Gut Health, Mitochondria and the Future of Personalized Medicine with Robert Rountree, MD

[00:00:00] Dr. Robert Rountree: It's great that we have this explosion of information on the internet, but as an editor for a journal for 20 some years, what I always tell people is try to go to the primary source. You know, if somebody says, hey, this is good for you, this is bad. If somebody says, blueberries are bad for you. Then I go, where did that come from? Track it down. Don't accept anything for granted just because one person said it.

[00:00:29] Dr, Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, Director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science backed and time tested approaches to well being. Let's take your health to the next level. Welcome to Next Level Health. My guest today is somebody I'm thrilled to have on the podcast, Dr. Robert Roundtree. Bob, as I know him, is one of the true pioneers in integrative, functional, and lifestyle medicine. He is a sought after speaker, author of three groundbreaking books in integrative medicine. And he's been in actual practice with a powerful blend of traditional family medicine, nutrition, herbal medicine, and mind body therapy in Boulder, Colorado. since the 1980s. He's also one of the original core faculty members of the Institute for Functional Medicine, the clinical editor of integrative and Complementary Therapies, and someone in the field I immensely respect. Today we'll dive into the intersection of nutrition, immune health, and chronic inflammation. Maybe AI a little bit. And hopefully you'll walk away with some practical diet and lifestyle tips to take your well being to the next level. Welcome, Bob.

[00:02:02] Dr. Robert Rountree: Hi, Melinda. It's great to be here.

[00:02:04] Dr. Melinda Ring: great to see you. It looks like you had an exciting

[00:02:09] Dr. Robert Rountree:  My face and the sidewalk had an unscheduled encounter. You know, it's ironic because I was on my way to the gym and I was, you know, gotta go jump on the treadmill and my foot just landed on the sidewalk wrong. And so,

[00:02:28] Dr. Melinda Ring: Yeah. I don't know if that's what they meant when they said no pain, no gain

[00:02:32] Dr. Robert Rountree: yeah, no pain, no gain you know, I know that when I was working out a few minutes later on the treadmill, people thought, don't mess with this guy,

[00:02:40] Dr. Melinda Ring: Yeah. So, so with this bruising, you know, before we jump into our conversation, was there anything maybe in the integrative medicine realm that you did to try to speed up healing or that

[00:02:52] Dr. Robert Rountree: I actually took something called probe resolving mediators that I think you probably know about.

Um, you know, we've used EPA and DHA and omega 3 fatty acids for many years. And it was a fairly new development to realize that you could use these preformed, anti-inflammatory substances that really have no side effects and are pretty good for calming acute inflammation.

So that was the main thing that I added to my regimen. I already take too many things.

[00:03:23] Dr. Melinda Ring: Yes. Yes. All right. Well, maybe we'll dive into that

[00:03:26] Dr. Robert Rountree: yeah, we'll dive into that. I already take a lot of things. So this was just one little boost. That I added on. I think it helped a lot. I'm actually healing very, very quickly.

[00:03:35] Dr. Melinda Ring: Yeah, that was two days ago and already on the mend. Yeah, I love those pro resolving mediators. There was a real shift in how we think about inflammation.

[00:03:45] Dr. Robert Rountree: Absolutely.

[00:03:47] Dr. Melinda Ring: So let's just start off by getting to know you a little bit. I love to hear people's personal journeys and how they shaped their entry into the field. And I know for me and for many, there's this pivotal aha moment when everything clicks. I understand you were 19 when a book of herbal medicine opened your eyes to a new way of healing. Can you take us back to that moment and really how it set you up?

[00:04:14] Dr. Robert Rountree: I was in college, I grew up in the deep south, in Alabama, North Carolina, and that's not an area that is really known for it's, it's, you know, I can't say for its culinary issues, because there's a lot of good food there, but not food that's good for you, good food, but not food that's good for you, You know, grits and gravy and ham, and so I grew up eating that stuff, and I had zero awareness About the role of nutrition and then somebody handed me this book herbs are magic healers by Paul Twitchell And I read it and I thought my god, I had no idea there was all this information out there

 I used to go to health food stores and there would be bins of herbs and, you know, whole grains and things like that. I started getting into the whole Adele Davis thing and, you know, a lot of other Nutritional oriented doctors, a guy named Allen Knitler, I think was his name. I started reading all that stuff. That was pretty fringe and radical at the time. And at first I thought, well, I'd like to be an herbalist. And then I realized, you know, I actually like biology. I've been studying biology in school. So why don't I combine the two, go to medical school? And so I, you know, went in there with this kind of crusader attitude like, I'm going to change the whole system. Well, it's a big system.

[00:05:35] Dr. Melinda Ring: It is a

[00:05:36] Dr. Robert Rountree: system.

