RHR: A New Model of Healthcare and Human Transformation

In this episode, we discuss:

• Meeting the team at Adapt180 Health™
• What Adapt180 Health™ is
• What’s included in an Adapt180 Health™ membership
• How we get you started on the path toward health
• Who’s a good fit for Adapt180 Health™

Show notes:

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Hey, everyone, Chris Kresser here. Welcome to another episode of Revolution Health Radio. This week, I’m going to do something a little bit different. I want to talk about the trajectory of chronic illness in the [United States] and around the world and some of the shortcomings of both the conventional medicine model of care and also even the fee-for-service Functional Medicine or integrative medicine model of care.

I’ve been treating patients for over a decade, and I’ve learned a few things along the way. And recently, with the launch of Adapt180 Health™, I had the opportunity to pretty much start from scratch and design a healthcare intervention in exactly the way that I think it should be, from the bottom up. And if you’ve read either of my books, you know that I have a lot of thoughts about this. And my own trajectory as a practitioner clinician over the past decade and before that as a patient [who] was interacting with the healthcare system, as someone who has dealt with a complex chronic illness myself, this is something that I’m really passionate about. And it’s an area where I think we have an incredible opportunity to make an impact on the conversation around healthcare in this country and around the world.

And so I invited some of the other practitioners and staff members from Adapt180 Health™ to join me so that we could discuss this new model that we’re using to deliver healthcare and talk about some of the reasoning behind it, why I made some of the choices that I made, share a little bit about some of the members of this service and what we’re seeing so far, how it’s going, and just give you a behind the curtain peek at what’s possible when we design a healthcare delivery [system] with best practices in mind. So I’m really excited about this episode. I hope you enjoy it. Let’s dive in.

Are you curious about Adapt180 Health™? Check out this episode of RHR for an introduction to some of the team and a look behind the curtain of our membership-based health transformation service. #functionalmedicine #changeagent #wellness #chriskresser

Meet the Team at Adapt180 Health™

Chris Kresser:  Okay, everybody. So we’re going to dive right in. I’m going to introduce the folks who are on the call with us from Adapt180 Health™ and then we’re going to talk a little bit about the background and what led to the launch of Adapt180 Health™, my experience, first, many, many years ago as a patient interacting with the healthcare or sick care system as the case may be, and then as a practitioner over the last decade of treating patients. And then we’re going to talk a little bit about our experience with Adapt180 Health™ so far: insights we’ve gained, what we’re learning, types of people we’re working with, and the types of conditions that we’re seeing, and how we’re approaching that with our unique collaborative model. So I’m going to start by introducing Tracey O’Shea. Tracey is [a] nurse practitioner who has worked very closely with me over the past several years. What is it now, Tracey, four years? Five years?

Tracey O’Shea:  Yeah, I think so. Four or five years.

Chris Kresser:  And Tracey is the Assistant [Health] Director at Adapt180 Health™ and not only treats patients but also plays a management role and oversees several of the staff members, nutritionists, and health coaches. And [she] helps me keep my finger on the pulse of what’s going on with Adapt180 Health™. So, Tracey, why don’t you start by giving people a brief background, how you came to this work, and came to work with me, and then we’ll go around the horn and introduce Danielle, Jessica, and Louise, or they can introduce themselves, as well.

Tracey O’Shea:  Perfect. All right, well thank you for having us. I really appreciate it. I’m excited. So a little bit of background is I became a nurse practitioner in 2013. At that time, I was working in a Functional Medicine office that focused on pain management. I was really lucky enough to find a mentor that introduced me to the world of Functional Medicine because I think I knew, much like a lot of other practitioners and people in this field, that the practice of medicine as it was in the conventional setting was just not for me. I knew I needed to find a community and a niche where I could dive deep and address the underlying causes of dysfunction instead of just managing symptoms and slapping Band-Aids on one symptom or another. And I found that in Functional Medicine.

I got started at the [Institute for Functional Medicine] (IFM) because that was what was available at the time. I became a certified practitioner through IFM. [I] ran across an ad or a job advertisement with Chris and Dr. Schweig at California Center for Functional Medicine. I applied honestly on a long shot because I thought it would be an opportunity of a lifetime and the universe had plans for all of us. So I started there about four years ago, four or five years ago, [as] Chris mentioned. I completed the ADAPT Practitioner Training Program when I got hired. And I’ve been working closely with Chris for that amount of time and have had the opportunity for us to start this new endeavor together, Adapt180 Health™. And that has been so far, so good. It’s a really great experience and I’m excited to dive [into] more of that. But that’s my background where I came from.

Chris Kresser:  Great, Tracey, thank you. And Tracey is also a faculty member for the ADAPT Practitioner Training Program. She helps me with that program and has been a great asset there. And she’s an IFM certified practitioner, as well. So lots of training background in Functional Medicine. We’re going to go to Dr. Jessica Montalvo next.

