Paleo Diet Risk Assessment: Update Three

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Howdy folks!

Sorry I have not written much of late. I have not even gotten to my massive stack of Science Bites I need to carve through. I’ll get on that stuff ASAP, but for now I wanted to let y’all know about some developments with the Risk Assessment program here in Reno. If you missed the earlier posts on this project, please check out Part 1 and Part 2.

Since December of 2011 I’ve been working with Specialty Health on this Risk Assessment program, and contributing my perspective on Evolutionary Medicine. Particularly gut health, systemic inflammation, and autoimmunity. Up until recently this has just been a friendly collaboration with no specific ties or obligations. That changed two weeks ago when I was added to the board of directors of Specialty Health, and we started talking earnestly about how we will take this program to the masses. I covered what the program is in Part 1, but I’ll provide an overview of where the program is, and where we are going:

1-The program provides a risk assessment looking at specific biomarkers to find people who are insulin resistant, inflamed, and at high risk of cardiovascular disease.

2-This program is unique in that we find folks who would otherwise pass through a screen as “healthy” but who are actually running around with serious problems, such as very high LDL-P, despite having “normal” cholesterol levels. For an exhaustive look at LDL-P, cholesterol, and the related material please see LecturePad.

3-People who flag as high risk are placed on a low-carb/paleo diet, counseled on sleep, and exercise, vit-D levels are tracked, and in some cases a very low dose statin is used to bring lipoprotein levels down. USUALLY, once the body starts to heal, folks can be titrated of the statins. Glucophage is occasionally used to address insulin resistance, but the heavy lifting is accomplished through an evolutionary approach to diet, exercise, and circadian rhythm (sleep).

The program to date has mainly been run on Police and Fire personnel with a conservative ROI of 33/1. The city of Reno now has all Police and Fire going through the program, and the conservative estimates of savings over a 30 year period are around $1.3 BILLION (yep, with a “B”).

We have been contacted by companies and municipalities around the world who are interested in the program. We have generated a ton of interest, and I think we are in a unique position to really affect remarkable change. We have faced one monumental challenge so far however:

We can order blood work for a Fire department, Law firm or Hospital system, provide the data analysis, and recommend treatment plans; but when we send this information to the affected people and release them to go work with their doctors and dieticians, the whole thing grinds to a halt. Our dietary recommendations are shifted to a high carb, low fat, grain based diet. The GP’s have no idea what LDL-P is, and cannot make heads or tails of what the hell we are recommending. We could pump millions of people through this program, save lives and money…but there are no Gate Keepers on the other end that know how to implement this stuff. Yet.

I sat down with the Specialty Health folks this weekend (after filming for about two hours as part of a documentary we are involved in…I’ll have some info up on that in a few weeks). We delineated our problems and came up with a solution:

A “soup to nuts” Evolutionary Medicine certification. This will cover much more than just the lipid based risk assessment, delving into endocrinology, immunology, and clinical medicine, all from the EM perspective. This is critical for several reasons:

1-As I mentioned above, we have no “Gate Keepers” that we can trust on the treatment side. We need to build a network of physicians, chiros, RD’s, RN’s, pharmacists, PT’s…who know this stuff front and back.

2-As solid as the lipid based risk assessment is, there are nuances that are not yet being addressed. There are multiple vectors which give rise to both insulin resistance AND systemic inflammation.  Poor sleep can chronically elevate cortisol, antagonizing thyroid production, and this can lead to elevated lipoproteins due to down regulation of the LDL receptor.  This condition looks quite similar to Familial Hypercholesterolemia and needs to be treated in a completely different way than elevated LDL-P from “simple” insulin resistance. This is one of the things I caught when I started looking at patient files and looking at the lab work, and that is getting integrated into the bigger treatment picture.

The pieces of the program will include the Risk Assessment program as it largely stands today, the nutrition certification we’ve been working on (should just be a couple of months  on that…update to follow soon), and the EM curriculum. I’ll tell you details on all this as it rolls out.

Perhaps the most important piece of the risk assessment program has been the data analysis portion. It’s one thing to assume we are helping people, quite another to validate this statistically. Specialty Health started as an orthopedic risk assessment program/Health Management business. In that time they have amassed biometrics on ~1.3 million people. It is from this database that we can make statistical predictions on health outcomes, likelihood of occurrence of say a stroke or heart attack, and how much an individual (or group of people) is likely to consume in healthcare services.  As good as that analysis has been, we have a really interesting development that will bring that part of our game to a whole new level. Dr. Jim Greenwald, the director of the Specialty Health program, is a hell of a connector. “Greenie” as he likes to be called, knows a remarkable number of people, and one of those people is pretty good at data analysis: Mohan J Kumar, one of the principals at Intel.  Greenie contacted Mohan and had him look at our database, then told him what we are up to:

1-Distinguishing “signal” from noise

2-Develop algorithms to delineate treatment flow, like in the Elevated LDL-P scenario, which could be caused by a variety of issues, including systemic inflammation, gut permeability, elevated cortisol, and thyroid deregulation.

What has come from this collaboration is an algorithm for which we are seeking a patent. All I can tell you at this point is it is pretty damn slick, and will help practitioners make sense of a mass of clinical data in a time efficient, productive way. It also beef’s up our ability to calculate ROI. I’m not sure if I mentioned this above, but the risk assessment is currently “only” looking at insulin resistance, blood lipids, and markers of systemic inflammation predictive of type 2 diabetes and/or cardiovascular disease. As we graft the full EM curriculum into the program this will expand to encompass: autoimmunity, neurodegenerative disease, reproductive issues, gastrointestinal issues…anything that appears to be an outgrowth of a mismatch between genes and environment.