[00:05:36] Dr. Melinda Ring: entrenched system.

[00:05:37] Dr. Robert Rountree: Yeah, it's a big entrenched system, and yet I love the science. I thought biology was amazing. The biochemistry was amazing. I just didn't like the way it was being applied. And so, you know, I held my tongue, went through the training, learned what I needed to learn, and then the year I got out of residency. which is in Hershey, P. A. I did a weeklong training with a guy named Jeffrey Bland. Uh, So it was at the place called the Omega Institute in Rhinebeck, New York. I spent a week with Jeff Bland, Leo Gallin, Sid Baker, and those were all the founders of functional medicine. It wasn't called functional medicine at the time. It was just nutritional biochemistry. You know, as applied to chronic health problems, and I was blown away at the depth of information, the research, etc. And I said, this is what I want to do. So almost from the very beginning in my practice, really from the very beginning, I've been blending that approach, what we used to call alternative medicine. I just call it good medicine now, progressive medicine.

[00:06:47] Dr. Melinda Ring: So you've mentioned this. So this is this

back to this idea of inflammation where we started with your eye. And of course it is the driver of so many diseases from the beginning. autoimmune, inflammatory conditions to heart disease, to Alzheimer's, everything, you know. So when you think about this, I know, you know, to some degree when we think about going upstream root cause, we're saying like, well, you know, are there any, is there anything happening in the body that's, It's creating inflammation, of course, but then also, what can we do from a lifestyle nutrition factor to build resilience and reduce inflammation? So do you have a favorite approach to, or certain nutrients or food components or supplements that you are like, you know, this is, this These are at the top of my toolbox. Like, get these into your diet. These are helpful supplements where the benefits outweigh the risks. Like, where do you, where do you fall on those? 

[00:07:53] Dr. Robert Rountree: Well, you know, it's a very interesting departure from my mainstream colleagues in rheumatology who are fond of saying that diet has nothing to do with rheumatoid arthritis. Right, and that's contrary to many, many published studies that show exactly the opposite. of that, that diet can play a huge role with rheumatoid arthritis. And I think the argument that's, that's often made by the specialists, and I do refer to specialists, I don't have any hesitation with them treating the acute problem, but the argument they make is, Once your immune system has flipped into this bad scenario, where it's overproducing inflammatory cytokines and other mediators, then the only thing that's important is to knock out those mediators. And that's why they don't believe diet plays a role, because they think it's a feedforward process that just keeps on going. So who cares what started it, but that belies the fact that you can go upstream and make dietary changes. And I do think food is really critical. I know you won't argue with me about that.

[00:09:08] Dr. Melinda Ring: argue with you there. Oh,

[00:09:09] Dr. Robert Rountree: Figuring out, you know, First of all, what food should the person avoid? And Dr. Alessio Fasano, we both know, has really done fabulous work in confirming this scenario of mucosal hyperpermeability, which is colloquially known as Leaky gut, you know, there's still docs that laugh at that term, and I think, well, do you laugh at the thousands of articles that are now written on leaky gut and how everything from lipopolysaccharides to antigenic fragments can get into the bloodstream, set off an inflammatory response, and then end up creating antibody production, you know, complement activation, Antigen antibody complex deposition in synovial tissue. So we can map out all the pathways by which the food can cause a problem. So we want to identify foods that are an issue. Is it gluten? It often is. But that's not a place to stop. You know, there's generally inflammatory foods. Processed foods, or I like to joke a lot in my lectures, sticky buns. Right? It's sticky buns. advanced glycation end products that bind the receptors on macrophages and other immune cells that activate them. So your first task, I think, as a clinician is to identify triggering foods. and those

[00:10:42] Dr. Melinda Ring: just to

[00:10:43] Dr. Robert Rountree: be through different mechanisms.

[00:10:44] Dr. Melinda Ring: So let me ask you two questions that come up a lot and I think can be somewhat controversial areas when it comes to the idea of food sensitivities, food reactions, etc. You mentioned gluten, and I think, you know, now there is, I mean, there's an ICD 10 diagnosis code for non celiac gluten sensitivity. So there is, even in the conventional world, recognition that there's gluten sensitivity. I'm sure you've seen this too. So I have this phenomenon where patients are like. Well, I go to Europe and I've got no problem eating gluten there. But then I come home and I eat, you know, and I eat a piece of bread and I'm exhausted or I have stomach issues or, or something. So is that something that you see in your practice? And, and is there some explanation that you have for that?

