- March 27, 2019
Kent Holtorf, M.D. is the medical director of the Holtorf Medical Group, and a founder and director of the non-profit National Academy of Hypothyroidism (NAH). He has trained numerous physicians across the country in the use of bioidentical hormones, hypothyroidism, complex endocrine dysfunction, and innovative treatments for chronic fatigue syndrome, fibromyalgia, and chronic infectious diseases, including Lyme and its co-infections. Lyme, in particular, has been the focus of the Holtorf Medical Group and has been a passion of Dr. Holtorf’s – not least because he, himself, lives with chronic Lyme. He is also a fellowship lecturer for the American Board of Anti-Aging Medicine, the Endocrinology expert for AOL, and is a guest editor and peer reviewer for a number of medical journals, including Endocrine, Postgraduate Medicine, and Pharmacy Practice. He has published innumerable studies and papers on his various topics of interest and expertise. He has helped to demonstrate that much of the long-held dogma in endocrinology and infectious disease is backed by evidence that proves it is inaccurate. He is also a contributing author to Denis Wilson’s Evidence-Based Approach to Restoring Thyroid Health. He has been a featured guest on many TV shows, including CNBC, ABC News, CNN, Discovery Health, TLC, The Today Show, and CBS Sunday Morning; in addition, he has been featured in print inTheWall Street Journal, LA Times, US News and World Report, SF Chronicle, WebMD, Health, Elle, Better Homes and Gardens, Forbes, the NY Daily News, and Self magazine – among many others. He joins Lauren on this episode to discuss his work at the forefront of chronic illness and thyroid medicine, medical “quackery” and evidence-based approaches not yet recognized by larger medical organizations, the need for healthcare reform in the US and how this might be achieved, and his own struggles with Lyme, which have greatly informed his methodologies and patient-centered care approach.
Key links mentioned in this episode:
American Association of Anti-Aging Medicine
Infectious Disease Society of America (IDSA)
International Lyme and Associated Disease Society (ILADS)
Dr. Richard Horowitz (leader in Lyme treatment and recovery)
Combination therapy for thyroid treatment
HPA Axis Dysfunction in CFS/ME and Fibromyalgia
Published Data from the FFC on Patient/Doctor Exposure and Treatment
National Academy of Hypothyroidism (NAH)
Listen in as Dr. Holtorf shares…
- about being both a survivor of chronic illness (Lyme) and a practitioner
- how so many medical practitioners who treat chronic illness came to alternative/integrative/experimental treatments because they themselves were once sick
- that societal guidelines are far more restrictive and often less evidence-based than innumerable anecdotal cases, particularly with regard to chronic diseases like Lyme – and how organizations like ILADS and the Infectious Disease Society of America still don’t even classify Lyme as a chronic illness despite the mounting evidence to the contrary
- that the fatigue of chronic illness is entirely different from general fatigue
- that he first went into anesthesia because he was so fatigued, and he knew this field would keep conversations with patients – which were further exhausting him – to a minimum
- that he started attending “alternative medicine” conferences, and found the studies and practitioners coming out of these events were far more evidence-based than the materials with which he was presented in medical school and in residency
- that he worked on optimizing his hormones to get well
- how everyone’s “normal” is different
- the studies from his Fibromyalgia and Fatigue Centers (FFC), which indicated that most patients saw – on average – 7.2 physicians without improvement in chronic symptoms (current numbers are more like 12-14 physicians without improvement in symptoms)
- how care in the US has become more segmented, and it’s deteriorating
- that doctors are the least empathetic group he’s ever seen
- what doctors are working against: the business model of health insurance (which is tied into quantity over quality, time restraints, and big pharma); ego and self-esteem issues
- how quickly his work has been dismissed as “quackery”
- how few practitioners can’t– and often don’t want – to take the time to find the source of chronic and invisible illness
- the stress connection to health – it can devastate the immune response and be a huge factor in chronic illness
- that he knew he had Lyme – and his blood was so thick he had to wait months to thin it out in order to properly test it
- that he used antibiotics for 4.5 years – and would never prescribe them that long for ANY patient
- that he is a fan of Ozone, LDN, stem cells, and peptides for treatment of specific chronic illnesses, and has used these therapies himself
- if you don’t fix the immune system, you won’t get rid of the infection; his ethos is root-cause based for this reason
- his whole life, he was never able to get out of bed before noon. Now, he is much more highly functional
- the chronic illness cycle of rest and anxiety when you can’t get to sleep despite total body and mind fatigue
- his take on the opioid crisis: that so many highly addictive opiates have been approved by the FDA because of special interest groups and big pharma
- the frustrations of the rising cost of medication
- how the US has the least free-market healthcare system in the world, despite our acceptance of capitalism – and how this is entirely tied to big dharma
- the frustration of communication between “standard” Western doctors and the more “experimental” medical establishment
- placebo doesn’t work in chronically ill patients in the same way it does in “well” patients – it’s more of a “no-cebo” among the chronically ill
- that the sicker the thyroid patient, generally…the more T3 they need (combo therapy of T3 and T4)
- that doctors are taught to memorize and to segment the body, rather than understanding multi-system symptoms and treatment
- the cost of chronic illness
- that Lyme is often misdiagnosed as Parkinson’s, ALS, and MS – among other conditions
- that his Lyme disease was initially misunderstood as HIV/AIDS because his immune system was so incredibly suppressed
- that coagulation of the blood is common among immune-suppressed patients
- that he is in favor of universal healthcare, but fixing our system is not as simple as that – it also requires a free market and reduced prescription costs, as well as a removal of price-fixing among big pharmaceutical companies
- restrictions on publishing medical studies: even medical journals are funded by big pharma ads, which presents a conflict of interest and some collusion
- that he encourages healthy, informed debate over angry outbursts
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Lauren: All right guys, thanks so much for joining us. I'm here today with Dr. Kent Holtorf, who is the medical director and founder of the Holtorf Medical Group in El Segundo. But there are five centers in the US and worldwide now, which is super exciting. He's also a fellowship lecturer for the American Board of Anti-Aging Medicine and the endocrinology expert for AOL Health. And he's been on a lot of TV and radio thus far, including CNBC, ABC News, CNN, Discovery Health — and he's agreed to be on our show, which is really exciting. And I was actually just telling him, this is the first interview I've done where I'm nervous because he's one of my heroes. I actually see a doctor in his practice and she's helped me turn my life around. So, Dr. Holtorf, thanks for joining us.
Dr. Holtorf: Well, thank you for being here, and thank you for the invite and for the kind introduction!
Lauren: Of course, so don't be intimidated by your own resume!
Dr. Holtorf: Wait, I don't know if I should be here now! (laughs)
Lauren: (laughs) Well, I'm so happy to have you here. And you're on the show for two reasons today, which is really exciting. You are both a survivor of chronic illness, and a practitioner. So I'm wondering if it's a chicken/egg situation here. Did you know that you were chronically ill when you were in medical school, or did all of this happen at different times?