New team members

Specialty Health recently presented our work to a LARGE governmental entity. I was contacted via my blog by folks in this organization as they read parts 1 and 2 about the risk assessment, and were very interested in learning more. Greenie gave a whizz-bang presentation, and things look very favorable for creating a relationship with this entity. At this presentation Greenie met a number of people, but one in particular took a special interest in the program, former US Navy SEAL, Stew Smith. I’ve been a big fan of Stew’s for a long time, and I can’t tell you what a treat it was to talk to him via email and help him get up to speed on what we are up to. Stew is a really smart guy and he devoured the material we gave him. He immediately saw the importance of the program for the military at large, so he wrote a three part series which appeared on Military.com. Please check these out and pass them around to anyone you know in the Police, Fire or Military. Part 1Part 2Part 3

Screen shot 2013-03-19 at 5.15.31 PM

I am beyond honored to be included in this project…I think it may be the “skinny end of the wedge” that opens the door to changing how medicine is practiced.

The New Clinic

Last Friday we had the grand opening for Specialty Health’s new Integrated Medicine clinic. Up until a few days ago, Specialty Health only had clinical access for L&I and Workman’s comp type of patients. With this new clinic we have a direct access option for the people of Northern Nevada to get top-notch Evolutionary Medicine care. The plan is to take this program “everywhere.”

I’ll do my best to get some blog posts written and some Science Bite’s spit out! I am spending a lot of time on curriculum development, looking at lab work, and trying to get the wheels on this wagon. I always knew something like this would take form, I just had no idea it’d be in Reno, Nevada.

Specialty Health

 

 

 

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  1. Jason Kompara
    March 20, 2013 at 6:14 am

    Fantastic article, Robb. It’s exciting to see that the movement is finally getting the traction it needs in order to affect policy and get people to understand what Evolutionary Medicine is all about. It’s easy to dismiss the Ancestral Health movement as the lunatic fringe until you see that projected $1.3 billion cost benefit, amirite?

    Anyway, I read Stew Smith’s articles. The improvements in the subject were encouraging. In the second article, there were some questionable recommendations included: avoid saturated fats and animal fats, focus on obtaining polyunsaturated fats, use plant oils as a significant source of omega-3s. The poorest improvement in the subject was in his HDL cholesterol – I feel like these recommendations may have been the primary inhibiting factor. As far as the advice on meds, I can accept that statins can be useful for changing the lipoprotein bio-markers to more acceptable levels as a short-term intervention, even if they are not worth the increased mortality/degeneration risks in the long term.

    I know that your recommendations aren’t exactly in line with these. I also know that it’s imperative that the medical community is able to accept the tenets of Evolutionary Medicine – they are the ones who are going to implement these interventions, after all. Are these deviations from the standard Paleo template a result of the consensus among the folks at Specialty Health, or are they concessions to make the recommendations more palatable to the general medical community?

    • Robb Wolf
      March 20, 2013 at 6:51 am

      Jason-

      The recs for low sat’d fat are for folks who are homozygous ApoE genotype. These folks seem to benefit from lower sat’d fat. I’d prefer we just see more mono’s in that, vs plant n-3’s…we are moving that way.

      If you read the glucophage piece I linked to it has an amazing ability to not only improve insulin resistance, but also deal with the collateral damage of systemic inflammation by reversing nonalcoholic fatty liver. It’s a nifty little drug.

      As to the statin, normal dosage is around 20mg and oftentimes higher. Our folks rarely go above 5mg. So, the integrated therapy is cutting statin dosage by at least 4x.

      No, this is not an attempt to kowtow to the establishment! This is just the best iteration of what we have presently, and it’s doing pretty well.

      Good questions!

      • Steven
        March 20, 2013 at 5:02 pm

        Hi Robb,

        Just wondering if you’re using Coenzyme Q10 with the statins and even generally for those at risk. If not it could be something to consider.

        The side effects of statins seem partially due to CoQ10 depletion and CoQ10 supplementation reduces side effects.

        In an RCT statins + CoQ10 had 45.3% fewer cardiac events than the statins + B vitamins group

        http://www.ncbi.nlm.nih.gov/pubmed/12841346

        Also LPS may cause long term effects via mitochondrial dysfunction (which can lead to CVD and other chronic diseases). CoQ10 is very good at reversing LPS mediated mitochondrial dysfunction

        http://www.ncbi.nlm.nih.gov/pubmed/21354301

        The risk assessment you’re doing with speciality health is amazing and could easily be the thing that pushes this mainstream

        • Robb Wolf
          March 20, 2013 at 5:40 pm

          They do rec coQ10 and I think the LPS issue is part of why we see such good results with the glucophage. You Sir, know your stuff!!

      • Russ C
        March 21, 2013 at 5:59 am

        Very exciting developments!

        Re APOE4s and reducing sat fats, 2 questions…

        1. Is the recommendation for low sat fats based on results seen on marker behaviors (e.g. reduced LDL-P), or actual health outcomes? Since I know you are aware of the q’s re LDL-P in the presence of low inflammation as you made a very explicit comment in your AHS 12 talk (~18:40 of video), I often wonder whether reducing LDL-P is actually the right thing to do for APOE4’s (as long as we can get inflammation down low)? Don’t know but if you have data on markers vs outcomes, could be very interesting to test w real data?

        2. On that note, how much APOE4 status data do you already have in your database? Is this an area for which your data could be further mined? I am part of a community of people who would be very eager to help with that. If low, could it be something easy to add?

        • Robb Wolf
          March 21, 2013 at 9:42 am

          Russ-
          Really good questions. I put your first question in my list of questions for Chris Kresser when he comes on the show again. he is MUCH better versed the nuances of the literature of this topic than I am. What I do know is certain genotypes DO see increased LDL-P with increased Sat’d fat intake. Whether reductions of LDL-P via this reduced sat’d fat approach equals better outcomes…I’m not sure. I suspect it does, for the simple reason that elevated LDL-P IS increasing the odds of something going south on us. Is high LDL-P a problem if we have super low inflammation, great sleep etc? I’m not sure.

