OneMedicine Podcast

Rob Lutz 00:02
Hello and welcome to the OneMedicine Podcast with Today's Practitioner. In each episode, we share the expertise of a respected thought leader, some you'll know, and others you'll probably meet for the first time. We cover topics important to you, always with a focus on improving the health outcomes of the patients you treat, while expanding your understanding of the many healing modalities being used today.

Rob Lutz 00:21
Hi and welcome to the OneMedicine Podcast. I'm Rob Lutz, your host and the founder and editorial director of Today's Practitioner. Today with me is Chris Meletis, naturopath. He's been on the show a number of times. I love having you on the show, Chris, it's always a fun conversation. I'll have you just reintroduce yourself in a minute. But the topic we're going to be talking about today is inflammation and providing practitioners with a toolkit, looking at acute, systemic, chronic inflammation and strategies that work. It's kind of just the general topic we'll be, we'll be talking about but Chris, would you mind just giving us a quick intro, your background and just tee us up for today's conversation?

Dr. Chris Meletis 01:06
Well, certainly. Thank you, Rob, and always great to be here, because it's great to be any place at any time. Vertical is a good thing. So I've been a naturopathic physician for 33 plus years. Graduated here from the school in Oregon, was the dean for seven years, written 18 books, couple international articles. And I love learning, and I will share what we all know as providers and practitioners. It's us as perpetual learners. And I will share a little tidbit. When I was teaching at Oregon Health Science University, local, MD medical school, I had the opportunity to speak to a fourth year graduating class. And during that fourth year graduating class, I said, do you folks not know so much more than the people that sat in these exact chairs five years ago during a similar lecture? The answer is, invariably yes. Diagnostically, therapeutically, you know a lot more. I says, But don't forget, five years from now, that's how the graduating class is going to feel about you, unless you're a perpetual learner. So that's why we do what we do. We do podcasts. We listen to podcasts because we're perpetual learners. We don't sit on our laurels and our patients count on us to be perpetual knowledge requirers.

Rob Lutz 02:12
That's great. Thank you, Chris. So this episode is going to help equip clinicians with a practical, layered approach to identifying, modulating and resolving inflammation. We're going to look at acute flare ups, chronic system, systemic inflammation and disease specific context, using nutrition, lifestyle and targeted supplementation. Inflammation as I think we are, we all know, is not the enemy necessarily, but dysregulated, unresolved inflammation is the root cause of most chronic disease, and practitioners need context specific tools, not a one size fits all anti inflammatory protocol. So that's what we're going to try to dig into here. And I thought we could start with framing inflammation clinically and establish shared language and clinical nuance around inflammation. So Chris, I've got a few questions, and I think this will kind of help us frame it out a little bit. When we talk about inflammation in a clinical setting, what distinctions Do you think practitioners most often miss - acute versus chronic versus systemic?

Dr. Chris Meletis 03:16
That's actually a great point of delineation. So think acute inflammation, we sprain our ankle, great. Actually, we're kind of splinting, naturally, that ankle to prevent further injury. That's an acute inflammation. It's there. And we listen for our body, and we stop walking on our ankle. Voila. We have a problem. If we inhale some dust or pollen or allergen, and our nose starts watering and we get a little sinusitis. Well, the mucus is actually from the irritation, is washing away those things. Likewise, we get something in our eyes, and that's an acute inflammation, the tears. So there is a natural, innate, endogenous, just wisdom of the body. Hey, acute, an acute, short term level injury, and something's coming along and helping our body deal with it or sequester it, kind of like circling the wagons. But then we have the chronic inflammation, and this ties into the bigger topic of inflammaging. Does inflammation accelerate aging? The answer is yes, and so we can either have a chronic inflammation that's local, like the trick knee. I used to be a runner back in the day, and I was very flat footed, and I have Chondromalacia patella ever since I was 26. I was diagnosed with that many, many decades ago, and so my knees are always talking to me. That's a chronic, localized inflammation. But then there's systemic inflammation. How about lupus? What about rheumatoid arthritis? What about inflammatory bowel disease. What about ongoing mast cell degranulation, or ongoing consumption of food allergens and so forth? That can be a chronic, ongoing issue, and that's where that inflammaging occurs. Then we have metabolic diseases as well, including cancer malignancies, but we also have things that go on, like pulmonary fibrosis, cartilage erosion, and then the one that none of us want to have, lest we forget, we have it is neuroinflammation. Neuroinflammation leads to an acceleration of like Lewy Body's and Alzheimer's disease and cognitive decline. So we have the chronic inflammation, which can be either very localized or very systemic, and that like, and I guess that's how I would put it. And then we have cardiovascular disease accelerated. So I look at inflammation as an accelerant. It accelerates dysfunction within the body.

Rob Lutz 05:38
And so why is suppressing inflammation not always the goal, especially in acute or immune driven cases?

Dr. Chris Meletis 05:47
Well, if we suppress inflammation acutely, we walk the fine line. Well, don't we want the mucus to get rid of a pathogen out of our lungs or dust out of our eye? And answer's yes, so the key here is, when is enough enough? And so they used to, when I graduated 1992, think we have to treat all otitis media, otitis media being that middle ear infection. Then out of Europe, they said, no, let's wait about 72 hours and see whether the kid, usually kids, would get better, because before we were just throwing antibiotics or antimicrobials at it. So once again, see if the, give the body enough time to see can it turn it around au natural, as it has done ancestrally for millennia.

Rob Lutz 06:33
Right.

Dr. Chris Meletis 06:34
And, but now it's lingering. It's not getting better. And/or what's happening in today's modern world, pre covid, post covid, all the news, heaven forbid. I mean, one of the best things you can ever do is fast from the news, in my opinion, because it actually helps the body. But what happens is that you are chronically worn down and stressed out, and so your natural hydrocortisone, that your body makes about 20 milligrams a day, is not there. And that's why, when our kids were younger, they would spike a fever in the evening. Well, we often feel crummier In the evening because our natural circadian diurnal rhythm is a lower hydrocortisone at the end of the day. So things get worse, and as parents, we know it gets worse on a Friday night and when the doctors are no longer in the office til Monday. And, but so, but if you knew a patient, have a, say, a low adrenal function, their salivary cortisol or 24 hour cortisol levels are low, then we're going to be a little bit more watchful of that acute inflammation, because acute inflammation can then get a life of its own. And so all of a sudden, if we can't breathe through our nose and our throats all swollen, and we already have a borderline case of sleep apnea, now we're becoming hypoxic, we're swollen. And so there's that fine line. So I think the thing is, listen to the body. I always put a line of demarcation for my patients. So if it's a cold, I'm giving them the five to seven to ten days around the peak of that, the bell shaped curve I'm looking for, hey, I want to be seeing that you're gaining ground and not continuing to lose ground. And the other big one for me is I don't want to see if a person has sinusitis or a bronchitis. I don't want to see the mucus turning colors. If it's clear, okay. Start turning yellow, brown, green, then I'm more concerned that we're going towards a bacterial infection. There's big controversy around that. Oh, well, not all bacterial infections cause color to your mucus. However, what I have found is the longer the mucus sits there in the body, the "we're warm, we're moist. And hey, we're incubators," and the mucus is mucopolysaccharides, so we're allowing a feeding growth medium for the bacteria. So morning, you cough up a little something, you blow a little something, it's colored grape. The rest of the day, you're doing fine. I'm happy with my patient. If they're still blowing or coughing up colors, then I'm going for antimicrobial approaches, starting with natural and then, if necessary, going other directions.