Dr. Holtorf: Well, it started when I was young —when, of course, you don't know. But it's interesting how a lot of doctors like myself … at a party or whatever you’ll be asked, “What kind of doctor are you?” I don't like ‘alternative’. ‘Integrative' isn't good; ‘functional’, I don’t like that. A lot of times, I say: “I’m a quack. Just leave it at that!”
Lauren: (laughs) Well, certainly there has been controversy around some of the treatments you’re a proponent of, right?
Dr. Holtorf: Yeah.
So, most doctors, I think that do this … they've either been sick themselves, or a family member has, and they realize that … ‘Hey, standard medicine doesn't have the answers.’ And that's what I was.
Growing up, I functioned very well, no [big] issues. I would have a tough time getting up, and my arm would stop working and I would have shooting pains. One pupil was bigger than the other …
Lauren: They look the same now!
Dr. Holtorf: Yeah, but that got even worse. They couldn’t find anything, but that was fine. And going through college, I was more fatigued than everyone else; and then through medical school and residency, I’m, like, ‘Hey something's wrong.’ And you go the university doctors who are, like, “You're just depressed and stressed.” And I was, like, “No, I’m not really!”
Lauren: A lot of us have heard that answer before!
Dr. Holtorf: Exactly! And basically, going through that and not getting anywhere, I’m, like, ‘Something's really wrong.’ But I would not consider anything so-called alternative; I was very evidence-based. I still very much am; that hasn't changed. But it's ingrained in medical school residency. All these other doctors don't even listen … “They’re quacks.” It doesn't matter how many studies you give doctors … it's like “No. No. No. I don't need to read that study.”
Lauren: Well, until a larger organization says, this is the standard, they’re not willing to accept it, right?
Dr. Holtorf: And still, with the whole Lyme thing, it’s not believed despite thousands of papers and research. And even on the clearinghouse for guidelines — so there was the ILADS; the so-called alternative, and the Infectious Diseases Society of America’s guidelines for Lyme — they took the Infectious Diseases Society’s down, because it wasn't evidence-based. It wasn't. And if you look at all these guidelines that these doctors go by, for any society, they found that …
I’ve written papers on what is evidence-based … they found that societal guidelines are worse than anecdotal cases. This is dogma; they don't change for 20 years. They don't consider anything that deviates from what they think it is.
It’s kind of like the TSH …
Lauren: We were talking about that before, in relation to thyroid …
Dr. Holtorf: Yeah, and they’ve also published a number of review articles, hundreds of references, showing that the TSH will only work for someone who's very healthy and not sick. But yeah, so we’ve kind of deviated here … but it started in residency or medical school and I thought, ‘I don't know what I'm gonna do.’ I was too tired to talk to a patient.
Lauren: I imagine there are a lot of people in medical school who are extremely tired because they really put you through your paces.
Dr. Holtorf: It's different. I was wondering what was wrong with my memory, and I was getting all this achiness. Anxiety … I've never been anxious before, can’t sleep. And I’m, like, ‘What are my choices?’ It was just so exhausting for me to sit down and talk to a patient; I just wanted to jumped out of my skin. So I went into anesthesia, because I thought,’ Hey, they're asleep, you don't have to talk to them, right?’
Lauren: (laughs) That’s fair enough!
Dr. Holtorf: But I was still very much struggling … you have to get up early and go to work.
So then I started to think, let me look at this so-called ‘alternative’. And I went to these so-called alternative conferences, and I just went to everything I could. And I realized, ‘Oh my God, they are more evidence-based than what they're teaching us in residency in medical school.’ It was unbelievable; I was, just like, ‘Oh my gosh!’
And so I started basically fixing and optimizing all my hormones, which were so-called ‘normal’. But after you learned about it …
... hey, normal doesn't mean optimal by any means. It doesn't mean it's not causing your symptoms.
Lauren: And everyone’s normal is different.
Dr. Holtorf: Yeah. Oh it's so true. And then also with chronic infections … I thought, I’m functioning pretty damn well here … what am I doing in anesthesia? I hate this.
Lauren: (laughs) Now you want to talk to patients!
Dr. Holtorf: Yeah! Nothing against anesthesia, but it’s the most mindless specialty. Anyway, I basically opened up a center where I treated people like myself … I couldn't believe how many people like myself were out there. And we ended up opening 22 centers across the country.
And we published our data and showed that patients, at that time, on average, saw 7.2 physicians without any improvement.
By the fourth visit, it was like 70% significantly better.
Lauren: Those are crazy stats, by the way …that someone would have to see, on average, 7.2 physicians…
Dr. Holtorf: Well, we’re more like 12 to 14 physicians.
Lauren: I’m not surprised. It's just like marketing [touches]. Because I probably saw that many doctors before I ended up at Holtorf. It's crazy to me.
Dr. Holtorf: Yeah.
I mean, care is getting worse. It’s so segmented. And we talk about doctors not caring. And I do think, in general, they're the least empathetic and caring group that I've ever seen in the way that they treat patients. But, you might say, “Why wouldn’t they want to help someone?” They do, but there are a couple of things that work against it. The business model first … they don't get any more money for diagnosing all these things and spending time… what is it, eight minutes, and then 15 minutes with charting. We’ll give you some antidepressants and we’ll give you a statin; it’s a volume game.
Lauren: And that's also tied into the pharmaceutical industry.
Dr. Holtorf: The pharmaceutical industry is so corrupt, with kickbacks. It's disgusting. But so let’s say we get a patient better, and they like their primary care or endocrinologist, or whatever it is, and they say, “I’m going to go back and tell them how great this is …” and I say: “Don’t do it.” It was freaking me out at first, 10-15 years ago, when the doctor would say to them, “No, it’s a placebo; that's quackery. You can't come back to my practice.” And I would say, “Are you kidding me?!”
Lauren: The doctors would literally take their patients out?
Dr. Holtorf: Yeah, they didn’t want to hear it.
Lauren: Well, I guess it puts them out of a job!
Dr. Holtorf: ...
... And we’ve found, the less a doctor knows, the more adamant they are they think they’re right, too.
So, let's say they go to all these new lectures and conferences, and they learn about Lyme … I had one doctor who called and asked how I treated a patient and I told him, and all of a sudden there’s silence. I’m, like, ‘“What’s wrong?” And he said, “I can't spend 20 minutes with a patient.” So the whole model … take Lyme or some chronic illness … it’s not going to help them, it’s going to make their life worse, and now the doctor is going to be stressed, and thinking, ‘I should be able to help this person and I can’t; I'm a bad person.’
Lauren: So it’s ego …
Dr. Holtorf: It's a huge ego, or it’s better to think, ‘I don’t believe in that disease. I don't want to believe in it.’
Lauren: And if you can’t see it … does it exist?
Dr. Holtorf: And all this stuff about invisible diseases … it’s crazy ...
… there are so few invisible diseases, it’s that people don’t want to look. And won't take the time. And in HMOs, they get bonuses on the least they do; there are so many incentives for bad care. And if you're a caring physician — and I don’t want to disparage all physicians, at all; there are many caring ones and they're working in a tough system — but what you find is, the ones that care the least make the most.
Lauren: Because they treat it more like a business.
Dr. Holtorf: Yeah … volume … get ‘em out, get ‘em out.
