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2009-07-24 Jeanne Drisko MD Integrative Medicine

July 24, 2009, By Kirkham R. Hamilton, PA-C
© copyright 2009, Prescription 2000, Inc.
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KIRK HAMILTON: Welcome to Staying Healthy Today, a health-oriented radio show committed to bringing you key experts in the fields of nutrition, prevention and integrative medicine.

Hi, my name is Kirk Hamilton, your host of Staying Healthy Today, and our mission is simple, to provide you credible and usable health information from interviews and our educational resources to help you Stay and Be Well in the busy modern world. Please take a few moments before or after listening to this interview to browse through the Prescription2000.com website, the home of Staying Healthy Today Radio, for our free educational services.

Today's show topic is: "Integrative Medicine. What It Is? And How To Incorporate It Into A Medical School Program?" I am very excited today to have Dr. Jeanne Drisko. Dr. Drisko is an M.D. and director of the Program for Integrative Medicine at the University of Kansas Medical Center. Dr. Drisko teaches medical students, practices integrative medicine, and conducts clinical research at the University on the use of intravenous vitamin C in cancer, the safety of bioidentical natural hormones, and trials to assess chelation therapy efficacy in cardiovascular disease treatment. Dr. Drisko also leads a fellowship program in integrative medicine for primary care physicians which started in 2008. She is a graduate of the University of Kansas Medical School and board certified in diagnostic radiology. Presently, Dr. Drisko is president of the American College for the Advancement of Medicine, and is a member of the following groups: Consortium of Academic Health Centers for Integrative Medicine, Institute for Functional Medicine, International Society for Nutrition and Cancer, and Women in Medicine and Science.

So it is a great pleasure to introduce Dr. Drisko. I want to thank you so much for being here for your leadership. One of the things I most admire you for is being able to bring integrative medicine into an academic center and evolve it, and, at the same time build relationships with traditional physicians. So, Dr. Drisko thank you for coming today.

DR. JEANNE DRISKO: Thank you, Kirk. This is a topic that I'm looking forward to discussing.

KIRK HAMILTON: Well you can jump right in and tell us what is integrative medicine? Define it for us.

DR. JEANNE DRISKO: Oh, boy, that's a tough, tough definition. When I sat on the Institute of Medicine Committee to evaluate complementary and alternative medicine for use in the American public, this was a definition that we spent days on, and I tell you, we never satisfactorily defined it. And you know, under that umbrella of complementary and alternative medicine, or integrative medicine, there are so many therapies. There's everything from naturopathic medicine, traditional Chinese medicine to allopathic doctors who are practicing, okay, integrative medicine. So when I use the word integrative medicine, what I'm trying to do is bring the best of those complementary and alternative therapies and integrate it into conventional care. So I think maybe we'll just stop at that definition.

KIRK HAMILTON: So tell me, then. I think the most interesting part is how a physician gets traditionally trained, the experiences they have either through their training or early clinical experience, and how that gets them to where they are. So could you explain how you got to where you are?

DR. JEANNE DRISKO: Well, it's been an interesting journey. I was the typical allopathic physician and I got burned out with my practice. I had too many nights of call and I was physically just exhausted. And I talked to a friend who is another physician and he'd recently been to a complementary and alternative medicine meeting and he recommended a few simple vitamins for me to take, and I think it was just like vitamin E and CoQ10 and you know, vitamin C, something very simple like that, and in two weeks I felt so much better. I was really mad because, I thought, we never learned this in medical school. We had an optional nutrition elective that we could go on Saturday morning for a few sessions to learn about vitamins and minerals and nutrition, and that was it. So I had this typical bias that this stuff was not effective, and then all of a sudden I was faced with the prospect of knowing that I had missed out on something huge. So I started going to different meetings. I started meeting people and I had the wonderful opportunity to train, retrain in integrative medicine, with Dr. Hugh Riordan at the Center for the Improvement of Human Functioning, and that was life-changing.

KIRK HAMILTON: Then your transition into integrative medicine really was from the nutritional biochemical approach. Because there's a milieu of therapies to try, but your entry road was, "I took a few supplements, I felt better." Then you met Dr. Riordan who was obviously an orthomolecular type of physician. So you came in through the nutrition route? Would that be fair to say?

DR. JEANNE DRISKO: I think that was absolutely fair to say, and it makes sense when you think of the way we're trained in allopathic medicine. It's very biomedical. So we're substituting drug therapy for nutrient therapy. But really, you know, that may be the door we walk through initially. But it broadens out so, so much - and it's such a wonderful way to practice because it isn't just nutrient therapy. There's all kinds of medicinal plants that are wonderful, homeopathy, acupuncture - I mean there's so many things to use to help people get well.

