Why Is Healthcare So Expensive? How Insurance Incentives Shape the Care You Get

All right, let me make sure I'm recording. All right, and we're live. Uh Dr. Rose, how are you doing? I'm great. How are you, Cole? I'm doing great, too. Um all right, so quick introductions here. My name is Cole Steeghs, and I'm one of the co-founders of MedMatrix, and I'm joined here by the brilliant Dr. Rose. Um Dr. Rose, why don't you kind of give those who don't know you, who live under a rock, kind of [laughter] your background and uh all that. Yeah, uh my name is Dr. Sasha Rose. I am a naturopathic doctor, a licensed acupuncturist. Um I sit on the Forbes Health Advisory Board. I'm a published author, and I'm one of the lead providers here at MedMatrix. Fantastic. Couldn't have said it better. So, um what are we going to be talking about today? We are talking about um kind of this sounds like a big topic, but taking control of your health. Um really kind of diving a little bit into the in health insurance model, how kind of um health insurance has shaped the conventional care model that most that we all kind of live with, um and kind of contrasting that with a more preventive approach to health care. Yeah, perfect. Um so like when did you start to realize that like kind of insurance plays a big role in like health care people receive? Cuz is it is it is it always been that way? Like what's Yeah, give like can you give me some context here? For viewers' context. Yeah, and I don't know if we need to say it cuz it's not as such a medical topic, but I think we probably should always say that, you know, anything that is discussed health-wise is just for is educational only, and we're not giving any medical advice today. I don't know that that's super applicable to today's topic, but um well, I feel like pretty early on I've been practicing for 20 years. I've been practicing functional medicine for 20 years and it um I think it's always been a little bit of a a struggle of wanting to kind of provide access, let people kind of use their insurance when they can, when when when possible, but but there the struggle is that the kind of medicine that I love and that I'm passionate about doesn't always it doesn't necessarily fit within that model. So, I think pretty early on in my practice just kind of finding that trying to find that the balance with that and [clears throat] I guess I would have to say like both working within and not within the system. Mhm. Um yeah, so it's it's been a while. Gotcha. When um again kind of just like higher level stuff here, when is when does it make sense to work with insurance and when does it when does insurance kind of almost work against you? Well, [clears throat] um that's a difficult question. Um when does it when does it make sense to use your insurance versus not using your insurance? I mean, when it's something kind of straightforward, if there's a medication that you need um and that you have a prescription benefit as part of your insurance plan, um use your insurance. Don't pay out of pocket. For, you know, I think we and we might dive into this later on, but you know, conventional medicine does have some preventive screening tests that are kind of built in, like a mammogram, a colonoscopy. Um you know, there are some tests that are intended, you know, they're preventive and if you're at you know, at a certain age, if you're a certain sex, then your insurance will cover that. Use your insurance for those things. Um I do you know like at Med Matrix we do not practice primary care. That's not our role and I really do want my patients to have a primary care doctor. I want I want them to have you know because there is a way that those offices when they're working well can serve my patients and that's and people will you know usually be using their insurance when they go see their primary care doctor for various things. So I I guess I would say when it's straightforward and also emergency care use your insurance. You go to you know what I mean obviously. I think it's obvious. If you're in an accident or you need to go to the emergency room. That's a great time to have insurance. If you are looking for deeper root cause um aspects of your care if you want a deeper level of preventive medicine it is often extremely frustrating to try to use your insurance and stay within the model to get those answers to get the comprehensive tests to get kind of a visit that's longer than 7 minutes to get a real in-depth comprehensive look at at your health. That is often Yeah, just a lesson of frustration. Okay, so why is that? And then that's why people work here. It's not so one one one question one piece of it is that there's this term like fee for service model which is really what our current health care system is and that is that the hospital that that provider that lab they get paid on like a procedure right or a certain or a you know, a certain a 10 a 10-minute visit, a 15-minute visit. That's how they get paid, and so every you know, unit of uh service time is paid for every proceed you know, that's it's very kind of itemized itemized, and that's how a hospital or a clinic will get paid. They're not getting reimbursed on like patient outcomes, right? Like it doesn't really matter how healthy a person is. It's not They're not They're not reimbursed with positive outcomes or healthier patients. It's just so like the more that's So, it's all based on productivity, and that's why the short visits. That's why providers are really kind of forced to have the to see as many people in a day, and that's why everything is just kind of like not personalized, and um because that's how that's how and that's how insurances that's how anybody's going to make money is by um those procedures and those those quick visits. Mhm. Um what was your what was your original question? Well, I guess like maybe let me ask a different way is like why does Well, I guess I asked like first we asked like what is insurance good for and then what is insurance not good for. Yeah. And then we kind of asked like why is that? So, you explained that like it's really not great for preventative health outcomes because it's more itemized. So, I guess like why from your clinical experience talking to a lot of patients, like why are so many patients like frustrated with the insurance model, and like why is what you just described like not the best system for patient outcomes? There's a lot of reasons why the current kind of insurance-based model is not the best for patient