Lauren: So did you find that you were able to use some of these “alternative therapies” to get well?
Dr. Holtorf: Yes, so basically I was doing fine, and then went through a very stressful divorce.
What’s interesting with this whole stress connection … stress is devastating to these chronic infections, and that's where it kind of gets us. Mostly women, but it can be both.
“Oh, I went through a divorce …. my mom died … my child was sick … “ And they’re told, “See, it’s all just psychological.”
Lauren: And then it’s very easy to write people off as hysterics.
Dr. Holtorf: Oh, it is! And it’s not the doctor’s fault, it’s the patient’s fault. So we had the 22 centers, Fibromyalgia and Fatigue Centers … and I just couldn’t get out of bed. I had night sweats, terrible anxiety … for months. And I could barely make it to work.
Lauren: And you’re a busy entrepreneur at this point as well.
Dr. Holtorf: I knew I had Lyme, but my blood was so thick, you couldn’t pull it out. It took months before I could get my blood thin enough to even take a test. And I tested positive. We were treating Lyme disease, and chronic fatigue syndrome, and fibromyalgia — before there was any Lyme. And I was right on that cusp. So I looked at the treatment … the standard so-called alternative [treatment] was high-dose antibiotics and so … I read the Horowitz, big guns; just, you know, more ways - I know he’s a great physician, but we find for a lot of people that doesn't work well.
Lauren: And it can destroy your gut microbiome and get you sicker.
Dr. Holtorf: Oh yeah … I mean, I did four-and-a-half years of the highest dose antibiotic …what I would never give a patient.
Lauren: How are you even standing after doing antibiotics for that long?
Dr. Holtorf: Yeah. And I would stop for two weeks and be just the same as I was before. So I really kind of went round the world looking for new therapies, just reading as many journals as I could. And then I went into heart failure, and I remember going to New York for a new treatment — and just trying to get on the plane. And I can't stand, so I’ve got to walk through a crowded subway and onto the plane with my head bent over, walking two miles an hour, sweating. I’m surprised I didn’t get beat up.
Lauren: Well, it’s being old before your time, that’s how it feels, doesn’t it? You feel like you’re possessed in your body.
Dr. Holtorf: And I got on the plane, and I thought, ‘I'm gonna die on this plane.’ But then I just felt too sick to say I’m done, you know? And that's how bad [it was]. But then I went through a lot of treatments. Many treatments worked very well, a lot of intensive things.
Ozone is awesome. LDN … there are so many things. And antibiotics have their place. But then what really helped me and has become the key to our practice, was really looking at the immune system and working on the immune system. If you don't fix the immune system, you won't get rid of the infection.
If you kill the infection, the immune will get better … because it’s the last to come back, and - I know we’re on radio here - but if you have a level of infection and immune system is below it, it's never going to eradicate it. Antibiotics won’t kill anything enough to just take over.
Lauren: And they’ll deplete your immune system anyway.
Dr. Holtorf: Yeah.
And then I found stem cells and peptides; that changed my life.
And I was flying to Europe to get peptides for myself …
Lauren: Before they were more widely available here?
Dr. Holtorf: Yeah. Now they are more available, but the problem is price.
Lauren: And then they're rarely covered by insurance.
Dr. Holtorf: They [insurance companies] don’t even know what they are. I’m not sure how much everyone knows about peptides, but there are so many that just do so many things. And to bring the cost down … I guess we can do a little plug here. … we brought the body protection compound 157 … BPC-157 …
Lauren: I'm on that. I take that orally and I inject it every day.
Dr. Holtorf: Nice! Before, it was $600 a month, so we brought it out as a supplement — same strength, same potency, that would cost $600 at a lot of compounding pharmacies — and we have it for $145.
Lauren: So because you were buying it in bulk, you were able to bring the price down. And attracting enough clientele, as well?
Dr. Holtorf: Yeah. And you have to do a lot of legal things. So it's always very costly to get that going. But I'm very happy with that, and we're talking to major pharmaceutical companies that were licensing some of the things we're making - oral - more bioavailable. So there are a lot of neat things going on with these whole integrated peptides. Some other ones are coming out as well.
Lauren: That’s really exciting.
Dr. Holtorf: And they can just help so many people.
Lauren: And you seem to be almost entirely in remission from your Lyme?
Dr. Holtorf: Never say that; don’t jinx it! (laughs) I’ll have some bad days now and then. My whole life, I could never get up before noon.
Lauren: You and me both!
Dr. Holtorf: Yeah, and now … I took my girlfriend’s kids to school at 8am and I've been getting up early. Before, driving at 9am, it was like, ‘What are these people doing up at this time of the morning?!’
Lauren: I don't know how people function. That's been my thing for the longest time … I've just been like I'm a zombie, so I don't know how people do it.
Dr. Holtorf: Yeah, I used to dread going to sleep because I know I would just lay there, and then you get more anxious and then you can’t wake up. The problem is, with that … even when I was functional, but I couldn't sleep … when you’re on a different time from the rest of the world, no one thinks you're doing anything. They would get all the emails at five and six in the morning. And say, “Oh, you're up early!” “No, I haven’t been to bed yet.” So that’s changed, and that’s a really nice bonus.
Another thing that goes along with this Lyme and Babesia and Bartonella is the anxiety. When you’re sick that's bad enough, but when you get anxiety — and so many patients have it — and add pain to that.
Look, there’s an opiate problem, but a lot of alternatives that we're using … you know, like IV ketamine, and there's so many things that you can use … but, I mean, the standard thing you go to pain doctor for, a bunch of narcotics —which aren’t great.
Lauren: And highly addictive.
Dr. Holtorf: Yeah, and the seizure medications, and Lyrica … and if you look at the studies and how those got approved, you can't believe the tiny, tiny difference on a graph, the difference between placebo and effect with those things … and everyone gains weight, and they can’t think. And they got them approved because they did 10,000 people studies.
Lauren: And then they had funding, and they gave money to the right people and had the right kind of interest. It’s just all in people’s pockets.
Dr. Holtorf: It’s true.
And if you look at the FDA, the approval committee, oftentimes 80% will have a vested interest in that drug.
Lauren: I mean, it's interesting because I feel like that's something that we're not talking about enough — the involvement of Big Pharma and big money, and where that's all coming from. And when you go to a standard Western doctor who says, “Well, we'll give you antibiotics, or we’ll give you Lyrica or whatever — as opposed to the kind of treatments and even testing that you guys do here at Holtorf Medical, which are frustratingly still considered on the outside of what’s considered normal. And yet someone like me, with a thyroid disorder and sleep disorders, I've had more relief using these protocols, and so many people I know are coming here now. People keep coming out of the woodwork, saying to me, “Oh yeah, I'm going to see a doctor at Holtorf Medical.” And I go, “Oh, you go there, too?!” And so certainly for Los Angeles, you guys are the place that people are going to for these therapies.
Dr. Holtorf: Thank you for that. And it's scary, because when you look at the cost of old medications that were pennies, now — like IVIG, a great treatment — every month, it goes up!
