Integrative and Functional Medicine with Dr. David Gordon

Integrative and functional medicine works with the 4 Pilars of a heathy lifestyle. John Malanca and Dr. David Gordon cover pain, sleep, anxiety and more.

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Transcript

John Malanca  0:00 
Hey, everybody, welcome back. John Malanca with United Patients Group, be informed and be well and today's a doctor I've had on before on another platform and I had a really great conversation with him and I wanted him him to be on our platform United Patients groups. So welcome Dr. Dave, good to see you again.

Dr. David Gordon  0:22  
Great, nice to see you as well. Thank you for having me on your your great podcast,

John Malanca  0:27  
of course, and Happy New Year to you. So let me go with your bio. Dr. David Gordon has more than 20 years experience working with patients his passion is providing non pharmaceutical options for chronic disease. It's gonna be perfect. I'm gonna go again, I blank out all my contacts and 321 Sorry, Joe, my editor. Three, two and when we take for the beginning here 321 Welcome back, everybody is John Malanca. With United patient group be informed and be well and today's special guest is someone I've worked with before in the past. Dr. Dave Gordon, how're

Dr. David Gordon  1:01  
you doing? Dr. Dave? I'm doing well. Thanks for having me.

John Malanca  1:05  
Thanks for being on the show. Let me read your impressive bio, but Dr. Dave Gordon has more than 20 years experience working with patients. His passion is providing non pharmaceutical options for chronic disease prevention as well as treatment using four pillars food movement, relaxation, and community as cornerstones of an integrative approach, which I'm a big fan of and I live that life as well. He received his medical doctorate and completed residency training at the University of Colorado and remains on the clinical faculty. Dr. Dave is a board certified and an internal and an integrative medicine and a certified Functional Medicine Practitioner with the Institute of functional medicine. for over 10 years, Dr. Dave has reviewed research on cannabis and our endocannabinoid system and witness the safety and effectiveness of cannabis while working with patients. He's excited to be on the forefront of cannabis medicine, bringing that knowledge to patients practitioners, as well as the general public. Well, cool, and you're out of Colorado, right?

Dr. David Gordon  2:03  
I am out of Colorado, originally California, born and raised in Los Angeles, but came out to Colorado for medical school. And it's two nights leave here. So stay here ever since the 90s. Yeah,

John Malanca  2:15  
it's good because a lot of people don't like the cold. I have some friends that grew up there. And then when they got you know, they're able to get out. They're like, Okay, I want to go to California to warm up a year, you're from the warm climate, you went over there and you get a few different seasons Sue, so, you know, I do a lot in the cannabis industry. And so why I wanted you as well as the integrative oncology world and functional medicine. And so can you talk about what's the difference between an integrative integrative as well as functional medicine? What's the difference in that how you're incorporating that into medical cannabis?

Dr. David Gordon  2:51  
Yeah, absolutely. It's a great question. You know, I, the way I describe it is I describe integrative medicine is really more of a bigger toolbox, really looking at a variety of different ways to deal with certain issues conditions, and that kind of know, that's how my career kind of started. After my residency, I went into practice, and quickly kind of was exposed to other practitioners, chiropractors, acupuncturists, psychologists, and said, Okay, I'm going to use these resources. So rather than just prescribe medication to everybody, which is kind of I'm oversimplifying a little bit, but which is kind of the standard of care. It was this integrative approach, let's use all these different tools, let's understand more about a patient's lifestyle and counseling and education. So that's kind of integrative medicine, at least how I describe it, again, just really opening up the toolbox, both on how you evaluate patients, and then certainly how you treat them. Functional Medicine is a term that's really only been around 25 years or so. And it's kind of a type of integrative medicine, I would say, but it's a little more specific focus, whereas functional medicine is really the mindset of how you approach conditions. And really, it's this concept of let's approach approach it by the root cause. So rather than just label diagnoses, someone's got migraines, or someone's got lupus, and then we're going to use maybe an integrative medicine approach to treat them. We'll use acupuncture, we'll use prescriptions, we'll use botanicals. Functional Medicine says, well, what's the root cause of your disease? Why do you have migraines? What are the system imbalances, and you just keep going upstream further and further to identify these root causes. And then you treat the root causes, you don't really treat the symptoms per se, you treat the causes of them. And that's a pretty unique philosophy, and that's really the difference. There's a lot of overlap, but functional medicine is really a philosophy and kind of a paradigm in and of itself.

John Malanca  4:49  
You know, there is a lot of overlap and I get him my doctor for the past 10 or 11 years has been naturopaths you know, and they look at the same thing and how different way of approaching compared to just here's a pill Dr. Dave take it you know and call me Call me later and I and I'm liking the way that cannabis is not a one size fits all and same thing with integrative as well as functional. The problem with integrative you know, I just finished hosting and moderating a integrative oncology conference which crinan I've been involved with past 678 years and you know, when we offer CMEs, to these integrative international integrative oncologist It's funny though, because with this one organization that was certifying that it couldn't have used in the past that was bringing it over to their organization, they weren't allowed to become a an accredited body meaning or for the organization, because Functional Medicine and integrative oncology or integrative approach isn't approved by the FDA. Do you run into that? You know, different different they do? Well, at least for the integrative oncologist, they do everything besides chemo, radiation, and then saying, well, stem cells aren't aren't approved. Ozone is not approved. So we can't, we can't certify that as a continuing medical education, at least for this other we did end up working but you run into that. That other I guess the AMA doesn't doesn't really frown upon it's not the right word. But look at them like, Hey, you're not following the guidelines? Is that something that you run into?