          As to the ApoE4 question: Everyone who does the advanced testing gets the ApoE test. How many of those people have the potential problematic APOE genotype? i do not have that off hand, but we clearly DO have that data.

          As I’m writing this I have an idea. I will put a blog post up in a week or so and ask folks to submit questions around this topic. Statistical findings, whatever. Then we can get the SH folks on the podcast and we can both knock out a shit load of material AND have it all in one spot, instead of doing all this piecemeal.

          I’m not sure if any of Dr. Tara Dall’s videos cover APOE specifically:
          http://www.youtube.com/watch?v=9xC1bujLukw

          But this is another good place to look, as is peter attia’s “Straight Dope on Cholesterol” series.

          • Russ C
            March 21, 2013 at 10:05 am

            Robb,

            Excellent. Thanks! I’ll really look forward to your next banter w Chris. Like many (I expect here), I listen to both podcasts every week, so a 2fer is something to really look forward to :-). I also keep up w Attia’s work and was active in the Q&A on this there during the big monster series last year. Look forward to hearing more.

            Meanwhile, I’m working within my (very large) company to generate interest in joining the party. My day job is creating change, and I agree with all here that your efforts here could create a really big and meaningful one for a lot of folks!

          • Russ C
            July 13, 2014 at 6:04 am

            Robb,

            Enjoyed your podcast w Nina Teicholz this week. Listening while driving, so couldn’t take notes, but you made a small remark early on that you had been seeing some people who saw spiked LDL-P in response to saturated fat subsequently test as indeed APOE4. Importantly, you said you were seeing improvement by shifting to a high MUFA proportion for fats. Very interesting as both the observation and the potential remedy are the same as some of us have been tinkering with in an online community (www.apoe4.info) where we swap our understanding of latest research and N=1 experiments.

            Can you say more about kinds of dietary (or other) shifts you have found to be required to obtain desired outcomes? Would be great to have our own experiments anchored in more rigorous and robust data.

            PS: If you or your team are interested in this subject, click on over to Keifer and Dr. Rocky’s “Body IO” podcast last week with Heart Surgeon Dr. Steven Gundry who spend ~3 min on this… and notably he comes to a similar conclusion…
            https://itunes.apple.com/us/podcast/body-io-fm/id850425607?mt=2

            Russ

  2. A
    March 20, 2013 at 6:38 am

    Amazing work, Robb. Your work is inspirational and I can’t wait to be a part of it as a soon-to-be physician.

    • Robb Wolf
      March 20, 2013 at 6:57 am

      We need you! We have hired several new docs, PA’s, nurse practitioners and RD’s to staff the clinic.

  3. Amy B.
    March 20, 2013 at 6:46 am

    Robb! Oh my gosh…congratulations on this awesome effort. It’s obvious that you were exactly right earlier this week when you said that you could shut everything else down (the blog, podcast, etc) and still have a profoundly fruitful and lucrative career with the police, firemen, military, and more widespread educational plans you’ve got going.

    Every now and then, you let on that you feel a lot of frustration and aggravation with the state of health and nutritional knowledge as a whole, both among the general public and especially among the orthodox medical community. I hope things like this — your work with Specialty Health and this larger evolutionary medicine education you’ve got going — remind you that while you certainly can’t reach everyone and change all their minds, you are still saving lives every day. Remember — for every one person who bothers to contact you to say thanks or send a testimonial, there are probably 50 (if not 100) who are benefiting just as much but haven’t taken the time to tell you so.

    As for Stew Smith, that is AWESOME! I hope more and more military folks get exposed to the evolutionary/ancestral health paradigm. As a USAF veteran, I can tell you military chow halls are complete disaster areas in terms of nutrition. I am FOR SURE not saying that good nutrition improves *everything,* especially when we’re talking PTSD from severe, prolonged combat stress, but when I hear about so many people experiencing all kinds of physical and mental health issues in the military, I have to wonder if things wouldn’t be at least *a little* easier to manage if our men & women in uniform had solid nutritional foundations. I did all right while deployed and also back stateside, but I “knew what I was doing” with food and made the best choices I could. For some guys, a Red Bull and two packs of Little Debbies was lunch!

    Anyway, I would *love* for the DOD and VA to get its hands on some of your data. The money involved in caring for these folks is staggering, especially the older vets. The statins, BP meds, glucose/insulin control meds, antidepressants…almost seems like they’re all standard across the board, and you’re considered abnormal when you’re *not* on a long list of pills when you get to a certain age. Now, I am *not* saying we shouldn’t care for the people who literally put their lives on the line, but we sure *should* be asking WHY we require so much medication, and what we can do to improve things at their roots.

    You are doing GREAT work. Your legacy is already gold among thousands of us, so screw the naysayers and keep on doing what you’re doing.

    • Robb Wolf
      March 20, 2013 at 7:04 am

      Thanks Amy! It’s an honor to be doing this work.

      Meeting the specialty health folks has been borderline miraculous. They had all this infrastructure, I had the bandwidth and connections. We are working with several companies now that have 1,000+ employees and in excess of $200/400 million in yearly revenue. Pretty big companies that are already seeing a change in their peeps. We are close on several fronts with formal relationships with several mil/gov entities. It’s funny, the push-back we normally get when we say ” we can really help you and your people” just evaporates as we show the bean counters “we can save you a LOT of money.”

      I’ll take it!

      As to PTSD, I’ll have some very interesting material on that in a few months. An anti inflammatory diet is absolutely beneficial.

      • Amy B.
        March 20, 2013 at 1:11 pm

        Can’t say I’m surprised about PTSD & diet. Dr. Joe Hibbeln, a Navy doctor pretty high up at NIH, has done a ton of research on n-3 and stress, depression, etc. I think if he could pour fish oil on chow hall food the way some guys do Tabasco, he would. ;) It makes perfect sense that people deficient in EFAs, overdoing it on crappy seed oils and refined CHO, and probably also whacked out when it comes to neurotransmitter production, would have an even harder time dealing with what is already an extremely stressful, emotionally draining experience (multiple deployments & intense combat situations). People in *the best* mental and emotional shape would have a hard time dealing with that, never mind people whose diets make them logarithmic degrees less able to cope.

