We are back with the incredible Dr. Richard Lee of Gene-Solve for part II of his neuroendocrine/hormonal primer. Today, Dr. Lee talks to the other half of the room (women) about some of the gender specific implications of stress, nutrition, and diet on female physiology. If you follow the M|Wod, this video is essential viewing and one of the most important and actionable pieces of content we have ever produced. Not sure who Dr. Richard Lee is from our last video? You can check out his bio and the work he and his team do at gene-solve.com. Seriously, we will fire you if you don’t watch this.
Kstar
Don’t fire me, I’ll watch. I’ll watch….
This, and previous content about blood testing and other non-mobility topics are stepping outside the bounds of what mobilitywod should be doing. Lee’s explanation is overconfident (about how much we actually “know”) and inappropriately reductionist. At best this hormonal diagram is a vaguely understood argument for eating well, managing stress, having good sleep routines etc. etc. I.e. all of the lifestyle pieces we know are good for the holistic concept of “health.” It is not support for taking bunch of “supplements” (i.e. medications) to mess with your hormones with unpredictable effects, especially not after paying this dude a hefty fee. This has been tried and failed over and over again. E.g. “Foods with beta-carotene in them are good for us, let’s just take beta carotene…oh wait, that causes cancer.” We should probably just keep eating carrots and be content that they are some who good for us and stop trying to “hack” or “game” nutrition, hormones etc. There are unpredictable and probably unknowable interactions and effects between all of the pieces of this hormone diagram just like there are incalculable, unknowable synergies between the ingredients of whole foods, how they are consumed, how they taste, what we had to do to procure them etc. that make them good for us. And please leave physicians out of this. We right to be hesitant to arrange blood tests for asymptomatic people and treat non-disease states. And it’s not because we are lazy, or ignorant or have some other hidden agenda. The goal of medicine should be to diagnose, treat and reasonably screen for pathology, (and has a hard time doing that without causing hair along the way) not to tinker with normal ranges of hormones at patient’s requests. Move well, sleep well and eat your broccoli.
Dr. Chris LIvingstone
P.S. There are physicians who watch MWOD, probably best not to have guests on who insult them.
Yep fair call Chris!
Just had a chat yesterday with someone saying they were at the cutting edge of epigentics, having taken a quantum leap ahead in this field. Basically suggesting they were able (certainly within 2 years) to be able to test/scan for and identify genes that are functioning undesireably, then target those with specific supplements to influence their expression to promote health and longevity.
I’ve participated in a demo by a similar company (if not the same) that has a portable scanner to test your antioxidant levels and similarly ‘prescribe’ supplements to help optimise them…
I just think people need to focus on the basics first and that dabbling in these areas is incredibly expensive (and potentially dangerous) vs just adopting a healthier lifestyle.
Fit regards
Craig
Dr Livingstone,
First, I apologize if you felt insulted, that was certainly not my intention. I was invited here by Kelly and Juliet to share the insights I’ve learned over my career, and my intent was to provide clear, actionable information that could befit patients and physicians alike. Secondly, I don’t feel it’s fair to label me as overconfident. With over 20 years of experience, I’m actually quite confident in my understanding of science and medicine. We actually do know quite a bit, even more now that DNA is in the picture at the point of patient care, and I’d be happy to discuss the specifics on any aspects of our treatments. What are you uncertain about? What could I clarify for you? The diagram on the board is simplified to illustrate concepts, but it’s not vaguely understood, it’s actually exceptionally well documented and clinically understood. (http://europepmc.org/abstract/med/10997609)
There is no question that eating well, sleeping well, and exercise are all important for health, but the reality of the lives that many of us now live, which include high stress, long hours, business travel, and inconsistent nutrition patterns are all factors that we cannot simply wish away. It’s not enough to tell someone “sleep more, eat better, exercise more.”, because (1) it’s often not enough after the cumulative effects of years or decades of a high-stress career, and (2) people aren’t likely to give up their job or lifestyle. Science can offer these people substantial health benefits, even if their ‘conditions’ are self imposed through a high-stress lifestyle. Furthermore, the effects of treatments are remarkably predictable. To say the effects of a vitamin supplement or a hormone treatment are unpredictable is simply an admission of not knowing how to measure it. I’ll admit, it’s not easy, but that doesn’t make it impossible. Again, what can I clarify here for you? I would like to be given the chance to show you what we know, and why we we know it.
It’s not fair to use an example like beta carotene say that this has been “tried and failed” because that highlights exactly what many doctors (myself included) are NOT doing. Instead, we treat each person individually based on their specific, measured needs. The fact that a single supplement doesn’t work exactly the same across a wide population should come as no surprise, because many in that wide population probably didn’t need it. If you gave aspirin to everyone in a movie theater before a movie, and then afterwards asked each one of the attendees if the aspirin cured their headache, the efficacy of aspirin wouldn’t look very good because most didn’t have a headache to begin with. Similarly, there’s no reason to think that everyone can be treated with 1-size-fits-all healthcare, whether through supplements like Vitamin D, or medications like Synthroid. It has to start with a clear understanding of the patient.