[00:11:36] Dr. Robert Rountree: Well, first of all, when multiple people tell you something and it's unsolicited, you start to think maybe there's something to it. But I do have people that tell me I can't eat gluten, I can't eat bread in the U. S., and I go to a bakery in France. The bread there is amazing that you get. It's always fresh bread. And what's different? Well, the cultivars, right? They've been growing it in a different way. for a long time. And there's all kinds of additives in the bread here that's not in the bread there. So, we don't know exactly what the culprit is. Is it a different structure of the gliadin that's in the bread? You know, I don't think we really know, but we know that this is reported enough that there is something real going on.

[00:12:21] Dr. Melinda Ring: Yeah, there's something there.

Yeah, for sure. Yeah, I, I I always tell people too, like, they're, you know, there may even be a component, like you're on vacation and you're less stressed and that plays a role too, but I, I agree. I think there is something about the quality of the food that's a real difference. Now related to that, really, in both conventional medicine and in integrative medicine, it's a real controversy about the value of food sensitivity testing. Now they're so readily, I mean, patients can order them on Amazon and do their own food sensitivity test. What is your take on doing those kinds of tests to guide an elimination diet, or At this point in your practice, do you recommend, in general, just remove the most inflammatory foods and see how you feel and add them back in and see if you have a reaction? Which way have you followed? Because you've been doing this for

[00:13:18] Dr. Robert Rountree: Yeah, I've probably used every major test like that on the market, and I find that the results are all over the map. You know, I will have a patient that clearly has reactions to foods, we can't identify what, and I do the blood test and it says, well, your problem's with yellow wax beans. And they go, I don't need yellow wax beans, right? Or you can't eat cornish game hens. And I go, you know, so I've seen a lot of results that just don't make sense. Whereas, it's hard to deny the effect of an elimination diet. You take somebody off of food for a month, and then they reintroduce that food, and within 24 to 48 hours, they either have a skin reaction or a joint reaction, or a malaise. It's hard to deny that. So I, you know, I've gotten much more fond of just doing straight elimination diets. That's what the literature supports. Um, it's detecting a wide range of reactions, not just immunologic reactions. You can't really beat it.

[00:14:22] Dr. Melinda Ring: Yeah, I agree. I mean, I think, I, too, have done a lot of those tests over the years to try to ascertain its value to my patients. And I think the greatest value that I've seen, because doing an elimination diet is hard. It's, you know, you have to be really dedicated. You can't let little things slip in. You have to really completely eliminate them. Ideally eliminate a lot of things at the beginning and then add them back in. Not do it one at a time kind of thing. And so it's a challenge. And so, the real value that I've seen in doing those kinds of tests is as a motivating factor for patients to be like, Oh, I am reacting to things. I guess I should do that elimination diet. And so it's something that I rely on much less and I think instead what I've leaned towards is thinking about healing the gut. And like you said, this idea of increased intestinal permeability or leaky gut and, and thinking about that along with the elimination diet as my first step when it comes to those inflammatory issues. But of course I trained from people like you.

[00:15:35] Dr. Robert Rountree: Yeah, I hope I got that message across.

[00:15:37] Dr. Melinda Ring: Yeah. Am I, am I, did I get it right?

[00:15:39] Dr. Robert Rountree: Yeah, you got it right. I'd, I'd say the one thing I'd add to that that's a relatively new piece is the use of CGMs in otherwise, otherwise healthy people. Like when contingent glucose monitors came out, they were a great thing for diabetics. Right, and I've prescribed them for years, they're helpful, etc. But just in the last year, we now have two over the counter monitors that are out there, the Stelo and the Lingo. Stelo is from Dexcom, Lingo is from Abbott. So they're the two big players in this field. Anybody can order them. And so I've started recommending them a lot to my patients because it's very telling. Here's a person that seems to be healthy. They put on a CGM and they eat, let's say, a serving of sweet potatoes. And their blood sugar goes through the roof. Well, that's a kind of reaction that they should know about. So it's adding this additional piece of information. You know, that's an inflammatory reaction. And you can go on the internet and you can read all kinds of things about which foods are good or bad, etc. But if a person eats sweet potatoes and their blood sugar goes to 190 that's an inflammatory reaction and they may not feel that.

 Now, along the lines of inflammation, and you mentioned some of these immune markers you know, we're, we're, What are we in now? The quadruple epidemic? I don't even know what we're up to at this point when you bring in, you know, COVID and the flu and RSV and

There's this idea of like, boosting your immune system, supporting the immune system. How do you guide patients on that? And, you know, do they need to test or should they just be naturally taking certain things? What are you, what's your guidance? And I know you mentioned you take a bunch of supplements, so

I do, I mean, I.