outcomes. It's really focused on largely on disease management. It's not looking at true preventive care. And so people are frustrated when um they First of all, at least in Maine and New Hampshire right now, there's a huge lack of primary care providers. And so people aren't even able to get a primary care doctor. Um if they have one, that individual and that primary care office is like spread really thin. So access is really limited, right? People have a hard time even keeping a doctor. Um No, they No, people no longer have a relationship with their primary care doctor. And when they do see their doctor, it's really short. And there's a high level of burnout among primary care doctors. And it's not their fault, it's the system. And people are not getting kind of really adequate attention or care, and it's the last It's not personalized in any way. Mhm. And I And And people are just feeling frustrated, and I think in a good way they have We have access now to social media, and we have access to kind of a world outside of our little town or our city, and we People are finding things like functional medicine. They're realizing that there maybe is an alternative. Right. People are going to their providers, and they're asking for more in-depth testing, and unless they have a very specific diagnosis already, the insurance will not cover testing. And or the provider feels like it's not warranted, and so they won't order it. And so So people get frustrated with that, and people come in, and they feel like they feel really tired, they feel exhausted, they're not sleeping, and they're either dismissed um or they're um they're they you know, they run one test and they say, you know, well, your thyroid is normal, and so you're fine. Um they're put on an antidepressant. Like it's very They people feel very dismissed. Mhm. And that's um that's I mean, again, I I I I don't blame individual providers. I just feel like it's the I feel like it's mostly the system. Gotcha. So, what in your opinion, like what's like I guess we'll we'll get into Sorry, we'll get into that later as far as like how can you take advantage of it and like what's the best use of functional medicine versus uh you know, insurance typical medicine? But I guess let's let's kind of stay on this topic a little bit. Um Why like what's the relationship between Because you talked about like the short visits. Like I feel like that's pretty logical. Like if you have 7 minutes with a patient, health is pretty complex as is. So, like 7 minutes pretty common sense. Not enough time to actually do anything. But where does insurance start to play a role in like the actual treatment side of things, right? Cuz it's also restricts patients that way as well. Can you kind of explain that when it comes to actually like, okay, now that you have a disease or you want to be preventative, like what what's the problem with insurance there? Right, because right, cuz insurance will only pay for certain medications. There's certain medications that are much more expensive than other ones. So, the So, to answer your question of, you know, how does insurance come into play with treatment? Um I I mean, a lot of a lot of um people are on certain medications because that is the only one that their insurance will cover. Like there might be other potentially better options for them, but if their insurance doesn't cover it, it's not possible for them. And so, literally, like their care is being shaped by their specific insurance plan. And that as we know, of course, insurance companies want to save money. So, they would that patient it the only medication available to that patient potentially is the cheapest one. And it takes a lot of uh work, documentation on the part of the prescriber um to try to get an authorization on a different medication. And if that patient doesn't have like doesn't check all the boxes in terms of specific diagnoses or test lab results, then their insurance will deny that medication. Um and sometimes that's true even with imaging, right? Like if somebody, you know, needs an MRI or a CAT scan or something, unless they meet very specific criteria, the insurance will deny paying for it. Um and so, I don't even think we realize kind of in general the put the general public realizes how like how kind of deep the insurance clause are into our health care and how how it's really does really shape so much of the the care or the lack of care that we get. Mhm. Um And yeah, and you know, in addition like uh things that we off that are like pretty big in our toolbox in terms of really high quality neutraceutical supplements, botanical medicine, um even like um certain aspects of like lifestyle medicine, right? Like recommending that somebody go to the gym regularly or you know, access something that's beneficial for their health in in terms of exercise or nutrition, none of that is insurance reimbursable, right? And so, that's just like not No one's No one's going to get reimbursed for taking some really safe, high-quality uh nutraceutical products. Um and they and they can be they can, you know, for some people they can be expensive um compared to I don't know, some pharmaceutical that's really kind of cheap. Mhm. Yeah. Um I guess why like I have my show notes here. So, like insurance really focuses on kind of like the symptoms and with disease, like not actually treating the root cause. Can you explain that's really what functional medicine focuses on, right? So, like what's the difference between like root cause medicine with like um that you'll see in more cash pay practices versus like conventional insurance medicine? Right. So, so kind of chronic uh conventional medicine is is the the goal or the intention it is really about managing chronic disease. And so, that's, you know, when for example, when we're going over blood work with somebody, it's like somebody with a with certain diagnosis, like they're just going to have a certain limited amount of blood work, and if they are, you know, technically their results come back within, you know, normal um then they're going to be basically stay on the same medication. If they're if they're not quite within the normal, then their medication is going to be adjusted. And then maybe they needed maybe they're having side effects from that medication, and so they're given a second medication to manage the side effects. And it's really literally just managing a disease. And um you know, we talk a lot about it's really kind of the lifespan, like it's really