I've written a lot of papers on health care reform, and people want the one-payer system … and I think you should cover everyone … but believe it or not, we are the least free market health care system in the world. All these ones that we call socialist, and ‘Oh, look at the great care they’re getting’ … basically are much more free market. You have no choice [in the US]; you have no way to negotiate.
Lauren: Well, when there’s all that money behind something.
Dr. Holtorf: Yeah, and I was looking at an article in the UK, and they don't use Cytomel, they don’t use T3. And a big reason is it costs so much there. It was six cents a pill, and now it’s, like, $250 a month.
Lauren: And that's down to these pharmaceutical companies.
Dr. Holtorf: Yeah, and then two other companies came in as competition — but they came in at the same price. The problem is, Big Pharma rules the world.
Lauren: How do you see reform in healthcare? How do you see the system changing? What can we do to make these medications more accessible to people? And make these treatments more acceptable and accessible?
Dr. Holtorf: I’ve written a lot of articles on this, and have sent them to a lot of senators … and got [a letter] back from Paul Ryan. And basically, they said, this will never work because there are too many people slurping from the trough. So who's going to change it? If you look at the whole pharmaceutical system, everyone's just making money down the line. And it doesn't change. So really, if you look at what's the worst, most inefficient model is insurance, where you don't have any say … is this covered or is it not? But without it, you don't have free market choice. It’s like, if you have insurance, it’s that much. But why is it 10 times retail price if I buy it with cash? Which is crazy; it should be the opposite. So there are so many forces that make it just economically upside down. So you can see why people are all confused with health care.
Lauren: And even what their rights are as patients. That’s something that comes up a lot on our show, because I have patients and practitioners on — and the realization that you can fight for your rights as a patient is a huge one to certain people. Because we just assume that we're going to get treated kind of crappy.
Dr. Holtorf: But it's interesting … and I think you're doing such a great service … because it's scary for people to go outside of their system. They go to their standard doctor, and, “Oh, he’s considered really good and he says I have nothing.” They want to know that they don't have anything and I don't blame them. But then they’re thinking, ‘Why am I sick?’ And they go to so-called integrated/alternative, and they’re told, “You've got chronic Lyme.” Or whatever. And some people are just, “No, no, I'm not accepting that.”
Lauren: Well, there's a fear. And the fear factor is really potent, isn't it? And that then adds to the stress, and then you get sicker because of it. And that's where your mindset, being involved with your physiology, is so important, isn't it? One of the things that we talk about a lot with the guests on the show is the relief of a diagnosis, the relief in knowing you have something and that you can put a name on it so that you can actually target your treatment. So I think not being able to put a name on something … and even with something like Lyme disease where - correct me if I'm wrong - but my understanding is that the CDC or whatever large organization, actually doesn't even believe in the term ‘chronic Lyme’; that it can’t be chronic?
Dr. Holtorf: That’s the thing. The Infectious Disease Society says there is no proof.
Lauren: Are you kidding me? You're living proof!
Dr. Holtorf: And you go to these conferences and they present study after study. We had a microscope, which would have no false positive because it's very specific; and we look at people's blood (and we lost our tech, we're looking for a new one), but, oh my God - just textbook … one person had Babesia …
Lauren: And these are the co-infections of Lyme … Babesia and Bartonella.
Dr. Holtorf: Exactly, it's kind of like malaria. And she ended up doing huge doses of all the anti-malarials, and then we checked it again … and there were even more. So it's like this whole standard treatment …
The Infectious Disease Society of America says there’s really no chronic Lyme, if you catch it early, then three weeks of doxycycline and you're fine. Look at the studies … 80% will relapse on that. So why is that standard? And they say, ‘“Oh, it’s not chronic Lyme, it's post-Lyme syndrome.”
Lauren: The irony as well, though, is that it would benefit these pharmaceutical companies for people to stay sick, right? They’re keeping people sick because the medications aren't working, but then they're denying them even any kind of proof that they still have something going on. They're just saying … well no, you're cured. And it's never as simple as that.
Dr. Holtorf: And it's the powers to be … lots of money, and egos even … and these big societies … what I find is that once you have a major society, whether it's the Endocrine Society or whatever the group is called … you come up with all this evidence and it’s, ‘No, no, no.’ At some point you would think they would say, “Okay, you're right; we were wrong.” But no, it’s 'la la la'…
Lauren: Dr. Holtorf just covered his ears! (laughs)
Dr. Holtorf: It's like … don’t confuse me with the facts; I've made up my mind. it's very frustrating.
Lauren: And, from a patient perspective, outside of the medical system, we're then told that there are some doctors who are quacks, and there are some doctors who are legitimate, but it's really up to you to do your own research. And we're not necessarily empowered with the tools to do that when we have large organizations, like the Infectious Disease Society and the CDC telling us things that aren't necessarily helping people who are experiencing chronic, invisible illness. It’s so frustrating.
Dr. Holtorf: You get some open-minded doctors.
And the system is such that if doctors working in the hospital were to treat thyroid like we do, or Lyme, they would be run out of their peer group.
We had this one patient who had terrible adrenals. I gave him a little touch of cortisol. He was on a number of other things, but he said, “Oh my gosh, I feel so much better from this.” And he went back to his endocrinologist to show him. And I had published a study on HPA axis dysfunction and chronic fatigue syndrome and fibromyalgia, and it showed that 80% are low in cortisol, and that basically the stem tests are just unreliable. And he says to the doctor, “I’m on this,” and he hands him the paper. It wasn't published yet. And the doctor looks at it and says, “That's a terrible paper.” And the patient says, “Why do you say that?” And the doctor says, “I read it.” And the patient says, “No, you haven’t read it because it's not out.” So the doctor took the paper, threw it in the trash, and said, “I don't need to read it.” And I've had that story with other situations, like bioidentical hormones being safer. This OB said the same thing. A friend of mine who was also a patient, said, “Well, what do you think of this?” And the doctor says, “That's quackery.” So the patient says, “Well, here's a review article, with 300 references. “ And the doctor says, “I don't need to read it.”
Lauren: Well, this is the thing about early adopters, too, right? Even Steve Jobs was laughed out of places when he first came up with Apple computers. And now everyone's using them. I think that there's something to the concept of saying, “Well, look, if this thing is working for me, even if it's the placebo effect …” If it's working for you, and if you go somewhere and you get an alternative therapy to the one that you may have previously been on or are using, and it starts working for you in a way that your previous ones didn't, then what can you argue with?
Dr. Holtorf: ...
... And we find that patients who are chronically ill, placebo doesn't work on them. It's more of a no-cebo.
They're more likely to say, “This is not gonna work. I don't want to try it.” So they don't get a benefit. It’s more likely they're going to say, “Wait, I don't feel as good.” So it's interesting … you give some healthier person some big red pills, a “happy pill” … and they say, “Yeah, I am happy.”
Lauren: You've got a compounding pharmacy here. I know that I had an experience with an endocrinologist at one point — when I had just started coming here, and was between different practitioners - who was so against the idea of a compounding pharmacy. And I know there has been controversy about … do you go to a regular pharmacy, or do you go to a compounding pharmacy? But at the end of the day, medications are medications. I think it's the bodies that judge whether these medications are clean or whatever. But I mean, you're running a medical group with a compounding pharmacy here. I've been on the medications and they've changed me. So I wonder what your take is on that?
