Ronald L. Hoffman, MD, is recognized as one of America's foremost complementary medicine practitioners. Dr. Hoffman received his Bachelor's Degree from Columbia College and his MD from Albert Einstein College of Medicine. He was trained in Internal Medicine at the Manhattan VA Hospital. He subsequently attended the Tristate School of Traditional Chinese Medicine and obtained New York State certification to perform acupuncture. He is a Fellow of the American College for Advancement in Medicine and the American Academy of Environmental Medicine, and is a Certified Nutrition Specialist of the American College of Nutrition (ACN). He was founder and Medical Director of the Hoffman Center in New York City, and now maintains a private practice there. Dr. Hoffman is also author of numerous books and articles for the public and for health professionals, and is host of the popular nationally-syndicated radio program Intelligent Medicine, and the Internet podcast of the same name—the longest running physician-hosted broadcast. He currently serves as President of the Alliance for Natural Health (ANH) and of the Board for Certification of Nutrition Specialists.
Robert Rountree: When reading your bio I was surprised to find you were originally from Southern California. I've known you for many years, and always assumed you were a hardcore, quintessential New Yorker. How did you get from SoCal to Columbia University?
Ronald L. Hoffman: Well, people always say, “What the heck are you doing here?” And, my California buddies that I grew up with, say, “How did you end up in New York?” I sort of think that I was really a New Yorker who was erroneously born in California. I had a New York spirit. I like the grime and the stress and the intellectual climate of New York, the seasons. So, I went to college in New York, and I just stayed. A lot of folks went East to go to college, but they gravitated back towards the West Coast. Because, yeah, we did grow up in paradise. California's a beautiful place. But I ended up here and it's been a fruitful life force for me. Because, so much of what I do is rooted here in New York.
Dr. Rountree: Is it fair to say that New York is the kind of place that challenges you—both personally and intellectually, and that out of those challenges comes more perspicacity, more discrimination, and the ability to look beyond the status quo, to think outside of the box?
Dr. Hoffman: Well, first of all, New York, when I started—and I started integrative medicine in the 1980s—was already a hotbed of integrative medicine. There's a long tradition of integrative medicine in New York. This is a generational thing. Not many of your listeners will recall Carlton Fredericks. But, Carlton Fredericks was a big deal in New York. He was especially a regional celebrity, but I think he might have been syndicated across the United States.
He was a big deal in New York. He was very instrumental in laying the groundwork for belief in an integrative approach. Then he teamed up with Dr. Atkins. And, of course, he became a low carb apostle. That was in the era when we were talking low fat diets and bad cholesterol and all that stuff. He disagreed with that. He and Atkins, ultimately, I think were vindicated by what we're now discovering about the impact of diet on cardiovascular risk and metabolic disease.
Dr. Rountree: How did you come to hear about Dr. Fredericks and Dr. Atkins? Were you introduced to them during medical school or early on in your career? At what point did you start getting, shall we say, radicalized?
Dr. Hoffman: Well, that's a good question. What happened was I went to college and I had no notion about nutrition and I had no desire to get into medicine. I was a liberal arts major, majored in anthropology, took a lot of foreign languages, and minimal sciences. I'd been a science whiz in high school, but I burned out on that. When I graduated, I worked for the city of New York for a while. And, during that time, I cultivated a lifestyle where I was into macrobiotics. I shopped for my whole grains and my adzuki beans at a place called Integral Yoga in New York. I learned acupuncture, did yoga, studied homeopathy and herbal medicine. This is well before I decided to go into the medical field.
And then, I said, “Do I really want to be a New York City bureaucrat?” I figured that by the time I was 45, I could be Assistant Commissioner of Sanitation in the City of New York. I didn't see that as a rewarding a career path. So, I decided to take a whole bunch of science courses. I had to play catch up, applied to medical school, and got in. But I was already oriented towards integrative medicine. So, I was a little bit of an outlier in my class. I remember being head of something called then Nutrition Study Group in medical school where we would actually sample things like tofu and tempeh.