about managing a disease so that an individual can stay alive longer. There is no intention about uh for health span. How well is that person going to live? It's not about that. It's not about mental health, overall physical health, um you know, mobility, uh metabolic health, hormonal health, like that's just not that's just not part of the picture. It's really like managing a disease so that somebody can literally stay alive. And, um, as opposed to what we practice, which is root cause medicine, and that is, um, we have the ability of spending more time with people. We're not limited by insurance. And we have a large toolbox that sometimes includes medications. It sometimes includes natural therapies. It often includes hormone optimization. It might include peptides or other like regenerative, um, medicine and a lot of lifestyle medicine. So, a lot of looking at like what what food, what nutrition is ideal for this specific person. It's not one diet for every person. It's very customized. Uh, same with exercise. Not everybody's meant to, you know, be a runner and, um, run 3 miles a day. Other people, Pilates or yoga, that's what's best for them. And so, we're really personalizing it and working with people and supporting people, um, in a way that's kind of getting to, well, why? And we have so many like advanced tests, you know, at our that available to us that help us dig deeper and figure out why somebody is fatigued, why they aren't sleeping well, why they can't lose weight, um, etc. And that process of like collaborative and working with somebody, we get longer term sustained results and we get people who are living better. Like that health span comes into play because most of us, I think, would agree, you know, you if fine, one type of medicine is going to let me live till I'm 99, but I'm going to be, you know, basically immobile and demented and incontinent for the last 15 years of my life. Uh that's choice A. Choice B is, you know, I die when I'm 80, but I'm like until that till I die, I'm moving my body, I'm you know, have really cognitively quite with it. I have all my bodily functions and I feel pretty good and then I'm done. You know, like I know which one I would pick. Mhm. Right. Well, often times, I mean, functional route Are you saying it's one or the other? Are you saying that you have to live shorter? [laughter] Hopefully you live to 99 and you're kicking it the whole way. But if I had to choose, I would choose short I would I would live a shorter life, but a better one. Yeah, heard. Same. Um okay, so you said something that's interesting that is kind of a buzzword. You said like normal range. And you referenced that in relation to insurance. Can you give an example of what you mean by like this normal insurance range and um kind of why that's significant? Yep. So, we talk about that a lot. We talk about normal versus optimal on the lab values. So, um when I have a new patient come in to the office and um for our listeners and viewers who might not be aware of this, we offer a very comprehensive lab panel right off the bat. And it includes everything from hormones to um micronutrient, meaning like vitamin and minerals, to um your liver enzymes, kidney health, um your blood sugar. It's It's very comprehensive. And my line at the beginning is that for some of these tests, I'm going to be going for optimal targets and that might not line up with what the lab has listed as its normal reference range. Now, a lab's normal reference range is simply based on statistics, on the statistical norm for a certain population. And um so for some of the tests, if I'm trying to get you to optimal health for you, my target may not line up with that lab's normal reference range. I want you to have optimal health, not like average. And um so the one that like you and I spoke a lot about on the last podcast, which was on thyroid health, was about TSH, which is thyroid-stimulating hormone. And this one is pretty much the main in conventional medicine, it's the main test that's used to monitor somebody's thyroid health. Mhm. The lab's normal reference range is 0.5 to 5. So anything in that, your thyroid is fine. It's considered fine. Now, we also do a full thyroid panel with additional markers on there, but just for that one test. In functional medicine, we have a more narrow window of optimal, and that's usually somewhere around 0.75 to 2. So it's narrow on both narrower on both sides. So somebody might not technically have hypo- or hyper- thyroidism, like overactive or underactive thyroid, if they're say at um a you know, a four. Um but um it it we would consider that borderline, right? And usually that person's going to come in and they're going to be fatigued, and they're going to be losing their hair, and they're you know, they're going to have a lot of the symptoms. And so that's kind of a very common difference is that somebody went to their doctor, they had their their been exhausted, they've had their they had that TSH run, and they were literally like a 4.98, and the doctor it wasn't flagged as high, and so the doctor was like, "You're fine." And to me it's really obvious that that person is not fine. Mhm. And that the thyroid probably is playing a pretty big role. Mhm. Yeah. What other example That was a really good example. What are some other common examples you see of like the normal range not being normal? Um another one I would say is vitamin D. Um that one comes up a lot. So, this is a little bit of a split I would say with from conventional medicine to in functional medicine. Um our lab, the reference range for vitamin D is um I think it's 25 to 80. Is anywhere within that is considered normal. And so, same thing. If somebody has convinced their doctor to even test vitamin D, maybe they had that done and they were at like 26. Doctor said, "You're fine. You don't need to supplement with vitamin D. You're good You're good." Um in functional medicine, we like to see we say optimal is, you know, I usually say 60 to 80. I know some providers even have it a little bit higher, more like 80 to 100. Um and again, there is a risk because vitamin D is a fat-soluble vitamin, there is a risk of toxicity, meaning it kind of gets stored in the fat tissue. Um and people can have, you know, reactions when it's really high, like kind of muscle issues and fatigue and cognitive changes. We don't see that happening until you're like well over 150. Oh, wow. But conventional medicine gets anxious if you're over 40 or 50. They will tell you to stop