Jessica Montalvo:  Oh hi, Chris. It’s good to be here. Thanks for the opportunity. I think that I am someone, who like many of my colleagues, went into medicine because I was looking to help people, and I was hoping to be engaged in problem-solving. I was really drawn to the complexity of human physiology the way all the systems have to work together to achieve optimal health. And I was drawn to internal medicine. So [I] completed my residency in internal medicine in 2007 at Northwestern, and then took a job in the hospital medicine world. And at that time, I was very focused on taking care of oncology patients and this led me into the world of palliative care. And I was finding a lot of meaning in my work. But I’d say about eight years into this, I started to feel restless. I felt like there had to be more to the practice of medicine. I was meeting people so late in their illness, and I felt that there had to be a chance to make a bigger impact upstream, and that if I didn’t take a chance and look around for another way to take care of people, I would look back 20, 25 years in the future and feel like maybe I had missed out.

So I decided that it was time to start searching. I wanted my practice to be less algorithmic;, I wanted to get back to the science that I had really enjoyed. And as I was searching, I started to come across this concept of Functional Medicine, which was really a mystery to me at the time. And I think it’s probably still a mystery to many of my fellow MDs, and I began to really learn about the power of nutrition and lifestyle and optimizing health outcomes and how possible it was to look for root causes that I really hadn’t even been taught about in my training. I, like Tracey, got my start at the Institute for Functional Medicine by attending their conferences, which were really pivotal in pushing me down this pathway of certification. And I then joined your Practitioner Training Program, Chris, at ADAPT and completed that, as well. And I became certified through IFM and decided that I wanted to do this work for real. I started a small practice, Mindwise Healthcare, [which] focuses on prevention and reversal of cognitive decline, for people who are familiar with Dr. Dale Bredesen’s work. And then when this opportunity came up to work with Adapt180 Health™, I was thrilled that I could continue learning and have colleagues who would really push me to keep learning and I would have colleagues, nutritionists, and health coaches where we could really partner together in taking care of people.

Chris Kresser:  Great, thank you, Jessica. Dr. Montalvo is, as you probably gathered, one of the clinicians at Adapt180 Health™, and it’s been a pleasure to have her. She brings a wealth of expertise and a really fresh insight into how we’re approaching these patients with chronic illness and those who want to optimize their health, as well, as we’ll discuss as we go through, that Adapt180 Health™ is not just for people with chronic illness, it’s also for people [who] are generally healthy but just want to optimize their health and their health span. So next, we’re going to go to Danielle Dellaquila.

Danielle Dellaquila:  Hi, Chris. It’s so surreal to be on your podcast after listening to it for I don’t know how many years now, five, six, somewhere around there. So thank you for hosting us and giving us the opportunity to talk about what we do here. A little background about me. It’s interesting when I think about the field that I’ve chosen and in hindsight how it was something that was pointing toward me my entire life.

I grew up in a family with a high rate of obesity, overweight, [and] diabetes. I went to undergrad school for exercise science. I did personal training for several years. And then I knew I  wanted more. It wasn’t enough. And one day, I was looking at my bedside table and I said what do I ultimately want to do as a profession? And I look at my bedside table and I see this enormous stack of books on nutrition. Nutrition has always really fascinated me and how it can either make or break our health. And so, yeah, I went to graduate school for nutrition, and ironically enough, I got married and pregnant in grad school. And so I became a mama a little sooner than I thought I might be and raised and homeschooled my children. And all along, [I] didn’t work professionally as a nutritionist, but it was always my passion. And so there were probably a good 10 years in there of self-studying, and during that time is when I discovered you, Chris, and other big names, [like] Mark Hyman and Dr. Mercola, and started really following and self-teaching through listening to podcasts and reading articles and all the resources. And then I ended up with my own gut issues after a series of antibiotics, after not having them for a good 20 years or so. So I discovered gut health and really became passionate about that, and [I] cured myself naturally through diet and antimicrobial herbs.

I ended up having [Clostridioides difficile] (C. diff), and it was a pretty scary situation. And I think that if I didn’t already have the foundation of health that I had prior to getting sick, it could have gone really, really badly. But I do believe [as] Tracey spoke of the universe that this sort of opportunity in hindsight, right? It was an opportunity to learn how I could better help people. And it was at that time that I saw your email. I believe it was the second cohort of the ADAPT Practitioner Training Program, and I applied two days before it started.

And at the time, it was just post-divorce and you granted me a good scholarship and I was so grateful. And I dove right into that and have not looked back. I worked as a nutritionist in a United Technology Health Corporation center, I’ve done adjunct faculty work, and I’ve also done a little bit of Functional Medicine through another online Functional Medicine platform. And [I] started with you this past June, and it’s been amazing so far.

Chris Kresser:  Great. Thank you, Danielle. And Danielle [is], as I’m sure you gathered, a nutritionist at the Adapt180 Health™ model. And we’ll tell you a little bit more about how that all works, how we utilize nutritionists, and how, as a member of Adapt180 Health™, you would interact with a nutritionist. And it’s been wonderful to have Danielle on the team. She also brings a wealth of knowledge and previous experience and really embodies the values of Adapt180 Health™. So next, last but not least, we’re going to Louise Buckley. And I just want to mention, we don’t have the entire Adapt180 Health™ team on the podcast. That would have been unwieldy. So folks we have on the show are representing the other practitioners and nutritionists and health coaches on the team. So Louise, go ahead.

