Guided by a certainty that our bodies are designed to heal Dr. Heather Sandison talks with Daniel about the future of medicine and what that might look like in part 1 of this series. They explore the difference between naturopathic and western allopathic medicine, how you define health and how N=1 for personalized medicine translates to clinical studies.
In This Episode We Discussed:
04:00 The mission of the collective
05:25 Difference between the naturopathic medicine and western allopathic medicine
07:07 The tools available for a naturopathic doctor
08:49 Western medicine vs naturopathy
11:09 What does divine intelligence mean?
12:40 What constitutes science based evidence
13:15 N=1 and how that relates to the results of a clinical trial
20:10 How do you define health?
23:22 What are the Walsh Institutes insights, what can it treat, and how is it different than traditional psychiatry
27:50 Optimal functional range vs traditional range in functional medicine
Dr. Sandison is the founder and medical director of North County Natural Medicine. Her healing philosophy blends modern research and diagnostic techniques with time-tested modalities including manual therapies, botanical medicine, hydrotherapy, diet, exercise, and lifestyle coaching. She is guided by a certainty that our bodies are designed to heal. Dr. Sandison’s passion is to guide and support patients as they co-create strong foundations for optimal health through sustainable lifestyle changes and integrative medicine.
Dr. Sandison earned her doctoral degree in Naturopathic Medicine at Bastyr University in Seattle. She has done additional training with the following experts: Environmental Medicine & Medically Supervised Detoxification – Dr. Bill Rea, MD
Orthomolecular Psychiatry – Dr. Bill Walsh, PhD
Mold & Biotoxin Illness – Dr. Ritchie Shoemaker, MD
Reversing Cognitive Decline – Dr. Dale Bredesen, MD
Dr. Sandison continues to deepen her knowledge of medicine by regularly attending conferences and with each patient visit.
Mentioned in This Episode:
Full Episode Transcript:
Daniel: Welcome to the Neurohacker Collective Podcast, Collective Insights. My name is Daniel. I’m with Research and Development at Neurohacker Collective, and I’m extra delighted today to have Dr. Heather Sandison with us. Dr. Sandison, I’ll say Heather from now on, is the Medical Director/Founder at a really cutting edge medical center here in North County San Diego called North County Natural Medicine. [00:01:00] She did her degree in Naturopathic Medicine at Bastyr, went on to do her postdoc residency training at the Center for Advanced Medicine, with some of the pioneers in environmental medicine and chronic disease. Her practice works with chronic complex illness and hormones and neuropsych, and towards a fully adequate personalized medicine, and general wellness and optimization.
[00:01:30] Why this is particular a delight is that Heather and I have had the chance, over the last number of years, to work clinically with a number of patients with chronic complex health issues and desire for elite optimization and all kinds of fun things, and take the best of the models that were available in naturopathic medicine and functional medicine and integrative medicine, and work on integrating the best elements [00:02:00] of those models and advancing them towards a more formalized system of personalized medicine and, specifically, doing a lot in the neuropsych space to start.
So we’re going to get to hear about what she does in the clinical practice and what a near term vision of the future of medicine that is much more adequate than what is currently available could look like. Heather, thank you for being here.
Heather S.: Daniel, getting a chance to talk to you is [00:02:30] always a treat, and about medicine, even more so. Thanks for having me.
Daniel: Let’s starts with the beginning for you. Why did you decide to study medicine?
Heather S.: Great question. Unhealthy people can’t solve the world’s problems. When I was a kid I remember, very distinctly, reading a book written for children about Sir Alexander Fleming who was an Englishman who eventually went on to change medicine. [00:03:00] He was found in a ditch. He was born to a farmer, and he was found in a ditch on the edge of death and a doctor walked by him, picked him up, and cured him, helped him, made sure that he didn’t die. He went on to discover penicillin, so he changed medicine for the better, regardless of how you feel about antibiotics right now. He changed a lot of people’s lives. A lot of people lived because of what he did, what he had to offer.
When I read that story I was struck, and [00:03:30] the hero in it was the doctor who saved him. That’s who I want to be, and have ever since I read that book. I want to facilitate healing for the humans that will save the world. There’s so many problems, and I know that Neurohacker is very aligned with that vision.