supplementing usually. Oh, really? Um and so, that's just a difference of opinion. It's not a right or wrong. It's a different interpretation of the research. Um we like to see optimal levels because we see people's mood, immune health, um calcium absorption. Those are just a few examples of what we see with optimal um vitamin D levels on the blood work. I have so many people whose energy goes up just by getting that vitamin D level up. So that's a dip. People will be like, oh, I had my D tested. It was normal. And I'm like, well, let me see. Let me see what the actual number is. Mhm. Yeah. It's funny. What percent of people in Maine have less optimal vitamin D? [clears throat] 90, 95. Okay. Wow. What about thyroid? Uh I don't think that's a regional thing, but um How many people have a imbalanced thyroid? Mhm. Oh boy. Um I mean, I don't know like I can only tell you the people that come into my office. Um and I think and I don't remember if we talked about this last week, but I would say I feel like um close to 50%. Oh, really? Wow. That might be my patient I think I said this. This might be my patient population that I see a lot of perimenopausal and menopausal women. And hypo and thyroid disease affects women more than men and definitely, you know, once you're over 40. Gotcha. You have a higher likelihood. Yeah. Okay. Um so I'm going to go a little off the notes. We're going to play kind of like a fun game. Okay. I think this will really help viewers whether you're watching this live with us, which we appreciate you joining. Uh make sure you drop some comments so we can answer them live. Um or you're watching the recording here is go through like different systems in the body and how functional medicine handles them versus conventional medicine. So the first one is gut health. Like how does how does insurance-based medicine handle gut health and like what things is insurance-based medicine good for when it comes to your gut? And then what and then the vice versa functional medicine. Okay. So usually if somebody's having some digestive um distress of some sort, they start with their primary care doctor. Um usually what I'm hearing is um take some take Miralax or which is a laxative. Maybe they'll say take me at Metamucil, which is a fiber supplement. Um and and then you know, this isn't a a Hopefully they will maybe say go see a nutritionist. That's always a good That's not a bad recommendation. Person doesn't get any better, comes back and they say, "Okay, well, we'll send you to gastroenterology." And that's not a bad thing, either. You know, I'm a fan of, you know, if the person needs an endoscopy or colonoscopy, great. That's good information. Um and that's kind of usually the extent of it. Maybe they are given um a proton pump inhibitor if it's an upper GI issue. Again, maybe they're It depends on what, you know, say nothing is found on the colonoscopy. Then um maybe they're again told to be to go on Miralax. It really depends on what the concern is, but that's pretty much kind of usually where it kind of ends. Again, if they find something on the colonoscopy, if it's more serious like inflammatory bowel disease, then there will be other medications and other things recommended. But Mhm. you know, if we're talking about constip- like just kind of general constipation, bloating, that kind of thing. Um so that's kind of it usually, and I'm making it These are generalizations. Um and then within functional medicine, we I mean, I've been specializing in gut health for a long time, and so I will ask I will take probably 10 to 15 minutes just asking questions about the gut. And so I go top to bottom, and I'm asking about, you know, heartburn, nausea, um gas, bloating, bowel movement regularity, bowel movement consistency, um hemorrhoids, all of that. And then lots about what what eating, what they're not eating. Have they ever had a colonoscopy, etc. And getting a lot of health history with that. If they've had any previous GI diagnoses, if they've taken what when they did take the Miralax, what happened? Did they do better or worse? Did nothing change, etc. History of antibiotics, on and on and on. And then we have some really great comprehensive stool panels available to us, which give us a whole readout in terms of what's the what's the microbiome? Is there a parasitic infection? Is there a bacterial infection? I've had a couple of these come back in the last week with candida overgrowth. Um Inflammation gut inflammatory markers, not systemic inflammatory markers, but specific to the gut. It's just there's just a lot of information that's available on these tests. And this is again, unfortunately, not usually covered by somebody's insurance. Um and so there's another kind of this tool is available to me, but not within conventional medicine because it's not, you know, reimbursable. Um but it provides so much information and it really helps us guide the treatment. Do we need to Do we need to treat a back a gut bacterial infection, a fungal infection? Do we need to just not just Do we need to build up their their microbiome? Do we need to specifically target inflammation? Is it a Is it a dietary piece? Again, we've got so many tools. I will use antifungals. I will use antibiotics. Um you know, when necessary and then a lot of stuff to help kind of restore the gut afterwards. Okay, got you. Let's do the next one. So, insurance-based medicine, so conventional medicine versus functional medicine for weight loss and low energy. Um insurance versus functional medicine for We're combining weight loss and low energy here. Yeah, I mean well I don't want when from what I understand most patients come in with both. They often do. They often do. Yeah, I mean again I would say probably 90% of our patients have low energy and um maybe 85% are trying to lose weight. So yes, you are correct. Um So well, I don't know. Conventional medicine um uh maybe lip service. Eat Eat better. Eat Eat better and and exercise. Mhm. With no with no more guidance, right? Again, 5-minute visit, what are what are they going to say? Um maybe referral to a nutritionist. Um maybe a prescription for something like phentermine, which is a weight loss medication. Um depending on the provider and the person's actual weight, um maybe they would be put on a GLP-1 agonist medication. Uh and then fatigue is tough. Hopefully they would do some testing. You know, they would at least look at iron and ferritin levels, thyroid health, um you know, ruling out anemia, ruling out