen is a neurotropic, neuroblastic hormone. It improves synaptic connections and improves dopamine; it changes cognition dramatically. This is the second type. 

D) The third subtype is the subtype that is toxic. This is a subtype of Alzheimer’s, it’s a different presentation of Alzheimer’s. It’s usually in younger people, it’s not so much influenced by the APOE4 gene and they usually present with a lot of frontal lobe symptoms as opposed to the typical hippocampal memory loss. But they do get- the first sign of somebody who’s got a toxic sort of brain is somebody who can’t multitask anymore. They used to do five things and now they can’t, they just have to delegate and that’s one of the first symptoms and we have a whole new world of work being done by Ritchie Shoemaker and others on the chronic inflammatory response syndrome. This is where the innate immune system is upregulated due to mold and Lyme and it causes this very specific profile of inflammation through the innate immune system which affects the brain and effects all the neuro peptides in the brain which regulate leaky gut which regulate hormones which regulate oxygen delivery to mitochondria. This is a whole subset of work that’s going on not in mainstream medicine, you won’t see it, you won’t find it, it’s not there but it’s in the research literature and we do certain things in our clinic to try and find out. We do questionnaires of that particular type, type three chronic inflammatory response. We look at the visual contrast test to see if people fail this test and we do spore counts and mold counts in their homes. Then we look at metals, heavy metals is a big cause and pesticides and air pollution and Lyme disease. How many people will have heard about Lyme disease epidemic, it doesn’t exist in Alberta right? Yeah. My entire day- do day-to-day, week-to-week- is made up by mold and Lyme, toxic people. They travel, they get it from other sources and we believe now the literature’s quite clear that Lyme disease may be transmitted by other factors, and there’s literature here in Calgary by Maureen Middleveen, that it may be sexually transmitted as well. This hasn’t been published in peer-reviewed journals but the literature is out there making those suggestions. With Lyme disease we find the pathogen inside the brains of people with Alzheimer’s disease. We find herpes simplex 1, the good old cold sore as a big cause. There is also a link between pesticides and Alzheimer’s. Glyphosate. How many of you eat organic food? Even organic food is riddled with glyphosate because of cross-contamination. It’s everywhere. Glyphosate is highly toxic to many core organs. It causes gut permeability; it shuts down neuronal pathways. 

E) Then the vascular subtype is with people with hypertension and atherosclerosis which decreases oxygen supply to the brain causing Alzheimer’s decline. 

F) And then we get the traumatic subtyppe; the brain injured people; I mean look at these statistics. Not all head trauma patients will develop Alzheimer’s, but there is 2.3 times increase incidence in mild or moderate traumatic brain injury. 4.5 increase in severe brain trauma. There are no studies linking mild brain injury to Alzheimer’s disease, but three or more concussions -a fivefold higher incidence for memory loss and cognitive impairment.

I’m out of time. Well there’s a whole slew of lab tests you can do to sort of think through this problem. You won’t get it under health care, you won’t get it from your family doctor, in fact you’ll get dismissed so it’s up to you to educate yourself. Dr. Bredesen’s book The End of Alzheimer’s is fabulous, I suggest you read it and you start working through your own cognoscopies, how you can work yourself up to see if you’re at risk and then therapeutically there’s at least 36 things you can do to down regulate cognitive decline and/or Alzheimer’s of which- guess what’s number one? Nutrition. 

One last word, ketogenic diets seems to trump every other diet when to comes to changing brain outcomes. Combine that with good sleep, exercise, stress reduction, you’ve got the four pillars of turning down mild cognitive decline of potential dementia, and then you can look at all the other factors with influence outcomes and just teach yourself because nobody out there is going to teach it to you and you definitely won’t get it from your medical doctors. So thank you very much. Thank you.

Judith Cobb:

Thank you, Dr. Hoffman, that was amazing. If you have questions please come and use the mic, we have about 8 minutes for questions, and at 9:30 you might get cut off right in the middle because we’ll be live streaming with Toronto, so questions?

Question:

Just a quick one, I know vitamin D is a really controversial item right now and is limited in information especially with auto-immunity, so what do you recommend for dosing, food versus supplements in the grocery list this summer?

