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Hello everyone. This is Matt Feret, author of the Prepare for Medicare book series, and welcome to another episode of The Matt Feret Show, where I interview insiders and experts to help light a path to a successful retirement. If you enjoy this podcast, I'd love your support. How? Well, it's simple. Please follow, like, and subscribe to this podcast wherever you're listening to it. Leaving honest reviews and 5-star ratings really helps the show thrive. Thanks. I'm very excited to announce my new book and workbook are live. Prepare for Social Security: The Insider's Guide to Maximizing Your Retirement Benefits can be found on Amazon and other major online retailers.

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You can find them and all of my books on all three of my websites, prepareformedicare.com, prepareforsocialsecurity.com, and of course the show's homepage, themattferetshow.com. This episode is brought to you by the Matt Feret Newsletter. Yep, it's my newsletter and you can sign up on any of my three websites as well. I recently relaunched it and send one or two emails a month covering a whole host of topics around wealth, wisdom, and wellness. I'd be honored if you signed up.

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Dr. Josh Levitt is a naturopathic physician with over 20 years of direct clinical experience with thousands of patients. He's helped many people find natural solutions to common chronic conditions like inflammation, muscle tension, biomechanics in posture, and pain management. On this episode of The Matt Feret Show, you'll get an insider's guide to Dr. Josh's approach to total wellness using natural solutions. Enjoy. Dr. Josh, welcome to the show.

Dr. Josh Levitt (01:45):

Thank you, Matt. It is a pleasure to be here. I know you have a lot of listeners out there and I hope that I can provide something of value, some insight, some little nugget that appeals to, well, at least one of them. Let's put it that way.

Matt Feret (01:57):

There you go. One's a good number to go after. If it's more, it's gravy. So tell everybody what you do, how long you've been doing it, and how you help people.

Dr. Josh Levitt (02:05):

Sure. So I am a naturopathic doctor, if that's unfamiliar to anybody. I have a four-year medical degree from Bastyr University in Seattle, where I went after I had kind of an interesting epiphany. I'll share a story with you, and everybody loves a story. I was traveling... I was a kid who always wanted to be a doctor. I studied neurophysiology at UCLA, and in between, after that college education, I took a year off and I was traveling around the world with a backpack, kind of living off of tuna fish and bread and hitchhiking, staying in youth hostels, sleeping on beaches, that sort of thing. And my hygiene wasn't the best at that time. I got a blister on my foot and that turned into this problem called cellulitis, which I'm sure you're familiar with, a very serious infection. I found myself very sick and walked my way into a pharmacy in Zurich, Switzerland, which is where I was when this occurred.

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And there I got the antibiotics that I needed. So that story ended uneventfully, cured the infection. But in that Swiss pharmacy, I saw this whole world of herbal medicine things and homeopathic medicines and this whole natural medicine world, which was totally foreign to me as a kid from LA, Southern California. And it lit this fire in me that really is still burning hot now. So I took that passion and figured out that there's this field called naturopathic medicine, which is kind of a modern take on herbal and nutritional science-based medicine, looking at all these natural things which have largely been forgotten at that time in western medicine and putting a scientific spin on that, an evidence-based spin on that. And anyway, I continued my education, after that trip, at Bastyr University in Seattle. And here we are, gosh, more than 25 years later, I have a clinical practice here in Connecticut. I founded, and I am the Medical Director of a nutritional supplement and herbal supplement company called UpWellness. And gosh, it's kind of crazy to hear myself say it, I've been doing that for 25 years now.

Matt Feret (04:09):

That's awesome. When you were saying Switzerland, I almost like, when you started telling that story, I started thinking maybe you were in Thailand, but then you went Switzerland on me, which is a modern, you said Western. Yeah, it's a Western country. And I always think of this divide as Western and Eastern medicine. Eastern might hang on more of the herbal supplements, the nature way first before the surgery. I didn't necessarily really even consider ever that Western medicine also can ignore other pieces of Western medicine, i.e. Switzerland. Why do you think, is that still the case? I mean, when I go into my pharmacy, I don't see that sort of stuff.

Dr. Josh Levitt (04:49):

Yeah, that's [inaudible 00:04:50]-

Matt Feret (04:50):

Still the case? Is there still a divide between continents, Europe and the United States?

Dr. Josh Levitt (04:55):

Absolutely. And I'm glad you picked up on that. And that divide is absolutely still there. In Europe, in many of the Western European countries, France, Spain, Germany, Italy, Switzerland, the use of herbal medicine remains first-line therapy. I mean, it's very common for what we would think of as Western medical doctors, MD type of doctors, to recommend herbal or nutritional approaches first. And that was true 25 years ago. It's certainly still true now. And the way I like to think about this, and I don't know, maybe this is a kind of an uniqueness to America, and it applies not just in medicine, but in other sectors as well, we have a fascination with the new.

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And I sometimes use a metaphor, hopefully you can appreciate this, about music. So here in America, we had vinyl records, which are now getting popular again, but vinyl records led into 8-track tapes, led into cassette tapes, led into CDs, and now we're onto solid state streaming media. And with each new technology, Americans got rid of the old one, that's no longer good anymore. Out goes the vinyl, in comes the 8-tracks. Out go the 8-tracks, in come the cassettes. Out go the cassettes, in come the CDs. It's this fascination with the new. Well, we did the same thing in medicine here. We had herbal medicine, nutritional medicine. Many people will remember grandmothers giving them cod liver oil.

Matt Feret (06:20):

I do.

Dr. Josh Levitt (06:21):

Or other-

Matt Feret (06:21):

Yeah, my mom did that.