[00:17:37] Dr. Melinda Ring: share what you do too

[00:17:38] Dr. Robert Rountree: I take a ton of things, and I think because I travel, it puts me in a high risk situation, right? And there are other people in high risk situations, like schoolteachers, right? Like young mothers whose kids are in daycare, you know, who are trading germs all day long. What's a normal number of colds to get every year? Maybe three? But then, if we're saying that, What about the person that says, I never get sick, right? I haven't gotten sick in 10 years. I think, okay, I want to know what you're doing. Sometimes they're not doing anything. They just happen to have a really good immune system. We have a series going of novids, right? People that never got COVID and some of them aren't doing anything. So some people do just have a naturally robust immune system. Now, what might that be? It could be genetic. Or it could be their microbiome,

[00:18:39] Dr. Melinda Ring: mm

[00:18:40] Dr. Robert Rountree: right? You know, I was gonna lead up to that .

[00:18:42] Dr. Melinda Ring: Yeah, alright, tell us about

[00:18:44] Dr. Robert Rountree: You know, so Martin Blaser, you know, that wrote Messy Microbe is saying, every generation, the number of microbes in our gut gets smaller and smaller.

[00:18:57] Dr. Melinda Ring: The number or the diversity of them.

[00:19:00] Dr. Robert Rountree: both, both the

diversity and the number. And this is based on some research. I think his wife was the one that did this. They were, they, sampled microbiomes of uncontacted tribes, Amerindians, in uh, in remote reaches of the Amazon. And these people had things that we would consider unhealthy. They had parasites, viruses, and yet they had no autoimmune disease.

[00:19:29] Dr. Melinda Ring: Hmm.

[00:19:29] Dr. Robert Rountree: Right? They had almost no heart disease. Now they might die from a venomous snake bite, right? Or they fall out of a tree or something like that. But they weren't getting the chronic diseases we get in our society. So what Blaze is saying is with the advent of C sections and being excessively clean around our young ones telling, yeah, the hygiene hypothesis along with the fact that there's antibiotics and animal feed, so that comes through in the chickens that we eat we just get less and less exposure to healthy microbes. We want to scrub our food so there's no microbes on our food, but you know, healthy food from a farm has got microbes in it, and those microbes can actually colonize our gut. So it's this lack of diversity. We've gone from many thousands of different types of bacteria in our gut to, in some cases, people have less than a thousand, you know, so we've really cut the number of different types of microbes, what's called the richness. Right? The richness of the microbe has gone way down. And we also know that the bugs that are there, the microbes that are there, are influenced by our diet. So, when we eat a lot of processed food, you know, especially refined carbohydrates, it actually affects the genetic expression of the microbes in our gut. So, if you got a particular microbe that may or may not be leaning towards inflammation, when it gets fed a lot of sugar, it starts making more inflammatory chemicals.

[00:21:12] Dr. Melinda Ring: Yeah, we actually just published in Nutrients an article on the impact of juice cleanses on the microbiome. And? Well, what do you think, Bob? I, you know, part of me, because I used to enjoy doing these three day juice cleanses, I felt good, I felt light. And, you know, I went in thinking like, Hey, there's a lot of colorful phytonutrients in these juices. Juices, maybe there's going to be a real beneficial effect because that's what they claim, right? Like, you're going to have less inflammation, it's going to support your immune system. And in fact, after a three day juice only cleanse, compared to a calorie matched whole food diet, so both, you know, in the 700 to 800 calories, there was a shift towards a negative in the oral microbiome and then also in the gut microbiome. And, yeah, sort of a sad day for the juice cleanse, but

[00:22:14] Dr. Robert Rountree: they fruit juices or green drinks or what,

[00:22:17] Dr. Melinda Ring: Yeah, a mix. Sort of the typical, you know, like those typical juice cleanses. We went with, you know, the exact one that gets shipped to patients. You know, we worked with a company to supply them. So it was a mix of green juices but some of them are higher in sugar because even if it's a green juice, it may have an apple in there to make it more palatable. So they, some of them still were fairly high sugar and of course they were lacking fiber, which our microbiome loves. And yeah, so, so back to my original question, which was the, so what I'm hearing from you is for immunity, we need to be supporting the microbiome. Ideally we do that for our kids, but do you, what do you do for that, for, from diet and or supplements for, for the microbiome? Do you take probiotics?

[00:23:12] Dr. Robert Rountree: Yeah, yeah. Well, I mean, I think the research is overwhelming that prebiotics really beat out probiotics. I still prescribe probiotics, but prebiotic fibers, especially the resistant starches, the things like the unmodified potato starch rice that's been cooked and then cooled, which changes its molecular structure, kiwi fruit on green bananas. Who would have thought?

[00:23:40] Dr. Melinda Ring: Unripe bananas.