hypothyroidism for fatigue. Uh maybe given an antidepressant. It's just a very limited toolbox, I would say, both in terms of testing and in terms of treatments. Um They just don't It takes time to talk to somebody to figure out why they're not losing weight and why they're tired. And if you have 5 minutes, you just simply cannot do that. Um So uh with weight loss, we I will often refer to a health coach, to a nutritionist. Um uh I will spend the time to figure out, you know, what the person is eating. Um if, you know, yeah, just what their relationship is with food. What what I eat healthy really means. Means a lot of different things. Um and what their caloric output is, right? So, I exercise means a lot of different things. What what what does that mean for that person? What's the What You know, what might be more appropriate for that person? And we do a lot with hormonal balancing. And so, there's a lot of people who are who really are kind of doing their best and doing all the right things in terms of eating well and um exercising pretty well. And they happen to be a 50-year-old woman and they are not They're gaining weight. Mhm. And that's often a, you know, a hormonal component. So, um look, you know, hormone optimization as well as lifestyle. Um and then we will use medications, right? We will use GLP-1s, you know, um at varying doses, um you know, kind of specified, personalized for that person if it makes sense. Um but it's always part of a bigger picture. We will use peptides when it's appropriate. Um but it's I really try to stay away from transactional medicine where somebody has a complaint and I hand them a medication and I say, "I'll see See you in 6 months." Like, to me, that's not great care. That's not changing the paradigm. So, you know, even if on the outside some of the medications might look the same, like the level of support, the level of investigation, of root cause medicine, like that's completely different. Um you know, maybe there are There is like another metabolic imbalance that needs to be looked at. And we'll We'll do the tests. We'll figure it out. Yeah, great. Okay. Um let's do insurance, conventional medicine versus functional medicine um for hormone replacement therapy. [laughter] It's a fun one. Yeah. Um all right, conventional versus functional medicine in terms of hormonal care, hormonal imbalance. So, um depending on what's going on, right? So, you know, is this a male, is this a female, is this a 24-year-old woman or a 54-year-old woman? It's all going to be different, but um I think in conventional medicine um we will see you know, maybe it'll be primary care, maybe they will refer the woman to a gynecologist um depending on what's going on. Um often it's going to be oral birth control, um which can be effective for various conditions. Um if there's a mood component, like a premenstrual um syndrome uh premenstrual dysphoric disorder, they may also be put on an antidepressant. Um and maybe referred to a therapist, and that those are not those aren't necessarily bad bad ideas. Um and then what else? Um for for for that's for like a younger woman usually. Now, an older woman, they might too. Maybe it might be the same. Might be a birth control pill, it might be an antidepressant, but often times if it's a perimenopausal woman or a postmenopausal woman um they will woman might ask to have her let her hormone levels checked and she's refused. Mhm. Or if they do run it, they'll be like, "Everything's normal, you're fine." And again, the unfortunately, the the feels dismissed. Uh maybe she's put on an antidepressant. Maybe she's told to just have a glass of wine. Maybe she's told this is just age. something you've heard before? Oh, yeah. Really? Yep. Just relax. Just have a glass wine. Really? Well, okay. Um and um Yeah, and likewise and again, I feel like you've heard me say this a lot, but um unless a woman is postmenopausal and having hot flash having hot flashes, um she will, you know, and even if she asks for some kind of hormone replacement therapy, she's told she's fine, she doesn't need it. And I am really a huge proponent of looking at somebody while they're perimenopausal, not just postmenopausal, and looking at the whole picture. Um and that's just not going to happen usually in conventional medicine. It's just not part of the typical training. So, when it in functional medicine, we're looking it's again, it's very personalized. How old is this person? Um is it a male? Is it a female? Uh you know, how much is low testosterone playing a role in this man's fatigue um or his, you know, low libido, low drive, all of that. Um how much of this younger woman's um anxiety and depression might actually be hormonal. It's different for every person and that's, you know, that's why we have we have the wisdom, the training, and the time to help figure that out. Uh so, is there additional testing that needs to happen? Yes, this person's labs might look normal, but maybe they're not optimal for that person. And so, combining that with whatever the health history's telling us with with what the symptoms look like can start to give us an idea of uh you know, estrogen is too high, progesterone is too low, testosterone is too low. What's you know, what's potentially playing a role? And looking at, you know, potentially changing nutrition to help alter that, maybe using some botanicals to help balance that. Um and then when appropriate hormone replacement therapy in safe low doses to help um to help balance that out. Uh but again, always comprehensive, always personalized. Mhm. Got you. Uh so we have a little comment here that's we kind of touched on but we'll retouch on it because uh this person was kind enough to ask it. So, can you give me guidance on iron and ferritin levels? So, iron and ferritin and just other vitamins versus conventional medicine versus kind of functional medicine. Sure. So, the question is, can you give me some guidance on iron and ferritin levels and what would you, meaning MedMatrix, offer versus standard or allopathic medicine? Um yeah, so this is on our this is on our initial panel and I'm like every day I'm ordering kind of follow-up iron, we call it an anemia panel. So, looking at iron and ferritin like once we've kind of started um certain treatments, you know, trying to to manage to monitor those levels. Um and unfortunately, people are often uh low in in either in both iron and ferritin. So, iron I don't put as much weight on iron because iron levels are going to fluctuate a little