In those days, it was all about a low fat diet. We explored alternatives and talked about the impact of diet. After I graduated, I went into a residency program where I remember bringing my macrobiotic lunch to the hospital. So, I was a little bit of an outlier even in those days. Then at the end of my basic training there, the question was, which “ology” would I specialize in? I talked to my advisor and he said, “You have a very promising background. Which type of fellowship would you like to pursue?” I said, “Well, I think I'm just going to go into the field of nutritional medicine.” I remember my advisor looking at me for a moment. He was silent and thoughtful. Then he said, “Do you mean that you'll be sitting in front of patients all day and talking to them about what kind of food they're going to eat?”
I said, “Well, there's more to it than that. But, yes, basically.” And, he said, “Oh my goodness.” He said, “You won't make much more money than a psychiatrist.” Which I guess was considered the lowest rung on the medical totem pole, spending 45 minutes in sessions with patients listening to their troubles. I didn't look at it that way because we already had role models that I could follow. There was Dr. Atkins and a smattering of integrative doctors in New York already. I just decided to venture forth and open up a private practice in New York. That was in 1984.
Then my influences were on the radio. I would listen to radio programs. Dr. Atkins was on the radio, Carlton Fredericks was on the radio, Gary Null too. Ultimately, Carlton Fredericks passed away. I got a shot at a radio program, which was initially like a half an hour, then became an hour. It was on weekends. Then it became a daily radio program and on weekends. I was doing six days a week. So, I had a lot of time with Q&A programs and guests in the 1990s. I had a continuously running radio program weekdays, which was pretty demanding because I had a daily practice as well, until the early 2000s.
Then it became just a weekend radio program. Podcasting was becoming a thing and I said, “Look, I have the momentum to do this. I'm just used to sitting down and doing a daily discourse. Let me just get into podcasting.” Podcasting was a new thing then, but now it's established. Now, I generate three or four additional podcasts in addition to my weekend radio program. And I'm still cracking away at it.
Dr. Rountree: I remember talk radio in the early days as being fairly independent. It wasn't run by big corporate conglomerates that bought up all the stations and then started dictating the content. So, you probably had a lot of leeway about what you could talk about.
Dr. Hoffman: Yes, I did. I actually had a lot of independence in terms of what I was saying. It's interesting because I flew under the radar a lot with the radio station. I could talk about these edgy things. I sometimes got into trouble because I would call out things that might conflict with sponsors. But the revenue was coming into the radio station. They were just happy that they were making money off me.
Dr. Rountree: I imagine you had callers asking you all kinds of questions about health issues that were not being answered by mainstream docs. Right?
Dr. Hoffman: Exactly. I just really enjoyed that because it keeps me on my toes. I have to be very eclectic and keep up with all the latest advances, not just in integrative medicine. They'll say, “Well, I've had this procedure, or I'm considering taking this medication,” etc. So, it really is a challenge to survey the whole breadth of medicine. That's why we call the program Intelligent Medicine. It's not just about integrative therapy. My bias is towards integrative therapies, but I also want to comment on conventional therapies, some of which are very promising, some of which are really over the top toxic, really complicated and expensive, and there are preferable natural alternatives.
Dr. Rountree: Those complicated, expensive therapies have now morphed into biologics, monoclonal antibodies, etc. Everything seems to have gone in the wrong direction in mainstream medicine in the sense that interventions have gotten progressively more costly and highly targeted to block specific physiological pathways without addressing root causes. Given that you've been doing this podcast for around 30 years, what kinds of trends have you seen?
Dr. Hoffman: Well, if you go back to that time, medicine makes tremendous advances and the technology is just exploding. This career is a gamble, as you know. You've been on this path for a long time yourself. There was the possibility that by 2015 or 2020, we would come up with safe, reliable, plausible cures for all the major diseases that afflict us in the United States. Cancer, cardiovascular disease and stroke, diabetes, cancer, and so on. But that hasn't happened. We also sort of saw this illustrated with COVID, that COVID was an unprecedented challenge. There was an opportunity to show that conventional medicine was far superior to things that we talk about, natural resilience through healthy diet and exercise and certain nutraceuticals. But they flubbed it. When it comes to COVID, the messaging is really poor, the vaccines and therapies had equivocal benefits and it was not exactly a resounding triumph for conventional medicine.
I went through the AIDS era when I first went into hospital practice. Unfortunately, it was the time when AIDS was rampant. I came on the scene in the early 1980s. And AIDS hit. We didn't really know what to do about it, and people were dying. That does represent a triumph of sorts for conventional medicine that we have come up with pretty effective therapies to, at the very least, keep people alive. Now, there are side effects and there are potential problems associated with these therapies, but they're very effective for a disease that was uniformly fatal.