Daniel: Yeah, this is exactly … the core of the Neurohacker vision is we’re developing products, services, knowledge, technology to make individual quality of life better, but it doesn’t stop at individual quality of life, it’s increased capacity to do the meaningful [00:04:00] things that people are here to do to make the quality of life for everybody else in the collective better. It just happens to be cool that what optimizes individual quality of life and what optimizes human capability are the same thing.
Heather S.: Right, yeah. Optimize the collective, the community.
Daniel: Yeah, so then why did you decide to go to Bastyr and do naturopathic medicine as opposed to do a tradition MD?
Heather S.: Yeah. My plan was always to do to a traditional MD program when I was in high school. So I went [00:04:30] to San Francisco and wanted to go to UCSF, the best place on the west coast to study medicine. When I was there studying my undergrad, everyone around me wasn’t focused on health, they were focused on disease. They were focused on the next exam. They were doing what they needed to do to jump through the hoops to become a medical doctor. I was pretty disillusioned towards the end of it, and really didn’t want anything to do with it. In addition, I had some health complex issues of my own and went and saw multiple medical doctors. I [00:05:00] had a jaw issue and so I saw dentists. I saw psychotherapists, I saw psychiatrists. I saw anybody and everybody who would see me to help me try to figure this out.
In the end, I got better when I saw a naturopathic doctor who did cranial sacral work. After that, it was never of a question of if I would study naturopathic medicine, it was just a matter of when.
Daniel: For those who aren’t familiar, what’s the difference between the naturopathic medical philosophy [00:05:30] and the tradition western allopathic medical philosophy?
Heather S.: Yeah, great question. Naturopathic medicine starts with the assumption that every single human body has a divine design that is specifically designed to heal, that everyone has this innate intelligence, this wisdom within them that goes in the direction of healing, and that what our job is as naturopathic doctors is to pull the … I think of it as a train going down the tracks, and there’s some brush in the way [00:06:00] that’s keeping it from getting to its ultimate destination. My job is to pull the brush out of the way so that that train can keep moving in the direction of health. That premise is not present in the conventional medical world. There’s a lot on anti, be it antibiotics, antipsychotics, antidepressants, antiparasitics. There are all these anti medicines, instead of things that are supportive. A lot of what I do is on the support-side.
In the naturopathic [00:06:30] medicine curriculum, you learn very quickly to support the foundations for health. That’s sleep, good digestion, good nutrients through diet, enough exercise, good stress-management skills, because everyone has stress, so you’ve gotta learn to cope and manage those. What I’ve found in clinical practice is that that doesn’t always cut it. There are people who are doing everything they can to get in bed before 10 and get enough sleep, get those eight hours. They’re drinking plenty of water, they’re working [00:07:00] so hard to have a great diet, and they still don’t feel good. I think that’s when I come in. I step in and see, “What are the layers that we can peel back that can help us to optimize function and optimize that healing power, so that you can regain balance?”
Daniel: While any good generally practitioner/medical doctor would say, “Yes, your food and your sleep and your stress-management and your exercise are important,” they’re kind of secondary to what are the drugs and surgeries that are the primary [00:07:30] thing. In naturopathy, the foundations are going to be primary, and then you’re going to say, “What additional things do we have to tend to with those addressed?”
Heather S.: Exactly, and you bring up a good point in terms of our tool belt. In naturopathic medicine, we can write prescriptions, we can refer for surgery, so we have those tools in our tool belt. But in addition to that, we study extensively nutrients, herbs that can be used with … hopefully have fewer side effects than the medications. Again, take that more supportive approach. [00:08:00] We study homeopathy. We study manual therapies, hydrotherapy. We basically just have a much larger tool belt.
It would be a disservice for me to not mention that I cannot do all of this myself. I have a team around me and we’re so lucky to be in North County, where we have great providers that always can help. I have an extensive referral network that I rely on. Also, all over the country. You and I have worked together to collaborate with other providers who are really doing cutting edge work [00:08:30] and an exceptional job of it, all over the country.
I definitely lean on collaborators quite a bit, because there’s a lot to delve into, but the tool belts of naturopathic medicine, I think, is more varied than the conventional medicine community, the drugs and surgery approach.