Rob Lutz 09:05
I think you kind of transitioned to answer my next question., but I was gonna ask you, what biomarkers and clinical patterns do you rely on most to determine whether inflammation is adaptive or pathological? Seems like you kind of answered a little bit of that. Is there anything else you want to add to it?

Dr. Chris Meletis 09:19
I would just say every person has a different tolerance and different, everybody knows their body, and this is why we as functional medicine providers, primarily have the benefit. We are not limited, usually to that 10 minute visit. We get our patients enough time to talk about how they're really doing, opposed to answer, question, question, answer. And so is this the normal course for a cold for you? Is there a normal course for a flu for you? The last time you got injured? Is this how long it took? And the moment it starts becoming a new thing, a new pattern, then it catches our attention because it's unique to them. We call it individualized medicine. We call it precision medicine. But like for example. If I get a cold, and right now I think I just got some allergies going on. But if I get a cold, I know it loves to settle in my lungs. In the case of my wife, it loves to settle through her sinuses. And so I know that if I do not abort, prevent, do the emergency injection seat within three to five days of the onset of some lung congestion, then I'm potentially going down a very slippery slope of getting worse.

Rob Lutz 10:25
Yeah. So mapping the inflammation terrain, you know, conditions and drivers. So this is kind of what we want to talk about here. What are the most common conditions where inflammation is the primary driver rather than a downstream effect?

Dr. Chris Meletis 10:41
That is a brilliant question, and as a doctoral thesis, PhD question of which came first the chicken or the egg? So when we have chronicity, chronic inflammation, whether it be localized or systemic, it becomes a driver for cellular dysfunction throughout the body. And so when we look at is it a driver? If it's inflammatory bowel disease, it's a driver. Now the question is, what drives the inflammatory bowel disease or the celiac disease, which we really don't think so much as inflammatory. Well, we know gluten would be the example of that. If it's rheumatoid arthritis, there's some evidence in the peer review literature that the bacteria called Proteus Mirabilis actually is a co-traveler with rheumatoid arthritis. Which came first? Is it automimicry? And it looks like and triggers the immune system to attack? Or is it a driver? We don't know, but clearly, gut health and dietary health all are drivers and ,but the moment we have cartilage damage, whether it be systemic lupus erythematosus, rheumatoid arthritis, or we get some neurological things like multiple sclerosis, then our immune system starts saying, "Oh, maybe I should pay attention." And it's kind of yes, you want to pay attention, but you don't want to become OCD. And when you get your immune system, as I describe it to my patients, OCD about your cartilage or your connective tissue or your intestinal lining, we got problems. So this is why we want to quiesce things and figure out, we're cruising along in life, all of us, all of our patients, and one day, they end up in our chair in a consultation room and say, "Doc, I have a problem." I said, "Have you ever had this problem before?" "No." Well, so something was a pivot in their lives, and then we figure out, what were the drivers like you just asked. Well, I, and I remember a case 25 years ago. Met a lady who was the Dean at the naturopath University. Happened to chat with her. I held the door open for her, and she was in tears. I said, what's going on? Well, my wife, my daughter, was just in a major car accident about six months ago, and ever since, I've been having all these joint problems, and it was enough to trigger autoimmunity, that self attack. So we find three to six months, usually beforehand, or longer, if they've waited a while to get to us, that something drove them to the straws on a camel's back, the thing that precipitated it. And so the quicker we get to that, the quicker we address it, the quicker and more likely we are to mitigate it, because we weren't wearing down that path of broken physiology for such a long period of time.

Rob Lutz 13:18
Makes sense. Great answer. How do you categorize inflammatory drivers of practice?

Dr. Chris Meletis 13:24
Oh, if it's obvious, like, okay, every time I drink dairy, I get mucusy. Obviously, that's an evident one. They say one in two people that eat nightshade families will get arthritic, joint problems, all things being equal. I remember sharing that tidbit with my mother in law, which had psoriatic arthritis. And in her case, she, her husband was a avid gardener when he wasn't working another 60 hours a week and, but she'd eat the tomatoes, and always during the summer, her arthritis was worse, which is kind of counter intuitive. You think it's cold, it's inclement, in Oregon, that's when your joints are going to talk to you more. I think the other thing which I do is, when there's an ongoing, protracted period of inflammation, that's why I do a lot of testing. And beyond just C reactive protein, beyond just a sed rate, I'm going to do an interleukin one. I'm going to do an interleukin panel through Quest Diagnostics, Labcore or a functional medicine laboratory. I want to see what particular cytokines are working for them. And we think cytokines, and we all learn this word, even when we're not healthcare providers. During the covid era, oh, you got to be careful the cytokines storm, because the cytok, cytokine storm is going to get you. And indeed, when it becomes a storm, an avalanche, for lack of a better word, it becomes a problem. We know that certain botanicals, certain nutraceuticals, really target specific interleukins. So if you're really wanting to go for precision medicine, and it's one of those complex, not the low lying fruit, but what we call zebras. When we hear hoof beats, we think horses, not zebras, but oh, boy, are there zebras out there that come walking through our doors because they've gone to everybody else, and they're now at our doorstep. And so that's when we start looking a little deeper. We use the advantages of technology, and we look at an in, a cytokine panel and say, what's really elevated? And if we see a TH one or TH two, we think autoimmune, we think allergens, we look at those different aspects of things, but if we know that the person was always sensitive to environmental allergies, that would have been me. I was a kid, I got allergy shots back in the day. I took all kinds of fun meds, because I was always a constant rash, and itch, and sneeze, and asthma and so I'm a very what we call atopic, there's what's called the atopic triad. So it could be eczema, it could be asthma and just generalized allergies. And so I already know my body has a preference or a predilection to go that direction. So I always ask, how does your body normally respond to and then we go from there. But I think quantifying is very important, because then we can use Boswellia, we can use turmeric, we can use an endocannabinoid like beta caryophyllene, because we know each one has areas that the peer review literature has shown it helps mitigate those specific cytokines.

Rob Lutz 16:18
It's great. So kind of last question in this this section, but where do practitioners most often over supplement without addressing the root cause? Anything come to mind?

Dr. Chris Meletis 16:30
It's actually a very insightful question, because I have became an over supplementer for myself, for my patients, and so what we want to do is we don't want to be just overly controlling inflammatory processes, which are transient, like the acute thing or the injury, but at the same time, we want to prevent the susceptibility to bronchitis or an asthma flare. So the example I give, and I give it quite often, is tube bathroom tiles or kitchen floor, floor tiles, and that's diet and lifestyle. So can you address it with diet and lifestyle? So we don't drive around. You don't see on a freeway regularly, vehicle attached to a tow truck. It's trans, it's a transit period of time. You get them out of the ditch, and then you're, you drop them off the auto shop, and then you get them back on to the road. So the concept is, if we can get them out of their quandary, their challenge, acute challenge, or chronic challenge, and then sustain them with diet and lifestyle and minimal supplements. Because I give the example that those tiles, diet, lifestyle, the space between the towels, that's grout, that's where we supplement. We fill in the gaps of lifestyle with supplementation.