Dr. Josh Levitt (06:21):

Yeah, right. Other kind of natural or nutritional medicines, herbal medicines were very common here in this country. But then when antibiotics get discovered and start being used widely in the late 1940s, early 1950s, better living through chemistry, modern biopharmaceutical research starts happening and we just forget about the cod liver oil, we forget about the herbal medicine, we forget about the nutrients, and we bring in the new. Whereas, and this is to your point, in Europe, if we stick with the metaphor, they kind of kept the vinyl records around thinking it's still good, it still works, it has a kind of unique sound.

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And then you each, and so in Europe, what you see is, yes, the new with the biopharma and the modern surgical techniques and all of that, but not at the expense of the old. And so that, I think therein lies the difference. And now we're at a point where, it's funny to see it in my 25-year career in medicine, that now natural medicine, herbal things, nutritional things are becoming vogue, are becoming cool, and we're starting to see a lot more attention than we did when I first got into it. So yeah, hopefully that enlightens you a little bit on that one.

Matt Feret (07:29):

No, it does. Thanks. And to follow that up, I feel, at least in my observing the world, that it's almost like an either or at times. Do you feel that in the United States? It's like you'll have a group of people that are like, well, I've got, I mean, I guess I could say this, cancer, and I'm going to try the herbal stuff first. But their doctors are all saying, no, you need to go do X, Y, and Z, and the herbal stuff doesn't work. It's almost, it's still not combined that way, at least, again, in my experience, in my observations of the world. It's either you got people who are buying supplements and doing the natural homeopathic stuff, and then people who are just like, nope, not at all, I'm going to go over this way. Is that divide still there, or is it getting better?

Dr. Josh Levitt (08:12):

Absolutely, that divide is still there. And I would argue that it is getting better, that's been my experience as well. I think that, yeah, we all have our lanes. There's a natural medicine or alternative medicine lane, there's a Western medical lane. And I think what easily happens to people providers is that they believe, because this is what they've been trained in, that that is the way. When all you have is a hammer, everything looks like a nail, so the saying goes. And Western doctors are particularly vulnerable to this. So it's like, if I didn't learn it at the school of medicine where I attended, the Ivy League University, then it must not be true. Well, that's of course not true. There's a certain expertise, education, training that happens to Western doctors, and there's a lot of stuff that's outside of that knowledge base. And so what we have now, and I do think the rift is getting smaller, is you have dogma on both sides.

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You have natural medicine people or proponents who are like, all Western medicine is bad, it's just big pharma, and they're trying to kill you and suppress the cures and all that kind of stuff, which is ridiculous. And then you also have Western doctors who are like, oh, it's all just snake oil on the alternative medicine side, it's quackery, et cetera, which is also equally ridiculous. So I find myself, I suppose we could use a metaphor, kind of on a bridge or at least attempting to build one between those two worlds, trying to say, look, there's good stuff on both side, there's not so good stuff on both sides, and let's see what we can do to bring those two worlds, that natural medicine world and that conventional medicine world, a bit closer together for the good of the patient. That's really all it should ever be.

Matt Feret (09:50):

How much of this divide do you think actually comes back down into some sort of the way healthcare is paid for? I mean, we were talking Switzerland and other Western European countries, it's socialized medicine, everybody's got it, everybody's got insurance, et cetera. Here, you could make the argument that over 65 with Medicare, okay, everybody's insured, but underneath that, there's a whole lot of other uninsured, but also the way things are billed around here, I mean, it's CPT codes, right?

Dr. Josh Levitt (10:18):

Yep.

Matt Feret (10:18):

And typically, CPT codes and billing, people can't bill for it. Do you think, I mean, sounds horrible to put it in those stark terms, does it come down to somewhat of the billing practices, what a doctor or a hospital or someone else would get paid for and what they wouldn't?

Dr. Josh Levitt (10:34):

I mean, there's no question. It's sad, but it's true. There's no question that that is part of it. There's also part of it that's just wrapped in cultural dogmas and history. But yes, the payment and reimbursement scheme that we are in absolutely has a role to play here because there are certain things, especially in the demographic of seniors, where the government insurance, Medicare, is paying for a certain CPT code and not for another, or paying for a certain product, which is typically pharmaceutical products, and not for an herbal product where that, and that's a very frustrating thing.

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There might be, and then we can talk about specific cases here, where an herbal medicine remedy, a supplement of some sort, might be useful to a person, but it might cost 30, 60 dollars a month, let's say $50 a month, we'll put it on there. Well, that's out of pocket. That's an out-of-pocket expense, whereas a pharmaceutical might be covered for a small copay or something like that. So yeah, absolutely. Whether it's services or products, the billing and reimbursements environment absolutely has a predictive role in the way that the care is administered. There's just no question about it.

Matt Feret (11:44):

And likewise, you're talking about the steps in Switzerland and even these steps, they go right to, or someone could, go right to a solution, and I'll give you an example. When someone might show up and say, my doctor wants me to have an MRI, their insurance company's probably going to go, well, they do an x-ray first. Did they take the steps to justify the cost? And sounds like what you're saying too, and I don't mean to put words in your mouth, which is like, okay, well, the solution is this pill, but there's one before that, there's some x-ray before the MRI, before the pill, there could be an herbal alternative there.

Dr. Josh Levitt (12:21):

Yeah.

Matt Feret (12:21):

Is that right?

Dr. Josh Levitt (12:22):

Absolutely. I'm a big fan of metaphor here. So I call this the fly in the kitchen phenomenon. So let's imagine that we have a problem, and the problem is that there's a fly buzzing around in the kitchen, that's our problem. Now, I would propose that there's a bunch of different ways that we could try to solve this problem. The first one, and at least in my opinion as a peace-loving person, is to try to get the fly out, maybe open the door, open the window, see if we could shoo the thing out. It's not a perfect solution. It takes some work, maybe not always effective, you might even have a risk of another fly or another bug coming in, but that's where we start. Let's open up the door and see if we can get them out. Then let's move up the chain.