        Obviously better nutrition & sleep can’t entirely *prevent* the long-term effects of war, but I’m guessing they’d go a damn long way toward lessening them.

        • Robb Wolf
          March 20, 2013 at 1:50 pm

          Amy-
          check out the work from Dr. Kevin Gilmarten and also lt. Col David Grossman. They came at all this stuff from a COMPLETELY different direction, psychology, but have arrived at the same place: Evolutionary Medicine. Both rec a paleo diet, both understand sleep architecture from the ancestral perspective. My good friend, Kirk Parsley MD, is a former seal, did med school then was running the medical side of the teams on the west coast. he is a sleep expert, see’s big overlaps with PTSD, TBI, sleep disturbance, hormonal dysregulation, insulin resistance…There is an NHRC back sleep study going on right now that is really interesting and is helping to put some clinical applications into folks hands.

  4. Renee
    March 20, 2013 at 7:10 am

    Dude,

    So. Awesome.

  5. Anna Morrison
    March 20, 2013 at 8:17 am

    Robb, I’m over-the-top thrilled that this project is moving forward. I have been 100% Paleo for 4 years and have never felt healthier, stronger or happier in my life. I am currently an RN in Nurse Practitioner School and can’t wait to graduate and begin practicing Evolutionary Medicine. I have been looking for a paradigm such as this within which to practice upon graduation, as the current medical paradigm is downright depressing from this ‘enlightened’ ancestral perspective. I’d been looking into Integrative/Functional Medicine, which, while being light years ahead of conventional medicine, still wasn’t a 100% fit. However, practicing Evolutionary Medicine is something I could get behind 150%. I will be closely following the Specialty Health program and am very interested in collaboration as a future NP. In my current position, as an RN, I spread the good word as often as I get the chance. So, please know that we are out here, fighting to change the system from within: one conversation, one patient, one doctor, and one colleague at a time. Thanks for all you do!

  6. Tony
    March 20, 2013 at 8:20 am

    Hi Robb,

    Thanks for your research, books, and tireless effort! In the 2 years since I’ve gone Paleo, my friends and family have watched my body and mood undergo a huge transformation…and for the better! I also have 3, and I’m working on a 4th, convert(s)! The more “doctors” and “mainstream medical professionals” give this (Paleo/Ancestral Health) a fair and unbiased chance, the easier it becomes to spread the word. I find my biggest challenge is people are constantly say, “But that’s not healthy.” “You look great, but what about on the inside?” So then I show them my blood work and they are stopped dead in their tracks, dumb founded as to why my levels are great and I look great, by “eating all that bacon!” Haha.

    Congrats on the Clinic! It’s going to cause some big ripple waves.

  7. Justin Sandy
    March 20, 2013 at 8:52 am

    Amazing Robb,

    You are true inspiration and we thank you for being a catalyst for positive change. I am a retired NFL player passionate about “true” health and wellness. My wife is a Certified Nutrition Therapist, and together, we have created Natural Instinct Nutrition to bring the “Paleo” style nutrition template to as many people as possible.

    Although I have a B.A., I have no formal education in “health or nutrition” (which could be said is a good thing at this point), but still want to be heavily involved in this Specialty Health movement and provide you with more “gate keepers”.(we are located in Boulder, CO) With no “formal” background in the health field, how can I help this movement expand? Is it through the Evolutionary Medicine Certification? Or will I need to receive an additional, more formal, certification on top of the EMC?

    P.S. – On behalf of the NFL I have done multiple speaking engagements with soldiers regarding PTSD and ways to cope. NFL players have very similar symptoms to PTSD after they retire, one major issue is Post-Concussion Syndrome. I look forward to the anti-inflammatory information regarding the PTSD as I suspect there could be some transferable benefits to post-concussion syndrome cases as well.

    Thanks Again, I Look forward to meeting you at AHS13. (and big John W. of course)

    to health & happiness.

    • Robb Wolf
      March 20, 2013 at 11:32 am

      Justin! Thanks for the kind words.

      You need to hook up with John Welbourn! You guys would have a ton in common.

      So, the networks I see developing are based around medical clinics AND gyms. Clearly there will be private practitioners in this, but we are developing curriculum for:
      1-Coaches and PT’s
      2-Allied HC providers
      3-MD/DO/DC/researchers

      So, I;m not sure how you could fit in that, but that’s the model at present. Shoot me an email to chris at robbwolf.com and I will make an introduction to both Welbourn and to the Specialty health folks. One thing we will need are passionate, articulate speakers to take this message out to the masses.

  8. Erik Schimek
    March 20, 2013 at 8:53 am

    Robb,

    You may find this book helpful, regarding PTSD recovery.

    http://www.amazon.com/Waking-Tiger-Transform-Overwhelming-Experiences/dp/155643233X/

  9. Joseph Doughty, DC
    March 20, 2013 at 9:03 am

    How do I get on a list to keep informed about getting more involved when you launch the EM related material?

    Thanks

    • Robb Wolf
      March 20, 2013 at 11:28 am

      Just keep an eye on the blog and sign up for the paleophysiciansnetwork.com

  10. Sabine
    March 20, 2013 at 9:15 am

    How can I get EM certified?

    • Robb Wolf
      March 20, 2013 at 11:27 am

      Details to follow! Like i said in the post, we are still getting the wheels on this wagon.

  11. Chris
    March 20, 2013 at 9:22 am

    Hey Robb,

    This is very exciting news. It is great to hear that efforts are being made on the treatment side to educate. A tag on question to the earlier post by Jason, but does one need to be genetically tested to find out if they are homozygous ApoE genotype. Is there a specific test recommended for that? It is hard for patients with a very high LDL-P number to tell if it is FH or instigated by thyroid dis-regulation. I’m wondering if a genetic test and/or careful thyroid tracking could shed some light. Thoughts?