Rob Lutz 17:49
Awesome. And that really kind of segues into my next section. So we're now, I want to talk really about the practitioners inflammation toolkit. And first part to focus on is this foundational layer, which I think is what you were talking about. So I think lot of practitioners say these are non negotiable foundations before supplements. And so before supplements, what are the top foundational interventions you want every practitioner to assess? Thinking about the foundational, you know you're talking to your patient, what do you want to make sure that they're doing before you even think about supplementing.

Dr. Chris Meletis 18:24
And so in my clinical practice, we all have our preferences in our patterns of thinking, and mine have changed over the last 33 plus years, and we, I guess I would also call myself out. I used to have my favorite herbs. I used to have my favorite supplements. Vitamin C was my go to. Vitamin D has always been my go to but then I had certain botanicals that I really like to use for immune system. Back in 1992 it was echinacea, some goldenseals, some astragalus. Now I've gotten into the fancy frou, frou stuff, but it doesn't mean that our friends of the past are not still friends. We had to remember that even in our own lives like, well, I got this great new friend. Well, a friend has been there for you for the last 20 years. So in practice, we often get these new shiny, blingy things, and have to remember, we had some good old friends in the past as well that helped, not only ourselves, our patients, for a long period of time. So I think the aspect of, I always focus initially on hydration. If we're not hydrated and we're, if anybody's ever seen our body cremated, there's not a whole lot of us left after all that moisture is gone, so most of us run around somewhat chronically dehydrated. There's exceptions to that, and there are patients, which I actually have, four of them right now, that are hyper hydrators, and they drink so much that their sodium and potassium on their serum blood levels are routinely below the normal threshold. Sodium is 135, they're 133, 132. Their potassium, the reference range at the bottom of it is usually about 3.5, they're 3.2 because they're not mineralizing their water. They just think more is better, but they're, they're the rare exception. So I focus on hydration. I focus on an environment which is sustainable for them, because we're all fighting what was called the allostatic load, that what we call Helter Skelter, for lack of a better word, moving towards entropy opposed to homeostasis, so our body is putting all this energy into maintaining the happy little Goldilocks zone in which we exist. But then, what about stress? I always look at stress. My undergraduate thesis in 1988 at Reed College was on psychosocial stress and immunosuppression. And you have to, you cannot look at the immune system or inflammation separately, they're traveling companions, so that's why inflammaging is so terrible. So I looked and said, "Hey, are you hydrated? And are you mineralizing yourself relative to your hydration?" For me, I have a coffee habit, and so I dilute myself in more than one way. Am I delusional with my coffee? Because it borrows from today to get through tomorrow. And so it's like, okay, we're not wanting to do that. So hydration, then food. Food is our best medicine. I grew up in the 60s and 70s, when Saturday morning cartoons were educational. On the commercials, you are what you eat from your head to your feet, and I just want to be a bill on Capitol Hill and all those lovely and Conjunction Junction, what's your function? It was like, wow, you can learn something on Saturday morning in between the cartoons. But the concept is, we are what we eat, and all of us weigh more than when we were born. So we've seen the cartoon of, are we a hamburger or a french fry and a Coca Cola Pepsi body, or are we made from fresh fruits and vegetables? So I focus on eating more healthy. I'm a proponent of using the ewg.org, Environmental Working group.org, Dirty Dozen and clean 15, for people that are on budgets. If not, you can't go organic all the time, eating fish that's not farmed. So fueling the body, just like I give the example if I offered everybody, and I do this to my patients all the time, and I have these intellers and PhDs and Nike executives, so I still give them the same example. So you're driving along, and you have the opportunity to ch, to load your car full of fuel, petrol, assuming it's not an electric car with 99 cent gas, there's a gas station down the road, 99 cents. Well, would you fill your car full of 99 cent gas? You're saying, I wonder what's wrong with it? Why is that so cheap? We'd be asking questions. There's a 99 cent hamburger down the road. Yeah, sign me up. I'll have three of those, please. It's kind of interesting how the human mind works, and so hydration, stress control, eating well. And then the other big one is clean air. Indoor air pollution is often equal to outdoor air pollution. There's exceptions, and so running the HEPA filter in your office, they've shown that laser printers actually put out as much secondhand toxins as secondhand cigarette smoke for some particulate matter. So I have three air filters at my 15 by 15 home office, and they're one for VOCs. I have an air quality checker, and I'm wanting to make sure I'm not burning it in my body. Same thing with the quality of the water, we had to make sure the water is good. I'm not a big proponent of fluoridated water. I'm also not a big proponent of Flint, Michigan heavy water, pun intended with the lead. And so what we want to do is have those things stress, but then also mindfulness. We are not grounded to terra firma. We're not grounded to anything like our ancestors. We walk around barefoot or leather footwear, and we walked, we talked, we communed with nature, and we're not doing that anymore, so we need to. There's no pun intended. Unplug, get back to the basics.

Rob Lutz 23:46
One, one that you did not mention, but we spoke about it before we started the podcast, is sleep. The importance of sleep.

Dr. Chris Meletis 23:53
Thank you, yeah, actually, you and I were having a little conversation about sleep apnea,. and I use, oh boy, I test so many people for sleep apnea. One could argue we're overdiagnosing sleep apnea. But if you think about it, hypoxia is a prime territory for cancers and for cellular dysfunction. We use the word oxidative, oxidation phosphorylation, well, oxidation requires oxygen, so how can our mitochondria work without oxygen? And so I routinely do a home sleep test for my patients off a website that I'm not affiliated with, and for $189 sometimes it's on sale for $141 you see, how do they sleep in their innate environment, in their bed, with their partner, with their dog, with their cat, whatever, with their pillow, for sure, and see, hey, are you succeeding in staying oxygenated? And then are you actually hitting that threshold, deep sleep, not deep sleep. And so now online, our patients and us as providers can order our own tests, but not as providers, just as human beings, it's reviewed by a sleep medicine doctor. It's Department of Transportation approved, FDA approved, and they'll tell you, Okay, this is how you slept. This is how much you're desaturated. And it's like, oh, it's a no brainer. So I thanks for reminding me about that.

Rob Lutz 25:14
Yeah, no, it seems like that's an important one, and it's top of mind for me, as you know from our previous conversation. So thanks for going through that list. And again, I think those feel like they should be non negotiable, no matter what someone's coming in for, right? You know what most your diet, your sleep, your stress level, hydration, all those things, you're going to be a healthier person, more resilient.

Dr. Chris Meletis 25:36
Athletic performance, being the best mom or dad you can be living for, I mean, these are investments into our bank account, which you said are non negotiable. If we're not doing the diet right, it's a debit, not a credit to us. If we're not breathing well and we're not oxygenating, it's a debit, not a credit. So I always give the example a health savings account on a daily basis. If I get stressed out, that's a debit. If I'm really stressed as a debit, debit, debit, and then I have to pay back that debt. If I make a mistake, and if the wife by chance went to Crumbl Cookie last night, even though I said I didn't want it, if I succumb to the Crumbl Cookie, I'm not picking on Crumbl Cookie, but they do have a Dubai Crumbl Cookie right now. They, which I just know about by chance. It's like, do I succumb to it? And if so, what do I have to do to make up for my indiscretion?

Rob Lutz 26:25
Yeah, sticking with this foundational, how quickly can foundational changes alone reduce inflammatory burden in your in your experience? Would you say?