Louise Buckley:  Oh, thank you, Chris. It’s really surreal, as Danielle said, to be here. And [it’s] really exciting to be a part of this team. So I have not been a health coach for my entire career. I, like many health coaches, have transitioned to this. I was a music teacher for eight years. And though I loved it in so many ways, it was a bit of a burnout situation for me. For the last two years of my teaching career, I was teaching overseas in the United Arab Emirates, which is a really beautiful and fascinating part of the world. And while I was there, the burnout that I had experienced for years throughout my time as a teacher really came to a head. And I suffered from a vocal hemorrhage. And because of that, I had to have vocal surgery followed by months of vocal rest. So I couldn’t speak at all for quite a while. Try teaching elementary music with no voice, right? So I was left with an awful lot of time to reflect on where I wanted my life to go and what should come next for me and what would serve me and how I could serve others, too.

And of course, like many health coaches and practitioners, I had struggled with my health for many years, including a very low point of having two autoimmune diagnoses and a lot of really bothersome symptoms. And, like many again, the conventional medicine model failed me. I was routinely turned away with comments like, “Your labs look great.” Or “Louise, we’re just not sure what’s wrong with you.” So, at this point, health coaching was already a path I had pondered several times. And it just so happens that during my few months of quietude, while allowing my voice to heal, is right at the time that the ADAPT Health Coach Training Program was launching its very first cohort. So I took the leap of faith to join the program. I moved back to the United States with no job, without much of a voice, but a lot of hope for the future. A few months later, I was speaking again, I was thriving in the ADAPT program, loving every minute of it, and really immersing myself in the art and practice of coaching and really trying to take those skills onboard.

And I then landed my first full-time coaching job while I was still in the training program and worked there for almost two years developing my voice as a coach and really learning to put the skills that I learned about in the Health Coach Training Program into practice. And so it will come as no surprise that it was a “pinch me” moment when this opportunity came to fruition. It was something I [had] hoped would happen, as I know that this collaborative care model has been a part of your vision, Chris, for a long time. And now that time has come. And it’s an honor to be here and to be stepping into my confidence as a coach with such a passionate and knowledgeable team around me. So thank you.

Chris Kresser:  Thank you, Louise. And even though this is a relatively new career for Louise, she had some fantastic experience working as a coach in a prior coaching-related initiative, a business, Noom, which many of you are probably familiar with or at least some of you are. So weight loss-focused digital coaching intervention, and so it’s been fantastic to have Louise on board. And it’s been amazing for me to see, to realize this vision of deeply integrating health coaching into healthcare delivery. And Louise, and our other coach Erica, have been instrumental in making that a reality.

All right, Tracey, so I’m going to turn it over to you to moderate for this next period of time. And then we’ll open it up and talk a little bit about how things are going so far and what we’re noticing about this new model of healthcare.

What Is Adapt180 Health™?

Tracey O’Shea:  Great. Well, I think we should probably all start with explaining what Adapt180 Health™ is, what this model looks like, and what your vision for this was. So yeah, why don’t we explain what Adapt180 Health™ is?

Chris Kresser:  Yeah, so Adapt180 Health™ is a health transformation service. That’s the way I like to talk about it. Because it incorporates certain elements of a Functional Medicine clinic that everybody would be familiar with, like:

• One-on-one visits with a Functional Medicine practitioner
• One-on-one visits with a nutritionist
• One-on-one visits with a health coach

But it includes many other elements that are less common in a typical healthcare delivery environment like ongoing education and training. So, for example, this month, we are doing a technology addiction challenge where we’re guiding all of our members through a program to develop a healthier relationship with technology, with their phone, with social media, etc. As I’m sure all of you know from listening to the show, this is a growing problem. Something we’re really concerned about that I think really impacts health. So it’s part of the bigger picture of health. And next week, we’ll be doing a sleep challenge. We have a monthly webinar with me. We have an app that has educational content. We have mindfulness sessions with Forest Fein who’s a faculty member of the Health Coach Training Program and is going to be teaching our Adapt180 Health™ members mindfulness. We’ll have fitness training content with Stefanie, our fitness expert who’s also a health coach.

So we know that most healthcare is self-care, as I like to say. It’s not just about what happens in the doctor’s office or in the virtual doctor’s office but what happens in between those visits with the healthcare providers that makes the biggest difference. So when I decided to leave California Center for Functional Medicine, the clinic I had started and run with Dr. Sunjya Schweig for many years, as I said in the introduction, I had the opportunity to start from scratch and design a healthcare intervention in the way that I think it should be designed from the beginning. And so Adapt180 Health™ is the result of that. It’s 100 percent virtual delivery. That was always the intention, but COVID-19 made the need for that even more clear and really accelerated the timeline, actually, of the launch of Adapt180 Health™. And this means that people can access this type of care regardless of where they live. And that’s important to me because even though Functional Medicine has grown by leaps and bounds, it’s still true that it’s really not accessible to many people, particularly those living in smaller towns or rural areas that are less likely to have a well-trained Functional Medicine practitioner nearby.

