On this episode James talks with Joel Evans, MD about how the Institute for Functional Medicine has created content for their programs in response to COVID-19. Joel discusses some of the research and literature they have put together on supplements and immune health that are correlating with COVID-19. This podcast gives great insight to a silver lining amongst this crazy time.
- How functional medicine could be relevant in treating COVID-19 and where they have focused their efforts
- What IFM has put together for other practitioners that has research and articles for supplements that have helped with the flu and other viral infections
- Why the fundamentals like gut health, immune health, and detoxification are so important
- And so much more!
Resources mentioned in this episode:
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Hello, and welcome to the podcast. This week, we have Dr. Joel Evans. He is a functional medicine luminary and has been on the front lines of helping the Institute for Functional Medicine create their content and programs around their response to COVID.
This couldn’t be a more critical topic because it has become clear, more and more that doctors don’t have all the tools they need to be able to deal with both the acute infections of COVID, but also these long haulers. So we spoke to Dr. Evans about this year, what’s happened, what’s happened at the IFM, some of the recommendations that they made initially, and now this new course that has just come out that is really focusing on helping clinicians around the world do much better with COVID using functional medicine interventions. Super interesting half an hour. Enjoy.
So a warm welcome back to the podcast, Dr. Joel Evans. Welcome, Doc.
Joel Evans: Great to be here. Thanks, James.
James Maskell: Really excited to talk a little bit here today, because obviously this has been a very interesting year for politics and for medicine, and also for really understanding what the future of medicine looks like.
So take us back, Joel, to, I guess, the first quarter of this year. I know that you’re really involved at the IFM. What was the first sort of moment when you realized that, one, that medicine was about to be really tested, and second, that functional medicine could be relevant?
Joel Evans: You know, it’s quite an interesting story. It’s actually quite a beautiful story because we had a situation where we were becoming increasingly aware that there was this new disease that was out there, this new infection, and we knew that it was serious, we knew that it was transmissible, though the extent of how transmissible it was, we weren’t quite sure about early on, but we had a belief that functional medicine would have a role.
This was an interesting conversation amongst the thought leaders at IFM because most people believe functional medicine has its biggest role in chronic disease, in chronic complex illness, and here we are dealing with something that’s acute and widespread. The question really was what is the role of functional medicine?
It’s not like we had an intellectual answer right at the outset, but those of us that were busy with busy functional medicine practices, especially in hotspots, so I’m right outside of New York City, so those of us in hotspots were dealing with cases pretty much early on. What our experience was that the functional medicine approach was helpful.
So we had patients early on with infections and I felt that patients that were under my care did better than those that weren’t. I had conversations with local emergency room doctors, they were patients of mine that are physicians on the front lines, and I came to believe through my direct patient experience that the functional medicine approach really made a difference.
Therefore we had conversations within IFM about what that meant for the responsibility of IFM as a thought leader and as an educator in functional medicine, and then we decided to create a rapid response task force. We got papers out right away. I was in charge of this first task force on botanicals and nutraceuticals, got of published paper on that. Then we talked about lifestyle, we had webinars, we talked about testing. So we really had a vigorous response. This course, then, is the latest form of the IFM response.
James Maskell: Yeah, great. Well, we’ll definitely get into the course and talk a little bit more about it as we go along. I guess at the very beginning, obviously, we’re dealing with sort of like an infectious agent, but as time rolls on, it’s sort of becomes clear that the comorbidities in people with these lifestyle-driven chronic illnesses, which has been like right in the zone of functional medicine.
So as you were going through the research, how do you decide where to focus your efforts? Because ultimately, I would say that there’s probably a wide range of ways in which functional medicine could be helpful. So how do you like focus the effort and attention of your work into those two sort of competing priorities?
Joel Evans: Yeah. So let’s look at the role of comorbidities. The way most of the physicians I know in the medical literature in addition was looking at those comorbidities is why do people that are infected or have COVID-19 with those comorbidities, why do the comorbidities make the clinical course of COVID-19 worse?
We thought, for example, with diabetes, it had to do with the fact that diabetics don’t do well with fighting infections, right? We all know that diabetics get more infections. In reading the literature a little deeper, what we realized is that a lot of these comorbidities actually predispose you to having more of a severe infection because of the other underlying imbalances associated with these comorbidities that really functional medicine is aware of.
So, for example, the comorbidities of, let’s say, obesity and diabetes or hyperglycemia, the underlying issues we see there are inflammation and oxidative stress, for example. Then it became clear that those with underlying inflammation and those with underlying oxidated stress had a increased risk of severe illness.