[00:23:41] Dr. Robert Rountree: Yeah, who would have thought? And I wanted somebody to do research on plantains because I was, I was just in Colombia doing some work down there and, you know, the plantains they serve are way delicious. So I'm hoping somebody will tell me those are actually really good for your microbiome. I don't, I just don't know. I haven't seen the study. So I do recommend food first, you know, eat, eat a wide variety of asparagus and, you know, brassica vegetables, blueberries, all those kinds of things to really feed the gut microbiome. And then if they need more than that, there are a lot of prebiotic powders on the market now. that I think are pretty good. So that's the first place I go. If a person really needs a probiotic, I think simpler is better. I use a lot of bacillus coagulans. Right? The spore forming bacteria used to be called Lactobacillus sporogenes, but it's not a Lactobacillus. It's actually one of the first probiotics discovered. So the research has been out for, I think, a hundred years. It's safe. It's cheap. It's available anywhere. Most everybody can tolerate it. So it's one that I use a lot. And I also use Saccharomyces boulardii, which is a strain of Cervicae that used to make bread and beer, etc. It's mostly published in articles where people are taking antibiotics and they wanted to prevent colitis. But there's actually pretty good data that Saccharomyces boulardii can increase something called secretory IgA.

[00:25:21] Dr. Melinda Ring: Oh.

[00:25:22] Dr. Robert Rountree: Right. So it improves your mucosal immunity,

[00:25:26] Dr. Melinda Ring: Oh. interesting.

[00:25:27] Dr. Robert Rountree: one barrier in your body is in your gut.

Let's shift gears. Let's talk about one other area that I think you're interested in

[00:25:35] Dr. Melinda Ring: About mitochondria, how do you break down that concept for patients and, you know, give them advice on feeding their mitochondria for energy and longevity?

[00:25:45] Dr. Robert Rountree: Okay, so the long held concept is that mitochondria are the powerhouses of the cell. That's where ATP comes from. And so that's the only thing that's important, right? You know, do you have enough energy? Don't you? So maybe you need mitochondria to help with athletic training, et cetera. I think what's new in the last 10, 15 years is the realization that dysfunctional mitochondria. are involved in every chronic disease you can name. So I first got aware of this when I was lecturing on the genesis of neurodegenerative disorders in a seminar series that I did something like 20 years ago, right? I started really diving into Parkinson's disease and what's going on with Parkinson's disease. And the data, even back then, was showing that Parkinson's disease is a problem with what's called mitochondrial quality control, right? Anybody who works in a factory knows about QC, quality control. So it turns out that mitochondria are not just these little bean shaped things in our cells that hang out and make ATP, but that they're constantly being replenished, right? They came from bacteria, so they follow the same life cycle as bacteria. They're splitting apart, they make copies of themselves, and when they make copies of themselves, the old pieces that have broken down get eliminated, right? There's enzymes that will gobble them up and get rid of them. What happens if you don't get rid of those extra mitochondria? They accumulate inside the cell, or the fragments accumulate inside the cell, and they're highly inflammatory. Our immune cells, the innate part of our immune system, is tuned in to detect the awareness, quote, foreign material, so we know that. Foreign bacteria, bad stuff, go after it. Sticky buns, bad stuff, go after it. But our innate immune cells are also tuned in to detect the presence of the insides of cells. So if DNA is in the bloodstream, our immune cells No, immediately, something is wrong. And they call that a danger associated molecular pattern, or a DAMP. Turns out that mitochondrial fragments are highly inflammatory damps. So when you've got a chronic disease where those whole mitochondria are not being replenished, not being taken care of, not being eliminated, and they're accumulating inside of cells and the cells are extruding them into circulation, that's highly inflammatory and has been implicated in all kinds of diseases. So not only if you have bad mitochondria, they aren't making enough energy for neurons to fire properly, et cetera, they also are spurring the immune system on to make inappropriate inflammatory reactions. So that has led us to realizing, well, we've got to have healthy mitochondria, not just in people with chronic fatigue, but also in people with type 2 diabetes. Well, what was that? What does that have to do with type 2 diabetes? You know, those are mitochondria, that's a whole different thing. Well, think about the, what you might call the, the obesity paradox. Where is that people who are really overweight, eat more calories but have less energy. So they're taking in all these calories, why aren't they burning that efficiently, and making ATP? You should feel better and have more energy if you're eating more food. Well, the reason that they're not is because instead of the mitochondria burning fat and making more ATP, et cetera, the mitochondria are doing is basically creating free radicals. Right? And so free radicals, oxidized particles, it's a form of rust, really. And those oxidized particles damage tissue. When you damage tissue, then what happens inside of your liver cells, your muscle cells, is you get insulin resistance. So dysfunctional mitochondria lead to insulin resistance. And that compounds the problem, which just becomes an endless cycle. In other words, if we can get the mitochondria working better, then the person starts burning fat, the process called beta oxidation, which takes place in the mitochondria. People know about burning fat. Well, you know, I get on the treadmill and it says, go into fat burning mode. So they know that concept, but maybe they don't realize we're really talking about getting your mitochondria to work better.