So, I'm not saying that conventional medicine is without some real incredible breakthroughs. I'm just saying that overall, what we're seeing is that while there are many positive things, there's still tremendous demand for natural alternatives. Being in this type of career was a gamble because it could have been that by a certain time our services would be obsolete because conventional medicine would reign supreme. We can't just rely on the eccentricity of people who don't want to do plausible conventional treatments to be our patients.
Dr. Rountree: You've written maybe a dozen books now, correct? The topics are wide ranging, from mitral valve prolapse and dyspepsia, to ADD and fatigue. Those are all areas where conventional medicine really hasn't made much progress.
Dr. Hoffman: Right. There are symptomatic treatments. But, if those were totally effective, then we wouldn't be seeing patients. Right? You do a lot of work with GI problems. I do as well. Many patients have been to top gastroenterologists with inflammatory bowel disease, with GERD, etc. Either they're getting incomplete relief or the side effects of the treatments that they're getting are just too overwhelming. They are looking for a natural, more wholesome way of addressing their problems. But these are not quick fixes. They involve exceptional patients who are willing to make lifestyle changes. The majority of the populace doesn't have a lot of buy-in for that, unfortunately. But I think people who are well-informed and intelligent are an important market for us, that they are looking for a better way.
Dr. Rountree: One thing I've noticed about your Intelligent Medicine Podcast is that you're very meticulous about citing the published research. “Where's the evidence? What do the papers show? What are the pros and cons around trying different interventions?” That is a big pushback against mainstream experts who say, “Oh, well, there's no evidence that any of these nutritional or integrative therapies work.” Let's pick vitamin D for example. I keep reading articles saying there's no evidence of vitamin D's importance. I'm baffled by this. Why are we still debating the value of an essential nutrient like vitamin D?
Dr. Hoffman: I've seen editorials in major medical journals saying we shouldn't bother giving patients supplemental vitamin D, and we shouldn't even bother testing for it anymore. It's just not cost effective. Let's put that one to bed. Then fish oil, no value. This is the last word on it, a study where fish oil comes up short. Let's close the coffin lid on some of these things. Multivitamins, not beneficial. That's just not scientific. If we were to say, “Look, pharmaceutical medicine, just don't go there. I mean, it's too toxic. It's too dangerous. No way no how should you be on any kind of medication.” That's equivalent to what some of these medical journals and media outlets are saying, when they say, “Well, it's basically unproven. It's all bunk.”
Dr. Rountree: I was giving a lecture recently on mitochondria during which I mentioned that statins should be prescribed with caution because they can inhibit mitochondrial function. But then I qualified my remarks by saying, “Look, I confess, I have and still do prescribe statins when appropriate.” I'm not rigid or dogmatic in my approach. I recommend what is necessary depending on the individual patient's needs.
Dr. Hoffman: Yes. Me too. I think we need to be discriminating because our medical training teaches us that there are some tools. But I think that the real role of a doctor is to be sort of a gatekeeper and to be discerning about the therapies that are out there and independently evaluate each one to see if they're suitable for our patients. I think it's in some ways comparable to being a financial advisor. There are a lot of financial products out there, and some of them are really bogus. I think ethical and responsible financial advisors who are not basically bribed by companies to select certain financial vehicles, give impartial information to their clients. Unfortunately, we're seeing a lot of incentives for doctors to prescribe medications. They're getting goodies. They're getting trips. They're getting kickbacks. That's a terrible conflict of interest.
Dr. Rountree: Absolutely. So what do you do when you're confronted with a common problem, like hyperlipidemia, and you want to get to something resembling an objective truth about how aggressive you should be in your treatment recommendations? Should you go straight to pharmaceuticals or is there value in trying diet and supplements? There's bias on both sides of the fence. How do you find up-to-date, scientifically reliable information that you can trust?