    • Robb Wolf
      March 20, 2013 at 11:26 am

      The ApoE testing is done as part of the advanced testing…I’m covering some of this at paleoFX, but it’d be a worthwhile blog post to go through and talk about those nuances.

      One of the primary thigns we look at when ruling out (or in) FH is cholesterol levels over time. FH USUALLY presents as high LDL-C, which is the only thing we typically hav eon folks ast LDL-P is a relatively new test. So, we have a firefighter, previously looking pretty good, LDL-P is above 2,000 and LDL-C has really taken off, doubling or perhaps even tripling. they may not look very insulin resistant…which would seem to fit the FH diagnosis. Then we look over at TSH, rT3 etc and we see a pattern of high TSH and rT3…now we have something that might make us suspect some thyroid/cortisol issues are at play. We will also typically see some elevated inflammatory markers.

      this is just one example…what i will do is as we generate these flow charts I’ll get them posted so folks can start thinking about them. In the mean time I’ll do my best to answer specific questions, but I’ll help a lot more people if I can get the curriculum DONE, then get it out en-mass. this is a bit like writing the book!

    • Russ C
      March 21, 2013 at 11:47 am

      Chris, It’s only $99 now to get your full genes (actually not completely complete) at 23andMe now…

      https://www.23andme.com/

      Price has come down since I did it, and can only tell you I’ve learned tons of stuff that I’ve been able to make very positive use of. You just order a kit, spit in a jar, and mail it off, then wait for your data to become available on the web. It’s an active system so that as new scientific papers referencing genes come out, your info is regularly updated. In one case with my Dad, there was only about 6 weeks between a major new paper coming out and they had it integrated into his updated results.

  12. Rakesh Patel MD
    March 20, 2013 at 9:36 am

    Congrats Robb,

    I am so glad things have progressed for you and Greenie. We,as well, have been getting inquiries from around the country regarding our program. The first responders and their families are so grateful and it has been an honor serving this demographic. But has you have eluded, there are “much bigger fish to fry”, if we are really going to make a difference. We really need to connect. Talk to you soon.

    • Robb Wolf
      March 20, 2013 at 11:20 am

      Thanks Doc! Hopefully I’ll get out to see you guys at some point.

  13. Bill S.
    March 20, 2013 at 10:01 am

    This is great stuff. This should be on the radar of every hospital and health care system.
    Even though I’m currently an Emergency Nurse, I will definitely certify in this, even if the health system I work for would not have anything to do with this risk assessment program. As an upcoming nurse leader/administrator, this would be part of my plan no matter where I end up.
    With a quality program like this, you have to have high quality and knowledgeable people enact the program and provide the follow up. This would fall under a specialty program.
    This has the potential to be the biggest shift in healthcare in years.
    Keep up the good work. I’d love to read and digest all the data.

  14. Sabine
    March 20, 2013 at 10:35 am

    I would like to speak a word of caution:
    Although certification may help “consumers” (pun intended) find supposedly knowledgeable practitioners, it is, and always has been a double edged sword.
    Certification always leads to a narrowing of focus, less innovation, rigid rules to be followed, and corruption. The focus switches rapidly from a passion to cash cow/commercial interest.

    We are already talking LIPITOR and METFORMIN when doing PALEO (????).

    I am debating adding yet another certification to a long list of those already held, however, I may be more useful providing unpaid and unlicensed community services and knowledge sharing with those interested and in need, allowing for increased flexibility and preserved integrity.

    • Robb Wolf
      March 20, 2013 at 11:18 am

      Sabine-
      I highly recommend you work on this alternate project. We need different directions of effort to get the whole picture adressed.

      And I’ll throw out a word of caution to the Orthodox Paleoites: Pharmaceuticals are largely a problem as they are being used as THE ONLY aspect of intervention. To the degree diet is adressed, it is pushing folks in the wrong direction. this program is built on nutriton, exercise and sleep modifications. THEN, when necessary, we add in some low dase pharmaceuticals.

      • Sabine
        March 20, 2013 at 5:23 pm

        Thanks Robb! I will always use my medical skills, preferably without drugs, if possible.That’s my passion.

  15. Dave
    March 20, 2013 at 12:05 pm

    Casinos, hookers and Evolutionary Medicine care. You guys have everything!

  16. Meredith
    March 20, 2013 at 12:21 pm

    I’m ready to help Robb… I’m nearly certified as a Health Coach and Non-Drug Practitioner… and using the Paleo approach for my clients. I’m looking forward to learning more about how I can help and/or what further certification I’ll need.

    I invite you to join our Ancestral Health Coaches Network on Facebook… it’s full of ready, willing and able folks…

  17. John Proud
    March 20, 2013 at 1:28 pm

    Hey Robb,
    I’ve been following your work for over three years. It’s good to see the power of the free market and facts change lives. I am a RN up in the Seattle area. Is there any MDs, PAs or NPs up here with some fight in ‘em for EM. I am looking to get out and do some work for real health and wellness. I am seeing too much of the same in my fields. Thanks, John

    • Robb Wolf
      March 20, 2013 at 1:46 pm

      John! thanks man. It’s just gratifying to see all this coming together. If you look here:
      http://paleophysiciansnetwork.com/doctors/WA

      You can see some folks in your area. Mainly DC’s and ND’s, but a few MD/DO’s in the mix. We have connections at the Hutch and the UW, so if yoou are really fired up about ths ping us an email at the contact page and I’ll see if I can get you some connections.

  18. Cam
    March 20, 2013 at 1:52 pm

    Epic! This, to me is massively important and on par with any major invention of the last 100 years. Huge, world changing stuff. I know you’re honored to be in this situation and I think I speak for many when I say how cool it is of you to keep us up to date on these happenings.