And although we’re not currently accepting international members, we do intend to do that in the future. And there are some entire countries in the world that don’t even have a single Functional Medicine practitioner. So we’re looking forward to being able to provide this type of service to people [who] are living abroad and who have been aware of Functional Health for many years and want to get support, but haven’t been able to because of where they live.

So it’s a 12-month membership and that was intentional, as well. I wanted to move away from the typical fee-for-service model for a number of reasons, [and] probably the biggest reason is that I’ve learned over time, both from my own experience and of course, from now treating thousands of patients, that with most issues that people are dealing with, you don’t get results overnight. And in an environment where you just see a clinician once every six months, the results are going to be limited for the vast majority of people. Yes, there’s certainly a small percentage of folks who can take recommendations that were made by a clinician and then successfully implement those on their own without any support. But that is a very small percentage of the general population, and those folks are in the distinct minority. For the rest of us, we need support, we need guidance, [and] we need ongoing accountability and care that can help us to make those lasting changes that will lead to us achieving our health goals. So that’s the way Adapt180 Health™ was designed from the outset.

What’s Included in an Adapt180 Health™ Membership

Tracey O’Shea:  Great. Yeah. I think the availability and accessibility of care was really the catalyst for moving this plan into action a little faster, maybe than we were expecting. So you mentioned it’s a 12-month membership commitment. Do you want to give us a little bit more of a breakdown into exactly what the membership offers and what it includes so that we can get some understanding?

Chris Kresser:  Sure, sure. Yeah, and it’s a 12-month initial commitment. But of course, we hope that members will renew and continue to be members because health is not something that just happens in the doctor’s office or you just do once, right? It’s not like, “Oh okay, I got healthy and that’s the end of it. I’ll never have to think about it again.” It’s a lifetime practice and focus, and it’s really more of a longitudinal thing, right? And the needs can change over time.

So let’s imagine a woman who’s 35 [years old] and joins us because she has Hashimoto’s [disease] and is really struggling with that. And then, during that first year, hopefully within the first six months, we’re able to get that under control and she’s feeling better than ever. And so now she decides to start trying to conceive, which is something that she had wanted to do with her partner once she was able to deal with Hashimoto’s [disease]. And then, obviously, she’s going to have different needs. Now she’s trying to conceive and then hopefully does conceive and is pregnant, and her needs will shift again. Then she delivers a healthy baby and she’s in the postnatal period, [and] there are different considerations there. Then the baby starts to grow up and she needs advice and support in how to raise a healthy kid. And so that’s life, right? Our needs change over time, but we always have a need for healthcare.

And so I wanted this to be the type of thing that people could continually come back to and benefit from as they move through their life. So when you sign up for the membership, it includes a certain number of visits, one-on-one visits with a Functional Health practitioner, so that could be an MD like Jessica or a nurse practitioner like Tracey or a physician assistant. There are many different types of clinicians or different license types that can very effectively practice Functional Medicine. And then it includes a certain number of visits with a nutritionist, and a Functional nutritionist trained in the ADAPT model, like Danielle. And then a certain number of visits with a Functional Health coach like Louise. So those are the one-on-one visits, and there’s some flexibility there. So if somebody has a lot going on, they can front-load those visits and have more of them more frequently, early on. And then maybe as things start to settle down, they can space those visits out over a longer period of time during the remaining part of the membership. And of course, if they want additional visits, that’s an option, as well.

And then, in addition to those one-on-one visits, we have all of the other group services that I mentioned before, like a monthly webinar with me, periodic challenges, an app with content delivery, and you can also interact with your coach between visits via text messaging in the app. So it’s really a combination of an education and training program, and a Functional Medicine practice, and a community.

Tracey O’Shea:  Yeah, I really think this collaborative model that we’ve created allows for us to provide and offer this team approach, where when someone comes and joins Adapt180 Health™, they have a full team and at all times are the nutritionist, the health coach, the Functional Medicine practitioner, and anyone else, the fitness trainer, are constantly communicating and always evolving the treatment plan. So I think that is what is really unique in this membership is that everyone is contributing to the plan at all times so that every piece of the puzzle [has] multiple eyes on it at all times. And that’s what I think is exciting about this multifaceted approach.

Chris Kresser:  Yeah, that was, as you know, and as anyone who’s read my books knows, that’s been my vision for so many years. And, of course, in certain environments, you get some parts of that, or you get lip service paid to that. It’s not unusual for a clinic to have a nutritionist or a health coach. But it’s becoming less unusual now. It was very unusual for a long time. But to have those people working closely together, and to have a team that’s specifically assigned to you, and a team that used to working together, and then have that team be actively communicating and also sharing and learning together via our regular meetings that we have, where we discuss cases, and our Slack channel where we’re constantly talking about members, and figuring out how we can work together to improve their health, that’s really what’s innovative here, and what’s needed. And there’s another saying, which is that healthcare is a team sport. But unfortunately, it is rarely practiced that way. So it’s been particularly gratifying for me to see how this is manifesting.