Dr. Hoffman: That's such a great question because right now, I'm writing about this issue. The new kid on the block for cardiovascular risk is something called ApoB (apolipoprotein B), as you well know. What it reflects often is risk that is concealed within a relatively reassuring LDL count. We know that cholesterol HDL, LDL, tell us certain things, but they don't really speak to risk. ApoB is considered now a new kid on the block. But what I'm going to point out in the article is that while some people now have called for kind of a jihad against ApoB, we should be screening people very aggressively for ApoB. We now have not only statin drugs, we have even more powerful drugs, the PCSK9 drugs that can literally obliterate your LDL, take your LDL down to low double digits, 20 or 30. That we could eradicate heart disease if we simply screened everybody for ApoB and then lowered it drastically. Because that would mean that no sticky, dangerous particles would adhere to our endothelium. Heart disease and stroke would be things of the past. Well…
Dr. Rountree: Some experts are saying there's no lower limit for how far down we should take a person's LDL.
Dr. Hoffman: Exactly. We call it cholesterol limbo. How low can you go? So, the flaw in that argument is, number one, that would be incredibly expensive. These drugs are costing tens and tens of thousands of dollars a year. $60,000, not uncommon. They're fine for people who have really out of control lipids, or for people who've had heart attacks or really advanced cardiovascular disease. They might make a difference. I, like you, am not totally averse to their use. But I'm going to cite the case study of a woman in my practice who's mortally afraid of cardiovascular disease, with a strong family history of cardiovascular disease. What we did with her is perform a full lipid panel. We found her ApoB was kind of high. It predicts risk. She's 69 years old. And, at 69, we can expect a woman to live maybe another 20 or 25 years, possibly.
So, during that time, that ApoB might be working away at her arteries and giving her a heart attack and prematurely hastening her death. But we did imaging. Imaging doesn't lie. Imaging can tell you that you have some degree of plaque or a high degree of plaque, or virtually no plaque. What we found is, six ways to Sunday, her coronary calcium scores were zero. Zero in all arteries.
Then we said, just for good measure, “Maybe just some of the plaque is forming in your carotid arteries.” But also zero. No plaque. Paradoxically, she has on-paper risk. But, as you know, and I think this is one of the messages of integrative medicine, which is a beautiful and functional medicine—that we're not just a series of numbers. We're a concatenation of many, many, many effects. Some of which may only be discovered in 2040. There may be protective factors that we don't know about yet.
She's thin, she's active, she takes vitamins, she's not diabetic, not hypertensive. She's got all that going for her. Merely because she has the ApoB that's high, I'm not going to drop a bomb on her with a powerful statin or PCSK9 inhibitor because theoretically that's the panacea for heart disease. We're taking just a very linear approach to problems which are very, very complex and multidimensional. That's why I think we have to be discerning in our approach.
Dr. Rountree: You're treating the patient and not a set of numbers.
Dr. Hoffman: Personalized medicine, big time. Absolutely.
Dr. Rountree: I heard a podcast with Dr. Tom Dayspring talking with Dr. Peter Attia about treatment of hyperlipidemia. They went into great detail about how the numbers are the only thing that matter. The person's overall state of health or mitigating circumstances didn't seem to be a factor.
Dr. Hoffman: Specifically, I'm addressing Peter Attia because Peter Attia, by the way, I think is brilliant. I listen to him. It's a little bit like I'll listen to sometimes cable TV from an opposite perspective to my political perspective. Because I want to hear what they have to say so that I can make an informed decision. It's unpleasant sometimes, but I subject myself to it. I listened to Peter Attia and Peter Attia is brilliant on a lot of subjects. But he's absolutely fanatical about taking certain medications for cardiovascular prevention. And he shares that he has a plaque score of seven or nine—very, very low. He takes not only a statin, which should suffice if you want to be very aggressive, but also a PCSK9 inhibitor. He's like a human guinea pig for a proposition that I think is questionable. Is this really going to extend his life?
Dr. Rountree: I have to hand it to Attia for being willing to treat himself as a guinea pig, but the rest of us don't necessarily need to go there too.
Dr. Hoffman: Yes. I'm a guinea pig, as you probably are, for about 20 or 25 plausible nutraceuticals. I'm all over that. But I think the risk/benefit equation on those is that the worst that can happen is that it might be bad for my pocketbook. Because supplements are generally benign. And worst case scenario, they may not be as effective as they're cracked up to be. But personally I'm sort of a science fair project for what I think might be helpful to extend the health and longevity of my patients. I try to walk the walk. So, I really experience some of these things with the benefits of exercise, of various diets I've undertaken, fasting and intermittent fasting and ketogenic diets. For many years I was a vegan. I've been all around the block on that. From experience, I can address some of these things. I think it's good for us to explore these avenues, as I'm sure you're doing.