Dr. Chris Meletis 26:34
Depends on how long the kimchi pot has been stewing in the ground. If it's been fermenting for a while, it takes longer. And naturopathic medicine, there's a philosophy, if you've had it for a year, it takes a minimum of a month to get it backtracked, and that's assuming everything else is aligned. And rarely, by the time we end up at a healthcare provider's office, are we having just one thing. There's usually a traveling companion of two or three other things that are going on, so we have to tease it out and prioritize it. And one of the things I also didn't mention is making sure a person's bowels are moving regularly. I have so many patients that now are constipated, they don't consider it constipated. My record was on my intake form. I They said that they were irregular. But of course, being a naturopathic physician, I asked more about that. Let's say I regularly go to the bathroom every two to three weeks. I said, what? I said, every two to three weeks, I regularly have a bowel movement, and often plugs up the toilet. So then you start seeing the Bristol stool chart of the hard, lumpy, bumpy poo. And then he's thinking, of course, the sharp contrast of that, does the water, you know, a seven on the Bristol stool chart, well, what happens to that stool? When it's dry, what happened to all that moisture? Well, we reabsorb the muddy water, use that term loosely, and no wonder we feel poopy. So with that, I think looking at how long does it take? So you got the bowels moving, you got the oxygen moving, got the, you know, some exercise going on. A body in motion stays in motion, another important consideration, and then all of a sudden, you're doing and you're seeing improvement. I have questions, what is our measure of success? Is it just improved quality of life, or is it trying to get us back to a previous year or decade in terms of wellness. If we've had lots of joint destruction of course, now going to be a bigger challenge, like if we had osteoporosis versus osteopenia, I've actually successfully had patients with notable osteoporosis go back to osteopenia, and they're in the late 70s and 80s, and we're actually seeing an improvement. So do we treat the lab? And are we just looking to see improvements on the labs? We're looking at improvement of quality of life, and how is the patient feeling, and so treat the patient, not the lab, but the labs are great mile markers know how we're doing on our journey.

Rob Lutz 28:46
What are the signals that tell you patients ready or not ready for targeted supplementation?

Dr. Chris Meletis 28:54
I will give the example of misery. If I'm miserable enough, would I consider doing Advil? And I, let's say I had a podcast with you. I'm no, I know I'm not drugged on Advil right now, ibuprofen. But is there, is there's a time where you just have to, kind of, you know, maybe we have a big road trip, we have a big conference to go to, and so you do what you have to do to get through that. And so, but majority of the time you meet the patient where they're at, if they're new to functional medicine and the concept of gluten free, dairy free, the concept of not eating out of fast food restaurants foreign, we take baby steps. And I'll give an example of a gentleman from Okinawa. He was adopted by Caucasian missionary family, that he was moving towards metabolic disease and then diabetes and but he was staying to his traditional Okinawan diet, which had a large component of carbs and not the fish based aspect of the Okinawan diet. And but yet, he was a desk jockey, and so he was culturally non relative, relevant, what would have worked in Okinawa doesn't work when you're now a desk jockey in the United States. And so for him, I tried to change his diet. I said, Well, you should eat these foods. He was so stuck on eating a traditional diet, so I end up having to do portion control. I said, Okay, you're gonna do rice, you're gonna do pasta, you're gonna do this. I says, instead of two cups of rice, you have a cup and a half, and instead of eating that first, you eat that second. So my approach to dietary control, including weight loss, is you eat your protein and your veggies first. You eat your carbohydrates last. You go to a Hispanic restaurant, you're going to have, of course, chips offered first, and then, of course, some sugary drink is offered or alcohol. And so you don't want to be doing that. You want to be eating your main course. If you eat a steak dinner, do you eat your bread? Because they usually have yummy bread with butter, or do you eat your steak and your green veggies and then you fill up with, and that changes the way your insulin levels are. If I eat a carb right away, it's going to spike my blood sugars, and by spiking my blood sugars, and spike my insulin levels, and then the whole rest of the meal is more in storage mode, whereas, as I tell people, there's no fat cheetahs if you're eating your protein first, whether you're a carnivore or not, and then there's a little space you can fill it in with some carbohydrates. And I think that, not to be political, the concept of flipping the pyramid recently towards healthier proteins and fats and not so much carbohydrates, is an intriguing one, which most of us functional medicine providers have been recommending eating a rainbow of fresh fruits and vegetables and then anything that's down the main aisles of the store packaged, dead food for dying people live food for living people, so shop outside of the store, we tell our patients that all the time.

Rob Lutz 31:43
Awesome. All right. So now let's start to dig into targeted supplement strategies, acute for systemic. So if we think about acute inflammation again, those are injuries or flare short term stressors that you mentioned. When a patient presents with acute inflammation, what's your immediate supplement hierarchy?

Dr. Chris Meletis 32:01
So acute inflammation. I'll use targeted botanical like turmeric, and often I'll incorporate the endocannabinoid system, where they've had stress as well. So I'll incorporate a CBD beta caryophellene, beta caryophellene is very powerful anti inflammatory. I'll incorporate some turmeric, some curry, and once again, look at cultures that have a lot of that in their diet, whether it be whether it be continental India or Thailand, where curry is there, there's been evidence, and there's, of course, a multifactorial aspect of this evidence, but there's less Alzheimer's disease in India. Well, okay, well, is that because they're more vegetarian, they're not eating as much, or is it also that they eat such a large quantity of curry, all things being equal. But so I will use something like a Boswellia, a turmeric and a CBD with high beta caryophellene. But the other big thing I do is I do omegas. Most of us, we and all we all know this. We're Omega six laden. We're trans fat and laden. And along the years, even as children, we've consumed things which we probably not ought not to have been now incorporated into our cell membranes, our BI layer of every cell in the human body, and so we need to improve that. So I routinely will do an Omega 369, fatty acid test on my patients. Only recently have I found one person which happens to have been my patient for 15 years, that did the test, which passed with flying colors, there's usually room for improvement, so I'll incorporate fish oil, EPA, DHA into that program immediately, along with a CBD and some anti inflammatory herbs and dehydration and eliminating pro inflammatory foods, whether those be IGE through allergy foods or IgG, what I call gradual foods. Take E for emergency room, G for gradual. So vitamins have all of a sudden, you and I knew that our favorite food, maybe it was called orange juice, and oranges was problematic, but I have a cold. Should I be drinking orange juice? Have I reacted immunologically to oranges. No, I find another source of vitamin C, like broccoli. So sometimes we, we crave the foods which aren't good for us. And of course, we know that for the diabetic, extreme example of the three P's, polyuria, polydipsia, and polyaphagia, all of a sudden, you're thirsty a lot, you're hungry a lot, and you're just feeding the diabetes. But lots of times we crave the things which aren't good for us. And so I think doing a food sensitivity test, even for an acute issue, if it's they have recurrent, acute issues, or trying to shore things up, are they eating unto their genetics? Of course, there's Peter D'Adamo's work of "Eat Right for Your Blood Type," but we want to go more precise, what's our immunologic response to something? And when it comes to IgG foods, once again, think of G for gradual, that's how I have my patients remember that, it has a half life of 25 days. And so if you all of a sudden, you're like, Well, I don't really feel any worse on that food. How do you know? You've been in the fog bank from the last time you ate your asparagus. Is a silly example. So then you do asparagus again and again, thinking you don't see that immediate reaction, whereas, if you and I had a peanut allergy, we ate the peanut we had an IGE, E for emergency room, reaction. Like, I don't think peanuts are good for me, but so much of the foods we're consuming we don't even know, because they're just part of the fog bank of mistakes made on a daily basis.