KIRK HAMILTON: So at your integrative medicine clinic at the University, how does a patient, if you have fifteen different modalities, how does a patient come into a center point and then get delivered to those other areas that might be most effective for them to heal?

DR. JEANNE DRISKO: A patient may have a very complicated medical history, and then they'll end up seeing one of the faculty physicians in our program. But a patient also has the option of calling up and saying I want to meet with your dietician, your nutritionist, who is absolutely superb. And so she has her own practice. She is able to see these patients and advise them and teach them in our demonstration kitchen ‘hands on' how to learn to how to eat and think about food. So they can come in through that point. Or, if they know they have chronic pain or some other process and they choose to see the acupuncturist. So there are different doors to go through, but a patient generally knows what it is they want at the time and asks for it. Now, we also have a safety net if a patient gets into the wrong door, let's say they need something else. We have every Tuesday, we have chart review, and so all of the practitioners get together and go over some of the interesting or difficult cases that they've had that past week and share patients and refer patients amongst ourselves. So it's a wonderful way to really take the best care of people that come to our clinic.

KIRK HAMILTON: Tell me about the assessment tools that you use in an integrative medicine practice that might be a little different than the traditional physician.

DR. JEANNE DRISKO: Well, first of all, we have a very extensive intake form which I can give credit to Dr. Riordan and to the Center down in Wichita, Kansas, for developing. That is a very important tool to really understand what's going on with that patient, and then we sit with them for an hour, hour and a half on the first visit, and really dig into everything about them. We don't just focus on - let's say they come for headache. Well we don't just stop at the headache. We try and understand everything about that person and then we do some different types of testing. Often, though, they've been to, you know, more than five physicians before they finally end up with us, so they bring a lot of very conventional tests with them like routine blood tests and colonoscopy reports and MRIs and on and on. But we'll do things a little bit differently. We'll look at their vitamin and mineral levels, and our lab here at the university is cooperating with us so we can send our patients there for these nutrient levels, essential fatty acid levels, so those are drawn on site. But we also do very specialized tests. Everything from hormone urine analysis to adrenal analysis to a stool analysis that incorporates DNA technology. We do genetic testing for detoxification panels and for cardiac panels. Just a variety of different types of tests. What we're trying to do is build a picture of that person metabolically, biochemically and totally.

KIRK HAMILTON: If you had to pick out your three or four favorite tests that you do?

DR. JEANNE DRISKO: Oh, tough question!

KIRK HAMILTON: I bet I could pick them out, but go ahead. Give it a whirl.

DR. JEANNE DRISKO: Well I tell you. I love neurotransmitter testing and there's so much argument about this now. It's a urine spot test and there's just so much argument about how valid it is. But I can tell you even though it does represent the total body burden of common neurotransmitters we're able to manipulate those by giving them nutrient building blocks, amino acid building blocks to build up those neurotransmitters, and it makes an impact in the patient's well-being. Their psychological well-being, their sleep, and so on and so forth.

KIRK HAMILTON: Give an example, just a short example of an entity that you would treat with the neurotransmitters.

DR. JEANNE DRISKO: Boy that's tough because you know our patients that we see have very complex chronic disorders, and it always shows up in some sort of anxiety, depression, sleep disorder, and I can't - I can't effectively treat them without looking at neurotransmitters, even GI issues. You know, more of the neurotransmitter serotonin, for example, is found in the GI tract than in the brain. So it's an important component.

KIRK HAMILTON: Tell me about stool analysis. Many people would think - "What does the gut have anything to do with a migraine headache, or joint pain or mood? Why do you do a stool exam? Number one, what are you looking for that's different than the average physician? Two, why do you use the DNA marker test?

DR. JEANNE DRISKO: Well, I want to make sure exactly what kind of bacteria is present. In particular, what kinds of the good guys, the beneficial microflora are present. Then I want to make sure that there's no pathogenic bacteria, there's no parasites, there's no yeast overgrowth. Sometimes I think with the routine plating and culturing of stool samples you can miss minute quantities of let's say a parasite, for example. So I really have found the DNA testing to be more powerful in that regard . But what's important is if the gut is in imbalance, it is dysbiotic, then the entire body is unhealthy. There's some much inflammation that occurs inside the GI tract, and if it's not healthy, then you're going to have translocation. And I want to tell your listeners that if they go to talk to their doctor about leaky gut, they're gonna get - the doctor is going to roll their eyes. But if they talk about translocation of things across the GI border, that's in the GI literature and they have actually shown, by electron microscopy, pictures of those cells in the gut pulling apart. That velcro holding them together pulling apart, and the things leaking across the GI membrane. So that inflammation translocates into the pelvis, into the lymph, into the blood stream. And if it's significant, if it's very high those patients are going to have all kinds of problems like inflammation in the pelvis and joint pain, headaches. So it's a very important system to look at.