bit more day to day. Um whereas ferritin is your warehouse or your storage of iron done primarily by the liver. And you can have again, quote, normal iron levels, but if your ferritin is at I mean, I have people coming in with a ferritin of seven and then I have people coming in with a ferritin of 11 and that's both of those are very low. For me, optimal, and in functional medicine we usually say optimal, this is for a woman, is between like 50 and 100. And a lot of women are well below 50. And guess what? They're tired. Um sometimes, you know, it's a woman who's still menstruating. Sometimes, um there's, you know, blood, you know, it's obvious blood loss, not always. Um but um obviously we can't give specific medical advice, but I guess I would say this is a perfect example, you asked a great question. It's a perfect example of uh more comprehensive testing and just having the ability, like once we do start um you know, a non-constipating iron supplement, and once we do start talking about diet and ways to get iron increased in the in the diet, I will then retest in 3 months and we can check that and find out if your energy's better. Um and I have we have the ability to to do all that. Mhm. Yeah. Okay. It's a great It's a great example, good question, JD. Hope that helps. Uh all right. Uh let's do one more, I'll let you pick this one. What's What do you think is another good comparison for conventional versus functional medicine? Um well, we kind of I guess we kind of Did we exhaust the thyroid one last week? Um that was a good one. Um Mhm. Oh, what about joint pain? Okay, joint pain's a good one. Yeah. Um so how does conventional medicine versus functional medicine approach joint pain differently? Mhm. Um well, joint pain, of course, is could be could mean anything. It can mean osteoarthritis, rheumatoid arthritis. It could be a different connective tissue autoimmune disease. It could be a tick-borne illness. Um it could be just simply inflammation or the person is really overweight. Um there's a lot of different and it doesn't have to be what just one of those. Somebody could have multiple causes for joint pain. Um again, in conventional medicine, I think unfortunately, if somebody is overweight, it stops the questioning stops there. They're basically like, you just need to lose weight and then you your joints will will improve. And you know what? They they're probably partly right, but they are not taking the time to make sure that there's not a tick-borne illness, an autoimmune condition also contributing, right? Um because we are complex beings, we have complicated bodies, and it's not we don't always just have one thing going on. So, um and you know, hopefully in conventional medicine, if like an x-ray is warranted, they'll do that. You know, they'll do the thing and then maybe send them to to physical therapy, which is also a good idea. Um and in functional medicine, we will do all of that, but again, we will do that testing to make sure that there's what is contributing. Is it simply this person just needs to lose weight? Not just needs to lose weight. That's you know, easier said than done. Um or is there a different type of inflammatory condition contributing to the joint pain? I know I'm always talking about hormones, but when the estrogen level drops in those postmenopausal years, that's often when the joint pain gets worse. And it's because of the lack of estrogen. Uh even with testosterone, even in men, when testosterone is too low, is sub optimal, that will often um men will often have have joint pain. And when we kind of optimize that, that will often improve. So, it's like a different I I feel like it's like a it's being more open-minded. It's a bigger toolbox. It's It's really looking at this individual like is it simply that they are eating a diet that is so inflammatory and that's the only way they know how to eat and they've been eating that way for 45 years. And that's you know what? We don't do anything. We don't add any supplements. We don't don't do any medications. We really work on re-educating them about what to eat. Okay. That's a great example. Um I know you guys got some comments coming in here. Um is leaky gut a problem among your patients? Um Sorry. [clears throat] How I guess how often are you treating people with leaky Yes. Yeah. Um yes. I would say leaky gut is a common problem among my patients. Um we do have tests for this. Um we have again that comprehensive stool test that I mentioned. That includes something called zonulin which is one marker that we can you know, kind of used to see the the degree of leaky gut syndrome and I'll explain leaky gut in a half a second. Um there's other tests advanced tests that we can do to to look at it and sometimes just talking to people I might kind of presume that they have leaky gut. So really quickly, leaky gut syndrome it's not an official um ICD diagnosis. It's up until this point it's still considered a theory but pretty widely accepted within integrative and functional medicine. So the idea is that there's a certain level of gut permeability. So in the small intestine primarily, there are these cells that line up next to each other and they need to be permeable permeable enough to let nutrients in from the gut into the bloodstream. But they need to be tight enough cell to cell to keep large and foreign particles from passing into the bloodstream. If there's a certain level of inflammation, if somebody has a diet really high in sugar and again inflammatory foods, if there's been history of antibiotics, some other medications, sometimes um like chronic proton pump inhibitor use PPIs, then you're going to get you're going to get these cells kind of separating and you're going to get increased permeability. That triggers the immune system to set off an inflammatory cascade and that inflammation can show up anywhere in the body. It might show up in the brain, it might show up in the joints, it might show up in the skin. Um but the idea is that it kind of flushes out that that um phrase it like every your health starts all anything with your health starts in the gut. And that's kind of what that's referring to. Um and so unfortunately the standard American diet is pretty inflammatory. Unfortunately, a lot of people have been on a lot of antibiotics as children and or adults. Um and we there's this Yeah, a lot of people are on Prilosec and Pepcid for years and years and years. So uh yes, um in answer to your question, I do think leaky gut is a common problem. And