Maggie McKay (Host): This is the fifth in a series of podcasts on integrative medicine with Dr. Yoon Hang Kim, Chief Wellness Officer. Today, we'll discuss the future of healthcare, perspectives from functional medicine.

Welcome to a podcast presented by Memorial Hospital. I'm Maggie McKay. Good to see you again, Dr. Kim. Thanks for being here.

Yoon Hang Kim, MD: Thank you. Great to see you, Maggie.

Host: So, let's start off with what is the difference between functional medicine and integrative medicine.

Yoon Hang Kim, MD: So, the way that I look at it is that integrative medicine, what powers it is actually wisdom of healing. For functional medicine, what powers it is the technology. So, that's the big difference. One's emphasis in the wisdom of healing, mind-body medicine, and different traditional medicines, whereas functional medicine, we want to use the technology to create an edge and help our patients and do what we call optimized personalized medicine.

Host: And what are some examples of technologies that are driving innovation?

Yoon Hang Kim, MD: So, one of the technologies in functional medicine, the first thing a lot of people think about is we use labs that are not generally available to physicians, such as nutrition where we can look at the micronutrients of vitamins, minerals. And while some of them, like vitamin D3, B12, folate may be readily available, the rest of them are not as available and often can be quite cost-prohibitive, whereas functional medicine by bundling these and paying cash. Most of the labs end up being about $300 at least in our Memorial Institute of Health and Healing. And we can drill down on nutrition. We can find out about people's microbiome and try to keep that as optimal as possible. We're finding that microbiome has a lot of influence in all kinds of different things, including memory, including heart health, not just digestion, autism. So, we have capability to do that.

We also have capability to look at hormone a little different. In Western medicine, I can order the hormone, but it's going to be a one-time value using specific functional medicine labs. I can generate a cortisol curve and compare it two different times. How is the cortisol in the morning? How is the cortisol in the afternoon? How is the cortisol in the evening? And that gives me multiple segues to intervene. And even for estrogen, testosterone, progesterone, it's really helpful to have the hormone, and we can get that from conventional lab. What's different in functional medicine is that we have labs that will generate, what we say, the whole curve. Basically, we can know about the things that these sex hormones are made from. And we can track the whole pathway. So, just get a lot more information.

The last thing that I'm really excited about is genetics. You know, the genetics kind of determine a lot of things. And before, we had access to genetics as long as 23andMe, and similar services have been available. But the thing is, after you get the code, what do you do with it? And it used to be that you had to search for different filters to make sense out of your genetic code. Recently, I found a company that this information is organized around actionable items in terms of food, supplements, exercise, meditation, and whatnot.

The last part is technology. I think that all of us these days have access to a smartphone, or most of us do. So, there are apps like Curable, which is for chronic pain. And in YouTube, I marked down different kinds of meditation. There's meditation called relaxation response, mindfulness meditation, breathing meditation, soft belly meditation. So, there are different things like that, that I can use to communicate teaching. And for keto diet, Dr. Eric Westman of Duke University only has like 600 plus YouTube episodes, so then I can introduce patients to that and they can learn from that. And the other part is Audible, which is like books on cloud. And there are digital examples of hypnosis or what we call relaxation or visualization exercises you can just do by listening to it in Audible.

So, I think before this, there was very little automation. And then, another category on their own are wearables that we're finding like continuous glucose monitors that's really changing. It can be your own personalized response in terms of what does it do to your sugar. And you can come up with a personalized approach to losing weight, improving diabetes. And there are other instruments that will measure your heart rate variability. There are rings now that will do amazing things and give you all kinds of information.

Host: So, there's continuous glucose monitoring, a watch and a ring that can help, these devices?

Yoon Hang Kim, MD: So, the glucose monitoring this summer will become over-the-counter, so you will not need a prescription. And I think the prices will come down. When it comes to like $100, I think, that will make it very, very affordable. There are devices where you can blow into, and it measures the acetone, and it can calculate are you in ketosis? If you're in ketosis, you're burning fat. If you're not in ketosis completely, how much are you in ketosis? I mean, what kind of food should you eat? And they can connect the two.