Daniel: There is a common perception that Western medicine is science-based, evidence-based is kind of the primary term. There are [00:09:00] websites on science-based medicine that are focused on showing what kind of scientific research is missing for things outside of tradition Western approach, and that natural medicine is generally some degree of folk superstitions, with maybe a little bit that has science and a little bit that is hocus pocus stuff. I think that’s actually fair, oftentimes, when we come to … I mean, [00:09:30] there’s obviously an assumption that if something is natural it’s good for you that some people have that is very unsophisticated, and if something synthetic it’s bad for you that’s oversimplified. Muscle testing is very different diagnostic method than actually running labs.
What I’m wanting you to get into here is that a naturally-oriented medicine doesn’t mean not high tech, and it doesn’t mean not high science, it means that it’s science trying to understand what the nature [00:10:00] of physiology is normally doing, rather than just saying, “How do we override one very small part of it?” But just speak to that for a minute, because when you say there’s a divine intelligence that can also kind of speak to the, “Oh, are you doing prayer healing?” A little bit more, is theism required? Is any particular other-than-rational belief system required? Is what you’re doing [00:10:30] drawing upon the sciences?
Heather S.: I love this question and I wish we had all night to talk about it, because there’s so many different directions we could go there. I’ll just take the theism first. No, absolutely not. There’s no religion in here, it is … for me, maybe you could classify it as a religion, but there is a certainty within me, it is my truth with a capital T, that every human body is capable of healing. So I start every interaction with any person, whether they’re a patient or not, [00:11:00] under the assumption that they can heal and that whatever stands in their way can be moved. Does that answer the God question?
Daniel: When you say “A divine intelligence,” what you mean by that, and I would say maybe if I’m going to translate it into closer to science language, is that this is a self-organizing system that has very complex regulatory mechanisms that [00:11:30] evolve to regulate well.
Heather S.: Yes.
Daniel: And if they’re not regulating well, there’s probably some problem in the way that if you identify it and clear it, it actually evolved to regulate well.
Heather S.: Precisely. I don’t know the details of human evolution, that’s not my area of expertise, but exactly. We came out of a system out of … the earth, right? We’re here on earth, and things like sea salt, we’re understanding more and more and more how sea salt is [00:12:00] created in these perfect ratios or these micronutrients that we need, and we were created on earth where the sea salt exists. Instead of taking a bunch of calcium and magnesium, maybe it makes more sense to get some sea salt, and that our blood pressure will be better regulated, that our adrenals will be better regulated. Excuse me, that all these things might run a little better if they are supported in a natural system, in a natural way that’s in alignment with the way we [00:12:30] evolved.
Now that goes back to … sorry, can we edit this part out? There was another piece of your question …
Heather S.: The science. Yeah, so I think the scientific question, “What constitutes evidence-based medicine and what doesn’t?” Some evidence can be just your personal experience, right? If you don’t drink enough water and you get a headache, and then you [00:13:00] drink more water the next day and you don’t, being hydrated. You can take away from that that being hydrated will probably keep you from getting a headache, if that’s what’s causing it. Just that interaction with that you put into your body and how you feel is evidence.
Daniel: Now I wanna play with this one for a minute.
Heather S.: Please.
Daniel: Typically, in the past, N=1 is like a bad word for meaning that you’re not doing science, you’re taking anecdotes as if they mean something when, of course, you didn’t control for [00:13:30] variables and it might just be no corelation at all. But as we start getting into personalized medicine, that changes when N=1 is actually the goal. Because, typically, the goal of a clinical trial is N=very large, does the treatment have some effect beyond placebo? When you’re controlling for placebo. But the fact that it has some effect on a bell curve, where some people respond very well, some very badly, you say, “Why is there that bell curve of effect? There’s obviously a [00:14:00] lot of other things going on,” and so maybe the people who it responded very well for, can we understand those details and that’s a good medicine for them and not for these people? The bell curve is taking all the personalization and it’s just averaging it, but those are all other variables.
Heather S.: Right. Yeah, and I think my point is more that there’s so many different places you can get evidence. When you look at evidence-based medicine points back to this triangle of what’s the hierarchy of good medicine, and placebo-controlled [00:14:30] large studies, randomized, controlled trials, are at the top of that hierarchy. My point is to just basically … I don’t buy it. I don’t buy it. I don’t think that that’s the best way, is that you have one variable that changes and it’s the dose of a medication or it’s a medication that works on one biochemical pathway.