Dr. Rountree: Exactly. As long as that doesn't involve an overpriced pharmaceutical that comes with unwanted side effects! Do you ever get a chance to address any mainstream medical societies or give grand rounds or formal presentations on some of the things you're doing?
Dr. Hoffman: I'm getting less calls to do that these days. But I used to be a little bit on the circuit. I remember speaking to an audience of a major VA Hospital in New Jersey. I also spoke at Ground Rounds in New York. And the Medical Society of the State of New York also had me give a talk. I'm fine with doing that. I've spoken at the Einstein, which is my medical school, and addressed the medical students there. But it can be time consuming and I'm not even sure if that's the audience that's going to be most influenced. Because, once you're in the belly of the beast in places like that, there's almost too much buy-in to conventional modes of treatment.
I think it may be getting worse in terms of the way that doctors are being regulated in their thoughts. Not only are they indoctrinated at medical school, but they're also being forced to make certain decisions by electronic medical records (EMRs)—where they forced to interact with them and they spit out a series of options. And it's going to even get worse where they are going to tell you basically, “Here are your choices. Choose A, B, C.” So you may not be able to choose out of the box. Or, certainly, you risk not getting reimbursement. You even risk being chastised by the powers that be, the HMO or the university that you're working for. Or, even professionally disciplined. Because, like, whoa, you didn't do the “right thing.” A person has an LDL of 190. Why didn't you put them on a statin?
Dr. Rountree: Well, just to give an example, I saw a patient the other day who also gets care at Kaiser. She said the doctor talked to her for five minutes, looked up her symptoms on the computer, and the computer basically told her how her condition should be treated.
Dr. Hoffman: Yes. That's where it's going. Fortunately, we have a big integrative community that is cutting loose from that paradigm. But conventional medicine, for a lot of people, is affordable medicine, let's face it. We have to figure out a way to deliver integrative care economically to people. I've talked to a few guests on my program who are trying to implement that. But, more and more, it's all what I call “paint-by-numbers medicine.”
Dr. Rountree: Yep. It's ironic that the more the public wants something else, the more mainstream medicine is hunkering down and getting even more rigid, even more corporate and cook-booky, with physician performance determined by relative value units based on how they fill out EMRs. So, it's like, as I said earlier, these trends are going in opposite directions.
Dr. Hoffman: Yep. I'm afraid that's the case. Because, what you just asked, is there a lot of receptivity to what I'm doing in the conventional medicine community? Not really. I can't say that. But what I can say is that the integrative movement is very robust and it has grown exponentially since we began our careers. That's to the good. Then there's the Institute for Functional Medicine, and I'm very involved with the American Nutrition Association, which has a paradigm that includes nutraceuticals and personalized nutrition. They're open to supplements, whereas conventional doctors may only go so far as to recommend eating a “healthy” diet, typically the Mediterranean diet. If it was just that, there wouldn't be a lot to talk about at the conferences. But we talk about applied nutraceuticals and vitamins and actually medical nutritional therapy, which is what we're all about, wielding nutrients and supplements as medicine. That's the way to go.
Dr. Rountree: The American Dietetics Association, which has been renamed to the Academy of Nutrition and Dietetics, lobbied for saying that only registered dieticians were legally qualified to give nutritional advice or talk about nutrition. And that even if you had an MD or a PhD in nutritional biochemistry, that was not adequate.
Dr. Hoffman: Yes. That's actually the rationale for the American Nutrition Association. Because we have career paths that involve a CNS credential, which is actually a very, very rigorous credential. I'm on a committee where we prepare the exam. And some of the questions actually stumped all of us. We're MDs and PhDs and master's degrees in nutrition. So, you have to have a pretty sophisticated nutritional knowledge base to become a CNS. If I had my druthers, as a layperson, to see an RD—and, some RDs are very progressive and they're open to the use of natural therapies that we espouse as opposed to this one-size-fits-all diet—I would choose to see a CNS. I think that they're a lot more broad-based and more functional medicine oriented. And I think the functional medicine movement is really great. You continue to teach at the Institute for Functional Medicine (IFM), right? You're on the faculty?