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And the next thing would be to swing at it with a rolled up newspaper or a fly swatter or something, a higher level of intervention. And then the next one, let's get out a bottle of some spray chemicals, like Raid or something, and spray it around the kitchen. Now we are at another level of intervention. Increasingly effective, but also increasingly toxic. And then the next one would be, and this is where it gets ridiculous, is let's say it's a flamethrower, right? We're just going to torch the place. So now we have a very effective but very toxic or dangerous intervention. And I would propose that it's good when you have a problem to look at what the options are, start with the gentle, lower toxicity, potentially effective interventions, and work your way up from there.

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And so using that metaphor, I think that the appeal of the new and the attractive and the shiny object in medicine is that we love to bust out that flamethrower right away. And this happens all the time. It's like pick your problem, it could be any problem from head to toe, inside and out, and we love to pull out the big guns right away. And my argument is that sometimes the big guns are good and necessary, but very often lesser or more gentle, less toxic, less expensive, depending on who's paying for it, tools will also do the trick. And so yeah, you're spot on with it. Yeah, absolutely.

Matt Feret (14:26):

Yeah. So let's dive in a little deeper then. So obviously, I mean, let's start with a supplement. What are the easiest, I don't know if easiest is the right word, what are the most common things that you've found that are treated in, to use your words, the big gun phase or phrase that really should be starting with herbal and natural substances first? I mean, I hear if you've got high cholesterol, take, what is it? Rice, red rice?

Dr. Josh Levitt (14:59):

Red yeast rice, is it?

Matt Feret (15:04):

Yeah. I mean there's a whole multi-billion-dollar industry obviously of over-the-counter supplements. And then these read stories about are they pure enough, are they not? Where are they manufactured? Where do we begin to think of all this? I mean, I know everyone listening has taken some sort of supplement at some point, including me. Where do I start with this in terms of what is it best used for?

Dr. Josh Levitt (15:25):

Yeah, it's a great question. I think if we pick a body system or a problem set, that's kind of a good way to structure this conversation. So you mentioned lipids and cholesterol. That's a good one. I think where we should start to dive in deep because it's such a ubiquitous problem, is joint pain. So let's look at joint pain and let's just say it's a knee, which is incredibly common, knee pain, back pain, these kinds of things are terribly common. And a very good example of how we love to pull out that flamethrower when opening the door, so to speak, or the window would do. So with respect to supplements and the natural approach, let's think of this person who comes in with knee pain, often goes through the regular routine, nonsteroidal anti-inflammatory drugs, maybe a prescription to physical therapy if they're lucky, an x-ray, an MRI that makes a diagnosis of a chronic degenerative meniscus tear, then an injection, and then a full-blown knee replacement.

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That's just kind of the march. That's the way it goes. And I would say that one probably started pretty close to the flamethrower. We just started with the drugs, and then we went to injectable drugs, and then we went to high test imaging and we can talk about the pitfalls of that, and then we pulled out the flamethrower with the surgical intervention. In many cases, a person with a painful knee can be easily made non-painful and fully functional, without any of those interventions, by way of controlling their excessive inflammation with dietary and lifestyle changes, employing appropriate movements as medicine, and this might be physical therapy or otherwise, and then judicious use of herbal nutritional supplements. And I can talk about a bunch of them I formulate in this category.

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So turmeric or curcumin, the active ingredient inside turmeric is amazingly useful as an anti-inflammatory compound. Boswellia is a resin from a tree, it's commonly known as frankincense, also very effective anti-inflammatory, which may even have some cartilage resurfacing capability at a microscopic level. Bromelain, which is an antifibrotic enzyme, breaking up scar tissue. Magnesium, decreasing muscle tension in joints. I mean, these are the kinds of things that can be employed as a protocol that can get somebody who has a severe pain situation, not just mild, completely out of pain without any of those intensive Western medical interventions. I've seen this hundreds of and hundreds of times.

Matt Feret (18:00):

And you've seen hundreds and hundreds of time address the problem and therefore no further steps are needed?

Dr. Josh Levitt (18:06):

Absolutely. I mean, yeah, that's exactly what I mean. And I think what it requires is a retooling of the way we think about it. When a person goes in to see an orthopedist with a painful knee, that orthopedist, and bless the orthopedist, they do amazing and miraculous work. I don't mean to throw anybody under the bus here. Surgeries are near miraculous, the way what we can do these days, but only when they're necessary and done on the appropriate patient. There's countless, really hundreds of thousands of unnecessary or inappropriate surgeries done every year. Which doesn't mean they all are, but some of them are. And for those people, yes, we can often see complete resolution, symptomatic relief without any of those big interventions. But it requires a different way of thinking. Like an orthopedist is looking strictly just at that knee and what can be done.

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Whereas when I encounter a patient with a painful knee, I have never seen a knee come walking in my office. So far, it's always been in a person who has another knee, usually, most times, and a hip and a foot and a back and a spine and a diet and a lifestyle and exposures and stress or not, this sort of thing. And so when you look at a holistic view of the person in whom that painful knee resides, that leads to different treatment plans. And so it's that holistic view that, I think, informs this perspective and really helps to put together a comprehensive plan that can really get a lot of people out of pain.

Matt Feret (19:35):

I was thinking of my own personal saga, and I'm not going to ask you for a diagnosis at all on a podcast, but I'll just tell you. I've dealt with right foot pain for going on two years, and I've gone to six specialists. Six, and each one of them diagnosed me with everything from plantar fasciitis to fibro, I'm going to mess this up, fibrosis, fibroids. Anyway, and had the MRI, everything else. And the result was either from literally cutting my foot open and peeling it back and taking a look to rubbing a compound on it and using insoles, which is what I'm doing now by the way, because like you, I'm like, let me go the non, I don't need the flamethrower. In those instances where people are going to 2, 3, 4, 5, 6 doctors, is that overkill? And by its very nature, are you going to get six different diagnoses? Or should you look more towards finding the right doctor the first time that will be considering all and everyone in between? What's the approach for someone who's been in this situation of multiple specialists, multiple appointments, and multiple potential outcomes?