I recently studied under Dale Bredesen, who wrote the book The End of Alzheimer’s. He’s a medical doctor who’s been studying Alzheimer’s for a long time. He approached a group in Australia [00:15:00] and was trying to go through an IRB study through the IRB, the process that you go through to set up a clinical trial. He was working with this group of people in Australia, and he said … he’d been studying Alzheimer’s for decades and he said, “Looking at this, there’s so many variables. We can’t just do one thing, so we’re going to do this, this, this, and this.” And he had a list of twelve things, and the group in Australia said, “We can’t do that. There’s too many variables. This isn’t good science. Can you please give us your protocol, because we want to give it to our parents [00:15:30] and help them so that they don’t get Alzheimer’s.” So they acknowledge in one sentence, in one thought, that the science that we’re saying is the best is not the best. It doesn’t include all of those variables that you were talking about at both ends of that bell curve.
In [inaudible 00:15:51] science that you do, what we’re doing is we’re trying to get the science to catch up with the complexity of the reality of life and medicine, that one variable [00:16:00] is not going to fix everything. There is no magic pill, but that if we can enhance all of these variables, maybe we can get those complex systems back in balance. That’s that brush that’s in the way of the train that’s going in the direction of health.
Daniel: So when you’re saying that you noticed that your own lack of water regularly creates a headache, what that doesn’t give us is what water will do for all people, because that requires [00:16:30] doing lots of people. What it does is say what water does for us, which … so this is the important thing, if I do an N=1 and I try and abstract a generalized truth, that’s bad science. But if I have a generalized truth on a bell curve and I think that’s going to predict what it does for me, that also ends up being pretty shitty, right?
Heather S.: Right.
Daniel: So this is where the Quantified self movement has been so interesting is, “Let’s do N=1 experimentation, because that will end up being what’s good for that person.”
Heather S.: Mm-hmm (affirmative).
Daniel: And so I think that’s one of the things that natural medicine [00:17:00] has paid attention to for a long time is individuals paying more attention to their own health, to their own subjective experience, symptomology, which is part of the trusting that there is actually some wisdom that you have in your ability to [crosstalk 00:17:16].
Heather S.: Yes, certainly. Acknowledging the individual is a tenant of naturopathic medicine, that each one of us is a little bit different. This goes into whenever the talk about protocols, I sort of loosely use the word protocol. [00:17:30] We do the Walsh protocol, we do the Bredisen protocol, we do this protocol and that protocol, and each one is very individualized. So I’ll take a training and it’s called a protocol, but what we’re trying to do is figure out for the individual how do we apply that protocol?
There is this danger of saying we expect every person to respond a certain way, that’s just not the reality. I can take one protocol and it can be different for every single patient I see in my office.
Daniel: [00:18:00] Yeah. It’s even important to notice that when you say something like the Bredisen protocol, it really is actually a … it’s not a, “For everyone that has Alzheimer’s do this.” It’s, “For everyone that has symptoms of cognitive decline that we associate with this word Alzheimer’s, that doesn’t mean shit, let’s do these assessments, see what’s out, and do a personalized approach to those things,” which is why it’s very hard to do a clinical trial for. So even saying it’s a protocol is still a personalization [00:18:30] within a framework of variables.
Heather S.: Right.
Daniel: Now then, Walsh is also personalization within a framework of variables, hormone treatment is, microbiomics is; so then, what you’ve been working on in the clinic is how to actually take all of those that are clinically getting really good results and say, “How can we actually have a meta protocol across all of them?” So we’re getting progressively more and more variables factored.
Heather S.: Precisely. This conversation starts to get really complex, [00:19:00] really quickly. Most patients that leave my office leave a little overwhelmed, so we have to tell them, “Call us. Be in touch. Let us know when you’re feeling overwhelmed. You don’t have to bite all of this off at once.” But the other thing that we do is we really try to organize it and make sure that the simple concepts are there. We’ve discussed this over the years, what causes disease? It really comes down to too much or too little of anything, right?
[00:19:30] At the very base, we can break things down into this simplicity that too much, obviously too much force if you get hit on the head with a bat, that is going to cause some structural problem that is going to cause some disease; if you get into a car accident, it’s too much. If you have too little of something, if you have too little of a nutrient, that causes other problems, so we wanna talk through with each patient I see, are they getting too much or too little of something? Is there a way that we can create balance [00:20:00] in a really simple way?