Dr. Holtorf: Well, they're highly regulated, and we really have to do everything the pharmaceutical companies do — especially in terms of sterility, although we don't do sterile compounding.
Lauren: What does that mean?
Dr. Holtorf: Injectable. We get that from other people.
Lauren: You don’t make them here?
Dr. Holtorf: But we do the oral … let's say, thyroid … we can do any ratio of T4 to T3. We can do timed-release T3 … you can't get time-released T3. You can get Cytomel and take it four times a day; some people take less and it works. There are so many things that we can do …
Lauren: Which gives patients more options.
Dr. Holtorf: And we can say, ‘Let’s change this ratio’. And there's natural desiccated thyroid, which just gets pounded by the Endocrine Society. Well, the makers of Synthroid are the biggest, they're basically funding every conference. And that works great for a lot of people, but the sicker the patient, generally the more T3 they need. And then you'll hear these studies … ‘Oh, it's dangerous …’ The studies don't show that at all. They showed heart patients coming out of surgery; they gave them IV T3. They had less A-fib, arrhythmias; they did much better. The studies don't show any danger.
Lauren: You just have to follow the money trail.
Dr. Holtorf: And they say, ‘She’s hyperthyroid … her TSH is suppressed … oh, my God, her heart's gonna blow up and she’s going to get osteoporosis!” Okay, so you’re saying, she's hyperthyroid. Her pulse is 52. Her body temp is 96. She can’t get out of bed. How is that …hyperthyroid is by definition hyper-metabolic … weight coming off, sweating, they're the opposite. We have all these other tests that prove it’s not correct. Like the sex hormone binding globulin test; it goes up in response to two main things — the amount of estrogen and the amount of thyroid in the liver. So if you have someone who looks like they have normal estrogen, a normal menstruating woman, and they have SHBG below 80, they're likely low thyroid. Especially if you're on oral thryroid, which goes through the liver first pass; it should be highest in the liver. If it's not in the normal range, you probably need thyroid. So that's looking at a tissue level, which is just one test.
But we like to do a lot of tests to really paint a picture. Because I feel part of our job is to convince the patient, too.
Lauren: Yeah, because when I first came in here, I was, like, ‘I don't know which way is up and I don't know who to trust at this point.’ I'd been to so many doctors; this was really new - almost an experiment for me.
Dr. Holtorf: ...
We do the tests because we know they're going to go to other doctors who say, “Oh, it’s dangerous!” Our job is explain why they're going to say that … what the standard is, and these are the risks and these are the benefits.
Lauren: To provide patient education, which very few practitioners do.
Dr. Holtorf: ...
That's why you really need to play an active role, and it's very hard to do; it's so much easier to say, “I trust my doctor.”
I get people at cocktail parties; they come up and they say, “I was feeling horrible.” And you start saying a few things, and they say: “Well, my doctor says my thyroid’s fine.”
Lauren: And they’ve only tested one number, haven’t they?
Dr. Holtorf: Yeah, and I’ll ask, “How’s that working for you?” And they just discount everything you say.
Lauren: Well, it’s cultural, isn’t it? This doctor-as-God concept. And that comes up a lot in my interviews as well.
Dr. Holtorf: And that’s totally changing. We encourage reading everything you can on the Internet. We can answer and explain … why … no, I can't believe this part, but this study shows this …
If a doctor won't let you ask questions, run from that doctor; it shows they can't defend their treatments.
Lauren: So many of us in the chronic illness world, we go from specialist to specialist and we bounce around … and we have limited periods of time with so many of them. Partially that's because of the system and the way it's structured. But when patients come to you here at Holtorf Medical, what's the difference in the level of care that you give them, in terms of bedside manner and in terms of the amount of time that you spend with them? How have you been able to structure that differently as an antidote to the system?
Dr. Holtorf: The problem is getting worse … the primary care doctor now kind of won't do anything; they'll just say, “Oh, this is abnormal; the TSH is 15. Go to an endocrinologist.” No common sense! We've hired so many doctors, and ...
... we're finding more and more doctors are being taught to memorize. They don't understand systems … you can't believe it. So they want the algorithm for the Lyme patient … “Okay, what’s the protocol?” There’s no protocol, everyone's different.
It drives them crazy!
Lauren: I think that's a really important thing to hear from a practitioner, that everyone is individual because I think that's part of the problem, right … that many of us are not treated like individuals. We’re treated like … ‘Well here's the lump sum of how you treat this particular thing.’ And that treatment may not work for this person.
Dr. Holtorf: Yeah, or they say, “Well. 80% of people, this works for. Why is it not working for you?” Well, there are 20% where it doesn’t! And so I think why it takes us so long to train a doctor, and a lot of doctors are very uncomfortable … the problem is if you go to a gastroenterologist, they’re going to just look at everything, and … how many gastroenterologists are recommending probiotics at this point? It’s scary!
Lauren: Well, how many prescribe antibiotics, and then don't prescribe probiotics with it?
Dr. Holtorf: Yeah, and I really think, for almost any specialty … and I'm going to get some grief for saying this, but …
... you could read the research, and oftentimes it's old research which is better … it's actually a great treatment and it’s cheap, but no one can make money on it …
Lauren: So it’s been buried under piles of papers!
Dr. Holtorf: So we have found we end up treating so many weird things that aren't just Lyme. And it’s really a passion to keep learning. And if someone comes in with something that I don't know, generally I’m almost always going to say, “Wait a minute, I need to figure out how to treat that.” And I'm telling you, almost always you'll find so many things that work better than the standard treatment.
Lauren: And your focus and treatment, and what you're known for treating, is fibromyalgia, chronic fatigue or ME, thyroid …
Dr. Holtorf: Thyroid, hormones, any chronic illness, anything weird! Neurologic diseases, traumatic brain injury. We treat a lot of things — and a lot of them are tied together. We learn in medicine that every system is separate. I hate the term ‘holistic’ because it sounds too foofy, right? If you tell someone you're a holistic doctor, they ask: “Where the incense?” So I say that, but I add, “But we can be very aggressive.” I'll do the highest dose of a medication, but it usually takes a multi-system treatment for so many things.
And people will say, “Well, what if you don't find anything?” And I tell them, it hasn't happened yet.
And actually, we pretty much have a very good idea. So even just if we look at the labs, and from talking to the patient — without knowing anything about them — we can pretty much pick out who's going to be chronic fatigue, fibromyalgia, chronic Lyme … and how sick they are. About 70% of the time. I think what really did a big disservice with something like a fibromyalgia label or a chronic fatigue syndrome label … it gave doctors the license to say, “Oh, you’ve got fibromyalgia. Here's Lyrica, or here's an anti-depressant." … Well, there's something that's causing it. I like that there are more, at least integrative, doctors talking multi-system illness …
Lauren: And getting to the root cause.