So we realized it’s not the comorbidities themselves, it’s the imbalances that are caused by or associated with those comorbidities that are really the problem.
James Maskell: Yeah. Can I ask you a specific question about leaky gut? Because I saw something over the summer, and it was like a Stanford study, I think, and it was saying like, well, why do some people get really sick with COVID and some people not? It was talking about microbes circulating in areas where they’re not meant to be. I was like, that sounds a lot like leaky gut to me. Has that come up over the summer and do you feel like that’s an entry point for immune resilience?
Joel Evans: Absolutely an important point for immune resilience, right? So those of us that understand leaky gut know that it’s associated with endotoxemia, right? Endotoxemia is an inflammation that’s caused by the transfer across that gut membrane of endotoxins which come from the gut. So clearly that is one of the long list of causes of inflammation.
Then you have the general gut health immune health link, and we see gut health specifically related to COVID as well. So gut health is critically important. Leaky gut, a main component of that.
James Maskell: So let’s talk about some of these nutrients that were in your initial report. I mean, obviously vitamin D has got quite a lot of press this year for sort of like the effect of having healthy vitamin D levels with the chance of you getting infected. But also, vitamin C has got some press, and more recently zinc. This is all in the armory of the functional medicine doctor. So have you found know either through IFM or through your professional channels locally in Connecticut, that sort of this is like shaking doctors awake to the fact that these things might be valuable and they should learn what they are?
Joel Evans: Well, what I would say is that there’s a lot of reasons that functional medicine talks about supplements, nutraceuticals, botanicals. A lot of that has to do with problems with deficiencies, such as low vitamin D, and then a lot of things have to do with how taking supplements can enhance, for example, immune function.
The fine line we have to walk is that here in the US there are very strict rules about what we can and cannot say both on our website, in podcasts, and even in our course, because the FDA and other governmental agencies have very clear guidelines that there is nothing out there that can prevent or treat COVID-19 in terms of supplements.
So officially, what we’re talking about here is a medical hypothesis, or what we believe to be so based on the literature. So what we believe to be so are that using supplements that help the immune system can be helpful in COVID-19.
Now we’re beginning to see, and just beginning to see, some literature about supplements and COVID. But when things first came out in the spring, there obviously would be no literature on SARS-CoV-2 and supplements, so we had to extrapolate from data on the flu or other viral infections like just old fashioned SARS or MERS. So using that literature, it became apparent that there are ways to enhance the health of the immune system.
So all of these nutrients that you just spoke about, A, D, E, now let’s talk about D, for example. D is so important for immune health, but what we now know is that people that have low vitamin D do worse and actually have increased mortality. Now there are studies that show that if you’re giving people in the ICU, vitamin D, they do better. So vitamin D can be helpful both as a preventative, but also as a therapeutic, for people that have low levels.
So there’s a lot of supplements.
James Maskell: Just on the personal level, for me just hearing stories from around the industry, I’ve heard of residents kind of asking like, “Hey, why don’t we know anything about this?” I’ve heard doctors showing up and sort of more interested in this is. Is that your experience? Obviously, you have a role inside of IFM, but you’re also a doctor in the community.
Joel Evans: Yeah, yeah. So this is what I was saying is that I’ve got physicians in my practice and they’re referring other people to me and they want to know. The reason they want to know is because they understand that there’s very little risk to taking some of these supplements, and so why not put yourself on the right side of a benefit when there’s real upside potential? So I do a lot of that, and I’m very proud to say that using these supplements wisely can really make a difference.
James Maskell: Great. Well, that literature that you put out early in the year was great, and we’ll put it in the show notes here for anyone who hasn’t got those reports on the botanicals. One of the things I learned from Dr. Hanaway, actually, from interviewing him earlier this year, was it wasn’t just certain nutrients, but actually there is a lot of research that the certain botanicals have action on certain receptor sites that seem to be important for COVID and that was another way of sort of connecting the value of products. I’m sure that was like right at the beginning of your research, as well.
Joel Evans: Yes, yes, yes. You put these nutraceuticals and botanicals together with this functional medicine matrix, if you will, and that’s really where the sweet spot is. They’re not separate from each other. You can’t just work with nutraceuticals and botanicals, you have to work on making people healthier. That’s where lifestyle actually makes a difference.