Dr. Josh Levitt (20:52):

Yeah, it's a very frustrating situation. I feel for you. And I know how problematic a painful foot can be because it can really, it starts there, it's really, I've seen foot situations turn into full body situations because when you hobble that way, all sorts of other things begin to break down, because you can't walk and you can't do the exercise you want to do. Anyway, so I feel for you, and I'm sorry, I hope you find relief. Yeah, I think, to the question, it's very easy for doctors, especially mainstream Western trained doctors, to look at a problem, make a diagnosis, which is either clinical or based on a radiologic image, x-ray, MRI, that sort of thing. And at that point, this is, I think the pitfall is that we make a diagnosis, I'll give you an example. In the foot, there's a problem that's called metatarsalgia.

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I imagine one of your doctors might've told you that you have that. So metatarsalgia, the metatarsals are the ball of the foot where you get the calluses, where it touches the ground, that's the head of the metatarsals, and algia means pain. So metatarsalgia means pain in the ball of the foot. And so it's a ridiculous diagnosis because the patient tells the doctor, I have pain in the ball of my foot. And then the doctor tells the patient, oh, that's because you have metatarsalgia, which is ridiculous. It's just reiterating in fancy medical words. And then from there, the point though is, I mean, it sounds so silly, but it's true. This happens all the time. From there we have a diagnosis and then we look to a menu or a recipe of treatment plans, which is some kind of another therapeutic order.

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Maybe some cream, maybe a pill, maybe an injection, and up the chain from there. And I think it's probably mostly fair to say that in conventional mainstream medicine, when the diagnosis is made, the thinking stops, and you just kind of look to the book about what the recipe for treatment is. If this doesn't work, then we move to that. And this happens across the board. Here's your first blood pressure medicine. If that doesn't work, here's your next blood pressure medicine. There's just a rubric. The way I practice, and I think this is true for anybody who practices a holistic form of medicine, is when the diagnosis gets made, the thinking begins. This is when we should say, okay, he has metatarsalgia or plantar fasciitis, or whatever it is. Why do you have that? What is going on? What is wrong? Is it your gait?

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Is it your station? Is it something in your diet? The diagnosis should prompt a whole new set of diagnostic inquiry, and those questions are why. And when you start to get to the answer of those questions, you start to find solutions that are, by definition, natural. There's one thing that's for certain is that your foot pain is not because you have an Advil deficiency. That's not the cause of your foot pain. And so it may be something structural, it may be something postural, it may be some excessive inflammatory reaction. I'm not sure what it is, but I can guarantee you that it's not because you need more Advil. That's not the solution. So that's the way that I like to think about these kinds of problems. I hope that's helpful and answered your question.

Matt Feret (24:00):

No, it is. Thank you. Because it was just an example that I personally had, but it also kind of goes back into what I was hearing you talk about is it's almost like how do you interview your doctor, isn't it? It's how do you know when you make an appointment with a doctor or a specialist, you don't know if he's going to take or she's going to take your approach or the by the book, you've got a problem, there's a checklist, you go through the checklist. And is there an opportunity to, how should people be thinking about this if they've got something like, oh, let's again, my foot, somebody else's knee. How do you figure out who does that stuff and who goes by just regular old checklist? I mean, you get online and you look at your provider directory or you ask a friend. How should people go about finding people that do what you just talked about and not just check the box?

Dr. Josh Levitt (24:49):

Sure. So it's a great question, and I understand that people aren't going to love this answer, especially in the insurance reimbursement schema. So depending on the state that you're in, you may or may not be able to get reimbursement for the kind of care that we're talking about here, but be that as it may, I think that a naturopathic doctor who's trained, like I am, should be a part of someone's healthcare team, especially if they have chronic ongoing problems. And the way, and we can talk about naturopathic medicine specifically, there are thousands of naturopathic doctors all across the country in probably every state. There is a national association that's called the AANP, the American Association of Naturopathic Physicians. They have a doctor search thing. You can type in your ZIP Code there and find someone that's close to you. These days, because of COVID, a lot of people are offering telemedicine services as well.

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And if a person is struggling with a chronic ongoing problem and wants to get a holistic view, I think a naturopathic doctor is the best trained type of person who can provide that kind of perspective and should be a member of anyone's healthcare team who's struggling in that way. Yes, in some states it's reimbursable. In the state of Connecticut, naturopathic doctors accept insurance, like all the docs at my office do, but not in every state. And so that's some specifics we can get into later if that's a subject of interest. There's also a category within Western medicine that's developing over the last few years called functional medicine. And those tend to be medically trained doctors, MDs and DOs, who have kind of, I don't know, seen the light, so to speak, had their eyes opened up to this holistic view.

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And they also will provide kind of a more holistic, comprehensive view on things. They tend to be self-pay and often rather expensive. So I would look for a functional medicine doctor or a naturopathic doctor to add to your team if you're struggling with this sort of thing. Because the conventional, mainstream, kind of hospital-based, clinic-based physicians, they practice in a certain lane, and it's really unlikely that you're going to get a broad, holistic, time patient-centered approach from conventional mainstream primary care. That's just not how the system operates.

Matt Feret (27:06):

Thank you. Quick slight pivot, and let's go into, sometimes I do decades, but we will just say older adults and you can fill in the blank of what age that might mean to you or anybody listening or watching. When we think about, you talked about pain and inflammation and musculoskeletal pain, did I say that right?

Dr. Josh Levitt (27:26):

You did.

Matt Feret (27:27):

All right. Nice.