Dr. Rountree: Yes, I'm still very involved with the IFM training programs. They are expanding more into the lifestyle medicine field and training more nutritionists. Many of IFM's faculty members overlap with the American Nutrition Association, which is a great thing to see.
Dr. Hoffman: There's collaboration between the organizations. We really want to not have redundancy, but instead have a symbiotic relationship.
Dr. Rountree: It's been pointed out over and over again that a typical MD gets 30 minutes of decent nutritional training in medical school. I've seen that complaint for decades now.
Dr. Hoffman: Yes. I think there are efforts to expand it. But it always gets lost in the imperative to get people to pass the examinations. Because, you've got to pass a series of competency tests, like passing the bar. You have to be trained to have the knowledge base to pass the exams, which are frankly kind of pharmaceutically-oriented. That's the shape of medicine that's influenced by pharmaceutical companies and the government research organizations that underwrite the medical schools. That's the way it is. Nutrition therapy or nutrition study is an idealistic thing for med students to do when they're exhausted and beleaguered and they can only cram so many facts into their heads.
Dr. Rountree: What do you think are the most important unanswered questions we have about nutrition right now? For example, I know that you're friends with Dr. David Perlmutter, as am I. David has raised the issue of whether we should be thinking a lot more about the harmful effects of elevated uric acid. Of course, we've long known about the role of uric acid in gout, but David is now telling us that it plays a significant role in metabolic syndrome and all kinds of diseases. What are the other issues in nutrition like uric acid that you think we really need to be paying more attention to, doing more research on, and finding out more about?
Dr. Hoffman: Well, what's always fascinated me in the field of nutrition is how do you individualize programs for people? Because it really is different strokes for different folks. How do you arrive at what is an optimal type of diet? I've explored different paradigms. I actually did metabolic testing for a while, which was something that my late colleague, Dr. Nick Gonzalez, did. He learned from Dr. William Donald Kelly about metabolic typing. According to Dr. Gonzalez, Kelly successfully treated a lot of patients with cancer.
Some cancers were treated with an extreme vegan diet, other cancers were treated with a carnivore diet, and for some cancers you could be on an omnidiet. How he arrived at it seemed like alchemy to me. I wasn't clear on how he arrived at these conclusions. But Kelly and then Gonzalez achieved a great deal of success in treating some very, very sick cancer patients. He also treated other patients with chronic fatigue syndrome and things like that. Is there a way to determine which diet will benefit each individual?
So, then I got away from metabolic typing because I thought I didn't really understand the scientific basis for it. Now, there's nutrigenomics, which has great potential. But I think its potential as being overly hyped, as in, “Take this test. Just submit a spit sample. We'll tell you what diet to be on.” I think with advances, we may get to a better understanding of what diet and what nutrients people really need. But I think we have to be wary even of the claims of nutrigenomics that it's going to tell us whether we should be a vegan or carnivore or somewhere in between.
I think that's a really important unresolved question. If you look at uric acid, some people are very susceptible to high uric acid and other people not. I think that Dr. Perlmutter has opened up a really important new window into understanding chronic disease. Because uric acid may not just be about gout and kidney stones. It may also be about risk of diabetes and hypertension and the major killers, so that if we target uric acid, that may be a good way of alleviating a lot of challenging conditions.
Dr. Rountree: I hear you saying that the future is really in personalized medicine and figuring out what the markers are that we can use to determine that. Is it genetics? Is it metabolomics? Is it the gut microbiome? Where are we going to mine the data that we need to do that? In that regard, you sound a lot like Leroy Hood, who, along with Nathan Price, just published the Age of Scientific Wellness. They're essentially saying the future of medicine is in using AI to collect and analyze big data.
Dr. Hoffman: Yes. Now, we have the computing capacity to help us discern that. Because as you know, as a clinician, we sometimes suffer from TMI, too much information. I used to be very, very avid about testing. I would just test people up the wazoo and cast my net really wide to get as much information as I could. Then I would sit there and try and piece it all together. And the human mind is limited. There's only a certain amount of pattern recognition that you can do. When faced with reams of information, it's hard to put it all together. Machine learning and AI have the potential, if we don't misuse them by using biased information, to help us solve some of these dilemmas. We now have the potential for even regular consumers to use some of that. I think there's a great potential, and maybe we'll see some really good stuff come out of that. I think it's a very exciting time for nutrition science.