when you have leaky gut, is it just like kind of lost hope or like what do you like what are some strategies that you use? Not at all. So obviously if there's a dietary, you know, lowering in inflammation overall, whether that's through food, through nutraceuticals, um there's I have pretty successful protocols for getting people off of these proton pump inhibitors when unless they absolutely need to be on it. Um Uh-oh. Uh-oh. Camera went out. Which one? Tech person is on vacation right now, guys. So Dr. Axe is going to replace the camera. While she does that, um we'll do a little shout out to MedMatrix that makes this podcast possible. Um so, if you do live in Maine or New Hampshire and you're kind of looking to, you know, take more control of your health and do some of this more advanced testing, work with providers like Dr. Rose, um who can spend more time with you, really understand your lab work, and really create a personalized plan, um you can go to medmatrixusa.com. And then, um when you talk to a patient coordinator, just say you came from one of our webinars. We really appreciate it when patients uh take the time to educate themselves because patients who are playing an active role in their health are more successful in their health. So, all right. Uh back to it. So, you were talking about uh leaky gut protocols and success rates things like that. Yeah, so overall lowering inflammation, right? And then there's So, there's specific ways to kind of get people off of those medications that may be contributing to the uh leaky gut. And then there's some really great um there's some great peptides, there's some great uh botanical and nutraceutical products that I've again had a lot of success with to heal leaky gut. It doesn't happen overnight. But it definitely um you know, people will start to to feel better. And um and they can do it without And then they can and they can be off of some of these medications as well. Great. Okay. Um so, you mentioned something like just now you said like people be on medications that will cause leaky gut, right? And we are often like a lot of conventional medicine is kind of a band-aid solution where they cover up symptoms and they don't really find the root cause. We are talking about insurance on this episode. So, how does insurance play a role in that where it's like you kind of do end up with these You see a lot of patients. I know a lot of patients come to practice where they had one issue, they went on one medication, went on another, went on another, and then they're kind of worse off than when they started. So, how does insurance play a role in that um kind of like covering up of symptoms? So, I think you know, people being on one medication and then another one and then the question of the role of insurance in those um I guess chronic and kind of uh domino effect of prescriptions. Um I think it's there's a lot of aspects to it. It's as you mentioned like a lot of people coming to see us. That's you know, that's That's That's the care that they've received up until this point. And it's really in you know, the insurance-based model is largely symptom management and it's not root cause based. And so, somebody has um some heartburn. They're put on famotidine or omeprazole. If you look at those medications are really supposed to be for 14 days, um but they're put on it and they're they're just never taken off. And um nobody's ever talked to them about what they might be eating that might be contributing or the fact that they're, you know, having a pretty hefty snack at 10:00 at night and then going to sleep. Like nobody's you know, that's kind of a very quick uh example of just looking a little bit deeper. Um somebody's on I'm trying to think of some other examples, but you know, there's so many where, you know, you just have you have one labrazole and you're given a medication and you have one symptom and you're given a different medication and then by the time they come in and this person's, you know, 65 years old, the list of meds is just and they've just been on it. Nobody like nobody's taken the time to see if we can actually start to uh if anything is lower the doses at least and then hopefully even just kind of whittle that whole list down because it takes individualized care and that doesn't fit into the model. Uh Um there really isn't you have to work on lifestyle, education, nutrition. You have to look at other ways to kind of optimize somebody's metabolism so that they no longer need the statins and they don't need the the antihypertensives and they don't need all these other things because they've they've done the work. Um or maybe they do need them but at much lower doses. Um and so it's it's hard because that's you know more often than not this is the only model that people know and the only option that's been offered. And it you know they might be in their 40s, 50s, 60s, 70s before they even realize that they don't want to you know we call it polypharmacy. They don't want that list anymore of meds. Mhm. Poly- can you explain that? Polypharmacy? Polypharmacy just means like many many drugs. Like you're just on you're just on a long list. Got you. I've never heard that before. Okay. Uh we're uh we're through all the questions here so we're going to just going to go right into Q&A um and then we'll do patient case study and then that'll be it. Um so question here and then guys for those of you who are live uh feel free to drop some more questions. Um can you explain mitochondrial health testing and treatment? And then if you can kind of tie that back to insurance just to stay on topic that we had. [laughter] Um sure. So mitochondrial health testing and treatment. So we now under- So a mitochondria is what's called an organelle. It's a it's a part of every cell in the body and it's sometimes thought of as like the engine of the cell. It's really where all the um energy metabolism pathways happen. And if and there's So for energy to be produced you need certain nutrients, certain vitamins, certain minerals. Um Um, and then you you even need kind of certain enzymes, which there's some very common genetic mutations that impact mitochondrial health. And so, even if you're getting the right nutrients, if you have these certain genetic mutations, your mitochondrial uh, health, your energy pathways might be compromised. And so, we have tests, both genetic tests and um, other kind of uh, nutrient, you know, level the testing nutrient levels to kind of figure out what somebody's