Dr. Holtorf: The problem with root cause is that everything becomes a vicious cycle. So let's say, stress lowers your immune system. Now you're more prone to get a chronic infection. Most people with Lyme probably don't ever have symptoms until something else happens. So they get older and they start getting migraines. And then they’ve got mold in the house …
Lauren: And they think it's toxic mold, but it's actually Lyme.
Dr. Holtorf: And that suppresses the pituitary, which suppresses all the hormones — but they look normal on tests.The mitochondria dysfunctions. Now, the brain doesn't work, and the adrenals stop working, and the gut is immobile. So then you get SIBO and that causes more inflammation, and leaky gut which then brings in all these big proteins — which causes all these allergies and mast cell activation ... So you say, ‘Well, what's the cause?’ it almost doesn't matter.
Lauren: Because you’ve got to treat all of it. Yeah.
Dr. Holtorf: Well, the root cause, at some point, was the infection. But if you go after that, it doesn’t work very well. Because you're making everything else worse.
Lauren: One of the things I remember when I first started seeing Dr. Hunt here … she said to me, “This is going to be the hardest year of your life. But after this year, things will look different.” And she was absolutely right. I'll never forget it, because I was sitting in her office and she said it to me, and my mom was sitting next to me. And it was really hard because, you know, you spend a lot of time trying to figure out what's going on. But you eventually do have an answer and then you can target your treatment. And I think that's one of the huge differences with the treatment here … because you are looking at the multi-system, because you're spending more time with patients — which, of course comes at a cost, right?
Dr. Holtorf: I spend three to four hours with a patient — because I treat the sickest of the sick. And it's expensive.
Chronic illness is expensive because you have to treat so many different areas.
We will try to use as much insurance as we can, and for labs which usually are pretty much covered. Or certain medications. But some won't be covered now, when they used to be; it’s kind of a crapshoot. And you wonder, why did they deny that? The patient can't get out of bed without it, but it's not “medically necessary”.
Lauren: You're bypassing the system by choosing not to participate in it. For somebody without the means, they wouldn't be able to necessarily afford the treatment. But it's also one way to bypass the system if you can find a way to raise the funds.
Dr. Holtorf: We started the nonprofit, the National Academy of Hypothyroidism, which was really designed to show doctors and patients the way we're diagnosing treatment of thyroid disease — and it's rampant. And it's so safe and cheap and easy to fix so many people.
Lauren: And it’s important that people know they can look up resources.
Dr. Holtorf: And it's tough.
It’s a double whammy, too, because a lot of these people can't work. So they have no money — and they want nothing more than to get better.
Lauren: I think also there's a misconception that a lot of people in the chronic illness world are lazy! It’s not that!
Dr. Holtorf: Or that they’re drug seekers — and that is so rare. But with the laziness thing, I think it's human nature to be empathetic for a couple of weeks or a couple of months. But then they say, “You know, you look fine. Why don’t you just go exercise? Why don’t you just eat better?” Even my girlfriend … the nicest, most empathetic … started saying stuff like that. And I’m, like, “Don’t go there!” But it's human nature. And so if people have a caretaker that cares and is patient and will listen … it's tough to find. There are so many divorces, and then you're on your own and stressed, and trying to fight for government aid and with the insurance companies … they just wear you down.
If you're sick, it's so hard to respond to an email! Or write a check, or go to the store. And you keep getting these letters, and you’re wondering why did I just get 10 bills for labs?
Lauren: How many, what percentage of your patients would you estimate are on some kind of government assistance, because they can't work or they can't afford treatment? How often do you see that in your practice?
Dr. Holtorf: It's not uncommon. I used to do disability hearings, but it’s just so frustrating. You can give so much evidence, and it doesn't matter — they've made up their mind. We had one patient who is doing much better, but she went in for disability and I asked her, “So how did it go?” And she said, “I think went great; it was very short.” And then the letter comes, saying she is denied because "if she's well enough to put nail polish on, she's well enough to work.”
Lauren: About advocacy … it sounds like when you got sick, you were acting as your own advocate because you were alone in school and you went through a divorce and all of that … are patients coming in on their own, or are they bringing an advocate with them?
Dr. Holtorf: It's interesting. Five years ago, I had never heard of having an advocate. But now we're bombarded with information. So you can see why, more and more, advocacy programs are becoming much more important. And we have a number of patients who will say, “Hey, please have anyone call me because I’ve been through this …”
Lauren: Creating community.
Dr. Holtorf: And we just brought on a therapist that specializes in chronic illness.
Lauren: Oh, how wonderful!
Dr. Holtorf: Also covering drug addiction and this opiate thing, which has been so mismanaged.
Lauren: What is your take on the opioid crisis? Because you did mention before that you have patients coming in who have been overprescribed these highly addictive medications, and maybe don't need them but need some kind of alternative therapy. How often are you seeing that in the practice?
Dr. Holtorf: The problem with opiates is that anytime you give an opiate, you're either overdosing them or under dosing them. How do you know their pain? You don’t know. And more times than not, we have people saying, “I’m not in pain. I’m hardly taking it.” So they want people off of them. But what are you going to put them on?
Lauren: If they're in chronic pain, yeah.
Dr. Holtorf: Even with people on narcotics, we’ll use ultra low dose naltrexone … not low dose naltrexone …
Lauren: Which I’m on, LDN.
Dr. Holtorf: You can't be on an opiate in general, because you're going to go through withdrawals. But tiny, tiny doses keep people from getting addicted, and also from getting tachyphylaxis, which means needing increased doses. So tolerance does not mean addicted. If you're using opiates, at high dose, you're going to get tolerant. But actually the tiny doses of naltrexone – tiny, tiny — will keep from escalating doses.
Lauren: It’s a wonderful drug. Wasn't it accidental that it was discovered?
Dr. Holtorf: Yes, for people on opiates … and even to prevent relapse of alcohol. They found all the new modulatory benefits at lower doses. And ketamine. We’ll put people on ketamine IVs or oral ketamine. And it's great because it doesn't suppress the respiration or anything like that. It works much better for neuropathic pain than opiates.
Lauren: And it gives them some energy too, I suppose!
Dr. Holtorf: Yeah, and they self-wean off the opiates.
So, you know, you’ve got to do other things for the pain. Others like ozone and IVIG … there are so many IV therapies, oral therapies that work. And sometimes you go through a number of them to find what works. We’ll treat a lot of treatment-resistant depression. We find, sometimes that medications for ALS work for this person.
Lauren: And that's where you're really at the forefront because you're also willing to experiment. And you have patients who, once you've gotten them on board with you, are also willing to give something a try. I think also a lot of us come here because we've tried so many other things.
Dr. Holtorf: With this [depression] patient, he was so dedicated; he’d tried electro-shock. He’d had electrodes implanted in his brain. And nothing was working. But he was very up on things and would read studies and ask, “Hey, can we try this?” So I was reading a study on ALS — which is Lyme, until proven otherwise, I am telling you — Parkinson’s, too — and there’s this ALS drug that's approved that blocks glutamate. Which is an excitatory neurotoxin, which also has to do with depression. So I said, “Do you want to give this a try?” And it's been the best thing that he's ever tried. And he's been on hundreds of medications.