Dr. Rountree: I run a lot of DNA-based gut microbiome tests on my patients and will be the first to admit that interpreting all the information you get can be pretty challenging. However, sometimes the patient will show their gut analysis to a gastroenterologist who will say, “This is all meaningless. Outside of identifying pathogens, gut microbial testing is a scam.” I realize that there is some disagreement about what it all means, but the testing is definitely not a scam.
Dr. Hoffman: Well, they're totally biased. And, as the saying goes, if you're not up on it, you're down on it. That's something that I've learned over time. But, in a way, it is good to have a little bit of healthy skepticism about controversial issues. Because studying stool at this point is maybe a little bit like phrenology. There was sort of a fad for how the bumps in your head would indicate this, that or the other thing. We don't want to overread. I've interviewed Dr. Martin Blaser, who's a real expert on the microbiome. He must be in his 80s. He's really steeped in the science. And he's very modest in his assessment of how far we can go from reading these tests. I'm not so conservative. I really believe in the importance of stool evaluation. It can tell us a lot. But, for example, let's say you're looking for a species that we think is beneficial—Akkermansia. I think it's pretty much acknowledged that it's a good thing. What do you do when you see that somebody doesn't have any of that or minimal amounts? Can we give them Akkermansia? Well, there are companies that are marketing Akkermansia. And that may be really good, but it may be that other circumstances, genetic factors or our diet, have more to do with it than whether you take an expensive powder to rebalance your intestinal tract. I'm open to the possibility that taking Akkermansia is going to be the bomb for dealing with a variety of things. But I want to be really precise about it and bring a sense of healthy skepticism to it. That's why when the GIs say it's bunk, no, it's not bunk. But their perspective is it's not ready for prime time, which can be not entirely unreasonable.
Dr. Rountree: Maybe not their primetime, which is overly focused on identifying conditions you can treat with a drug. Many gastroenterologists don't have much to offer people with chronic GI diseases besides biologics. “Hey, you have some early stage of inflammatory bowel disease so let's put you on Humira,” which seems like overkill.
Dr. Hoffman: Right. What's interesting about these drugs is there's been really diagnosic and therapeutic creep. I think you remember the days when, metaphorically, you'd wage war, step-wise. You'd start with a little diplomacy, and then you'd pull out the slingshot, and then you might go to bows and arrows, and then go to maybe a .30 caliber rifle, and then get the cannons out. Then, last resort, nuclear weapons. Right? But, these days—and I really think this is influenced by the pharmaceutical industry—the paradigm has flipped. They're saying identify the disease early and get in early before there's any damage.
I see patients who are often confronted with that. They want a second opinion. They say, “Well, my doctor wants to start me on Humira or Remicade,” or whatever. And there is a whole new raft of these biologics for gastrointestinal problems, autoimmune problems. I mean, I just had a lady who is older and frail and they wanted to put her on a very, very powerful immunosuppressant for her MS. I said, “Let's hold on with that.”
She went on a program with diet. She's very careful with diet. Takes the whole panoply of supplements that I put her on. Well, a year later she says, “I just went to my neurologist.” The neurologist says, “You're fine. I'll see you in a year.” No need for powerful meds. So, really it's the early stages where we functional medicine doctors should be intervening to see if we can spare patients the ravages of some of these medications. It's an opportunity for prevention rather than “let's hit it hard before it gets worse.” I deplore that trend. But, boy, it sure is a money maker for the pharmaceutical industry because these drugs aren't cheap. If you watch TV and you notice the drug ads, the commercials aren't for things like Lipitor or hydrochlorothiazide that are off-patent, cheap drugs. They're pennies for a pill. The ads are for really powerful cancer drugs and immunosuppressive drugs. Because those commercials are expensive. And, I say to myself “Why oh why are they putting these commercials on for people with relatively uncommon conditions?” The answer is, if they can get three or four people watching that commercial to go to their doctor and they get put on those medications for a lifetime, that will pay for the commercial in spades.
Dr. Rountree: So true. So what would be your strategy for treating a patient with inflammatory bowel disease, who wants to know the latest evidence-based approach outside of a biologic? Do you have a particular trusted source that you rely on? I'm asking this in hopes of providing direction to our readers who want to know where to start with integrative approaches. For example, I've steered practitioners towards Dr. Joe Pizzorno's Textbook of Natural Medicine,
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which is very comprehensive.