Rob Lutz 35:23
So how do you balance resolution of inflammation without impairing tissue repair? Kind of back to what we talked about originally, where not all inflammation is bad, it serves a purpose. So how do you balance that for someone who's coming in with an acute issue, without impairing the tissue repair?

Dr. Chris Meletis 35:39
Yeah, okay, clean up the diet. I mean, if they're willing to, I know they're miserable, and now, now, when you're miserable, you're often not as motivated. But do the hydration. Eat super clean. Often I'll put a person on a little bit of a short term Soup Diet, very easy to digest food. Make sure their bowels are, are emptying, and there's not a whole lot of burden there. And so I'll put them on a very soup diet, and I actually have a vegetable soup I recommend routinely for people, and I just will put them on a soup diet, high vegetables and a good hydration and some broths, and just take that burden off. Because if we're not focusing our energy on digesting, rarely do we have a person that's anorexic or orthorexic that cannot live without a few days of food. And if you think at certain cultures and religious practices, some people go without food for protracted periods of time. So assuming there's not a dysglycemic blood sugar issue that prevents that, like hypoglycemia or medications that require food, I go for a semi fast with soups and so forth, and try to incorporate that. And then teas, lots of teas, anti inflammatory teas. And then we will supplement accordingly. If they're miserable and they have to show up to work, otherwise they're going to lose their job, and then they lose their house, and their kids will go hungry, we'll then give them some other things to implement. From a like I said, a CBD beta caryophellene, a curcumin, a Boswellia, something like that, to help them not feel so miserable. And think of a mom or a dad that's a homemaker. They're, they're Mr. Mom or Mr., or a Ms mom, and they're at home, and they have three little rugrats. They don't have any time off. They still have to show up and do their parental duties. And so then, of course, we meet them where they're at. And so if misery is misery, but if they're heavily motivated, and you get them through the first two or three acute issues, then all of a sudden you have nouveau days, and they say, what more can I do to improve my health? And then we convert them. It sounds like a cult, but it's not.

Rob Lutz 37:40
So let's kind of take the same approach talking about systemic and chronic inflammation. So for chronic low grade inflammation, how does your supplement strategy differ from acute care?

Dr. Chris Meletis 37:50
Oh, yeah, from a chronic perspective, once again, they've been in broken state, or dysregulated, this homeostatic state. They've endured too many debits in their health savings accounts. Then I go very high dose Omega fatty acids, assuming they're not on blood thinners. I go very targeted with addressing stress, because if they've been chronically stressed, and even I might not have a salivary cortisol or urinary cortisol test on them, but they just present as an adrenal fatigue, burnout person. I will then go ahead and get provide adaptogenic herbs, because, after all, our adrenal glands not only control our blood sugars, not only do they, of course, produce our catecholamines and EPI, norepi, that fight or flight or fright response, but they also, of course, provide that hydrocortisone, those 20 milligrams, and I would say 85% of my patients from the age of 25, to 30 onwards, have subpar hydrocortisone levels, and their cortisol curve is low, so they're trying to get through a day with less than 20 milligrams. And that 20 milligrams is for a normal chillax day, like Jamaican, no worries, man, kind of day like, "hey, life is good. I'm on vacation. Everything's perfect. There was no problems with TSA and I got I got all my luck". So life is good and you're on vacation over next three weeks, but you're supposed to be making 20 milligrams a day. That's a physiological dose. And I know that dose very well, because I actually have a patient that's pan pit. So I diagnosed her with Cushing's 20 years ago. She had been told she was histrionic, and she happened to be in the Navy, as a Navy officer, back when Navy officers were not Navy officers in the 50s and 60s, that was female, and they just said One Flew Over the Cuckoo's Nest. I said nah, so I did a cortisol test, found out she had Cushing's. Disease, diagnosed and confirmed by the local neurology and medical school. She actually had a pituitary gland scooped out because she had a huge adenoma that was impacting her vision, and she's on 100% hormone replacement and 100% thyroid, 100% hydrocortisone. But every one of us when we are ill with a one degree temperature need an extra five or ten milligrams of hydrocortisone. But if your adrenal glands aren't producing it, and you're only making making, making 12 milligrams a day, and you get sick, then you got that breakthrough, runaway inflammation that leads to that systemic and chronic aspect that you were discussing. So what has became an acute issue now becomes a more entrenched, larger issue. So routinely, I will give adaptogenic herbs, along with the anti inflammatory approaches of the omega fatty acids, and Dr Russo did some work. Dr Russo is very well known for his research in the Endocannabinoid space, and he found endocannabinoid deficiencies in fibromyalgia and certain pain conditions, no receptive things, and it's like so if you're adrenal fatigued, might you also be endocannabinoid fatigued? Because both get stressed by the same general mechanisms. So I support adrenal and the endocannabinoid system together, and I always like to do it with a high absorption molecules, because not, as we all know, not all botanicals are created equal.

Rob Lutz 41:09
True. What role does mitochondrial dysfunction play in perpetuating inflammation?

Dr. Chris Meletis 41:15
Everything. I love the mitochondria. The mitochondria love us. As we get older, our mitochondria become more dysfunctional, our mitogenesis, you like the word biogenesis or mitogenesis, often decline. Free radical damage is, of course, something we all know is one of the many theories of aging, is free radical damage, and but 90% of free radicals are created by the mitochondria within our cell. And so by taking care of our mitochondria, and I always hold up my phone for my patients, and I have a little iPhone. I'm not promoting iPhones. I have an iPhone. I open up one of my pages show all my apps. And I'm saying those apps are like the DNA in your cells. They tell each specific cell what to do. But if your iPhone, your cell, doesn't have a charge, you have a glorified $1,000 paperweight or plus, plus, and so you have to fuel your free radical, clenching, your pain management, all with mitochondria, because all those biochemical pathways require it. We know, like, for example, NAD is necessary, which is part of that whole mitochondrial oxidase and phosphorylation and the Kreb cycle necessary for 500 enzymatic pathways. So without taking care of your mitochondria, we're in a world of hurt, and we're not going to win any battle because we don't have the energy to do it. So I'm big things like niogen, coQ10, PQQ pyrroloquinoline quinone. Of course, there's a urolithin a that's out there, along with several other things. Punicalagins from pomegranate, which supports the creation of your lipid aid within the gut, back to the gut. So the gut microbiome, of course, is always part and parcel. Many of us that do functional medicine testing will see a section on the functional medicine stool test that says opportunistic, autoimmune considerations. And there are a group of little critters that actually drive, or are potential drivers for autoimmunity and so forth.

Rob Lutz 43:09
And, well, it sounds like mitochondrial support is almost foundational in a lot of ways.

Dr. Chris Meletis 43:16
I think for, I think for everything, to be honest with you.

Rob Lutz 43:18
Yeah.

Dr. Chris Meletis 43:19
Tell me a part of my body that doesn't need some mitochondrial support. He says your red blood cells don't because they're denucleated. Well, the bone marrow that makes my red blood cells need it, or the kidney that has to have erythropoietin to drive the creation of red blood cells and reticulocytes, they, it needs it. So everything is tied into having energy for you and me to talk, to communicate, to drink, to digest and once again, healthier GI tract. So how can you treat a leaky gut without taking care of the mitochondria? And we now know butyrate, that short chain fatty acid actually crosses over that single layer of cells and actually goes into the citric acid cycle. So butyrate actually goes into the citric acid cycle, and actually within that single layer of helping with the tight junctions to support the mitochondria so that the intestinal tract can do what it needs to do.