Dr. Bruce Hoffman:

So, those are the  foods that contain vitamin D, this is how you can calculate your vitamin D needs, but I can tell you it’s not that accurate. Every Calgarian that I’ve ever seen who’s not on vitamin D supplements is vitamin D deficient, everyone. But you can’t tell them how much to take because everybody has a variation in the amount they need, depending on A) The VDR gene receptors which is from the 23andme gene test. because the people with a VDR plus plus gene need a lot more vitamin D. The state of the small intestines is where you absorb vitamin D and many people have very disrupted small intestines, and they have SIBO and small bowel SIFO with fungal overgrowth and they don’t absorb the D vitamin and you need the D vitamin and you need a lot of oil. In fact, Vit D – this is a fat-soluble vitamin. I can’t tell you how many people are fatty acid deficient, the majority of people by far. Everybody’s taking omega-3s, that’s epidemic right now, everybody comes in taking fish oil- fish oil isn’t it. It’s got benefits but you need your omega-3, your sixes, your nines, your mono and saturate fats; your saturates in order to absorb vitamin D and vitamin A and vitamin E which are fat soluble. So, to answer that question is complex but patients hate me, they always ask me questions and I say “I’m not sure, it’s complex”, they go “give me an answer”. Then I will do a ten minute explanation, and they go “oh I see”. So that’s the kind of complexity that this requires to answer that question.

Question:

For people in our industry, it’s really hard for us to help with stuff like this especially now that Alberta does not test vitamin D, so how do you recommend we help people that do come to us with these issues when we can’t convince them to their doctor to get tested for this?

Dr. Bruce Hoffman:

So, it’s a great question. First of all, you can get vitamin D tested just so you know, there’s a trick. Yes, the trick you got to have a friendly GP who’s going to lie and say you’ve got celiac disease or malabsorption syndrome or osteoporosis. They need to sign a form, if they sign the form you can get it done, but I can tell you from my experience, none of them will, but if you have a good relationship with them and you can prove to them that there’s a need, they will do it for you. If you put a circle where it shouldn’t be and you don’t cross the box where it should be, you’ll be rejected. It’s that weird, that’s firstly. Secondly you can get vitamin D from private labs so people have to spend out of pocket. 

This notion of having Canadian healthcare pay for your functional medicine and wellbeing, please give it up, it’s not going to happen. You have to have health as an extremely high value and you have to invest in your health with your own after-tax dollars because they won’t let you deduct it in order to maximize your health outcomes. Please don’t think that Alberta health care is going to do this for you and I don’t think they should by the way. People always feel almost shattered when I say that. The disease based system,  we already pay exorbitant taxes to fund the free health care and they do a good job of you know, when we have a heart attack and go to the emergency and we get 5-star treatment and intensive care. Don’t try and muddy the waters asking that system which treats tertiary disease, to start doing preventative medicine overnight. I think it will creep in overtime but if you want them to do functional medicine and preventive medicine and start to fund what you do your taxes will be 95%. It can’t happen, so please be responsible, get rid of an adolescent fantasy that health care should take care of all this, it won’t and I don’t think it can afford to. You have to have health as a high value, you have to invest in yourself, you have to educate yourself,  you have to become your own patient advocate and you have to do what it takes to get you where you need to go.

Question:

Hello, outside of MRIs, EEGs, CAT scans and others in our regular system, how do you feel about the spec imaging, neurospec imaging?

Dr. Bruce Hoffman:

Neurospec imaging? It’s not- it’s generalized but it’s not specific. You can see signs and symptoms, you can see certain images like you know the ring of fire, Daniel Amen’s. It’s not specific but it is done. PET scans, more accurate and some of the more advanced PET scans are more accurate. Neurospec is sort of a secondary test, I wouldn’t use it as a primary test unless you got free access.

Question:

Hi, I just saw on a slide that you said with inflammation it had to do with Pitta and Ayurveda and what the relationship was there?

Dr. Bruce Hoffman:

Are you familiar with the Ayurveda? So, I evaded talking about doshas- doshas are constellations of elements, vata is air and space, pitta is fire. What is inflammation? Fire, too much fire.

Question:

So, someone with Pitta is more susceptible to Alzheimer’s?

Dr. Bruce Hoffman:

I don’t know if that’s statistically true, but theoretically of the subtype one, inflammation, I would say, I would posit a guess, I don’t think studies have been done- now Bredesen knows a bit about Ayurveda.  I was astonished that he did, so I would think they may be something to that, there may be literature on that  that but I can’t say for sure, but it makes sense. Pita is the hardest to treat by the way. 

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