Daniel: Okay, so let’s actually unpack this, because I think this is super valuable. If you were going to define health for us, how would you do it?
Heather S.: Oh, I love this. I worked for a guy named [inaudible 00:20:18] and he said it was the absence of limitation. I love that and it’s what comes up for me first, not being fully prepared for this question, and yet I don’t [00:20:30] love that it’s the absence of anything. I want it to be that full fulfillment of potential. It’s not the absence of disease, because I think the medical model has been that way for a long time, but it’s that ability to reach your full potential I think.
Daniel: Yeah, so the absence of symtomology obviously was a very old way of thinking about it, allopathically. And we all know that someone can get diagnosed with a cancer that was growing for years, asymptomatically, or [00:21:00] any kind of disease that as a very long, asymptomatic development period; so, absence of symptomology is no good. And you can have something that is not an overt symptom, but is radically lower degree of thriving. If we want to start saying, “How do we define thriving,” that’s a different thing.
Heather S.: Right, and then there are the people who don’t even realize they’re not thriving, who are just kind of going about their day because this is their normal. All of a sudden, somebody turns them onto, I don’t know, say Bulletproof Coffee, and they’re like, “Wow, [00:21:30] I didn’t know I could function like this,” or Qualia. They get to live that full potential. I love it.
Daniel: I wanna come back to understanding health aging disease in a minute, but just so that people have a reference of why this is … that there’s something interesting here at all, clinically, what do you work with with people? When people are coming, what are they coming with, and what do you see happening that we wouldn’t see happening in most hospitals?
Heather S.: Yeah, great. Naturopathic doctors are trained and [00:22:00] licensed as primary care providers, so I do pap smears and I do physicals for school kids and I do hormone balancing, tons of hormone balancing and functional medicine and thyroid. We’re happy to do that. I love it. I would say it’s probably about 40 to 50% of what I do. And then, what gets me really fired up and excited is this more complex chronic disease, and working with patients who maybe have been diagnosed with Lyme, or chronic fatigue, fibromyalgia, who have [00:22:30] seen every doctor and are searching for the answer. I would say no good scientist ever stops asking questions, and no good doctor every stops trying to get better at treating patients. No one is batting 100, so these are difficult cases and I would never claim to say that I can cure every one of them.
I do see us helping. I see people getting better who haven’t been able … they’ve plateaued for a while and they haven’t gotten that [00:23:00] next step towards optimal health, and that is really, really satisfying. The other big chunk of what I do is in the mental health space. You were kind enough to turn me on to Dr. Bill Walsh, and with his therapies I have seen profound healing in severely mentally unstable people, so schizophrenia, bipolar disorder, and certainly anxiety and depression.
Daniel: Let’s talk about that one for a minute. What is the gist of the Walsh Institute [00:23:30] insights and what that can treat and how it’s different than traditional psychiatry?
Heather S.: Yeah, so Dr. Walsh has a database of over 35,000 patients. He’s been doing this work since the 70s and he worked for a long time with Carl Pfeiffer, who’s a medical doctor. He’s since passed, but Dr. Walsh and this massive database, basically inform the way I approach patients with any mental health disorder. He’s looking [00:24:00] at five primary factors, whole blood histamine, this indicates … in addition of homocysteine, he uses this to asses … we, I use it to, to asses whether or not somebody’s able methylate, so histamine and homocysteine are both things that we can measure easily in the blood and they require methylation in order to be metabolized. So if you have lots of it, if you have excess in the blood, it gives us an indication that you are undermethylated. If you have too little of those things, then it gives us an indication that you are overmethylated.
[00:24:30] I think, this is a little bit of a tangent, but the MTHFR craze and the SNP craze around 23andMe and some of the other genetic testing at the level of the single nucleotide polymorphism, they talk a lot about the undermethylation side and they miss that whole overmethylation side. I’ve seen that be a detriment to patients, so my preference whenever a patients comes in asking about methylation is to use Dr. Walsh’s approach, because [00:25:00] it gives us the phenotype, not just the genetic potential, but actually what’s happening in the body. Homocysteine and whole blood histamine are two of the markers that we look at to determine if somebody is under or overmethylated in the Walsh protocol.