We’ve done webinars. It’s in our course. How well we sleep. I can’t minimize the importance of stress. Stress can really be a problem. Everyone’s fearful with COVID, so stress goes up. People have economic consequences, stress goes up. That causes, as you know, a defect or a decrease in the ability of the immune system to protect against function, and it also causes gut issues. So it’s a double whammy.
James Maskell: Absolutely. Yeah, that was a good stuff. All right. So now you’ve got this program and you’re sending that out and doing press releases, I guess, to let more doctors know that this research is available. We sent it out to our email list. The next step, it seems, was to actually create a program to be able to educate clinicians. That’s what we’re here to talk about a little bit is that IFM has a new course, and this is really focused on a functional medicine approach to COVID specifically and to, I guess, more immune-based issues.
So why don’t you give us an idea of sort of when you decided that a course was going to be necessary, and how did you start thinking about what pieces you’d have to pull together to make a comprehensive course?
Joel Evans: Well, we started seeing a lot of questions coming in about our work on the nutraceuticals and botanicals, which is how did we recommend these be used in the context of patient care? Because the initial work listed, let’s say, 15 nutraceuticals, and it was do we give all 15 at once? We were hearing that a lot of doctors were doing that and we soon realized that we needed to surround that information with some clinical guidance. So that’s how this idea for the course first came to be.
Then on the parallel track was the increase of cases in this country and around the world. So this was something that was becoming more prevalent and therefore the need for guidance as to how to treat this was obviously greater. So that’s how we decided that this course was important.
We basically have three important foci of this course. So number one, in my intro to the course, I say it’s not just the virus, right? It is a lot of the virus, because it’s caused by the virus, but it’s about more than the virus, right? So it’s about the host, it’s about the person, and what is it about the human being that makes you more susceptible to a poor clinical course? So we talk about that.
Then it’s about the virus part, which is what do we know about how the virus replicates, the virus replication cycle? We go through the viral replication cycle and show the areas where nutraceuticals and botanicals target this virus replication cycle to prevent virus replication.
Then the third piece, which is equally as important, is this whole bigger question of socioeconomics and race and why is it that we’re seeing such disparities in different socioeconomic and different racial communities? Part of that is explained by differences in the comorbidities and then part of it has to do with social needs of health, social determinants of health, implicit bias.
We don’t really know much about that in the functional medicine world because we haven’t been educating people about that in the functional medicine world. So we have a whole crop of educators that are educating us in this course about why the social determinants matter, right? Why an experience of prejudice or racism can actually change your susceptibility to severe COVID-19.
We talk about the social needs of health, where we talk about either supplements or just clean water or good food. What if you can’t get good food, right? So what do you do?
Then we talk about implicit bias, which is the most well-meaning physician may have biases and not interact or make recommendations in the same way to someone of color or low socioeconomic status, and how by not making recommendations because we have a preexisting belief that they won’t be able to make use of them or have interest in them that then that takes away the possibility that they could use them.
So we talk about that, and that’s why it’s such a comprehensive course, because it addresses everything to do with this infection.
James Maskell: Absolutely, yeah. That’s really interesting. At what point did you realize that that third part was going to be a critical part of a course on immunity?
Joel Evans: Well, we at IFM have always been interested in this issue because the experience of racism or social determinants of health is something that’s real. So when you talk about cardio-metabolic disease, we’ve got a whole advanced practice module in cardio-metabolic disease, for example, and we’re always revamping our curriculum. So it’s always been on our program development agenda that we’re going to be talking about these things.
So we were in the process already internally of updating our curriculum, and then when we saw the numbers, the sheer discrepancy in different communities, so communities of color, low socioeconomic communities, it was imperative that we push that agenda or that curriculum development to the forefront.
James Maskell: Beautiful. Yeah. I love that. Well, one of the things I think is really exciting about this course that I’m just kind of realizing now is obviously this is a worldwide phenomenon and it’s not like another version of the IFM in some other country. We really need a worldwide solution for a worldwide problem. Obviously, with IFM moving to a streaming format for its education, it’s creating an opportunity for physicians around the world and clinicians around the world to get ahead of the game and to start bringing the best research to everywhere around the world.
Joel Evans: Exactly. Exactly. We are hoping that our international partners are aware of the course and will spread the word and we’ll get a lot of interest worldwide.
James Maskell: So what are your hopes for this, Joel, in terms of I know that you’ve been plugging away at making an impact in medicine with your own practice and obviously teaching through the IFM. There’s a lot of, I know, different modules that you’ve been involved with and the IFM as an organization, you’ve been very close into. I mean, what does the IFM hope that this course can mean for transforming the practice of medicine?