    Suggestion: I’d love to see some curricula aimed at the everyday people like me that covers paleo nutrition on Coursera.org or some other sort of free quality education. My last class had over 100,000 students from all over the world. It just happened to be a nutrition class that was about as legit as spray-on hair in a can.

    Kudos to you and the team around you,

    Cam

  19. Jason M
    March 20, 2013 at 2:07 pm

    Robb –
    I work for a large company (over $15B revenue) and have been searching for a way to broach this subject with the health department. Is it possible to get some materials to present at my company?
    Thanks!
    Jason

    • Robb Wolf
      March 20, 2013 at 2:12 pm

      Just shot you an email.

      • Bill S.
        March 20, 2013 at 2:39 pm

        Is there a way you could shoot this information to me also?

        Thanks,
        Bill S.

      • Russ C
        March 21, 2013 at 6:22 am

        Can you send to me as well?

  20. Jamie N.
    March 20, 2013 at 2:39 pm

    Robb as a RN working with patients in the “chronic” phase of life, it’s hard not to become disheartened with our current sick-care system. I have looked into furthering my education to include NP school, but always pause due to fear of propagation of the same idealogy and attitudes that I see day after day…. Evolutionary Medicine is something I could get behind and you’ve definitely sparked my interest!

    • Robb Wolf
      March 20, 2013 at 4:49 pm

      We need you! Whether that is as an RN or NP. I think we have a chance to REALLY change things.

  21. Krista Cortellini
    March 20, 2013 at 4:49 pm

    Amazing progress Robb. I hope to be a part of this movement as a future DPM…hopefully some of my classmates will be on board as well!

    • Robb Wolf
      March 20, 2013 at 5:40 pm

      Right on!! How long till graduation?

      • Krista Cortellini
        March 20, 2013 at 5:53 pm

        Finishing up my 1st year in May – 3 more after that then 3 years of residency. Ready to influence some changes in health(sick)care ASAP though!

        • Robb Wolf
          March 20, 2013 at 7:40 pm

          Good on ya kiddo! Keep me posted as your progress through school.

  22. David Fisher
    March 20, 2013 at 6:13 pm

    Great stuff Robb, glad to hear the update. Its great that you guys got some RDs involved at the clinic.

    Greenie certainly has contacts. It was Gary Taubes who originally connected me with Greenie when he found out I was in Reno.

    I’ll be back in Reno for a visit in May. Would love to get together for a bit if the schedules align. I am definitely looking forward to hiking those desert hills around your side of town (where I also used to live). This dreary, cold, snowy Michigan winter is sucking my will to live!

    • Robb Wolf
      March 20, 2013 at 7:39 pm

      Let me know when you will be here. I’ll be gone for a chunk of early April.

  23. julianne
    March 20, 2013 at 8:31 pm

    Thanks for taking the time to update us all. The project sounds amazing.

  24. Butch P.
    March 20, 2013 at 10:14 pm

    How about to folks like me that do not have any insurance coverage ?

    How can we access your program ?

    • Robb Wolf
      March 21, 2013 at 9:47 am

      Butch-
      My goal is to have folks use HSA’s…essentially cash and cary. So, if you are paying cash, we should be able to accomodate you just fine. Do you live in the Reno area?

  25. Tamara Griffith
    March 20, 2013 at 10:49 pm

    I’ve been following this carefully. Ever hopeful something like this clinic would be near me here in Texas. I have personal reasons of course, due to my husbands health, and how standard protocols supposedly saved him only to kill him slowly with more pain than before. I agree with nutrition, exercise education and then use pharmaceuticals as might be required. We have been n e paleo protocol for more than two years and is only reason my husband is working and having a life not disabled or worse dead.
    Perhaps I’ll just save up and find a place and start a clinic hiring only staff that are willing to real healthcare. I have no education in healthcare, (i am a pilot/mechanic by training) but I drive nurses and doctors crazy reading everything, questioning and demanding better tests even paying outside of insurance (a waste of time insurance is lol) trying to find the cause of the health problem not just label it and treat the symptoms slowly incapacitating the patient.
    If ever need a pilot just call me!
    Keep p the awesome progress!

    • Robb Wolf
      March 21, 2013 at 9:46 am

      Right on Tamara! You ar eon a very short list of folks who have offered piloting skillz to the movement!

  26. Barb
    March 20, 2013 at 11:33 pm

    I’ve just got your email update and now I’m too excited to sleep. Damn it!!
    I am a certified nutrition coach and run a small nutrition business in Edmonton, Alberta which is based completely on ancestral and Paleo principles. I would love to bring this into Canada!

    Canadians desperately need this information… Please count me in. One of your former posters had asked for some promo materials. Can I please have those as well?

    Congratulations! I’m so excited… This is huge!!

  27. Erin Luke
    March 21, 2013 at 5:41 am

    This is so exciting! I’m currently in my second year of school studying to be a nutritionist, but it’s so hard to swallow the SAD stuff that gets preached in class. I’m doing what Amy Kubal says and keeping my head down and serving my time though. I’m SUPER EAGER for your nutrition certification, and looking forward to spreading the good news when I graduate. I’d love to be a part of your team (in Florida) in the future :) Keep doing what you’re doing – changing the world one life at a time.