[00:30:41] Dr. Melinda Ring: So I feel like we have, you know, some pretty readily available markers like C reactive protein for inflammation.

[00:30:49] Dr. Robert Rountree: Yeah.

[00:30:49] Dr. Melinda Ring: Does anybody know if they have dysfunctional mitochondria? What's a, what, how do they know?

[00:30:57] Dr. Robert Rountree: There's some pretty fancy tests that you can do in more sophisticated labs.

Um, your average person the best thing that's available to them is VO2 max testing,

right? Where you go to a, not to a doctor's office, but to an exercise physiology lab, where they put you on a bicycle or a treadmill. and puts you on an oxygen mask and it tells you how much oxygen you're taking up when you exercise. So that's going to tell you the mitochondrial health in your heart muscle, your skeletal muscle, etc. So that's a pretty good functional indicator

of what's going on with 3 radicals. The other thing you can do is in some labs you can get markers of oxidative stress and the one I like the best is oxidized LDL.

[00:31:45] Dr. Melinda Ring: Mm hmm.

[00:31:47] Dr. Robert Rountree: So, oxidized LDL cholesterol is really at the genesis of atherosclerosis, hardening of the arteries. And there are now a number of labs that offer that, so it's not an esoteric test at

all. And there are studies that show that people that live near a highway have very high levels of ox LDL.

People that smoke cigarettes have high levels of ox LDL,

[00:32:12] Dr. Melinda Ring: Okay.

[00:32:13] Dr. Robert Rountree: So that these kind of markers are starting to emerge.

[00:32:16] Dr. Melinda Ring: Yeah.

[00:32:16] Dr. Robert Rountree: So they're secondary indicators of what's going on in the mitochondria.

[00:32:21] Dr. Melinda Ring: Okay.

Yeah, the VO2, I know, sometimes it's even done at gyms, but I know Northwestern, later this year, is opening a human longevity lab, and the VO2 max is a part of that full day assessment. So it's interesting. I hadn't correlated that with mitochondrial health. I had sort of just thought of it as like cardiometabolic health, but not getting to that really intracellular

[00:32:44] Dr. Robert Rountree: Yeah, well, cardiometabolic

[00:32:45] Dr. Melinda Ring: deep rationale.

[00:32:46] Dr. Robert Rountree: Mitochondrial health. Right, they're one in the same. So there actually have been some studies on people with long COVID, you know, that were totally healthy. They get COVID and now they can't get out of bed. Well, what's going on? We think the virus actually damages the mitochondria directly. VO2 max testing is a pretty good way of confirming what they tell you subjectively, right?

[00:33:12] Dr. Melinda Ring: other than zone two exercise, which is again, sort of like the hot thing right now to try to boost VO2 max, are there other things that we can do? Like you talked about overeating being a bad thing. Is fasting a good thing? Are there other things that we should do?

[00:33:29] Dr. Robert Rountree: Yeah, I think so. I mean intermittent fasting, especially when you get over about 14 hours at night Ideally seem about 16. What's that really doing? It's inducing temporary ketogenesis, right? So otherwise I'd say well, everybody should just go on a ketogenic diet, but have you ever tried that like Yeah,

[00:33:50] Dr. Melinda Ring: Few people be able to do that long

[00:33:52] Dr. Robert Rountree: Really hard to do it. So the idea is maybe within intermittent fasting, you can induce temporary ketogenesis and you can get some of the same effects. There's also a number of supplement companies that are coming out with ketone drinks. You know, there's one that I've tried a number of times that actually I think works pretty well. The problem with them is that they don't taste that great. Right? So, you know, what's one of the big ketones is acetone. So I tell people ketone drinks can taste like nail polish remover.

[00:34:28] Dr. Melinda Ring: My God.

[00:34:28] Dr. Robert Rountree: So you really have to, the companies really have to be clever with flavoring to get it to be palatable. But there's some pretty good studies using those drinks as a way to jumpstart the mitochondria. So where did this whole concept come from? Treating kids with seizure disorders with ketogenic diet. And realizing you can have these kids with intractable seizures. Right? Which indicates something is wrong with the mitochondria, with the neuronal firing, etc. You put them on ketogenic diets and it induces neuroplasticity. It actually changes the whole metabolism of the neuron. And after about a year on these diets, sometimes these kids go off all anticonvulsants. So that was kind of the proof of concept. There's something about those diets that's changing the mitochondria. We need to figure out how to capture that without having to go through the hardships of being on a long term ketogenic diet. And I think the overnight fasting, at least 16 hours, maybe better called time restricted feeding, is one way to do that.