mitochondrial health actually looks like. No surprise here, these tests are not reimbursable. They are not covered by insurance. Um, treatment is uh, hopefully based on some of these test results. So, you may have heard of um, like the most common genetic the test for this is called an MTHFR test, and that's looking at a methylation if you have an enzymatic mutation in terms of or variant in how you are kind of handling largely it's like the B vitamins and how well those B vitamins are being processed. If they're not processed optimally, you're going to have a higher tendency for inflammation. You may have a more higher risk of things like fatigue, depression, anxiety. And this is genetic. This is maybe something that you've been dealing with most of your life without knowing why you had these tendencies. Um, so if we have that information, that can help us figure out what nutrients make sense for you, what diet makes the most sense for you. Um, and a lot of people are like, well, I just figured out that I have this mutation. I'm going to get my tids my kids tested also. Um, or, you know, my father's been dealing with depression his whole life. If I can convince him to get a test, that might help, you know, help him figure figure this out. So, good information, not part of the conventional insurance-based model, um, unfortunately. Okay, great. Um, Karen, I hope that helped. Um, all right, so why don't we we always like to do a case study for those of you who are joining us for the first time? So, why don't you do a case study? So, probably a patient who went to insurance, kind of wasn't getting the help, and then came to MedMatrix, which is I most of the patients. to like, hmm, which one to pick from, Yeah, I'll let you pick whatever patient you want. Go through case study. Okay. So, um, this is a man. He is, um, uh, I think he's 50. Maybe he might be 49, 49 or 50. And he um, so, he came to us probably around nine or 10 months ago, and he had, um, he had all the standard meds. So, he was on a statin medication. He was on two blood pressure medications. He, um, was, uh, overweight. He was on a medication for heartburn. He had had a previous diagnosis, I think already, of fatty non I think non-alcoholic fatty liver disease. And, um, low energy. And, um, not feeling great. And had tried with his primary, you know, it was it was it was a series of primary care doctors over the years who had basically he didn't have a long relationship with any of them, and they would see him and they'd see his, you know, they'd see his cholesterol was still high and so they'd keep him on the statins, his blood pressure was so high they'd add another medication for that and he wasn't you know, this started in his when he was like 40 and this is had been his life for 10 years. He was just kind of on these medications and so he came to us just feeling kind of like I really don't feel good. I haven't felt good for a while. Uh and I don't really like it's just over understandably like overwhelming for him, right? He's like where do I don't know what to do and I'm just given more meds and nobody seems to have an answer for me. And so we you know, his his lab work did not look great on that initial panel despite being on some of these meds. Um and nobody had ever talked to him about what he what he was eating and he was kind of an example of like he's like well I you know, I sometimes I'll go for a walk. Like that was the extent of movement. He's like a workaholic, lives alone, doesn't like mostly does take out. And so a lot of it was kind of educational, you know, I mean it wasn't like the sexiest treatment plan right off the bat. It was really like let's make let's do some baby steps in cutting back on the take out and like learning how to cook some real food and boosting is you know, boosting the vitamin D, boosting the vitamin B B12, just some real kind of basic things. And um he I don't think we even did anything bigger than that initially, but he already even with those I'm going to call them simple, but you know, these are not the lifestyle things are not easy. Um he's the one doing the work, but after it made enough of a difference that I did see some improvement on the blood work. And then we were able to maybe I think we did bring him we did do some hormone optimization with him. He did start to get a little bit more energy, which helped him go to the gym, right? And then going to the gym, he was like motivated and he started to to actually want to work out and have the energy to work out. His mood improved. So, it's kind of a little bit of a um a positive domino effect in that regard. And he is now on a very low dose, we call it a microdose of a GLP-1 medication, which has really helped his metabolism. Um he's down to one blood pressure medication. He's off of the proton pump inhibitor. And he's cut his statin day. He's still on the statin, but he's on a lower dose. And um he doesn't feel 100% right now, but he feels probably like you know, 85% better. And he's every time I talk to him, it's better than the last time. Mhm. Yeah, it's a big improvement. Yeah. health, right? Awesome. Cool. All right. Uh well, that's it for today. Dr. Rose, do you have anything to add? No, I hope that we I just hoped that some questions were answered. I know we you know, people ask it's a conversation I have frequently with people of kind of you know, why are you you know, insurance, like why why can't this be covered by by my insurance, that kind of thing or I mean, I think almost everybody who comes in here is has felt dismissed, um has a level a certain level of frustration with the current system. And um for the most part, it's really not individual providers. I think most providers go into this into this because they want to help people, um but it's just they kind of end up having their hands tied behind their backs. And um so just so that people know that it's like we hear you and we know how frustrating it is. And I think the more people that know that there are other options and that there is this different approach and that we every day we just see people feeling better and that's really rewarding. Fantastic. Yeah. Cool. Thank you Dr. Rose. All right, and then if yeah, watching live or watching recording and you want to actually get some medical advice and kind of come up with a personalized plan for you, you can go to medmatrixusa.com and apply to be a patient. All right, everyone, thank you so much for joining and we'll see you in the next one. Bye guys. Thank you.