  28. Shawn Roussin, PAC
    March 21, 2013 at 6:43 am

    Robb,
    I’ve been a Physician Assistant for 12 years, and up until 5 months ago I had mostly practiced in Surgery and acute care clinics and ER’s. I’m now at Dartmouth Hitchcock – Manchester, NH, in the Internal Medicine Department. About 6… years ago I lost 60lbs and got rid of my hypertention and hyperlipidemia. I’ve into triathlon for 3 years, but mostly recently started Crossfitting in the Fall of 2012 at Crossfit Reclamation in Exeter, NH.
    I had read several books on Primal/Paleo and clean eating, and finally on 8/23/12, made my transition to about 85-90% Paleo. Nothing, aside from the birth of my two kids, has been as rewarding as the changes I have felt since “adapting” to this lifestyle. Reading this post intrigues the heck out of me. I still often feel like a Paleo-virgin when I hear you and numerous others speak or write about your ever-expanding expertise.
    Seeing “sick”, chronically ill patients day after day in internal medicine has me wondering what I can do to promote this lifestyle onto them. That may just start with this “soup to nuts” Evolutionary Medicine Certificate.
    I see you have other mid-level providers (NP’s, PA’s) “on board” in some capacity. What exactly are they doing, and more importantly, whay can I do to help?
    Forever Grateful,
    ShawnSee More

    • Robb Wolf
      March 21, 2013 at 9:32 am

      Well, you are part of a team, a network right now, right? We are just going to create an alternate network that the foundations of treatment start with sleep, food, exercise. THEN pharmaceuticals as needed, instead of as the first option. Sign up for http://www.paleophysiciansnetwork.com and keep an eye on the website.

  29. Barrett Reznick
    March 21, 2013 at 7:23 am

    Robb,

    I noticed that you have sent over some info to someothers. Can I request that you send me some info I can pass along to my benefits department. We are a publically traded health and wellbeing company, that services many large and small companies wellness programs/benefits programs. If I could get you or your program into the door of my company, I know we could change the world, one person at a time!

    Feel free to look us up:
    http://www.healthways.com/

    • Robb Wolf
      March 21, 2013 at 9:26 am

      Barrett-
      I did not shoot folks any additional material, just made an introduction to the SH folks, which I just did for you.

  30. Barrett Reznick
    March 21, 2013 at 7:24 am

    Forgot to mention, that my corporate department is already open to the Paleo concept, as they ofter host Whole 30 challenges. It is about getting your info in front of them!

  31. Lynn
    March 21, 2013 at 8:11 am

    Wow, Robb, what exciting news indeed! We have a family member recently diagnosed with Type 2 diabetes and NAFL disease. Her total cholesterol is 203 although with a high LDL and her doc wants her on statins. I have no idea of her trig number, but she is a self-confessed sugar addict/high carber and obese for many years. Her doc is obsessed on the LDL-C, no mention of inflammation, reducing carbs… Makes me crazy. I want to send her to Specialty Health – she lives just over Donner Summit in the Sierra foothills.
    Robb, you are my hero.

    • Robb Wolf
      March 21, 2013 at 9:08 am

      Awe, shucks, thanks Lynn!

      She can definitely go to the clinic.
      330 E Liberty St #200 Reno, NV 89501
      (775) 329-6200

      She will need the will to change. That’s the hurdle.

  32. Sonya
    March 21, 2013 at 10:23 am

    This, THIS, is what I’ve been looking for as a PA-C. After practicing in a closed-minded/blinded establishment for too long I am thrilled to see this taking shape. And if you need more PAs remotely, PLEASE get in touch! Otherwise I will wait patiently to do the course and be able to practice with like-minded folks in the Pacific Northwest. I’m so antsy to be able to help! Thank you for all your work and passionate force to motivate change. You’re saving lives, Robb. Fantastic work!

  33. Tina Bock
    March 21, 2013 at 11:49 am

    You’re pretty awesome!

  34. Chris Tunstall
    March 21, 2013 at 1:41 pm

    Robb,

    This is too awesome. Congrats on making stuff happen.

    I’ve been on my own paleo journey for three years now and never looked or felt better. My wife’s a paleo PT and would love to be certified in your program. I’ll keep watch here for updates, but if there’s anything you can tell us to whet our appetite, please do!

    Meanwhile, if you think about extending your patent coverage into Europe (we’re English), get in touch. I’m a partner in a well known patent attorney firm and it would be an awesome privilege to be involved in this project in any way.

  35. Italian
    March 22, 2013 at 7:33 am

    I am reading “PALEO DIETA” written by you Robb.. I am from Italy.
    I am opening my mind, thank you.

    Lucyly, I’ve never eaten too much glucydes or sugar, but I am learing milion of thnis I did not known.

    Thank you very munchm Robb.

  36. Julian
    March 22, 2013 at 11:30 am

    Awesome.

    I’m a EE with a strong understanding of probability and stochastic processes. I’ve been trying to come up with a way for me to help spread the good food word, especially within my company (~$6B electronics & communications). I’m also well practiced in public speaking…and have spent a lot of time speaking to people about paleo & modern disease.

    Is specialty health hiring or looking to expand into other areas? I would love nothing more than to become part of that team. Let me know what hoops to jump through and I will jump.

    Cheers,
    Julian

  37. Glenda Glass
    March 25, 2013 at 9:03 am

    I’ve been following this with ever increasing excitement. I’m a clinical microbiologist with 30 years of experience, and also a clinical herbalist. I give talks on how to avoid chronic disease, especially the Metabolic Syndrome complex, through the hospital where I work, and also in the community at large. Here in the San Joaquin valley in CA, the diagnosed diabetes rate is almost 10%. My program is 100% paleo, and I have seen great improvement in people adopting the it. Just as ground breaking is the auto-immune stuff, which standard practice medicine cannot deal with at all. I am approaching retirement, and will have (finally) lots of spare time to develop the health coach aspect, and very much want to certify as a EM specialist. I can contribute knowledge of adaptogenic plants (such as Ginseng, Reishi, and Eleuthro (formerly Siberian Ginseng)that act to help the body deal with stress and can help normalize blood sugar levels in concert with the other therapeutic interventions. Please let me know if I can be of help with your and SH’s work in Reno, or if SH is looking to expand the project into other areas.