Tracey O’Shea:  Yeah, I’m really excited to continue to be part of it and see how this evolves. But so far, it’s been a really pleasant environment to work in. And the feedback that we’re getting from members is pretty positive as far as the level of support because that’s always, I think, what we wanted to do was to be able to support a member at each step of the way. Because we often find that if you get frustrated or you hit a hurdle, it’s a lot easier sometimes to just throw up your hands and stop. And then months later, we find out that everything, the treatment plan just stopped for a while, because they didn’t have that level of support. So that’s really what we’re hoping to shift is to keep this momentum going by having constant touchpoints throughout the treatment.

So should we talk a little bit maybe about what they might expect in their first month of coming to see us and what those visits might look like. I think that is probably a question that people will have.

How We Get You Started on the Path toward Health

Chris Kresser:  Yeah, let’s do that. And I designed this very specifically, and I’ll talk about why I did do it the way I did. And then we can ask Danielle to talk a little bit about the nutrition visit, and Louise, talk a little bit about the goal-setting session. And then you, Tracey and Jessica, can talk a little bit about the Functional Medicine consult.

Tracey O’Shea:  Perfect.

Chris Kresser:  So some of you that are familiar with my work, I know some of you are listening to this have been patients of mine, or are patients of mine and may have even gone through my previous process at California Center for Functional Medicine way, way back when I started my practice more than 10 years ago. I’ve done things a little bit differently with the initial appointment or the initial interaction. One of the things that frustrated me so much when I was a patient dealing with my own chronic health struggle was when I would show up to a new doctor, a new clinician, and sometimes the appointment would be 15 minutes, sometimes it’d be [a] half hour, and sometimes it would be even an hour long. But it never felt like it was enough to really get a sense of what was going on. And so when I started practicing, I really wanted to address that and figure out a way that I, as a clinician, could get my head around what was going on for this patient, and get a sense of where they’ve been, what they’ve tried, what the results of that were, what’s going on in other areas of their life, and get a holistic picture of their health and the things that they’re dealing with so that I could then make better decisions for how to proceed and how to create a treatment plan.

I called that process the case review when I was at California Center for Functional Medicine, and it was very successful. Patient feedback was really positive. People felt like they, for the first time, really had the opportunity to get everything on the table and be fully understood. And it’s been very successful in the ADAPT Practitioner Training Program where I’ve taught that model for the last several years. With Adapt180 Health™, I wanted to iterate on that a little bit further, and rather than just making an appointment and things that happen before the appointment, I wanted to turn that into an entire phase or process.

So the first month of the 12-month membership is called the discovery phase. And during this phase, we have the same goals. We want to learn as much as we can about the new member coming in. We want to know what their primary goals are in working with us, we want to know some of the things that they’ve tried before and what the results were of that. We want to get them started on lab testing. So we order a comprehensive blood biomarker panel right at the beginning of the month so that they can get that testing done and it’s ready by the end of the month when they see a Functional Medicine practitioner. And we want to allow them to hit the ground running and get some results right away so that they’re feeling confident and positive about their work with us.

So the way it works is we start with a nutrition consult initially. So that’s their first appointment; they meet with a nutritionist. Danielle is going to tell you a little bit more about how that goes. It’s an hour-long meeting. Right after that, they get the requisition for the lab work so they can go out and get the bloodwork done, and it’s ready by the end of the month. Then about three to five days after their nutrition consult, they have a goal-setting session with one of our health coaches. And that’s also about an hour long, and Louise is going to tell you how that works and what transpires in that session. And then they, for the rest of the month, can work on the guidance that they got from the nutritionist so they can start getting results during that first month and start putting into practice some of the things they discussed with the health coach. And then at the end of the month, they have an hour-long visit with the Functional Medicine practitioner. And that’s where the labs are reviewed and then a plan is created for the next several months of their membership.

So why don’t we start with Danielle and she can tell us a little bit about how she thinks about those sessions and structures them and what the outcomes are, and then we’ll switch over to Louise for the goal-setting session.

The Nutrition Consult

Danielle Dellaquila:  Great. Yeah, as Chris mentioned, there’s a series of paperwork that we have folks complete so that we have as much information as possible prior to each of our initial consults with our members. As far as nutrition goes, I try to get into the nitty-gritty of their nutrition/dietary history, what their current eating patterns are like. We request that members report about three days’ worth of Cronometer intake to let us know, or give us a pretty good idea or a general idea of where they’re currently at as far as micro and macronutrients go, what their typical eating patterns look like. And then we get into an in-depth conversation about food sensitivities, what types of foods they try to avoid. Typically, folks who come to us are already eating pretty clean diets. If you’ve been following Chris’s work for years, and you know anything about what he promotes, most of these people take these considerations to heart and do a very, very good job with their diets. Every once in a while, we’ll get someone who’s heard of Chris via Joe Rogan. And I had one recently, and this person happened to [have] a little bit more of a Standard American Diet type of history. But generally speaking, we get people who have pretty clean diets.

So my job is to support them and tweak their diets. Maybe provide insight into different sensitivities that they might be experiencing based [on] their symptoms that they have or haven’t given thought to before. And then I like to give people an idea of what the eating plan, the dietary recommendations that I’m giving, what that actually looks like. So we give a seven-day sample menu guide and meal plan with recipes to get people started, as well as other resources on dietary restrictions or specialized diets. And then we’re always available to answer questions. Many people will ask questions based [on] after they’re given their program, and via [a] portal, we’re able to answer those questions for them.