Rob Lutz 44:07
Makes sense. Okay, so you got patients that are taking supplements, some on their own, but you prescribe the protocol. How do you rotate or layer supplements to avoid diminishing returns? So someone is just taking CBD forever, right? Is that a good thing? Is it a bad thing? Or do you rotate? What do you do? Or is it just keep taking all these things?

Dr. Chris Meletis 44:28
I mean, I can tell you, and I think all of us on this, you know, listening to this podcast or participate in the podcast know about pill fatigue. We have to create a program that's sustainable. Compliance is key. When I first graduated, I told, told my patients, so imagine you and me 30 years ago. I said, Well, Rob, take your pills three times a day. Well, guess what? Compliance was near zero, because three times a day is pretty hard for people. And so then I said, Okay, well, let's do it twice a day. Well, compliance went up, so I stick with twice a day as a compliance point, morning, afternoon, evening, right? Something like that. And then. And it's like, what do we need that's endogenous to the human body? So whatever the human body makes au naturale, anandamide, into AG, it has CB, one, CB, two, 5h, one, aa, GPR pathways all for the Endocannabinoid. So is that something that we can just gradually support on regular basis? Yeah, do we make essential fatty acids? No, we don't make essential fatty and so why they're essential. But now from our essential fatty acids, we can make resolvins which are anti inflammatory, and there's enzyme pathways there. So once again, that's innate vitamin D research at Oregon State University, and Linus Pauling, type in Linus Pauling OSU, Oregon State University. And they have this whole department dedicated to nutrition. And you can see all the clicks of the peer review literature, anti autoimmune, inflammatory, cardiovascular disease. So once again, vitamin D, we make it in our body. Things that are essential, the essential amino acids, essential fatty acids, those are ongoing investments. And then the anti inflammatory aspects of herbs, like curcumin, turmeric, if you have a chronic issue or systemic issue, yeah, it's a long standing thing. And so in front of me right now, I have a product, which is a CBD curcurmin, highly absorbable from a company work for and I would continue taking this product because has over 400% bioavailability compared to a normal CBD, plus it has been made a beta caryophellene. I our body makes co Q 10, so I have a highly absorption, absorbable co Q 10 happens by the same company, and it is over 400% more bioavailable than any other Ubiquinol in the marketplace, proven for peer review literature with European technology. And I do the same thing with my omegas. Investing with high absorption capacity, like one of my omegas is equal to nine of the regular omegas out in the marketplace. Those are the standards. Vitamin D is a standard, the endocannabinoids. And then I add other things, like I have fatty 15 in front of me. I have omega seven from C buckthorn, a plant in front of me. Those are just ongoing things. And then a good multivitamin. Everything else is individualized, in my opinion.

Rob Lutz 47:16
So you got your kind of foundational supplements that you take, and.

Dr. Chris Meletis 47:19
Then I have another 20 bottles of pills I take as needed.

Rob Lutz 47:24
That's great. All right, so we've talked a little bit about CBD, and, you know, I think there's a lot of practitioners of high interest, but there's a lot of confusion around CBD, so maybe we just spent a few minutes talking about CBD in clinical practice. You know what a practitioners need to know. So I've got a few questions around that that hopefully will tea some of that out for us. So CBD is widely used but poorly understood. How do you explain its role in inflammation to patients?

Dr. Chris Meletis 47:50
Patients and colleagues, for that matter. So until the work of Mechulam and his colleagues in 92 and the endocannabinoid system, really don't know. I'm at a trade conference, and I'm speaking on CBD, or a beta caryophellene or the terpenes, and we weren't taught it in school. I mean, most of what I've learned, and unless you were just a recent graduate, we didn't learn about the endocannabinoid system. We didn't learn about most of these cytokines pro inflammatory or anti inflammatory, because some cytokines are anti inflammatory as well, and so first and foremost, it's endogenous in our body. Your cat and dog also have an endocannabinoid system. In fact, you'll see a lot of pet products with CBD in it. But the qualty of it really is questionable. I've written a 10 chapter book, which you could put a link on if you want to. It's free. I'm not looking to make any profit off it, on the endocannabinoid system. And the reality is, it has a multitude of benefits, most of which we don't even fully realize. It's still a burgeoning field, just like recently, on a random off the wall point, we have just found a new salivary gland in the human body, 2020, 2020 is when it was discovered. It has been validated, and it lives, the salivary gland lives in our sinuses. And after all the dissections and all the study in the human body, they discovered a new salivary gland. Like, what the heck? Yeah. And just like I graduated from school, we thought the blood brain barrier was impervious. Now we know leaky gut, leaky brain, right? And we know that a lot of things crossover, and we also have a microbiome of multitude. In fact, one of my other free books, the microbial mucosal milieu, describes the skin microbiome, the oral microbiome, the prostate and vulva and uterine microbiome, and potentially a blood and brain microbiome, of course, a lung microbiome as well. So it's like everything which we didn't know now we know, and so then it just keeps us humble. What don't we know? Pretty much, probably everything. I know that the human body has needed for millennia and has pathways in what I call catcher mitt receptors are the catcher's mitt. It makes his own ball and plays catch with itself. Probably want to support that. And so the cannabinoid system, CBD and beta caryophellene, for example, which is also anti inflammatory. We live in an inflamed world, and we live in a stressed out world, and most of us don't have the adrenal capacity to quench the fires like we ought to. We're not in Shangri La or and so I tell my patients, they ask me, What should I do? I says, retire. If you can go to an island where they have small little waves, a nice tropical breeze, where you have enough money, where unplug, unplug from the world, and watch the waves, get your daily massage, get your fresh smoothies, and I can tell you, 99% of my patients will have great adrenal function. They'll feel great again. Once again, we have the benefit of modern living. So imagine ancestrally, go back two or 3000 years, where they weren't just foraging and hunting and gathering, but they had the benefit of just fresh air, community with nature, pondering life, and then, you know, that's called healthy. And I think that's one reason we see the older generations. You and I've talked about our parents, and they're resilient. I mean, when we see an 80 year old or 70 year old or onwards, and we're saying, like, wow, they're tougher. They keep on going much better than some of our teenage, teenagers, young people. Our young people are often not as a good health as a 70 year olds. What the heck? And there's a big question like, why is that? It's because organic food was food was organic. We didn't hide from the sun with, you know, all the sunscreen, with all the nasty chemicals and 1950s Better Living Through Chemistry, so we're living in a dystopia of having advanced so much but regressed because we've lost our way from nature.

Dr. Chris Meletis 48:36
Yeah. What inflammatory pathways does CBD influence that differentiate from NSAIDs or botanicals?

