The Assess & The AddressThe Assess & The Address

nbj: Tell us about the clinic.

Mark Menolascino: I run a functional integrative medicine clinic here in Jackson Hole, where we have a healthy, fit, educated clientele, but we are also attracting people from all over the region. We have clients who hear about us through word-of-mouth and fly in for week-long visits. We have ranchers and people who you wouldn’t expect to seek out this functional kind of medicine. And they’re using their own resources to do it. We provide a concierge level of service without the fee. We feel that if we’re asking for direct-pay, largely outside the insurance paradigm, then people should get more. They should get a doctor who calls them back, who lets them use email. We run our practice right on time, our staff is friendly, we provide ancillary services that meet our patients’ needs, and we’re open to suggestions.  It’s a real dialogue, almost like the relationship that doctors used to have with physicians before the seven-minute visit and the insurance reimbursement model where you’re incentivized to do procedures and write prescriptions.

     At the end of the day, you’ve got to provide a higher level of service than the next person down the street. You’ve got to provide more insight and deliver results. In our practice, fibromyalgia, chronic fatigue, irritable bowel syndrome—they don’t exist.  Our clients don’t have diabetes, and they don’t get heart attacks because we’re looking at them through this lens of functional medicine. We’re developing a preventative, personalized, holistic, integrative medicine plan that is unique to each patient.

nbj: No fibromyalgia?

Menolascino: When I say that certain common ‘diseases’ don’t exist in our practice, what I mean is that medicine developed this garbage-can term called fibromyalgia syndrome, chronic fatigue syndrome, irritable bowel syndrome, to give clients a label for what’s ailing them. Those people do hurt with fibromyalgia, they are tired with chronic fatigue, their digestion is a mess with irritable bowel, but why does that unique person have that condition? Because, at the end of the day, you can have 15 different paths to the same end-point called fibromyalgia.

The functional medicine lens lets you look at people in that personalized way to say how did that person get to that point? There are commonalities, of course. With irritable bowel there is typically dysbiosis, typically food sensitivities, and these are things that we evaluate in all of the patients, but when it comes down to it, everybody is so biochemically and genetically unique that you have to tap into that individuality to develop a personalized approach. This is the new era of medicine. By looking at the gut microbiome, functional genetics, methylation and other markers, by looking at nutrient deficiencies and amino acid imbalances, you can see that unique thumbprint for that person and know which direction to go towards the healing process.

A good example is one of my clients who goes to the Mayo Clinic for her executive physical every year. When she came to see me, she was on two diabetes medicines and a statin drug with poor control of her blood sugar, her A1C, and her lipids. Six months later, she was off all of her medicines and her numbers were in line. She went back for her executive physical at Mayo. Afterward, her doctor called me and said, "‘How in the world did you do this?’ I told him and he told me, ‘Well, that will never work on a large scale’ and I said, ‘Well, it’s working one-by-one. If we can do it one-by-one, then we can do it ten-by-ten.’"

     Too many doctors dismiss that this is even possible. When the Cleveland Clinic adopts a functional medicine program, that means this is a scalable model. A great example is Dr. Mark Hyman working with the Saddleback Church in California. Rick Warren, the pastor, met Mark and they ended up serving 20,000 people. They worked in small groups with a functional medicine approach to losing weight and reversing diabetes. Guess what else they found? People said, "Yes, my weight went down, but my sleep got better, my asthma got better, my skin condition went away, my irritable bowel went away, my fibromyalgia is better." So you work on one thing, but because it’s a functional lens for personalized medicine of the entire person, all of these other things get better too. That’s what we see in our practice as well. Another couple I see were spending $1,200 a month on medication and they’re now spending zero. Their numbers are better, and they spend about $350 per month on supplements and probably 50% more on better food. It’s a better outcome with fewer side effects and, at the end of the day, better health.

nbj: Given your position at NeuroScience, how do you view nutrition’s role in the ‘brain space’?