Chris Kresser:  Great. Thanks, Danielle. And then, a few days after that, generally three to five days after the nutrition session, they will have their goal-setting session with the health coach. So Louise is going to talk a little bit about that.

The Goal-Setting Session

Louise Buckley:  Yeah, absolutely. So, as you said, that goal-setting session happens really early on in the membership, and it serves a few really important purposes. First, of course, we want to establish the coaching relationship. As coaches, we want to develop a rapport with the members because this is somebody we’re going to be supporting throughout the journey. So we want them to feel comfortable with us and vice versa. And setting the stage for our work together is crucial. Members are really heartened to hear right away that I, as their coach, am going to be there. That they’re stuck with me and I’m going to be supporting them throughout their membership.

So we set the foundation by clarifying what the member’s vision is for their health. And I refer to that part of the goal-setting session as splattering the paint on the canvas. Just painting a pretty picture of what the member wants their life to look like. And of course, their health is included in that. The idea is that the clearer we can both be about what that big picture looks like for the member, the more likely that we can make it a reality. And so after we get some clarity around that vision, we have our macro view. And from there, we zoom in a little bit and discuss long-term goals, which is where the rubber starts to meet the road a bit more. The long-term goals we set are usually on a roughly three-month timeline or so. That gives the member enough time to work toward a particular healthy habit or milestone, but not so much time that momentum is lost.

So I support the members in clarifying what healthy behaviors they want to be engaging in three months from now to start moving them a little bit closer to that vision that they have for their life. And we make sure those goals are compelling and attainable so that the member walks away from the goal-setting session feeling pretty confident about achieving them, though, of course, their health coach is going to be there to support them in making those goals happen. And the way that we do that support on an ongoing basis is via texting. We begin the text-based coaching about a week after the goal-setting session. And we check in with members via text every week as a brief touchpoint to see how things are going, to see what action steps the member is ready to take to continue moving forward toward those long-term goals. We don’t want to get three months down the road and realize that we’ve dropped the ball on those goals. We want to move toward them with intention each and every week. And so the health coach is there to offer support, troubleshoot obstacles that may come up along the way, celebrate wins, of course, and add some accountability to the process. And members can also schedule live coaching sessions as follow-ups at any time. Because texting is great, but you can only do so much via text, as well. So we do encourage members to continue to check in with us with live coaching sessions, too, after that goal-setting session is done.

Chris Kresser:  Can you talk a little bit about the roadmaps we’ve developed, Louise?

Louise Buckley:  Yeah, absolutely. So the first month, as we’ve been talking about that discovery phase, is really laid out. They’ve got their nutrition consultation, their goal-setting session, their Functional Medicine consultation. But after that, you might be wondering, what’s next? Who do I see now? When do I see them, right? And it can be a little bit unclear. And some people would like a little bit of support and guidance as to how they should use their visits after that first month. So we’ve put together a few roadmaps. And the roadmaps that we’ve put together offer some suggestions about how a member may want to use their visits. They have support sessions that they can use at any time, and the support sessions can be used to see their health coach, their nutritionist, or our fitness trainer. And then, of course, in addition to those support sessions, they get to see their Functional Medicine practitioner. And so we’ve got roadmaps to give people an idea of, hey, here’s when you might want to see this person, when you might want to see this person. Because again, we want to keep people moving forward with intention. And we want to offer as many supports as we can along the way so that people have a bit of an understanding of how they might want to spread those visits out.

Chris Kresser:  Great. Thank you, Louise. Okay, so we’ve had the nutrition consult and also the goal-setting session. And then, as I mentioned, the member is engaged in implementing the nutrition recommendations that were made and working on some of the goals they established with the coach. And they’re doing this with the support of the team. If they have questions, they can get those answered. And then at the end of the month, they have the one-hour Functional Medicine consult. So Jessica or Tracey, why don’t you tell us a little bit about how you’re approaching those?

The Functional Medicine Consult

Jessica Montalvo:  Sure. Tracey, I can start if you’d like.

Tracey O’Shea:  Perfect, go for it.

Jessica Montalvo:  So I think that the Functional Medicine consultation really starts off preparation on our part. When someone is coming to see me, I already have the benefit of not only all of the materials they’ve submitted to be reviewed by nutritionists, and by the Functional Medicine clinicians, but I have the nutritionist and the health coach notes. And I can already start to put together a picture of this person to be thinking about what I will want to focus on, things I want to ask more questions about. And so I really do spend, the first part of the visit is very much spent hearing how things are going so far with their nutrition plan, how things are going so far with the goals that they have set with the health coach, and then I get a chance to really dive it to questions, usually about symptoms. Things that they may have noted in passing on their paperwork, I can spend time diving in because we have an hour instead of 15 minutes or 30 minutes. And that gives me a better sense of what they’re really needing to focus on. We spend some time thinking about how we can work well together. Many of the people who are here are looking for someone to spend time discussing what’s going on with them. They really do want some answers and some details. And when you ask them, “Well, how can you and I work well together?,” it makes it clear that this is a partnership from the get-go as opposed to a more typical, “Here are your recommendations and see you in six months to a year” kind of model.