Daniel: Just to specify, when you say it gives us the phenotype and not just the genetic potential, for those who aren’t familiar what that means.
Heather S.: Yeah. Oh, so phenotype is what’s actually happening. The way I describe this to patients is that genetics, when you look at genetics, it’s almost the way you would look at an architect’s plans for [00:25:30] a house. It gives you the instructions for how to build that house. You can take those plans and you can put that house at the beach, you can put carpet in it or wood floors, you can put it in the mountains. There can be a happy family in it, a sad family in it. You don’t know anything about what’s actually happening in that house until it’s built and it’s a living, breathing organism. The genetics are those plans, that potential. It’s all that potential that that house could be, and that’s the way the 23andMe data looks to me.
Daniel: So when a person is an Olympic athlete, in the best health in the world, [00:26:00] and when that same person later has cancer, they have the same genome?
Heather S.: They have the same genome. It’s just, what got turned on? That’s another great segue into the other things that Dr. Walsh is looking at, but the histamine gives us some … methylation is something that’s required to turn on and off genes, so histone modification and methylation and all of these things that happen inside the nucleus to your DNA, determines what gets turned on and turned off. When I work with [00:26:30] the Walsh protocol for patients, some things get better in two weeks and other things get better in four or five months, and it’s the things that are better in two weeks usually have to do with the nutrients. We’re just correcting a nutrient imbalance. The things that get better in four and six months, that is that modification to what’s being turned on and turned off in the genome. It’s based on nutrients, we’re not changing the genome. We’re just changing … we’re not changing the potential even, we’re changing what actually happens in terms of the phenotype.
Daniel: Genetic [00:27:00] expression.
Heather S.: The expression, thank you. So whole blood histamine, homocysteine, looking at under and overmethylation, and then zinc and copper, and copper storage, and your encryptive [inaudible 00:27:13] are the other thing that we look at. We’re looking at those primary … there’s five or six numbers that we’re looking for, and then Dr. Walsh, through his work and extensive years of study, has determined a functional range, so this optimal range. On a lab core result, you might say, “A zinc of 75, [00:27:30] 80 is totally normal.” Dr. Walsh says, “It’s not functional, it’s not optimal, until it’s between 90 and a little over 100.” Same thing with copper, you can see a copper that … then again, there’s also the zinc/copper ratio, so we’re looking at multiple things in that regard. Not only the finite number of how much is there, but then that ratio of zinc to copper.
Daniel: This optimal functional range compared to traditional range is one of the keys in integrative medicine in general.
Heather S.: Mm-hmm (affirmative).
Daniel: [00:28:00] Speak to that?
Heather S.: Yeah. I think this is the bell curve that you were referring to, right? You’re not dying if you are within the lab core range, but take thyroid for example. We could take this Walsh work, as well, but there’s so many, cholesterol … this list goes on and on and on and on. If you are within the range but still normal, but all of your thyroid hormones are way low and you’re [00:28:30] THS is hovering around 3, 3.5, everything’s still green. It’s still good to go, it’s not going to get flagged. But somebody might be feeling absolutely awful.
Heather S.: These are my poor patients who come to me and say, “Oh, look at my labs. No, my doctor ran all my labs. He said everything’s normal. Everything’s normal. I don’t feel good. He told me to go see a psychiatrist. He told me it’s all in my head.” Oh, it just breaks my heart. It’s horrible. But those patients can be optimized, and that’s where the functional medicine is different from seeing a conventional doc.
Daniel: So somebody [00:29:00] has a Vitamin D of 35, and that’s normal.
Heather S.: Not normal. I totally disagree.
Daniel: Or they have a testosterone of 350 …
Heather S.: How old are they? Male of female?
Daniel: Male, and I would say it doesn’t matter, at any age, 350 life just sucks [crosstalk 00:29:18].
Heather S.: Well, at ten.
Daniel: Ten, yeah. Pre-puberty it’s okay, pre-puberty. This idea that you have optimal and then you have a disease-state, and there’s a pretty big range [00:29:30] between optimal and a full blown disease-state. One of the things that we’re looking for is if we’re not just trying to do absence of acute disease, we’re trying to do optimized well-being, then that range makes a big fucking difference.
Heather S.: It makes a huge difference.
More to come in Part 2