  38. JT
    March 25, 2013 at 9:48 am

    Robb,

    This is fantastic! As a health insurance consultant, my job is to lower health insurance costs for my clients. The only real solution is improving the health of our clients’ workforce. Once we get the buy-in, our success is limited because we have no “real” solutions. Insurance companies, wellness companies, and my colleagues believe in the conventional wisdom regarding nutrition and exercise. You would be appalled by the solutions. It is depressing as the only person advocating the Paleo lifestyle and being ignored. A 33:1 ROI will change the paradigm.
    Do you plan on expanding into the commercial health insurance market or workplace wellness market?
    I would love to learn everything I can about the program and the ROI results. The opportunities are endless!
    Thank you.

  39. HP
    March 27, 2013 at 5:09 am

    Robb, Great stuff. In regards to low saturated fat recs for homozygous ApoE genotype folks how low does this translate into grams per day? I’m mainly thinking about it from cooking lean meat in a pan and what cooking oils they would use.
    Thanks

  40. charles grashow
    March 29, 2013 at 2:05 pm

    Robb

    Did you supply Richard Nikoley with “dirt” on Paul Jaminet??

    http://paleodrama.tumblr.com/

    “I got right to work, dug up some worse dirt on Stefani, emailed her and just made sure she knew who the more capable bully was. Then I decided to be proactive. I got dirt on a bunch of others and made it clear to them that “denouncing me” would be far worse for them than acquiescing to Melissa’s demands. It wasn’t easy. Any idea how difficult it is to find dirt on Paul Jaminet? Well, at least Robb Wolf made up for it. That was an easy one.”
    http://freetheanimal.com/2013/03/bigger-letter-frauenfelder.html

    • Robb Wolf
      March 31, 2013 at 7:54 pm

      Hey “Charlie” Where the fuck did you go when I offered a phone call? Why is your ISP always changing around? Did you know when I had my comments analyzed and looked for posters with different ISP’s you and Evelyn are the “ONLY” people who come up, other than I believe 2 other people? “Charlie” do you find that at all odd? “Charlie”, why are you trying to drag me into this horse-shit when I told evelyn to GFY so I would no longer need to look at the fecal emanations of a broken, pathological, borderline personality?

      • sonny
        April 1, 2013 at 2:01 pm

        they’re probably govt paid disinformation agents. They spend more time trash talking and besmirching names in an effort to confuse and divide instead of focusing on the more pressing issues.

  41. Mel
    March 30, 2013 at 11:18 am

    Robb: Evelyn deserves an apology for the “f— ‘em” remark of yours recently posted on her site (spoke at PaleoFx, I believe). While you didn’t reference her by name, it’s quite clear to whom that comment was referring.

  42. Erin
    March 30, 2013 at 12:25 pm

    I read you need pharmacists! Pick me!! I graduated 5 years ago with my PharmD and I currently have experience in hospital, retail and mental health in Oregon. It is very frustrating to watch patients take a “magic” pill and yet receive no guidance or take any responsibility for lifestyle factors. Not to mention, at least 99% of my patients believe if its prescribed by the doctor, the medication is 100% safe. To be part of a team where pharmaceuticals are used as a complement, rather than sole treatment approach, would be refreshing to say the least. That should be the norm, but unfortunately, it is not.
    I also am part of a committee through medicare looking to decrease hospital readmission rates and total healthcare expenditure for the top 10% of utilizers. Perhaps outside of the scope of your current system, but obviously your comprehensive approach to patient care will be the answer here, too. If I mentioned such a system at this point, though, I fear there would be a lot of blank stares in my direction.

  43. Abby
    March 30, 2013 at 2:39 pm

    Robb –
    Amazing work, congratulations. I live in Reno, how do I get involved? Will being an RN/MD/PT/etc. be a prerequisite for the Evolutionary Medicine certification? Also, I follow a Paleo diet and would love to get my “baseline” numbers (as you and others often suggest), is Specialty Health’s new Integrated Medicine clinic a good place to have that done?
    Thanks for everything you do!
    -Abby

  44. Jenny
    March 30, 2013 at 7:09 pm

    Robb,

    As an RN in an emergency department treating approx 72,000 patients per year for a lot of chronic disease related complaints, I am beyond ready to start attacking this problem from a curative/preventative standpoint rather than a reactionary one. I cannot wait for the certification to be available. I would love to bring this program/mindset/lifestyle to my community. I am 100% on board and would love more information on how to make this vision a reality to patients and practitioners. There are currently no MD’s or DO’s in my area who practice with an EM focus. I would love to be the catalyst in making that change. Keep the info coming and let me know how I can further this cause.

    Thank You,
    Jenny

  45. Mel
    March 30, 2013 at 8:16 pm

    …And she’s still waiting on the FIRST apology, Robb, for telling her to go f— herself.

    • Robb Wolf
      March 31, 2013 at 7:43 pm

      Mel-
      that’s good to know Mel. why would a tell a borderline personality bully “sorry” when is an annoying moron? Please, educate me on this.

  46. Carrie
    April 8, 2013 at 6:31 pm

    Hi Robb,
    I am a pediatric physical therapist and am very interested in the program. Because I work in pediatrics, I am working more with cerebral palsy, Down’s syndrome, autism and ADHD than with inuries. Just curious as to whether the evolutionary medicine program will address these issues as well. I also work with occupational and speech therapists who may be interested, any room for them?

    • Robb Wolf
      April 8, 2013 at 8:07 pm

      Carrie-
      CP and some of these other issues do seem to have autoimmunity linkage…so much that we do not know.

  47. Thomas J. Hill
    May 5, 2013 at 4:13 pm

    The elimination of overly processed foods and sugars is a good thing. Overall health and wellness is even better. What are the statistics about the effects of a paleo-style diet on kidney function? I have seen studies about high protein intake, such as from protein supplements, negatively affective kidney function. Does the paleo-diet have such side effects being seen? Are studies even following this question?

  48. shannon breeze
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    • Robb Wolf
      November 21, 2013 at 10:08 am

      wacky…have tried both home and work and they load for me.

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