So, I think the technology can't do the work for you, but it is making it a lot easier. So for example, meditation can be sometimes very difficult, especially when we're under heavy stress, yet you can turn on either the app or YouTube and then, just watch and let it lead you. And it's like having a coach right there, right beside you.

Host: That's amazing. Just look how far this has come in such a short amount of time. What are some tests that are unique to functional medicine, Dr. Kim?

Yoon Hang Kim, MD: So, the test that I am appreciating more and more is a microbiome test. And what this is is a DNA testing of our stool, and it builds a map of the most significant bacterias. It screens for parasites, it screens for pathological bacterias, what we call probiotic bacteria. Then, it gives us an idea of what's not supposed to be there, what's missing that's supposed to be there, what are the ratios of different bacteria. So, we used to just know it was present, not present. Now, the technology has come a long way and we are able to do what we call quantification, which means that we have an idea of how much of those bacteria or organisms are present.

And for example, a patient who had diarrhea for the longest times, we found out by doing this testing, that person has yeast overgrowth. And as soon as we addressed it, that person's probably a decade-old diarrhea just got better. And without the testing, I probably would not have gotten it. And the conventional testing does not necessarily use DNA. So, they have to grow things out of it. And to do that, it's not always easy. So, it's the idea of false positive or false negative. False positive means false alarm. False negative means missing the boat. It's there, but you can't see it. And in the past, I think that we really had trouble with false negatives. The yeast is there, but we can't grow it out. So therefore, they'll say it's not there. And if the test says that yeast is not there, it's hard for us to say, "Oh, here is some medication for you to take," and it doesn't work as well. Whereas if you say, "Okay, yeast is here. I documented. I've tried a lifestyle modification. It's not working. Here's medication to correct it."

Host: That's a lot of good, useful information. And it sounds very hopeful and it sounds like it's just evolving more and more. Is that fair?

Yoon Hang Kim, MD: Yeah. I have access to probably thousands of tests and I would say that I use less than 10 all the time. But it's always nice to have that, because a patient came in specifically, "I am concerned about mercury exposure." And I said, "Why? Why are you concerned about it?" "Because I have fillings that are all silver." They say silver, but it's mercury amalgam. And if you throw that, the EPA gets really upset. They're saying that it's poison. But magically, when it's in our body, then it's okay, they say. So, according to this patient, she's thinking that she may have mercury poisoning. So, what I can do is I can get a 24-hour urine excretion, as well as a blood test. So, the conventional medicine, we do the blood test, probably not the 24-hour urine excretion. But by doing it this way, I feel like it's a middle way and be able to test if mercury is an issue. Because if it is, this woman is ready to go to what we call biologic dentist, drive two hours, and spend thousands of dollars to get this mercury out of her. So I said, "Wait a minute. For $300, we can't tell if there is a problem." And then if there is a problem, then I will not stop you. I will agree with you that maybe that's what you need to do. And I had another patient that he said, "I love eating sushi. I don't know why I'm so tired." And then when I checked his blood, it just didn't look normal. And just because he had a history of eating tuna every day, I checked his lab for mercury and it was positive. So, I told him, "You can still eat sushi every day if that's what you want. Just eat tuna once a month and other times just get salmon." And that's what he did and then everything became normal in a matter of months.

Host: That is amazing. In closing, Dr. Kim, is there anything else you'd like to add?

Yoon Hang Kim, MD: Yeah. I think one of the most exciting things is that we're just finding out microbiome has effect on brain. So, I'm really looking forward to working with patients with autism and their anecdotal stories that child who couldn't speak. After having the microbiome optimized, they were able to speak. And that is like, I think, not the norm, but more like a miracle story. But I would love to see that at least and then other providers say they've seen that.

Host: That's amazing. Wouldn't that great? Well, thank you so much for your time and sharing your expertise. We look forward to talking with you again in episode six of this series.

Yoon Hang Kim, MD: Thank you.

Host: Again, that's Dr. Yoon Hang Kim. And to learn more, please visit mhtlc.org. That's mhtlc.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. Thank you for listening. I'm Maggie McKay. This is a podcast from Memorial Hospital.