Dr. Josh Levitt (27:28):

Well done. It's a mouthful.

Matt Feret (27:29):

I get a lot of stuff wrong, but I got that right. When we think of going back to supplements, are there things that we should be proactively doing when we don't have any symptoms, when we don't have any health issues to prepare us for the later ages and stages of our life from a supplement or from a kind of a natural homeopathic standpoint?

Dr. Josh Levitt (27:51):

Yeah, so that's a great question, and I think I probably take a little bit of a different take on this than a lot of people in my kind of position, especially after a few decades of doing this. Lots of natural medicine doctors take all sorts of supplements for prevention, and you have got your fish oil and you've got your magnesium pills and your turmeric pills and all that sort of stuff. I like to believe, and I'm inclined to believe that if a person is otherwise well, they should be able to manage their health into the future with very minimal amounts of external supplements coming in, mostly done by way of diet and by way of a healthy lifestyle. And then use the supplements to fill in any gaps that might be there because of any disease risks that a person might have, dietary deficiencies that might be uncovered.

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So I think that a minimally processed diet that is foods that are largely coming from the, think about it as the perimeter of the grocery store, foods that are in their form that they were in in the farm or in the field or in the fishery, so to speak. And that will give you the most nutrient-dense type of diet. And then, and this is a gross deficiency in the diet of most Americans, is spices. So I'm a huge fan of spices, which it's amazing to think about this, and a lot of the spices in the spice rack are now supplements, but you don't need to use them as supplements in a pill, they can be used right off the spice rack like they have been for generations. In fact, these spices that are now relegated to those little three-inch jars that are collecting dust on most people's pantries, we fought wars and traveled to new lands to find these things.

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They are the most concentrated sources of the medicines that we use in many nutritional and herbal supplements right there in the diet. And they taste good. They enhance the flavor of your foods. Fantastic. So I think that a minimally processed diet that's richly infused with spices is the first place to go. And then if there are specific or individual risks, then we fill in the gaps with a little vitamin D if you live in a cold climate for much of the year or whatever the case may be. So yeah, I'm not a big pill popper unless they are necessary or they're very specific for a specific reason or risk.

Matt Feret (30:07):

Thank you. So if you move past, let's just say, getting older and into specific fifties, sixties, and seventies, and all of a sudden you may have chronic pain, you may have that wrist or that tennis elbow that keeps coming back.

Dr. Josh Levitt (30:21):

Yeah, the stuff that's coming back to haunt you.

Matt Feret (30:23):

Yeah, exactly. The old football injury from high school that's been chirping at you, but now it actually hurts over time. Are there different in terms of preventive, I guess, or reactive pieces when you get into that 55, 65 plus range, I mean, even cognition, the mental capacity piece as well as we think about all the things that can ail us or attack us in later stages of our life. From a preventive standpoint, anything you want to talk about there, but also, again, normal aches and pains, you mentioned earlier, joints, et cetera.

Dr. Josh Levitt (31:01):

Sure.

Matt Feret (31:01):

What's that journey like as you age into those years?

Dr. Josh Levitt (31:04):

Yeah, absolutely. So I think that sticking with the joint pain kind of example here, when a person goes from being otherwise well, and then now that thing is chirping at starting to really be a problem, the old football injury or the old sprained ankle that's now becoming a problem, there's usually a combination of different things that are causing that joint, that body part to start yelling at you in the way that it is. And in my experience, there are three main areas, and this will lead directly into conversations about the supplements that we choose to use to treat these things. So when a joint starts becoming problematic, whether it's a lower back, a neck, a shoulder, whatever, hip, knee, it's usually some combination of the following three things. Number one, excessive inflammation, so more inflammation than there should be given the stimulus. So inflammation is a very hot button subject, and we should get into it a little bit more detail, but when inflammation is excessive, it becomes part of a pain, it can be a pain trigger itself.

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So we want to control excessive inflammation. I'll talk more specifically about how we do that. Number two, muscular tension. And muscular tension, just like inflammation, can be there for a number of different reasons, but when there is excessive muscular tension in the muscles adjacent to a joint, that joint is more likely to be painful. And so we want to control muscle tension, and there's ways to do that with movement-based therapies. There's ways to do that with, what I call medicines, which are supplements and nutritional or herbal.

(32:32):

And then three, not talked about very often is something called fibrosis. And especially in the old injury example, fibrosis is gristle. It's like scar tissue formation, which can be macroscopic, large scale, or microscopic in an area that's been repeatedly damaged like a repetitive strain kind of thing. And fibrosis is another problem in or around an affected joint that can restrict blood flow, that can restrict range of motion, that can compromise or squeeze on nerves and cause an otherwise healthy joint to become painful. So those are the big three, inflammation, muscle tension, and fibrosis that will make a non-painful joint become a painful one.

Matt Feret (33:13):

Inflammation, you said you want to talk about that a little bit more? Let's talk about that. That is hot button. There's a lot of people out there talking about foods to fight inflammation. And then of course, again, all the aspirins and Advils in the world. Talk a little bit more, is that hype or is that real? The inflammation of the American diet and et cetera?

Dr. Josh Levitt (33:36):

It's both, I think. And I think it's a good subject because there's so much misinformation about it. If you look at the mainstream media about inflammation, you would be led to believe that this is this terrible demon and it needs to be squelched or that fire needs to be put out at all costs. Inflammation is just bad. That's what you would glean if you read blog posts about it. Well, the truth, it couldn't be further from the truth. Inflammation is a biological imperative. It's a immunological reaction. It's how we heal. It's how we fight off infections. It's absolutely fundamental to our survival. The problem is, is what I said earlier, which is excessive inflammation. And it's funny, this is an interesting little historical side note here. Inflammation is named after fire. Inflamo means to set a blaze, is fire in Latin. And inflammation and fire are very similar in that when fire, we need it, we use it to cook, we use it to stay warm.