Dr. Chris Meletis 49:45
It works more on a fundamental level. So we have, of course, with the NSAIDs, we often look at cyclooxygenase and lipooxygenase. There some overlap there with those. Anadamide has actually been shown to help with those pathways as well, but they're helping not with a handout or a bull in a china shop approach is helping, for like condition them to actually have them work more efficiently. And in fact, it's shown that with anti inflammatories like NSAIDs like let's give ibuprofen or indomethacin as example, one of their mechanisms, the same thing with Tylenol, which is not an NSAID, is that actually they work by conserving anandamide, our natural endocannabinoid. So wouldn't it be greater to have us really well conditioned like an athlete? And what do they say as we get older, our biggest risk is lower grip strength and lower lower leg strength, because those are the things that increase our mortality and morbidity. And so once again, why not condition those natural pathways? And so that's what CBD beta caryophellene, the terpenes do. And what's became very popular over the last 20 years, and also as functional medicine providers have seen it. We as consumers have seen it, all the essential oil companies. Well, there's a lot of terpenes in those essential oils, and it's one of the many things that flow to our boat there too, is those essential oils. So and once again, a full spectrum endocannabinoid CBD extract would provides a lot of that. I always wanted to make sure we have some beta caryophellene in there. And what is absorbable, opposed to not absorbable, the worst thing to ever take is a supplement that looks good on paper. The label looks good, the bottle looks good. It was surely expensive, but there's no research showing that it's actually going to move the needle. And so when you see a 400% improvement in CO Q 10 bioavailability, a 400% improvement and essential fatty acid, Omega 3 absorption with European based fish oil or CO Q 10 delivery, or endocannabinoid delivery, why wouldn't you built for something that you know they've done the pharmacokinetics and pharmacodynamics.

Rob Lutz 54:05
Right. That's the bezi sort, right that you're talking about.?

Dr. Chris Meletis 54:08
Yeah.

Rob Lutz 54:08
What conditions have you seen the most consistent results with? So there's pain, neuroinflammation, autoimmune flares, sleep mediated inflammation, any of those, or anything else that you see really consistent results when you're using CBD in your practice?

Dr. Chris Meletis 54:25
Well, I would answer that with we've gone back to the foundation. If they're doing their foundational work of hydration and sleep and addressing the adrenal function, making sure they're not eating inappropriate foods for themselves, I see improvement generally, across the board on all of those and then I look at the supplementation as icing on the cake to the cherry on top, it takes the last little bit of edge off. But let's say they have osteoarthritis. I have an 85 year old friend. He still does 200 pound free bench press at 85 years old, and he is an Adonis of a fellow and but he has osteopenia of the neck. I can guarantee you the rest of his body is not osteopenic because he's doing weight bearing. But guess what? His neck doesn't do weight bearing. So, and so they were saying, Oh, we're going to give you bisphosphonates. We're going to give you drugs to help, well, the osteopenia of your neck, like, okay, probably not your issue. Well, we need to make sure D is good, make sure X, Y, Z is good. He happens to have, for the last 20 years, slept on a ramp because he didn't want to address sleep apnea. So he figured if I sleep on a ramp, that might address it, but he didn't want to get tested. And him and I just after it a little bit on it on text message, well, hey, I told you this 20 years ago, I'm going to tell you again, get the test. Here's a link, right?

Rob Lutz 55:41
Exactly.

Dr. Chris Meletis 55:41
And it's like oxygenation. But if you do those things, I see invariably good improvement across the board. There are some challenges where there's such dysregulation, either genetically, and we look at epigenetics, you know, diet and lifestyle in those environments. We can't always leave a stressful environment, a stressful family dynamic. We were born into a family, and they come to our various gatherings, but we don't necessarily want to invite them. It's kind of obligatory. So there's just some stress in our life. And once again, don't turn on the news. News fasting is one of my recommendations, because the talking heads are always stirring the pot for every side of the conversation. It's like, Oh, we got ya, we got ya, we got you. Yeah, you got me to use adrenal function and brain chemistry with your little talking point. I already know that the world's a hot mess, so I don't have that kind of extra bandwidth, and none of us do, to be honest with you, so and then circling yourself with good friends and family, I think that's another thing. It's they've shown that with the centenarians, they had a circle around them, and the centenarians are the ones that were able to beat the inflammatory process. They were able to eat and consume healthy food and in a mindful way. So if you and I were to sit down right now in the middle of our podcast and try to digest our food, not going to be as good, because we're focused our energy, our focus on communication and sharing our passion. But now, if we have some Mozart going on, or we're looking over a Mediterranean from Mediterranean villa, and there's a little music going on, and then all of a sudden we have that gastronomic experience where we salivate, we get our digestive juices, but our sympathetic and parasympathetic nervous system is so dysregulated, so mindfulness, making sure you're present in the moment. You're enjoying the moment. Because right now, our moment is only moment we have that's guaranteed.

Rob Lutz 57:31
Right. Okay, so let's now talk a little bit more about personalization and protocol design, thinking about frameworks, not necessarily formulas. How do you personalize inflammation protocols based on genetics, gut health or immune phenotype?

Dr. Chris Meletis 57:45
Yeah, so what part of my intake form is always, Hey, how are you digesting? You have acid reflux? Do you have trouble digesting food? And I asked a lot of details about what comes out the tailpipe in terms of amount of gas, amount of burping, undigested food, below distension, because we're not fueling the body, just like we're not fueling our automobiles, we're not going to get performance. So food is our medicine. We've heard it 1000 times. It was attributed in the western world to Hippocrates 400 BCE. And I give the example, most likely, he came home one day felt crummy. His wife or partner said, "Hey, eat some food. You'll feel better." "Oh, I should write this down. Food did make me feel better, right?" So the right food, not the wrong food. But I think from a foundational perspective, I we all play detective as functional medicine providers and as all providers. So what makes it better? What makes it worse? Always ask them that question. What have you been doing lately that might have made it flare up, because they know they're, they're giving us the answer, because they're, the human body, you know, if you put thought to it, like, well, I did have pizza last night, and it wasn't the best pizza, and there was gluten in it, and I had garlic, and garlic, in case of my case, always messes me up. And it's like, okay, well, I kind of just diagnosed myself. But once again, from a simple perspective, have them, the patient, tell us what they know, flares things. Avoid those flares. If it's a nightshade family, it's nightshade family. If it's not drinking enough water, if it's not pooing enough, it's not sleeping enough. Well, of course, you look at the word restoration or restore. First four letters is rest, so we're not rusty. And then omegas, the vitamin D, the vitamin C, cat or dog makes vitamin C. Guinea pig makes vitamin C. A Capybara does not make vitamin C. Oh, a guinea pig does not make vitamin C, rather. A capybara does not make vitamin C. Humans don't make vitamin C. Primates don't make vitamin C. And the front vented Bulbul bird does not make vitamin C, so, but all other creatures make vitamin C, hmm. Think Vitamin C is important. Well, how our monkey has to have 88 milligrams per day per kilogram of their body weight. So we compare ourselves to our monkey, and we weigh 70 kilos. That's about 5000 milligrams of vitamin C a day. Some of you know have kidney stones. That's a lot of vitamin C and, and you would want to taper that off, because I will share a silly story. I visited a small zoo that had rescued chimpanzee, and I found out that chimpanzee, that was a female, was in heat, and I was wearing a Kid Rock black T shirt with gold on it. And apparently when they're amorous, they will throw their poo at you. I apparently was very attractive to this chimpanzee, and I got a face full of chimpanzee poo. I can tell you, there was a lot of vitamin C and fruit there, and so once again, it does cause it to be a little bit mushy. So too much vitamin C, you get the mushes. A silly little story, but it was a humbling at the time, and I can tell you that it was some semi fermented poo as well, from what I could tell. It's humbling. That's all I can say.

Rob Lutz 1:00:48
Yeah.

Dr. Chris Meletis 1:00:49
And we went back to that Zoo 20 years later, chimpanzee was still there, and I walked up to that exhibit, and she made a vocalization that no other person was able to elicit. Apparently, I still had her heart.