KIRK HAMILTON: Tell me how you assess the controversial area of, I won't use the word ‘food allergy', I'll use the word ‘food intolerance.' How do you approach that, and do you start from the gut and say, "Does dealing with the gut help with that?" and then what testing would be used and how do you deal with that?

DR. JEANNE DRISKO: Well, I use IgG testing and this whole area is fraught with difficulty. There are multiple companies that are doing a lot of IgG testing and they're often using an open 96-well plate. And they'll paint those wells with antigen, with food antigen or environmental antigen and it's open to the environment, and then they'll just put the patient's sera into these open wells. There's all kinds of cross-contamination and contamination from the open environment. So we've worked with Dr. Vincent Marinkovich, and he's since died and I'm very sad and miss him very much. But he developed a closed system where the antigen, whether it's food or environmental, is painted or coated onto a string in a closed system and then the patient's sera is drawn up into this closed system and the string is then - there's fluorescence that's associated with it if there's increased IgG. So I've been very careful to use that system, and I want to tell you again that this is unpublished but I did a comparison. I drew one person's blood and divided it into ten samples and I sent two of those samples blinded to five different labs. And the system that - the closed system that I was discussing, that was pretty reproducible. That actually showed very good comparison. But the other four labs had - one lab actually had half a sample negative on one and half the sample on the other - and then on the next sample that half was positive. So it was completely opposite. So it's very difficult to use IgG testing. I just wanted to get that caveat out. But, IgG food testing, that being said, I think is very important. It's a guide, it's a tool. Because that sensitivity reaction from eating that food may not occur until the next day, or the day after, or even the day after. So it's very hard for the patient to keep a food diary and know what's going on. But the gold standard is the food withdrawal diet, so they're off everything except a few foods that tend not to be irritating. And then gradually add them back in a food at a time. But that's very difficult for the patient and the practitioner to do. So you use the IgG food testing and then you take those foods that the patient is sensitive to, you withdraw them for a month, not their whole life, for one month because it's not allergy. You allow the body to clear those IgG antibodies and then you start adding back the foods one at a time and you go very slowly. So you add dairy, for example. You wait four days. If they're fine, you add the next food. But if you react to that food in that four day window, then you have to wait until they're completely better before adding the next food. And then you'll take that offending food out for another three to six months. In fact, I want to just comment that I've found that patients who have significant dairy sensitivity almost never get their dairy back in their diet.

KIRK HAMILTON: You're preaching to the choir. I'm biting my tongue over here, as best as I can.

DR. JEANNE DRISKO: I probably was a little long-winded.

KIRK HAMILTON: No, that's fine. And could I just interject and say that probably if you treated the abnormal bacteria and fungi in the gut, that you would have less food intolerance?

DR. JEANNE DRISKO: You bet. I'm so glad you said that. There's this whole story about the gut barrier and we're doing some research with that. We think that there's a protein that may be important that gets destroyed. When that protein is broken down the gut barrier is broken down and then those proteins in the food are not digested very well and then they become reactive. So it is a gut barrier function. You're absolutely right.

KIRK HAMILTON: Let me ask you...What have been some of your most joyful experiences in doing integrative medicine?

DR. JEANNE DRISKO: Well you know...I tell you I look forward to coming to work every day. When I was in conventional medicine, allopathic medicine, on Sunday night I was just almost sick. I thought, "Oh I can't go back." I can't stand it. But now I look forward to it. And every day is fun! But I think it's the patients that make it fun and we really have a nice group of people that come here. I don't know. It's just great!

KIRK HAMILTON: When you refer out to... let's say a massage therapist or an acupuncture or whatever that you choose...what are your three favorite modalities to refer out to, that just seem to work for your patients or you?
.
DR. JEANNE DRISKO: Well, I don't know. That's tough . I think naturopathic medicine is very important because they have an entirely wonderful but different type of training than we do not in allopathic medicine. But acupuncture is very powerful for people. We are also very interested in energy therapies here. Neuro-biofeedback...and I'm hoping to get a device here soon in the next couple of months that we can start using here in our clinic. So, gosh, Kirk, I don't know. What's your favorite?

KIRK HAMILTON: Oh I just love to see people take charge of their health. I'm a pretty basic guy. You know, I get them out exercising, eating whole foods and they lose some weight and they start to see the power come back. What my greatest joy is, is not that a patient is perfect. My greatest joy is to see a patient go out and do well, and then stumble, and then be able to look back and say, I know what it is...and I know I can get out of this, and have the confidence and the belief that they can...because then they don't need me really anymore in the same way.