[00:35:40] Dr. Melinda Ring: And I think that's a pretty reasonable timeframe in terms of like, you know, eating within an eight hour window. Sometimes people go a little too extreme. They're like a two hour

[00:35:51] Dr. Robert Rountree: Yeah, one meal a day,

like, Oh,

[00:35:53] Dr. Melinda Ring: meal a day. I am like, I don't

[00:35:55] Dr. Robert Rountree: yeah, I don't know. about that. Yeah. But what, you know, what did you have in those other meals? I mean, it's gotta be good food. And so at the Institute for Functional Medicine, we talk about a mitochondrial support diet and it's mostly colorful fruits and vegetables, you know, minimally processed. So no fruit juices, cleansing juices, things like that. It's more protein. If you're going to do carbs. Very complex carbs, but maybe in the beginning I wouldn't say no carbs at all, but a minimal number of carbs you're certainly not eating potatoes and pasta and and Rice and things like that that again can spike your blood sugar that you'll see on a CGM So so a diet that keeps your glucose low As low as possible is actually going to be one that stimulates what we call mitochondrial biogenesis. And I, I just like saying that phrase out loud. Mitochondrial biogenesis, I think, I want that, you want that,

[00:36:56] Dr. Melinda Ring: we

[00:36:56] Dr. Robert Rountree: all want more mitochondria, and none of us want to jump into Lake Michigan in January.

[00:37:02] Dr. Melinda Ring: Yes. Oh, so you're, you're saying that because the cold is another way to stimulate I totally agree.

[00:37:07] Dr. Robert Rountree: If you can do it

[00:37:08] Dr. Melinda Ring: If you can do it all. Yes. Yes, I am. We have a grand rounds coming up on temperature and, and depression and things like that. I, I'm much more likely to lean towards infrared sauna than a cold

[00:37:22] Dr. Robert Rountree: Yep, yep, yep. But it does, I think there's pretty good data on that, stimulating mitochondria, it's through a concept called hormesis, the whole idea that, that something that may seem like it's bad for you if you get too much of it, you know, if you jump in Lake Michigan in January, and you stay in there, then you freeze to death from hypothermia. But if you're in, if you just splash in, you get in and back out again, it turns on all kinds of stress response patterns. And those stress response patterns, hormesis, actually activate all kinds of mechanisms that stimulate growth of more mitochondria. So the name of the game is to get more healthy mitochondria and to eliminate the bad mitochondria.

[00:38:10] Dr. Melinda Ring: Okay, well I think you just gave us a bunch of really good practical tips to do that. I want to touch on one more thing just because it came up when we were setting up today. And, and you mentioned AI. And I know, so Artificial Intelligence article recently, you know, Perform better than doctors. Perform better on its own than even supported by a doctor. Like where, where do you think AI in healthcare is going and how does it play a role in the integrative functional medicine world?

[00:38:44] Dr. Robert Rountree: Well, certainly in radiology, you know, I mean, I, I, I like knowing that AI is involved in reading those 3D mammograms on my patients. You know, the data is pretty clear that AI helps pick up abnormalities that we haven't been able to pick up with the human eyes alone. What's been exciting in medicine is the emergence of multiomics, right? The ability to take a patient and look at their entire genome, right? Which has got a lot of variation. So we can look at their genome, we can look at their gut microbiome, and we can look at their metabolome, which basically means we can look at thousands of different metabolites that are in the bloodstream. Now, I've been reading organic acid tests and amino acid tests for decades And I cannot tell you I've gotten a lot better in interpreting them, right? I still look at a urinary organic acid panel and I go, well, this could mean 15 differentthings Right? So I think the excitement of AI is to be able to look at all that data and to start discerning patterns.

[00:40:00] Dr. Melinda Ring: Yes.

[00:40:01] Dr. Robert Rountree: And, you know, I will say that Snyder's group out in Stanford, they're doing a great job of that. You know, they're some of the first people to look at what's called exposed omics data, all the things people are exposed to, to look at how people's metabolites change from day to day and to start making sense out of it. So this is happening. with the gut microbiome, which we're talking about earlier. The gut microbiome you know, it's gone from being a scenario where you cultured for a couple of bad bugs. That's what I did in college. I worked in a micro lab and you look for salmonella and shigella and bad kinds of E. coli, a handful of bacteria that you look for. If they weren't there, the person was fine. And then we developed DNA testing. Suddenly we're finding thousands of these things. Right? Well, what do they mean? I've never heard of that bacteria. Dr. Chris Mason that swaps subways all over the world found that something like 50 percent of the microbes that are showing up in people's guts on the International Space Station, that they were looking at the microbes of the, of the astronauts, and they were finding bacteria that we didn't have names for.