(34:34):

We love a candle at dinner, but when the candles light the curtain on fire and burns the house down, fire can be terribly destructive. So when it's contained and controlled, it's necessary, it's useful, we depend upon it. But when it's out of control or excessive, it's an extremely destructive force. And inflammation is exactly like that. When it's contained and controlled and appropriate, we need it and we depend on it for survival. When it's excessive and out of control, it is indeed one of the most, if not the most destructive forces in our body. And it's associated with every chronic disease there is all from head to toe, whether it's your foot, I'm sure there's some amount of inflammation involved, or flagging cognition in an older adult, cardiovascular disease, autoimmunity, you pick your disease, there's a chronic disease and there's inflammation at the root.

(35:23):

So we have to look at controlling or modulating inflammation to make sure that it's appropriate for the stimulus. And this is the beauty of where herbal and nutritional medicines come in. When your diet's richly infused with omega-3 fatty acids, the kind of thing that you get if you eat wild caught fish, and the kind of thing that you don't get enough of if you just eat a highly processed type of diet, good omega-3 ratios in your body will lead to better control of inflammation regardless of the stimulus. The consumption of spices. Turmeric, like I mentioned, is one of the, and it's active ingredient, curcumin, remarkable medicines for controlling and modulating inflammation, again, regardless of the stimulus. So yeah, inflammation it's both true and overly hyped and greatly misunderstood, but very much a part of the perpetuation of chronic pain in so many people.

Matt Feret (36:21):

So this might be a silly question, but I'm going to ask it anyway. When you talk about inflammation, it is when I feel pain, I know that's inflammation. Is there a point though earlier than that where I could recognize high inflammation in my body without it actually metamorphosizing into pain? Is there any way I can go like, oh, you know what, I don't know, my neck is too thick or my fingers are, are there any signs that I've got chronic inflammation that may be getting to a point where bad things are going to happen?

Dr. Josh Levitt (36:55):

Yeah, there are. I mean there's two ways to frame that. One is the clinical experience of inflammation. And going back to our Latin discussion here that the way doctors learn this is with a little Latin poetry, and I'm going to butcher the pronunciations here, but the signs, the clinical signs of inflammation go by this four word Latin poem. One is rubor, dolor, calor, and tumor. And I'll say them again, rubor, which means redness, dolor, which means pain, calor, which means heat, and tumor, which means swelling. Inflammation is all four of those things. When someone has something inflamed, like you smash your toe against the coffee table and it gets red, hot, painful, and puffy, that's inflamed. When something's just puffy, like a foot, but it's not red and hot, that's edema. It's got the swelling piece, but not the pain and not the redness so much.

(37:49):

And so inflammation has those four characteristics. There's another one that we add on which includes loss of function, and that's the clinical experience of something that's inflamed. That's pretty gross, pretty crude, pretty obvious if you look at it. And then there's more subtlety. So we can draw your blood and we can look at all sorts of different things in the blood. We can look at sedimentation rate, and CRP, and a bunch of different cytokines and leukotrienes to assess whether or not somebody has a smoldering fire there, and then address those things. So for the nuance, if you really want to assess whether or not there is some kind of smoldering fire that's not red and hot and painful yet that requires some fancy laboratory, they're not that fancy, some laboratory test that your doctor can do.

Matt Feret (38:33):

So I'd get my annual physical and they take blood, and then do I request a certain type of test or is there more than just the generic ones that I get every year to make sure I'm not dying?

Dr. Josh Levitt (38:46):

Yeah. A lot of times for a routine annual physical, again, coverage dependent, you usually won't see tests for just broad spectrum inflammation there. Probably the most useful one just to generally assess whether or not there's inflammatory markers present is called a c-reactive proteins, abbreviated CRP. And that's a really good test for people to do just generally and, at least in my opinion, everyone's coverage is different, ought to be covered as part of routine annual screening. And then you can go from there.

Matt Feret (39:17):

Okay. Thank you.

Dr. Josh Levitt (39:18):

Yeah.

Matt Feret (39:18):

Can I move back to supplements really quickly?

Dr. Josh Levitt (39:21):

Sure, of course.

Matt Feret (39:21):

Again, multi-billion dollar industry, there's a lot of them going out there. Do you have any favorites? I mean, you mentioned a couple spices already. Do you have any favorites? You said vitamin D. Stuff that actually does, well, I don't know, it's going to sound weird, does work and then, because maybe not all of them do work, right? The natural-

Dr. Josh Levitt (39:42):

Yeah. The ones that work are my favorites. How about that?

Matt Feret (39:44):

Yeah, there you go. So which ones work then?

Dr. Josh Levitt (39:47):

Yeah. And I'm going to put a qualifier here because you're right now asking a person who formulates and sells nutritional supplements as part of my career. So I am as biased as biased could be when I answer this question. So just let's put that out there, right?

Matt Feret (40:03):

All good. Totally get it.

Dr. Josh Levitt (40:04):

To avoid any perception-

Matt Feret (40:05):

By the way, you also have expertise because you've actually done this, so that's not that bias.

Dr. Josh Levitt (40:09):

Fair enough. Yeah. And I'm not going to just say, oh, it's mine that are the best. Mine are the very best ones. That's the only ones that you want to buy. Of course, I take great pride in what we do make at UpWellness, but we certainly don't have the corner on that, you're right, multi-billion dollar market. And it's really challenging for the consumer, I got to be honest, because there is a lot of money to be made. I mean, let's be real here. There's a lot of money to be made and it's very difficult for a customer, a patient to assess the quality because, let's take, think about this for example, if I decided that I wanted to sell lettuce pills, pills that are made out of romaine lettuce, I could have raw, I could get my raw lettuce that's going to be eventually dehydrated, powdered and put into a capsule.