At GeneSolve, our researchers and programmers have spent the past three years documenting the known interactions you call ‘unpredictable and probably unknowable’ into a software system; this system powers the network of doctors that bring GeneSolve’s approach to their patients. It’s remarkably accurate and precise, and I’d love to show it to you. Is there more science left to learn? Of course! But to say we know nothing is simply not supported by the volumes of research that’s been done (here are just two examples: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0030-1269854 and http://archpsyc.jamanetwork.com/article.aspx?articleid=207557). Just think, as recently as 10 years ago, we knew a lot less about the neuro-endocrine system overall, and there was almost no such thing as actionable DNA data. Today, the landscape of what we can do has changed so dramatically that a doctor now has, if anything, too much data to work with. Today, there is less intuition and guesswork needed, assuming the data can be organized and understood.
From a patient perspective, I think it’s unfair to a patient struggling with fatigue, weight gain, or sleep issues to classify them as asymptomatic. They certainly don’t feel asymptomatic, and I’ve personally seen the positive effects in my patients when we address the underlying causes of their symptoms. What we call “normal” as physicians includes 95% of the population, guiding us to treat only those in the upper and lower 2.5% percentiles. Someone with a Vitamin B12 level at 3% of a population average deserves to know that this number can and should be addressed. So too with everything else we can measure and correct.
Lastly, to claim that our only role as doctors is in pathology has two big problems. First, the principles and practice of modern medicine (particularly in America) has left us with one of the highest per-capita health care costs in the world because we have focused on only treating pathology. If this is our sole purpose, then all of us as doctors are failing miserably, as obesity, diabetes, and chronic disease skyrocket. Instead, I’d suggest that our most ethical choice is to do anything and everything we can to discover, measure, and correct all factors that contribute to these epidemics long before patients are diagnosed and treated by a physician at an advanced disease state. Secondly, and perhaps most critically to the patients themselves, to focus on pathology and ignore prevention turns a blind eye to so many of the advances science has made that can help people live better, happier lives.
I searched online for you to reach out directly, but could not find you or your practice listed anywhere. Please feel free to reach out to me through our website or at doctors@gene-solve.com and I would be happy to continue the discussion.
Dr. Richard D. Lee,
Medical Director, GeneSolve
Adjunct Professor of Medicine, Stanford University
*causing harm not “causing hair” and somehow, not “some who” in my last post (autocorrect oops)
I watch MWOD because my doctor, who is either lazy or ignorant or has a hidden agenda, told me never to run again and to quit all lower body training.
I had gone to him with knee pain and came away with a prescription to Mobic, one dose of which could drop a rhinoceros, and the news that my athletic career was over.
I don’t know what would surprise him more, to learn that I’m running once again and squatting in the 400′s, thanks to MWOD, or that those who dare to criticize doctors might know whereof they speak.
I’ll watch MWOD to consider the possibilities.
Thanks for your detailed response Dr. Lee. I’m sorry I was unclear, I was trying to be concise. I’m not debating the correctness of your whiteboard hormone diagram. What troubles me is your unjustified confidence in the downstream effects of these hormones and especially with tinkering with them with supplements such as your DIM. There is a long history of examples of the danger of knowing better than Mother Nature. E.g. Trans fats created to replace wrongly maligned saturated fats end up causing heart disease, though not discovered to do so for decades. You give the example of the ill effects of bisphosphonates but these weren’t apparent until these drugs had been on the market for many years. There is a definite line between a healthy lifestyle change (supported by millions of years of trial and error by culture and evolution as to what promotes health) and an intervention like a supplement/drug which is novel to us and perhaps investigated in a handful of short term studies. The other part of your discussion which troubles me is reliance on surrogate endpoints. The study you give a link to on vitamin D supplementation concludes “Vitamin D supplementation might increase testosterone levels.” Who cares? Does anyone brag about their testosterone level? Do you get a hormone report card at some point? I would be fascinated by a well designed and powered study with a patient oriented outcome like better sleep, improved performance or reduced all-cause mortality from taking a given supplement compared to placebo, (or in your case from a population with gene “X” getting such a benefit.) Do you have some links to studies like this? In Kelly’s language you’re using correlates. To complete the example, who cares your mobilization improved hip flexion by 6.78 degrees measured by laser goniometer: can you squat better? And there’s no physiotherapy intervention I’m aware of that was later found to give someone atrial fibrillation or bowel cancer or dementia like countless drugs have. The potential long term risks of your interventions are completely absent from your discussion. And finally I never stated I was against prevention, though again we should be careful our “prevention” is not doing harm itself (like screening leading to over diagnosis and treatment e.g. mammography and DCIS, PSA and early prostate cancers etc. etc.)
Chris Livingstone, MD, CCFP (you didn’t find my practice because you didn’t search in Canada)
Great dialog, Drs Lee & Livingstone!
Here’s a great email we got from an m|wod subscriber whose life has been impacted in a big way by the information we’ve put out about blood testing.