Joel Evans: Well, I think, big picture, the mission of IFM has always been about changing the way medicine is practiced. So it’s our hope that this crisis, this pandemic, that there can be some silver lining in this dark cloud, and that silver lining might be that people in the conventional medical world that are feeling that they don’t have anything to offer their patients will look to us, take the course, and realize that this functional medicine approach has scientific legitimacy and a basis in solid scientific and medical literature, and that that will open the hearts and minds of both policymakers and healthcare providers across the globe.
James Maskell: What do you think the chances of that are?
Joel Evans: I’m still bullish. I think that this really can happen. I think if you can have this successful podcast, James, all we need is one influential person that’s listening and it just takes right off.
James Maskell: Absolutely. Yeah, well, look, I’m bullish as well. I mean, obviously over the last few years, we’ve looked at lots of different ways in which we think that maybe medicine could evolve. Is it going to be on the backs of burned out doctors who see that doctors like yourself who practice functional medicine are able to have a great career and a great life doing it? Obviously, clinical insufficiencies is a great opportunity, too, especially when there’s conditions that they are not able to support.
I guess, one thing that I’ve seen happening a little bit is there’s just been this conversation about long COVID, right? So when people have an infection and they get symptoms, one of the things that I’ve been in this world for 15 years, and Lyme disease has been an issue where perhaps only the functional medicine community or sort of offshoots of the functional medicine community have been able to understand, that there may be long-term implications of acute infections. A lot of chronic Lyme patients have made their way into functional medicine practices.
I mean, you’re in Connecticut, so you know better for that. But it seems to me that perhaps the functional medicine doctor is now better positioned to be able to help people with some of these complications of an acute infection.
Joel Evans: Yeah. It’s really appropriate that you brought up Lyme as an example, because that’s what we’re seeing. So the medical community is calling these people long-termers or long-haulers, and people can have many different ways into this long-termer category. Sometimes it’s a severe infection and then they only get mildly better. Other times they can have mild infection and actually have chronic stuff that never gets better. So the conventional approach to this hasn’t yet evolved, and so what our functional medicine practitioners are finding is that patients are coming to them because they’re being dismissed by their conventional doctors because the conventional doctors don’t know what to do.
Now, we, on a institutional level, are very much interested in the conventional approach to long-haulers. We have a functional medicine approach that we are going to be introducing in our course. Our course, it’s six hours. It’s like a Netflix release, you can do all six hours right away, do it on your own time. Then starting January, we’re going to have monthly webinars where one of the topics is going to be, in addition to literature updates, we’re going to be talking about the long-haulers. But we’ve reached out to the conventional universities that have long-haul centers and we’re in dialogue with them to actually have them present, as well, what their work is at these university centers.
James Maskell: Yeah. It just seems so critical is that, yeah, like your average physician doesn’t know what to do, has burned through their toolkit, and ultimately in the functional medicine office, you can see the improving function, gut function, detoxification function. There’s so many different ways in which we can sort of work on those fundamentals, so I think that’s the right place to be.
Joel Evans: Yeah. Yeah. As the functional medicine community, we hear about functional medicine successes. There’s the Health Gut Registry. We’re creating a registry. We’re interested in functional medicine practitioners to share their experience. But there’s a lot of excitement that we are going to be able to contribute to improving the care of these long-haulers.
James Maskell: Beautiful. Well, look, thank you so much for being part here of the Evolution of Medicine Podcast. We’re really excited to think that this could be a moment where more and more physicians can see the fact that functional medicine is an important sort of next evolution of care and excited to see IFM leading into that reality.
I know it’s been a busy year for everyone at IFM to try and meet this demand, so thank you for all the work on the front lines. Yeah, who else has been on your team out there?
Joel Evans: Well, we’ve got 15 people that are on it, but I’m co-directing this course with Robert Luby, Patrick Hanaway, Bob Roundtree, Gary Goldman, Yousef Elyaman, there’s Kara Fitzgerald, there’s Deanna Minich. There’s just so many. James Carter, University of Colorado. So I would love to go through everybody, but those are just a handful.
James Maskell: Wonderful. Well, that’s a great team effort. Thanks so much for all you do to bring this to the forefront.
For everyone who’s listening, we will have links in the show notes to sign up for the program. It is a rolling sign up between now and, I believe, next June.
So thanks so much for listening. This has been the Evolution of Medicine Podcast. I’m your host, James Maskell. See you next time.
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