DR. JEANNE DRISKO: Ah, well said. Absolutely!

KIRK HAMILTON: That's my greatest joy!

DR. JEANNE DRISKO: Absolutely!

KIRK HAMILTON: That's when I jump up and down and slap them on the back and, I've been known to yell and do the other things, too!

I wanted to ask the question that, coming from a more traditional point of view...we could make the same mistake that I think a lot of times allopathic medicine makes, and that if we just replace vitamins and minerals, or a (natural) therapy with, instead of drugs or surgery, but we allow disease to happen, what are we doing? And so, what I'm saying is you could have a multitude of alternative therapies, still let disease happen, and then jump in and treat with whatever...

DR. JEANNE DRISKO: Uh-huh.

KIRK HAMILTON: That's my concern because basics are basics. Do you see that, or am I looking through other glasses?

DR. JEANNE DRISKO: No, you know I think you've hit on something that's key to the answer to the healthcare crisis, and that's wellness and teaching people to do the very basic things that keep them well. And try and reeducate all of us, the patients and the practitioners, as well, what it is that is the basic things that can be done.

KIRK HAMILTON: Well how about...tell me five basic things that you would want people to do. That if you said - I say to myself many times...I'm sitting (in front of a patient) and I go, "You know,
I ‘ve said this about a million times in the last 25 years. If I could get most of my people to do four or five basic things, they wouldn't see me, most of them wouldn't." Do you have a little list of things that you would love to see people do every single day, from this day forward?

DR. JEANNE DRISKO: I'm thinking of some of my younger patients now. If they eat three meals a day and it's whole foods and don't skip breakfast and don't go out and do the ‘hunter-gatherer' thing, which is what I call these young people...they go out to the restaurants or pick up food here and there. If they would eat their meals at home and learn to prepare their meals, I think that would be the first most important thing. That's the foundation. And then, learning how to, and making ways to sleep through the night and get a good night's sleep. Then the third thing would be to be less frantic in the day. Really slow down, breathe from your stomach, fill those lungs up with good air, breathe slowly. And then enjoy family, enjoy relationships. Find joy in life. So those are just some key things. I mean they're not even medicine driven.

KIRK HAMILTON: Tell me what a whole food is. I use this word all the time and if I walk out in the middle of the street and give a talk and I say, "Eat whole food," and I see a glassy-eyed kind of fog looking back at me. So, how do you tell people that?

DR. JEANNE DRISKO: Well, we're promoting seasonal local eating here right now. In fact, Lisa did a demonstration of tomatoes in the kitchen today for a group. So if you're going to find the foods that are fresh...that are grown outdoors, or, if you are an omnivore, if you do eat beef, you're going to find beef that is grass fed and is not corn-fed and slaughtered in the packing plant sort of situation, which is easier for us here in the midwest to find. But just foods that are real and not processed and not manufactured.

KIRK HAMILTON: How about slowing down? Give me a tip or two to slow down. I can't imagine when I look at your resume and I know where you go and I know the organizations that you belong to... How do you slow down?

DR. JEANNE DRISKO: Well I'm very adamant about taking a day of rest. And I think that was - that's the way we were made. We were supposed to take a day of rest. And so you really can't do work on that day. You spend time with your family, you cook, you walk, you read, and I find if I - I had to learn that the hard way. That was part of my burnout when I got burned out early on in my career. But if I don't do that, I'll say, oh well, I have to get this paper done, let's say. And so I work on my day of rest, then the next day when I'm at work my brain is tired. I can now read the signs very carefully.

KIRK HAMILTON: Tell me as we're closing up here, how people can at least go to your website and look at what - I took a virtual tour of your clinic because I was just interested in comparing it to our clinic. But how can you go to your website and is there a group of integrative medicine programs across the country? How do they get in contact with them?

DR. JEANNE DRISKO: There are integrative medicine programs that are in private offices and those can be found either by looking at the American Association of Naturopathic Physicians, AANP, or ACAM.org or the Institute for Functional Medicine or the AAEM, Allergy and Environmental groups. So there's multiple groups, and those websites will point you to physicians in your area. And that's the best resource I think for patients.

KIRK HAMILTON: Dr. Drisko this has been a blast. I mean I love doing this and I love interviewing people like you who have experienced and done research, and have been with patients and actually experimented on themselves as well. You're just doing a great job! And medicine in the world would be better off if we had more practitioners like you. So thank you so much for being there today in Kansas, and for those of you who are listening, we hope that you Stay and Be Well, until the next time on Staying Healthy Today Radio.

DR. JEANNE DRISKO: Have a good day.

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