And we spend the second part of the visit taking a deep look at the bloodwork that was completed. And I take them through all of the markers. And we think about what are the general patterns that we’re seeing. And we, really that takes quite a while to do that. And to people’s satisfaction, I’ve had a number of people comment on, they’ve never had somebody spend so much time going over their blood work. And then we spend the final moments of that visit thinking about how we’re going to move forward. What is the most appropriate testing to investigate the imbalances that we see, whether that’s from blood work or from symptoms? And how should we follow-up and where [might] our treatment plans go?

Chris Kresser:  Great. Thanks, Jessica. And this is, of course, where we might order additional testing, as well. So Tracey, what kind of testing might a member expect to see after that first Functional Medicine consult, of course, depending on their circumstances?

Tracey O’Shea:  Right. Yeah. And I think it’s important to note that our comprehensive blood panel is not just a typical [complete blood count] (CBC) or liver function. It really is very comprehensive. So by the time you see your Functional Medicine practitioner, we’ve got a really good idea of your thyroid function, your liver function, your metabolic function, [and your] nutrient status. So it’s a really nice robust panel that Jessica was discussing. And that’s why it takes a lot of time because there’s quite a lot of markers. And that’s our opportunity to really start to see if there are indications of imbalances that need further work and further lab work done.

I would say traditionally, the follow-up markers that may be ordered after a Functional Medicine consultation would likely be blood markers that are following up on anything that was abnormal. So if cholesterol is high and we’re starting to see some indication of metabolic dysfunction, we may have the member do some glucometer tracking at home or maybe do some more advanced lipid panels to follow up on that. Or if we have some severe nutrient deficiencies. So there may be some additional blood work to be done to follow up on some of those initial imbalances and things that we noticed are starting to present a pattern. And then often, we’ll move into the next steps.

So if someone’s presenting with a lot of gastrointestinal complaints, and there’s a lot of indication of malnutrition or malnourishment, then often we’ll start with the stool test, and maybe some [small intestinal bacterial overgrowth] (SIBO) breath testing to get a nice evaluation of the gut and start with this laying this foundation of optimal gut health and diving deep into gut. We may also do some hormone testing with like a DUTCH urine and saliva test to take a look at hormone levels, adrenal function, maybe even do some sex hormones, some blood sex hormones, if there’s some indication that there might be some dysfunction in hormone regulation. Heavy metals are on the table. That’s the nice part about this Functional Medicine consultation being at the end of this month and having already gotten an assessment of the nutritional status and where the member is with their goals. And then having this discussion with them, [as] Jessica mentioned, is an opportunity for us to see what this member want[s] from this experience. And does it align with what we’re thinking and what we have to offer?

So I would say there are the standard things that we may order if someone’s presenting a certain way. But that’s the great part about this; the way that this is set up is that [there are] lots of options, lots of different opportunities to investigate imbalances depending on what is collected over that first 30 days and what kind of information we have to help drive [and] make those decisions. Go ahead.

Chris Kresser:  Yeah, I was going to say, and this is, as you know, Tracey, one of the areas where my thinking has evolved over time. When I first started practicing for the case review, we would often order all of those labs even before we saw the patient for the first time, right? So we would have the blood work, then we would have the stool test, the SIBO breath test, the urine organic acids panel, saliva or dried urine cortisol, and sex hormone panel, and sometimes other testing, as well. And certainly, there’s logic behind that. And it makes sense to have those data when you’re working up or evaluating a patient. But what we found over time is that you can’t act on all of that information at once anyhow, right? You have to use your clinical judgment to figure out what the most pressing problems are and address those first. Because even if the patient can afford to get all that testing, which can add up, and even if they have the time to do it, because the testing can take a lot of energy and attention, we don’t want to overwhelm their system with too many treatments at once.

And so I purposely designed the model this way so that we start with a blood panel, which gives us a really good baseline foundation of understanding what’s happening physiologically for the patient. Then as we get to know their situation in that first month, we can make more educated, informed decisions about what testing would be most appropriate and helpful initially, and start working on that right away. And then over time, we can add whatever other testing might be necessary. So it’s, I think, more efficient [and] more economical, while still giving us that really comprehensive view.

Tracey O’Shea:  I totally agree. I think it feels less intense all around for the member[s] [and] for the practitioners. It really feels like it flows a lot better. And then there [are] a lot more places to step in and support versus just here [are] eight different lab kits and here [are] five different protocols. It’s just not realistic, so I totally agree.

Who’s a Good Fit for Adapt180 Health™?

Chris Kresser:  Right. So Danielle and Louise, maybe you could talk a little bit about the different types of goals and outcomes, desired outcomes that you’re seeing. Danielle, as a nutritionist, you’re the first point of contact with members. So they’ll tell you why they came to see us and what they’re interested in. And then, of course, Louise, you’re digging deeper into people’s overall goals that may or may not be directly related to any particular health condition that they’re dealing with, but [it] might be more holistic in their approach to health. So, yeah what kinds of different members are you seeing?