Lauren: Wow. And I'm also wondering, have you had personal experiences — particularly because you're in medicine and you’re confronted by other medical professionals on a very consistent basis — have you ever had situations where you've had to justify how you were feeling and had to explain to people that you have chronic Lyme?
Dr. Holtorf: Oh yeah, I remember being in the hospital and the doctors were talking infectious diseases … they knew me and they said, "We are not talking about your chronic so-called infection.” I had no immune system; it was just so bad. And then I hear the nurses talking about me as they were changing shifts, and saying, ‘Well, this guy has to have HIV, but it keeps coming up negative.” Because my immune system was worse than an AIDS patient — not an HIV patient, an AIDS patient.
Lauren: And how great that you're here — living, breathing, talking.
Dr. Holtorf: Yeah. We have so many patients with immune activation of coagulation. We find this goes along with Lyme, Babesia, especially with inflammation. And that's why their blood’s so thick. And it can lay down fibrin on the vessels — so, it's not a clot, but it now acts as a barrier. So basically, nutrients can't get in, hormones can't get in, oxygen that usually takes two seconds to get into the cells from the blood actually can take up to two minutes. And the waste products can't get out. So they're all toxic.
Lauren: It’s like a drain that's all clogged-up.
Dr. Holtorf: Yeah. And so sometimes a little bit of heparin until you can get it under control, and all of a sudden things that didn't work before start working. One of our lab techs was also working in the ER at UCLA, and heparin just made him feel so much better all the time. We hadn't seen him for a while, and he came in for some IVs and said, “I want to get going on some treatment again.” But he also said that he was in the ER and mentioned he was on heparin, and someone said: “What the hell is that?!” And the ER doctor says, “Oh, yeah, we see a lot of these Lyme patients like this; let’s up your heparin.”
Lauren: So someone was open to it! I think it's wonderful because you're not only continuing to be at the forefront of research in these conditions, but also to be educating and to be engaging in conversations with other medical professionals. Whether or not they choose to believe you. It’s a tough position to be in. And you have to be brave about it. But you've managed to find a way through.
Dr. Holtorf: I’ve also gotten … definitely older, maybe a little wiser.
Lauren: And a huge part of this chronic illness experience is patients who are often feeling like they're not listened to, doctors who may or may not be listening or maybe aren't listening in the right way. So I'm wondering, how do you see, with the way the medical system is structured right now … what needs to change for the treatments that you're doing to be more widely accepted, for patients to be able to get more affordable prescriptions and care? Is it as simple as policy change? Where do you see the solution?
Dr. Holtorf: I laid this out in an eight point program, but I didn't put it up because people will read the title, “Health Care Reform” and say, “Oh, you're not for universal health care!” Well, no, I actually am — but we're not going to get there by keeping the [current] system and giving everyone insurance. Open it up. Be much more free market. But then just give the people money to decide. If they don't use it, they can keep the money. Guess what …they’re not going to spend as much if they don't need it. They’re going to shop around.
Lauren: More like an HSA, do you think?
Dr. Holtorf: Yeah … they’ve wrecked that though. They tend to wreck everything. It's almost useless now … you can't get things approved on HSAs, and it’s such a small amount now.
Lauren: Do you think it's more of maybe a policy change with regard to Big Pharma so that we can actually shift where the money trail is?
Dr. Holtorf: I talk about that too…But keep an open mind!
Lauren: Yeah, that’s a big thing, guys … keep an open mind! Because if you're still sick and you're not getting better … maybe go somewhere else for treatment! Maybe try some other avenues.
Dr. Holtorf: It’s hard to get people off the idea of, ‘Everyone needs to be insured.’ No, you don’t need to be insured. You need to be able to have money to pay for care. And with insurance, the costs just skyrocket. All the bureaucracy. If you're choosing, then you're going to make the right choice. Do you ever call the hospital and ask how much a procedure is? And which hospital you can go to? I remember I got some plasmapharesis treatment, to filter the blood, and so I went over to Torrance Memorial [Hospital] and I said, how much is plasmapharesis? And they said, “I don't know, but I’ll give you 80% off.” And it turned out that the cost after the 80% off was $30,000 a treatment.
Lauren: Oh, my God. How could they not give you 80% off?!
Dr. Holtorf: Exactly!
The whole system is crazy. And there is no free market in drugs. They're allowed to price control. They're allowed to collude.
Lauren: Well, look at Martin Shkreli, and these people who are price-gouging diabetes patients with their insulin. It’s disgusting.
Dr. Holtorf: And I'm telling you, these old meds that just cost nothing … suddenly, oh, we’re bringing in generics.
Generics can be price-fixed, too. They start going up, so now they're $5 less than the brand name.
Lauren: So it's really about having more of a watchdog …
Dr. Holtorf: ...
We need to model after countries that work. But people have in their mind …either everyone's covered by insurance, or they're not. And it's not that. These countries that cover everyone, they have so many mechanisms to lower costs that are free market. But everyone [down the line] is getting paid because they can afford it … because it costs 1/10th of what it is here.
Lauren: Do you ever feel like you're in an echo chamber … educating other medical professionals about this and and talking about it? Because I just think about the number of videos I've seen on the Internet in my research, or on Facebook even, that just pop up as sponsored (because Big Brother's watching and they know what I've been researching!).
Dr. Holtorf: Yeah, it’s scary, huh?
Lauren: Oh, it’s so scary. But are about the discrepancy in healthcare between what we've got here in the US, and what they've got in Norway or Sweden … it's usually Scandinavia that's used as the example of something that's working, right? And yet we're so deep into what we're doing here, that we're unable to find pathways to reverse it.
Dr. Holtorf: Again, it's used politically … see, socialism works!
But when you look at these countries where it's working, again … they are more free market. And we’re … worse than the Mafia! It's all collusion, everyone's included, politicians. I think term limits would help. And the FDA is owned by the drug companies, and you know … where are they getting all their money?
I went and hired a private investigator to look at where the Endocrine Society gets their funding; he came back with, “You don't know how many layers of nonprofits they have.
This other guy I know has a very tiny pharmaceutical company, and he came out with a timed-release T3. One of his great friends was chief of staff at a major university, so he asked him, “Would you want to use this?” And the friend said, “I would totally use it, but I would lose my job because we’d lose our funding.” And you can't get this stuff published in a journal because where does all the journals’ money come from? Big Pharma’s ads. So, there are so many issues.
Lauren: You mentioned that you got a response from Paul Ryan.
Dr. Holtorf: It came from the office of Paul Ryan. That was made very clear; I’m not quoting him.
Lauren: Was he saying that we're too far gone?
Dr. Holtorf: Yes, it was basically saying that. Yeah, to start working on that you’d have chip away at special interest groups.
Lauren: At least he was honest about it.
Dr. Holtorf: It’s nice because ...
... we have so many patients who cry on their first visit. They say, “You believe me!”
Lauren: It’s wonderful that you’re providing that relief for those people in this world of invisible illness, because so many people can’t understand it because they can’t see it. And there are so many practitioners out there who may not have seen it and so they don’t believe it either.