Menolascino: I did a Master’s in pharmacology and one in immunology. During the pharmacology portion, I ran a clinical trial center for most of the new antidepressants. I saw 200 people a week doing clinical trials for Big Pharma, and I really walked away unimpressed with antidepressants. I really don’t think they work, and I think that a lot of the people we’re treating for depression really are dysthymic, which typically presents as an adrenal, thyroid, nutritional issue. Most of the serotonin in your body is not in your brain, it’s in your gut.

     When I was in high school, the brain was a black box. We didn’t think that anything talked to it, there was no interaction, and there was no immune system interaction. Now we know that there is this new concept called psycho-neuro-immuno-endocrinology. Psychology, neurology, immunology, endocrinology—they’re all tied together. The nervous system cells have receptors for the immune chemicals. The immune cells have receptors for the nervous system chemicals. There is a crosstalk between the two. Dr. Gottfried Kellermann of NeuroScience, he saw this 15 years ago and he’s been on the forefront of developing this pattern. I met him and saw the work that they’re doing, which got me incredibly excited about the future of the brain.

     We're pretty terrible at treating mood disorders right now with anitdepressants. We’re using antidepressants to treat hot flashes, which really doesn’t make any sense to me because you can balance the sympathetic nervous system by evaluating the neurotransmitters and modulating with safe amino acids rather than with pharmaceuticals.

     We can pretty much prevent heart disease, we can prevent a stroke, but cancer we’re still working on. Cognitive decline is interesting too. As a consequence, Baby Boomers feel more in control of their physical being, but it’s their future cognitive being that really worries them. We look for ways to protect the brain long-term, because you don’t just get Alzheimer’s in one weekend.  It’s a long process. I think it’s a multifactorial decline. At the end of the day, it’s about oxidative stress and inflammation. And that’s what heart disease is, that’s what endothelial dysfunction is, I think that’s what diabetes is, and I think that’s what Alzheimer’s is. It’s all about inflammation at the end of the day and oxidative stress is driving the inflammation. You have to address those two things, and by looking at the neurotransmitters, you can actually get an insight into that far beyond the new CRPs and myeloperoxidases, far beyond these basic, low-level inflammatory markers.  It’s all about pattern recognition.

nbj: Are these more sophisticated tests cost prohibitive?

Menolascino: Here’s the thing. These neurotransmitter tests are not very expensive, a couple hundred bucks. At NeuroScience, we have a sleep program that assesses your melatonin and cortisol, and it has a targeted GABA-based supplement that is probably the best sleep aid on the market. We have a way to get everybody off Ambien now in this country, and you’re going to see that promoted very strongly by the company. No one wants to prescribe Ambien, no one wants to take it, the FDA wanted to cut the dose in half. It’s not a good drug for people to take long-term. It’s hard on the brain, so isn’t that a win if we can use targeted amino acid therapy? We call it ‘the assess and the address.’ Assess the individual’s imbalance and use targeted amino acid therapy to address that imbalance.

nbj: How far away are we from this personalized medicine going mainstream?

Menolascino: Like a lot of things in our world, the change is exponential. One of the big reasons is that we’re now drawing into healthcare people who weren’t into healthcare before.  Silicon Valley, the computer guys, software engineers, people who think in mach speed. These are not people who wait three years for an idea to come to market. They have an idea and then two weeks later, they have a prototype. There’s a snowball that’s moving down the hill and every time it rolls, it gets twice as big.

     I think we’ve hit the critical mass that every innovation has to hit to start spinning at full speed. I go to these functional medicine conferences and every one of them is sold out four months in advance. At the end of the day, two things will happen. One, the economics will drive this change. It’s just not sustainable to do what we’re doing in healthcare. Two, the consumers will demand it. They’re demanding this type of medicine, a personalized approach, and they’re not satisfied with the old four-part cholesterol test, the old-fashioned diabetes risk assessment.

The current model is that we wait for it to break and then we find a way to fix it. I think you’re going to see Big Farm and Big Pharma take a hit with this, that whole paradigm is going to shift and it’s going to be empowering. We’re going to put it back on the person to be self-empowered, self-aware, and I think people are ready for that. It’s going to take a certain segment of our society to drive it, but my desire, my hope and dream is that it trickles down to everybody.