Danielle Dellaquila:  I would say, a whole array. It’s so interesting, as you said, in the beginning, Chris, this isn’t just a place where sick people are coming. I’ve had more than a handful, surprisingly to me, because I guess I wasn’t necessarily expecting this, of folks who just want to come to create ultimate wellness. To be as well as they can possibly be. And, of course, there are a lot of autoimmune dysfunction diseases, some folks coming who’ve been sick for so long and people don’t even know what’s wrong with them yet. And so, for me, that’s been a really cool and interesting thing to be able to wait and see what all of these tests that the Functional Medicine practitioner will be ordering. I sit there and think to myself, oh, maybe it could be this, maybe it could be that. So since we’re still in the beginnings of this, this is the part that I find the most exciting and fascinating, and can’t wait to be able to see these results of the tests.

Lots of different micronutrient deficiencies, for sure. Lots of zinc deficiencies, [vitamin] B12, folate. So working on these types of micronutrient imbalances and trying to, when possible, make the appropriate food recommendations and dietary recommendations to increase their status of these and using supplements when needed, as well. Lots of gut issues, lots of gut infections. So yeah, it’s been really cool to watch it all unfold.

Louise Buckley:  I’ll share, too, if I may, Chris.

Chris Kresser:  Go ahead, Louise. Yeah.

Louise Buckley:  I was just going to share what I’m seeing on the health coaching side. [I] definitely agree with Danielle’s reflections there. I’m seeing a lot of different types of people come through the door. But one thing I see in common with a lot of our members is that they are very learned. They are studied, they are savvy, [and] they have done their reading, they’ve done their research, either because they’re sick or because they’re really interested in optimizing their health.

So we’re seeing a lot of people come through the door that have an innate love of learning, a curiosity and intelligence, and people that really want to understand how to take some of the things that they have learned and apply it to themselves. We know that only about 6 percent of American adults engage in the top health behaviors, right? That’s a stat that we’ve talked about many times. So there’s obviously a gap between knowing and doing, right? So I would say I’m definitely seeing that in our members, too, because our members are smart and savvy, but sometimes they do need help applying the things that they know. And they want to know even more, too. They’re hungry for knowledge. So that’s a lot of what I’m seeing in the coaching so far.

Chris Kresser:  Yeah, and it’s my dream that people join this or any service like it before they need it. That would be the ideal, right? Because we know it’s so much easier and more cost-effective to prevent a disease before it occurs than to address it after it’s already occurred. And that’s been one of the most satisfying things to see with the members that we have had so far is a yeah, a significant chunk. We actually just did some research on our current members and found that probably about 20 to 30 percent are people who are primarily there to optimize. Maybe they’re not sleeping as well as they could, or they’re a little bit tired, or they’ve got some minor digestive complaints, or they’ve got some specific performance goals or something like that. But they’re not dealing with a really debilitating complex chronic illness. And they want to take action that they know will improve their quality of life and lead to better performance and more happiness and well-being, and that’s awesome. That’s exactly one of the use cases for this service. And, of course, we also are here to help people who are dealing with more significant health challenges. But I think drawing the circle wider to include people who are really interested in feeling better, feeling happier, feeling more robust and resilient was a primary goal of mine with the service. So I’ve been very happy to see that that’s happening.

So we are, unfortunately, out of time. I think we’re going to have to have a part two of this episode because it’s been really fun to talk about how this model is playing out so far, and I hope it’s been interesting for you as the listener to learn more about it. I really do feel that this is the future of healthcare. It has to be. What we’re doing right now is not working. The incidence of chronic illness continues to increase, and there’s more and more research in lots of different fields, from health coaching to understanding the role of community and support and healthcare delivery to research supporting Functional Medicine, to studies that come out pretty much on a daily basis that are exploring the impact of sleep deprivation and chronic stress and environmental toxins and poor diet and other aspects of the modern lifestyle on our health.

And we’re facing a lot of challenges, as individuals, as a society, and as a species. We are, as I’ve discussed many, many times, living so far outside of what our natural relationship with our environment has been over millions of years, that we’re really suffering from this mismatch between what our genes and our biology were designed for and the kind of environments that we’re actually living in. So we really need a much more comprehensive and supportive approach to healthcare, and that’s why I’m so excited about Adapt180 Health™. And it’s been such a pleasure to get it out there in the world and see the results that we’re getting so far with the members from all over the [United States] and, hopefully, soon from all over the world.

I want to thank everybody on the team for joining me, Tracey and Danielle, Jessica and Louise. If you want to learn more about Adapt180 Health™ and join us as a member, you can go to Adapt180Health.com and all the information is there, and then you can also speak to a new member advisor to learn more about the service if you have questions. Thank you, everybody, for listening. Please do continue to send in your questions at ChrisKresser.com/podcastquestion. We’ll definitely have a part two of this episode in the future where we talk a little bit more about the experience we’re having. Maybe share some case studies from the practice and share what we’re learning over time. It’s exciting to be involved with this new endeavor. Okay, we’ll talk to you next time.