(41:00):

I could get fresh, organic, fresh from the farm, crispy green lettuce, dehydrate that, put it in a capsule, and that would be great. And that would cost me quite a bit because my raw materials were really good and high quality. Or I could buy rotten, moldy romaine lettuce that was just going to be thrown away for dirt cheap, get it out of the dumpster. I could dry that, powder that, put it in a capsule, and you would never know the difference. And quite honestly, nobody would check because this industry is not terribly well regulated from the federal perspective. There's a lot of internal regulations that reputable companies will put upon themselves to make sure that the lettuce, of course, we don't make lettuce pills, that might be a good idea though, but that the lettuce is good quality and it's starting, that it's clean, that it was harvested at the right time, that it doesn't contain contaminants, that it's shelf stable for X number of times, X number of years after data manufacturers.

(41:55):

So really it requires a person doing a little bit more homework than you would if you just went to a pharmacy to pick up a pill to make sure that there's third party independent laboratory testing, to make sure that there's a quality assurance program that the manufacturing facility that makes these products has, it's called CGMP, certified good manufacturing practices. And you can always ask a good company for certificates of analysis of the materials that go into those products. I know that's a lot for a person to ask, but there are very real problems where that moldy lettuce is absolutely on the shelves in every product category that there is. And so you have to stick with companies that you trust, and not just because some person online told you to trust them, but that you'd had to do a little bit of homework. And that really is just the state of affairs.

Matt Feret (42:49):

That seems a little silly. Why do I, okay, to your point, I go to the pharmacy, I have one prescription, I hand the prescription in, I know it's the right one, right? [inaudible 00:43:01]-

Dr. Josh Levitt (43:00):

Yeah. It's going to be a variance. They gave you a 50 milligram pill, and there's going to be a variance put on manufacturing by the pharmaceuticals that there has to be no more than 10% up or down to that 50 milligrams per pill. And yeah, you can have some assurance that that is going to be true, whereas in the nutritional supplement world, that is simply just not yet happening. In Europe it is, by the way, in Europe it is. There's more regulatory oversight there.

Matt Feret (43:26):

That's where I was going too, because go back to your Switzerland example. I mean, this country, for all of its wonderful things, seems to make older adults and seniors, and even not seniors, go do their own research. They seem to make them put them through different decision points much later on in their life than they need to. And in the example of, I mean, I do Medicare and Social Security, I mean, there are 50 choices every year that you could choose from, from a Medicare plan, and it means you could pick 49 wrong ones. Social Security, you can pick to retire at age 62 or age 70, anywhere in between there. But in Europe, for example, they don't. It's almost like that we'll take care of it, we'll do what's best for you. And it seems, is it the same way? I think you already answered it. Yeah, it's not this way in Europe.

Dr. Josh Levitt (44:16):

It's not this way in Europe, there's even national databases that supplements need to be registered into, and many of them are scrutinized in this sort of way that I just described. But in this country, no, we right now don't have a federal register of nutritional supplements or herbal supplements. And it's very difficult for the consumer to make sure or to ensure that what they're getting is of quality. And a lot of people, of course, just buy on a price point. Let me give you an example, that's actually just an egregious example I learned about at a conference several years ago, that you've heard maybe of an herbal product called St. John's Wort. So pretty famous. It has some antidepressant activity, pretty popular supplement. There's an ingredient in St. John's Wort that's called Hypericum, and this is the active compound that does the work.

(45:04):

So the person who was giving a lecture was running a laboratory that was checking, assessing the levels of Hypericum in the St. John's Wort products and found that in one particular product in the US it was St. John's Wort, but there was no Hypericum in it at all. And he was kind of curious about, this is weird. This does have all the genetic markers. It's definitely St. John's Wort, but where's the medicine? Of course this stuff isn't going to work because it doesn't have any of the active ingredient in it. Turns out that what had happened in that particular case is that the St. John's Wort was very good quality. It was grown in Europe. It was processed and extracted. So the Hypericum was removed by some fancy extraction technology and encapsulated and sold to people in Germany, in this case, who probably got a good product.

(45:56):

And then after they extracted that Hypericum out, there was the leftovers, kind of like the fibrous pulp that's left in the juicer after the juice is already out. So what did they do? They sold it to the Americans. It was St. John's Wort. It was cheap. It was like my moldy lettuce example. And this St. John's Wort is actually St. John's Wort, it just has no active ingredient in it, so it's not going to do a darn thing for a person. They powdered it, they encapsulated it, and they sold it as St. John's Wort on the shelf. And so this is a problem. This is a problem that we have in this country.

Matt Feret (46:33):

I know we don't like regulation and oversight as a country, right?

Dr. Josh Levitt (46:36):

Yeah.

Matt Feret (46:37):

Individualistic and all that, but is that the answer? Needs more oversight, scrutiny?

Dr. Josh Levitt (46:43):

I think I hesitate because I don't like it either. I like the free market. I like the ability, I don't want big government coming down on this herbal medicine industry and telling us what we can and can't do. But if the regulations help to filter out or screen out some of those bad actors, because someone who's doing that, by the way, is just a bad actor. That's a fraudulent. That's someone who's there for the money and for the money only. And so if there's a way for regulations to ensure that companies aren't just putting profits over people and screen out those bad actors, even if it makes companies like ours go through a couple extra steps, that's a challenge. I don't love to have to leap over those other obstacles, I'm hedging my bets here, but I would agree that there does need to be some more scrutiny than there is right now because there's just too much junk out there on the marketplace.

Matt Feret (47:40):

Yep. Not brand specific, but kind of a re-ask of a question I didn't ask well enough a couple of minutes ago, which was vitamin D, St. John's Wort, milk thistle, those sort of things. Are there products or particular compounds out there that are no-brainers, great for you, not necessarily done by modern medicine that you should actually work with? And I guess by the same token, are there ones out there, like maybe this benign St. John's Wort example, that jury's still out, you can buy it, you can ingest it, it may or may not work for you. Are there any kind of levels of efficacy by vitamin D versus vitamin C that you've run across?