Dr. Holtorf: They’re also scared; they say, “I’ve heard I could be in trouble for doing this [kind of treatment].” And the patients who cry … it’s bad for me, because I’m a crier. I even cry when they make a deal on Shark Tank!
Lauren: (laughs): It's funny because my mom comes with me to all my appointments, and I’ve had this happen in several appointments, when my mom has cried. I’ve been fine, I’ve had myself together. But my mom has gone, “It’s just so wonderful that they believe you.” She’s been the one that I’ve turned to after failure after failure after failure with different practitioners.
Dr. Holtorf: Wow. Even significant others and so-called friends will say, “Oh, she’s got this problem…” Or, “She wants to be sick.”
Lauren: Nobody wants to be sick, guys!
Dr. Holtorf: And then you start losing all your friends, all your support.
Lauren: I think that happens to a lot of people. I’ve been very lucky because I reached out to all my friends early on. It only took me about four months to get wise to myself and tell my friends I needed their support.
Dr. Holtorf: That’s very nice. Support groups can be very good, but there are some that get very negative.
Lauren: Well, I’ve had someone else on the podcast call it “symptom porn”. People go on some of these Facebook groups and the like, and where there’s wonderful community support, there’s also an echo chamber of negativity and no solutions.
Dr.Holtorf: It’s so easy to get into that space because you’re feeling horrible and no-one is listening to you.
Lauren: It’s so easy to get there, and especially if you don’t have mental health assistance as well. It’s wonderful that you guys are taking on a therapist on staff, because it’s so important and I don’t think everyone realizes that they need that additional support in the chronic illness world. Now, I'm also wondering, because a lot of patients will come to Holtorf Medical and have to make some lifestyle changes — whether it's diet or exercise, which of course our empathetic friends will always be happy to recommend to us! Or, whether it's a schedule for which they take their medications, etc. This is a very general question because chronic illnesses affect everyone in so many different ways. But how strict do they have to be about those lifestyle changes?
Dr. Holtorf: That's a good question. And a lot of our doctors here are very strict with their lifestyles and are very healthy. But I don't talk much to patients about what they need to do, because I don't want to be a hypocrite. I probably shouldn't be saying this! They laugh because I'm having Skittles for breakfast! I do work out religiously … I go every four months for eight minutes! And even then I hate the eight minutes! People will get that [advice] elsewhere. For me to spend my time on that … there are so many great resources and health coaches and nutritionists and books … Look, definitely, so many small things can help. Certainly I need to change myself and I'm working on it and talking to a nutritionist here, but I struggle with it — more than anyone.
Lauren: But I think that's really good to hear, because I think it's a very human connection that you have with your patients in that way. So many of us go to the doctor, and the doctor says you must do this! And you're looking at patients as whole people in this crazy world we live in, and saying. “You’ve got to live your life.”
Dr. Holtorf: That’s been my response exactly.
When a patient asks, “Can I have a glass of wine?” I tell them, “You’ve got to live.”
Lauren: And don't deny yourself things that give you pleasure, as well, right? Especially if you're someone who really needs those moments of joy.
Dr. Holtorf: You’re not going to live longer, but it’s going to feel like it!
Lauren: So we've covered so much in the interview today, and I like to wrap up the interviews with some Top Three Lists.
Dr. Holtorf: Uh-oh!
Lauren: (laughs) So in terms of these top three lists, you're answering them both as a practitioner and as a patient, right? So my first one is: What are your top three tips for someone who suspects they may have something going on health-wise and are seeking wellness?
Dr. Holtorf: It really depends on the person, but I think you really have to want to find out what's going on. Some people feel terrible, you know, and when they go to the doctor, they say everything's fine.
You might not want to take an active role in your health, but nowadays you have to.
Check everything I say. Question me. Bring back other people's comments; I’d be happy to answer them. And again, if you have a doctor who doesn't do that …
Lauren: Be wary.
Dr. Holtorf: Yeah. [Not everything] works for everyone. People go online and get a lot of great information.
If we hear something good or a patient brings something to us, we’ll try it; we learn from our patients all the time.
And we'll try it, but then we play percentages … ‘Okay, how many people got better, and how safe is it?’ We do all the risk benefits. Finding a doctor that will sit down with you and actually listen — and not cut you off.
Another study showed that when a patient starts talking, doctors now will cut him off after nine seconds. That's the average.
Lauren: What?! I would think it would actually be shorter, when I really think about it! It might be more like three seconds in my experience! (laughs)
Dr. Holtorf: So … find someone who really specializes in getting to the bottom of your illness. You can go to those standard doctors first and hear what they have to say. And if it works, all the power to you. That's awesome. And they’re obviously getting people well.
But, the big thing is … if you don't fit in a box, that's where standard medicine falls apart. And I think the more diagnoses you have, the more likely it's something underlying it.
A person will say, “It's funny, my doctor says no, I don't have that.” Okay, what he's saying is that you have 46 diagnoses that have nothing to do with each other. What are the odds of that? So really find someone who will listen.
Lauren: And dig, dig for the answers. And obviously you've also had to make certain lifestyle changes and take on certain treatments yourself for your own health. What indulgences or cheats do you allow yourself?
Dr. Holtorf: (laughs) Oh, I take the fifth on that one! No, I’m not perfect by any means. I think I could lose some weight and I could work out and I’d feel better. But I'll be here until midnight. I need balance in my life. I don't currently have great balance, so I'm struggling with that. And don't take everything so seriously.
Okay, you're sick and it's so hard … your temper is short and people are going to irritate the hell out of you. But you need to laugh at yourself and don't take yourself too seriously.
Lauren: That’s come up a few times but it's one of the rarer answers — about finding a sense of humor.
Dr. Holtorf: I think there's a lot of manufactured outrage right now. If someone disagrees or says something, I'm outraged!
Lauren: Because that’s what we see people on the news doing. They just yell at each other.
Dr. Holtorf: There are very many different truths — it matters where you've come from and how you look at it in different contexts. People have different opinions.
I don't think you can be happy by being angry all the time.
I can imagine someone sitting there and listening, and thinking, ‘I feel like crap and he's saying be happy!’
Lauren: And that could come across as being condescending, but you've also been in the deepest depths of it, too.
Dr. Holtorf: And it's not discounting how sick people are.
People are so much sicker than even their loved ones know, than even the doctor knows. It's the most horrible thing ever. It's like something you would never wish on your worst enemy.
And the problem is … I looked sick, which I guess was a blessing, right …
Lauren: Well, you don’t now!
Dr. Holtorf: Oh, thanks! But people will tell you, “You look great.” And you’ve got to learn that’s human nature, and they don't mean to be mean when they say, “Why don’t you just go exercise?” They're trying to help. People are on a different path.
Lauren: And I guess it’s about practicing forgiveness. And patience.
Dr. Holtorf: Yes, forgive yourself and forgive others. Holding grudges will kill you.
Lauren: Yeah, well that will only make you sicker. It's not going to do anything to the other person, is it? Well, Dr. Holtorf, thank you so much. I know we've covered so much. This is such a dense episode, and I’m really looking forward to getting it out there.
Dr. Holtorf: Awesome. This was a pleasure. Thank you for having me!