Dr. Hoffman: Right. Well, I think one of the reasons that people come to us is because we could sort through the BS basically. Because, frankly, there's a lot of BS out there. And, there are a lot of claims. I mean, people say go on a vegan diet. People say fast. Some people will say drink juices. Some people will sell you a product, Tahitian Noni juice or something like that. It may sound self-serving, but I think there's a role for us to be traffic directors and intelligently review the information, as you did. I attended your lecture recently at IHS, and you provided an evidence-based rundown of some of the plausible therapies for these conditions. Sometimes, frankly, we have to depart from an evidence-based approach because, in naturopathic medicine before there were double-blind placebo controlled trials, there was evidence that was based on traditional folkloric methods of dealing with illness that really worked. We can't deny the importance of those things.
Dr. Rountree: If we have a reader that's saying, “Hey, I'm interested in this approach, but it all seems really overwhelming.” How do you get them started along this path of getting more training, more depth to their knowledge base? How do you shepherd them along? Are you doing any mentoring?
Dr. Hoffman: Well, I think one of the ways is through educational outreach such as what you and I do. I consider my efforts in the podcast and the radio show to be educational. I like feedback from people who tell me how some of the things that I talk about in the program work for them. Simple recommendations. If you want to lose weight, eat a handful of almonds before each meal. According to the scientific study, it works. I invite people to give me feedback, did it work for you? Something as simple as that can make a difference, can create a sense of fullness.
My goal is outreach through my own efforts, but also through the organizations that I belong to. I'm also now president of the Alliance for Natural Health (ANH), which does a lot of educating. ANH is an organization that is more of an advocacy organization. We have lobbyists in Washington to argue for access to natural therapies and to prevent further infringement on our right to obtain supplements of our choice. But we do a lot of educational work as well to try and make people aware that there is an alternate path to healing that's not a pharmaceutical, surgical based path.
Not to deny the importance of those things as a backup plan, but by being involved in the organizations and by doing the communication that I do, and through interviews like this, I think we're getting traction. This is an important moment for us because Covid, let's face it, has not been a resounding vindication of conventional medicine, for sure. I think a lot of people are disillusioned by the messaging, by the lack of efficacy of the treatments and vaccines, and they're looking for a better way. This is really an opportune time for us to reach a dissatisfied segment of the public who are looking for other answers.
Dr. Rountree: For sure there are lots of folks out there looking for other options to address their health issues, and I so appreciate your passion and commitment for putting solid information out there. What's the best way for people to follow you? Is it through your podcast or your website? Any new books coming out?
Dr. Hoffman: It's all available at drhoffman.com. That's the website for Intelligent Medicine, the podcast. You can subscribe to the newsletter there. I invite you to just fill in your email and we'll get a newsletter out to you in your inbox every week. Then there's podcasts, which you can subscribe to. You can go to your usual podcast source, Apple Podcasts or Stitcher or all the various places where you get podcasts from. You can just subscribe. Podcasts are so wonderful to listen to because you can really be very creative with your time and learn. There's no excuse for idle downtime when there's so much knowledge out there to acquire. People do all kinds of things while they listen to podcasts. You can multitask.
To Contact Dr. Ronald L. Hoffman
Ronald L. Hoffman, MD
Private Practice, New York, New York, USA
President of the Alliance for Natural Health (ANH) and chair of the Certification Board of Nutritional Specialists
E-mail: drrhoffman7@gmail.com; drrhoffman@icloud.com
Dr. Rountree: Exactly! Thank you so much for sharing your thoughts with us today. I suspect this won't be the last time we're in touch.
Dr. Hoffman: Well, absolutely. I'd be happy to join you again because I always enjoy talking to you. We are certainly kindred spirits. I really admire the work that you do because you really exemplify the spirit of innovation and a holistic outlook with a rigorous adherence to science. I know that you are a real truth teller when it comes to that. You hold yourself to very high standards.
Dr. Rountree: Well, I do my best as I'm sure you do too!
Dr. Hoffman: Thank you so much.▪
Ronald L. Hoffman, MD, is in private practice in New York, New York, USA, and serves as President of the Alliance for Natural Health (ANH) and chair of the Certification Board of Nutritional Specialists. Robert Rountree, MD, practices family medicine in Boulder, Colorado, USA.