Dr. Josh Levitt (48:22):

Yeah. It's a huge question that you just asked, which is fine. I think let's break it up into two things. There's some stuff that I think people can readily take and probably should over the counter based on their own sort of situation or what they're attempting to do, what their risks are. Vitamin D fits into that category. You should get your vitamin D level assessed. Vitamin D is very important, especially for people who live at higher latitudes or for people who have darker skin because darker skin doesn't convert sunlight into vitamin D as readily. So get your vitamin D level checked and then optimize your vitamin D level based on whatever your laboratory test is. Shoot for a target, probably a fair target for the general population is somewhere in the realm of the lab test coming back as 50 or so is probably about right.

(49:06):

And vitamin D can be used safely as long as you are monitoring your, and that's a test that could be added onto your routine blood work. I think it's also totally reasonable for people, especially if their diet is suboptimal, it's not a nutrient-dense diet, they're eating processed foods, to consider a multivitamin and a multi-mineral or those are often packaged together. Mineral deficiencies are widespread and they're not the kind of deficiencies that cause deficiency diseases. These are like suboptimal, just get enough to prevent a deficiency disease, but not enough for optimum functioning. And if we start to think about the way our diets work and the way the RDAs are constructed, they're like the minimum amount to prevent deficiency, which is maybe different in many cases than the optimum amount for vibrant health. And I think of minerals like magnesium, very commonly deficient, zinc, selenium, there's a lot that can be done in terms of risk factor reduction by making sure that your basic vitamin and mineral status is optimized.

(50:10):

And then when it comes to the herbals, there are some, and I think the easiest way to describe them is the ones that are readily available in tea. There's like your chamomile and peppermint and these sorts of things are safe for general use, which is why they find themselves in tea. When we start getting into this stuff that's extracted and higher potency and supplements, then I think it's wise to consult with somebody who knows what they're talking about. And I can't tell you how many times I've seen people who are taking all kinds of pills from a health food store clerk who has no business recommending these kinds of things to someone. Get yourself a naturopathic doctor or an herbalist who knows what they're talking about, if you want to start dabbling in the fancy stuff like licorice root or St. John's Wort, this sort of thing.

Matt Feret (50:58):

That's awesome. Thank you for that.

Dr. Josh Levitt (51:00):

Yeah.

Matt Feret (51:01):

So pill form, powder form, liquid form, are there any type of absorption rates or ways I should go about doing some of those things or preference?

Dr. Josh Levitt (51:11):

Yeah, it's a great question. It totally depends. I mean, when I make a product that I'm making for the masses, and this is a tricky thing, I talked earlier about this individualized approach that we can take in the clinic when we're talking to a person, and that sounds great and it's very poetic, but then out of the other side of my mouth, I'm talking about making supplements that are for the masses that aren't individualized. And I think that can be done. It can be done in a way that's sort of like the best stuff for the most amount of people, which of course is not going to be perfect for everyone. And then we get into the question of the delivery system. So a lot of the products that I make are in capsules, and that's basically because they're easier for more people.

(51:54):

Are they perfect? No, but it's a familiar delivery mechanism. It fits into the Western medical construct that people are used to, take two pills twice a day, take one pill three times a day, that kind of things. They're used to it. So pills, for convenience sake, I think are ideal and they're the dosage and delivery system that most people are familiar with. I'm also a big fan of powders that can be stirred into water for a number of different reasons. One, it gets people drinking more water or other smoothie type of things, you can add other things there, and it's a great way to get higher doses of things.

(52:27):

So I have a whole line of products that I made that we call Mojo, which contain adaptogenic herbs, which are these like tonic herbs and improve energy and are good for general health, especially health that is compromised as a result of stress. These are herbs that have been used for millennia and are very useful for managing stress, and you need to take them in fairly high doses. So powders that taste good, that stir into coffee or water, are another great mechanism. I use powders a lot for adaptogens. And yeah, liquids can be great for electrolytes, stirring salt into water. I guess it depends on the product and depends on the person, but there's lots of different tricks that we can employ to get these things into people.

Matt Feret (53:09):

That's awesome. Look, I want to be respectful of your time. I could talk to you for hours, but let me ask this question. Is there any question or there's anything that I didn't ask you that I should have done around this subject and around our conversation?

Dr. Josh Levitt (53:23):

Gosh, I think we covered a lot. I mean, I hope we provided something of value to people. No, I think, I mean, yes, we could go on and on for hours and we could go from head to toe and inside and out, gut health and all this sort of thing. I think what I want to convey, I think, to people the most is that there is more out there than what your physician is telling you. Like everything that, they have your best interest in mind, but they have education and training that is in a fairly narrow area. And if I've done my job, it's sort of to expand your listeners' minds about what is possible in the realm of natural and alternative medicine. And hopefully do it in a way that doesn't feel, that is science validated, evidence-based, and not the kind of dismissive quackery that a lot of doctors will try to convince you that it is.

Matt Feret (54:17):

Dr. Josh, this has been awesome. Thank you very much.

Dr. Josh Levitt (54:20):

Well, it was a pleasure. Thank you. You're very good at asking pointed questions and I think, I hope that we enlightened some people out there today. It was a pleasure.

Matt Feret (54:28):

I hope so too, thanks. Dr. Josh, thanks so much. If you liked this episode, please follow, like, subscribe, and rate the show. Make sure to hit The Matt Feret Show website for links and show notes. Until next time, to your wealth, wisdom, and wellness. I'm Matt Feret, and thanks for tuning in.

(54:50):

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(55:30):

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