Rob Lutz 1:01:03
Lucky you.

Dr. Chris Meletis 1:01:06
Lucky me. Hey, but hey, we bonded over the poop. So I think vitamin C, vitamin D, kind of recap of the same things. I don't really have anything to add to that, other than support the endogenous pathways, support the essential nutrients, and, honestly, a multivitamin. I mean, even the standard USDA and national departments of health and all this have commented upon, there's we're low in one or more micronutrients, but now we get to selenium or molybdenum. Parts of the Midwest are so low in molybdenum they have a 1/3 higher risk of esophageal cancer. And then what about chromium and blood sugar dysregulation, a factor we eat more carbs than we ought to. So once again, a good multivitamin. So I got a one a day multivitamin from a professional company, and I take my one a day multivitamin, and when my guts gets thrown off, I take my probiotics. There's no question. And then when my guts really thrown off, I will add a product that is IgG extract immunoglobulin to bind up the endotoxins and lipopolysaccharides within excess dysbiotic production, because lipopolysaccharides are created by certain bacteria, including E. coli, and so I actually have binders, charcoal and other things that I, when I know I've did a faux pas, consciously or subconsciously, I bind up my mistakes as quickly as I can and throw down the friendly critters to do battle.

Rob Lutz 1:02:30
And how well should a practitioner expect before meaningful clinical shifts occur? So you're working with a patient, and I know it's going to depend on the patient, but you know what's kind of a general timeline to see some results?

Dr. Chris Meletis 1:02:41
Back to a minimum of a month of diligence once they clean up their diet and lifestyle and they've been supplemented properly, a month for every year that they've been dysfunctional, is usually my rule. I think creating a realistic expectations for patients. Patients come in thinking, well, if I take this drug, let's say, if I gave that person in chronic inflammation, 20 milligrams of prednisone or four milligrams of methylprednisolone, a methylprednisolone pack, I know I'm going to get to feeling better, but it's a false narrative, because they're drugged to wellness. And since we're being compared, from a functional medicine perspective, to the magic of pharmaceuticals, and I prescribe these medications at times, if I have a patient with severe bronchitis moving on to pneumonia, yeah, they're gonna get a methylprednisolone pack. If they're slipping and they're not better by that mid 10 day period, five days, they're getting worse and worse and worse, I'm not going to have them die because of my philosophy of like, oh, I don't want to do drugs and or if I knew that they've been in during a lot of stress at work or at home life. I know their hydrocortisone levels are low. I'm going to augment that in the short term, very short term. It's a long term use of interventions that usually come with side effects.

Rob Lutz 1:03:53
Okay, so starting to get towards the wrap up here, but want to talk a little bit about clinical pitfalls and some final takeaways. What are the most common mistakes practitioners make when addressing inflammation?

Dr. Chris Meletis 1:04:05
Not going hard enough. And that's where we tell the patients to do the hard work. And they get, invariably, my protocol of the sleep and hydration and making sure they're pooing a couple times a day, ideally, and they have a Bristol stool chart of two of around a three and a half or four, never a one, two or three, and then making sure that they are focused on mindfulness and that they're adding to their health savings account. And so a lot of my patients are entrepreneurial, they're business or executives, and I get them to start thinking spreadsheet. On your spreadsheet on a daily basis, have you added or subtracted? And have you been subtracting for a protracted period of time? It's time to start adding in an aggressive way and then other things. Dosing. If I just do one omega fatty acids, it's gonna take a lot longer to rehydrate the sponge, so to speak. Or if I just do a few drops of water. Is it going to rehydrate the sponge? So because I have chronic inflammations, is a topic very near and dear to me. I've been battling it for a protracted period of time, whereas a person that comes in healthy and well and just looks for a maintenance program, one best is an omega. For me, I take three vessels of omega. I've also added the fatty 15, and the 7, because I'm trying to go from several different approaches and see what moves my needle, and we can, once again, tweak the labs. We can see, okay, these things are improving, but ultimately what the patient wants is, I don't care how good their paperwork looks like, and they want to "I feel that. I feel more alert, I have more quality of life." Because I think most of us would agree quality and quantity and we had a choice of having really good years or just having a lot of years. We want really good years.

Rob Lutz 1:05:48
I agree. So, you know, maybe this is the wrap up, the clinical pearl of the podcast today. But if you had to summarize your inflammation toolkit into three guiding principles, what would they be? I think you talked about them, but if you want to just kind of bring them up, summarize them, what would they be?.

Dr. Chris Meletis 1:06:05
Avoid triggers first, always, you know, remove the splinter. If you know something is causing your finger to be inflamed, address what that is. If it's because you have a big old splinter there, you do all the pharmaceuticals, Tylenol, Advil, you can do pain meds. You do opioid and, Oh yeah, well, my finger feels better, the moment you're off the med, you're like, oh, still got a splinter in my finger, it still hurts. And so remove the obstacle, address the cause, always foundational. And then number two, after avoiding the triggers, is build the foundation. And you did a great job of asking that question multiple different ways. Fuel the body, support the body, give it the kind of performance, performance enhancement you expect. So the rest the sleep, the oxygenation, the hydration and the good food, no, 99 cent gas. Okay, I would love to fill a car for 99 cent gas, but I would worry for the rest of my driving experience until that tanker was empty, what I just do to my car? And likewise, we should be asking that question, what I do with that special deal at the fast food restaurant? Food versus food stuff, so to speak. And then the other thing, which we often are very afraid to speak about, is that mindfulness side of things, whether it be church, being your best to be in nature and unite, great. I go out of nature, I feel like I'm communing with the universe or God, or it's mindfulness. It's positive affirmations. And one of the affirmations that I recently saw, and I will pull up on my phone here, because you just got me to think about it. And I do a lot of saving of affirmations, having daily affirmations, and starting your day out with positivity is important. And so this is one that I just found, literally on social media, "act like you're blessed, talk like you're blessed, walk like you're blessed, think like you're blessed, smile like you're blessed, live like you're blessed, and you will be blessed. Read that again you will be blessed." And once again, "attitude of gratitude, it's not the half empty, half full. I have what I have this very moment, and I'm going to appreciate being in this moment." And every cell in our body hears our thoughts and our words, every cell so if you're feeling like you're be a quiet Eeyore, and it's better to be Pooh, a little Tigger ish, and sometimes we have to fake until we make and I think most of our patients know that, and I think we all do. It's like, okay, yeah, so we keep on, perseverance wins the race. I tell my patients, keep on doing it. And I tell them the success stories. I said, individual results will vary, but they need hope. And one of the things which most of humanity doesn't have right now is a whole lot of hope. So we're really messengers and conveyors of hope and the realistic constructs that their body, their human body, has to be in agreement.

Dr. Chris Meletis 1:06:06
It's awesome. Well, thanks again, Chris, this was a great episode. I really appreciate all the insights and information that you shared. I appreciate it, and we'll see you next time.

Dr. Chris Meletis 1:08:58
Hey. Thanks for having me.

Rob Lutz 1:08:59
Thank you.

Rob Lutz 1:09:01
Thanks for listening to the OneMedicine Podcast. I hope you found today's episode interesting and came away with a few insights you can apply to your practice. If you're looking for the show notes, they can be found in the link below. You want to go deeper on this topic or anything else, please visit todayspractitioner.com and consider registering for our weekly newsletter as well. Thanks again, and I hope you'll join us next time you.