[00:41:13] Dr. Melinda Ring: Wow.

[00:41:14] Dr. Robert Rountree: Wow. Well, what does that mean? We don't, we don't know what it means. So it was really cool when it first started coming out because we had this snapshot of everything that's going on in a person's colonic bacteria, maybe even further up. But then the more we started looking at it, the more complicated it got. And every new test would have 10 or 20 new bacteria I'd never heard of. So we've got to have AI to interpret that. We, I don't think we can proceed much further in multi omics analysis without the help of, of, of Large language learning models, AIs, you know, we've got to have machines to help us do that.

[00:42:00] Dr. Melinda Ring: Like you think A. I. is going to help us get to true personalized

[00:42:04] Dr. Robert Rountree: true personalized medicine, it's already happening behind the scenes, but the human brain just can't pick up on all the patterns that are going on there. It's one thing to say, hey, you've got high LDL cholesterol, right? But you know what's really going on behind the scenes with lipid particles? It's much more complicated. I just heard a presentation by a lipidologist at University of California and you just want to pull your hair out because he said, well, actually the data on LDL cholesterol is highly variable and it's unreliable. We go, oh my god, so you actually have to look at all the different particles, their composition, how big they are, how small sure. and then the sub particles. So we're going to need AI to make sense of our ability to come up with all this data.

[00:42:55] Dr. Melinda Ring: Right. To collate all of that into somebody's individual risk and, and what the appropriate treatment is. Okay. Well, some exciting things on the horizon, hopefully.

[00:43:05] Dr. Robert Rountree: I will just close out the conversation with saying, if that is one of the problems I've always had with things like the Neutrogenomics tests and other sorts of tests. It's sort of like, you know, so many of them, or like a 23andMe, so many of them, my advice is the same as it would have been before doing the test. Eat more fruits and vegetables, get enough sleep, manage your stress. So hopefully though, with AI with more ease and lower cost of gathering so much information, we can actually really start to individualize for a person what they need at that moment in their life. We're not that far off. We're not that far off. But right now, it's hard to beat Hippocrates and Michael Pollan, right? Eat plants, not too much, You know, things that you can name, I mean, real food, how do you beat that? But I do think we can get specific, and it will be nice to have a day where we tell the person, this particular kind of food is good for you.

[00:44:05] Dr. Melinda Ring: Hmm.

[00:44:06] Dr. Robert Rountree: Right? Even a food that we thought was healthy for everybody, maybe for that individual, not a good idea.

[00:44:12] Dr. Melinda Ring: Okay. Well as we wrap up I'd love for you to just share maybe one final thought on a personal wisdom or a piece of advice that you'd offer to help listeners take that next step to improving their health.

[00:44:26] Dr. Robert Rountree: Probably the first thing is that the more you educate yourself, the better. know, and don't just use one source. It's great that we have this explosion of information on the internet, but as an editor for a journal for 20 some years, what I always tell people is try to go to the primary source. You know, if somebody says, hey, this is good for you, this is bad. If somebody says, blueberries are bad for you. Then I go, where did that come from? Track it down. Don't accept anything for granted just because one person said it. Do your own fact checking, follow that through, see if it makes sense to you, because there's a lot of conflicting advice that's out there. So I think that's the number one thing. And then the second thing is we all need to move more.

[00:45:22] Dr. Melinda Ring: Yes.

[00:45:23] Dr. Robert Rountree: It's just, I mean, you can't go wrong with, even if you go to the gym and trip in front of the gym and you think, see, I shouldn't have done that. Well, get up and go get on the treadmill anyway. Like we, we are not a society that moves a lot. We sit in front of our computers all day. And so it takes a certain momentum.

[00:45:44] Dr. Melinda Ring: Yes.

[00:45:44] Dr. Robert Rountree: To do that. So movement is good. Find something you like. I love to dance. So dancing swimming, hiking, whatever you need to do, move more.

[00:45:56] Dr. Melinda Ring: Whatever gets you off your butt, huh?

[00:45:59] Dr. Robert Rountree: Gets you off your butt.

[00:46:00] Dr. Melinda Ring: Yeah, great. Well, Bob, I have really enjoyed having a conversation with you as always, and I'm always inspired by the depth of your knowledge. And I know our listeners will be inspired too. So thank you so much for joining me today.

[00:46:17] Dr. Robert Rountree: You bet. Anytime.

[00:46:20] Dr, Melinda Ring: Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or review on Apple Podcasts. I'd love to hear your thoughts and suggestions for future topics or speakers. Be sure to follow Next Level Health with me, Dr. Melinda Ring, as we continue exploring the path to healthier, happier lives, together.