Dr. David Gordon  6:27  
Yeah, in a variety of different ways. And no, sometimes at least when it comes to CME, continuing ed, definitely have been able to do some formal continuing ed, at least in the in the cannabis space, I would say. But even within the institute of functional medicine, there have been some courses that are CME eligible and things like that. So I think it brings up an interesting point, the challenge of, of Kinda, yeah, what's approved, what standard of care, what's evidence based medicine, that's kind of where the challenges have always come up, not always on the CME side of thing, but more when just discussing you get often just a wall put up immediately, if someone hears the term integrative medicine or functional medicine, cannabis, you'll hear things like, oh, there's no evidence for that, or I only do evidence based medicine. That that is a pretty, I guess, I guess, frustrating take on my apart because it's this, we've created what we call standard of care, and then say, we don't do anything that's not evidence based medicine. But in reality, the bulk of our standard of care is not supported by the evidence in so many different conditions. Certainly, some areas there are and that's what's frustrating to me is kind of the people who kind of make the rules of what standard of care gets to say, Well, what you do is not evidence based medicine, what I do is even though there's no evidence to support it, and that's a pretty frustrating topic. I mean, just to give you an example, I think it was last year now two years ago, 2019. Jama, the journal American Medical Association, so you know, one of our major journals, posted the guidelines for the American College of Cardiology, and you know, all our heart disease guidelines and only 8%. Were supported by what you call like level one evidence, large scale, double blind, randomized trial. So this is cardiology, the area, we have the most research of any specialty, and yet only 8% are really supported by what's considered the great evidence. So when people say, Oh, in cannabis or functional medicine, you're not evidence based, I'm like, Well, you're not evidence based either. You just get to make the rules. So you get to say whatever you want. And that's, that's kind of an area that I run into is pretty frustrating when, when trying to introduce concepts to people, and they immediately just put up this wall and don't kind of acknowledge that what they're already doing isn't any more evidence based on what I do.

John Malanca  8:55  
It's tough. You know, being a health advocate, and a patient advocate, and also a caregiver with my wife. That was the thing that really frustrated us that we would go to main institutions, Stanford being one of them. And when we shared, we're using cannabis and other non evidence based, I guess, methods. You know, they totally, I mean, they put they put me in a whole different category, you know, it's like, well, there's no proof about that, you know, why would you do that? I'm researching. I mean, when you're thrown into something of health and wellness or sickness, you'll do anything for yourself, and most certainly for your wife or your loved one as well. And, you know, if something worked, I mean, when you get that diagnosis, you'll try anything, and I always talked about that if someone said eat a blue pen, you know, it has killed cancer cells, you better believe I'm gonna start eating that blue blue pen and it's it's disappointing that, like you said, Oh, it's not evidence based on that. They kind of turn the cheek and not really take this side of the medical practice seriously. You know, I've had a lot of, I've worked a lot of oncologist both integrative as well as conventional, as well as bunch of functional medicine, I just feel that a whole, having the, the toolbox, bringing to the table, when you're when you're battling diseases is as serious as cancer and others. Why not have an arsenal, you know, and even work together, you know, like cannabis cannabis work together. And I don't want to have anybody ever if they've been diagnosed with cancer, not go to conventional, right? I would never talk anybody out of doing that. But you can. You can use them simultaneously. And you hear this as well. I'm gonna try this. And if this doesn't work, then I'll try this.

Dr. David Gordon  10:52  
To hear both. I mean, my I mean, people coming to me, obviously, are already kind of interested in looking at a broader array of options, and they've been given. So when folks are coming to me, have probably less of an argument. But when I'm talking to clinicians, or when I'm talking to patients that are, you know, maybe not coming to me for a visit, but they're just after a lecture where it's the first time they've heard of something, you know, I'll really say, Well, you know, what are your goals? And then when it comes to Well, what about this physician? What do they say? Or, you know, you're not evidence based? I said, Well, really, how do you? How are you describing evidence based in terms of thinking about all these options? I mean, I describe evidence based, kind of based on how it was originally defined about 20 years ago, which was actually three prongs. It was the best scientific evidence, the clinicians opinions and experience and the patient's goals and preferences. And using all three of those is really truly how evidence based medicine was defined. So when I talk to a patient, they're looking at it, I say, Well, what we're doing is evidence based and what you said, when, when you were working with training, you're doing the research. So when I look at a patient, say, with cannabis, and cancer or any other condition, we're going to use all the scientific evidence, I have not just one study that fits my viewpoint, I'm gonna look at all of it. And then I'm going to say, Well, what's my experience with patients? What are other clinicians experience with patients? And then I'm gonna say, what are the patients saying? Well, I've got a huge battery of data, for example, on cancer that says, well, cancer patients who use cannabis feel like it helps and really feel like it's a valuable part not going to exclude all those patients. Because they weren't in a randomized trial, these are real individuals struggling with what you obviously know, is, is a life changing diagnosis. So I think using all these tools is true evidence based medicine. And if we approach everything that way, one, we we kind of would do better for our patients, but really be able to then do better with the hard clinical research that we all want. But if you don't acknowledge something even has the potential to help, why you're going to bother investing research and that and so I think it's some of its for me is just describing it in that terms for patients, for clinicians and say, if we ignore the patient side of it, we're never going to get great patient outcomes.

John Malanca  13:17  
You know, and you talk about ignoring the patient. Yeah, as you know, I keep on saying that I work with integrative oncologist and functional medicine, the first conference that I attended, I want to say now got a 678 years and probably about 70 years ago, but the very first one we sat in, and after the conference, they did a panel discussion with the doctors up there. And so one of the audience said, what are the what what are the what steps do you approach a cancer patient when they come to you? And to our surprise, and I was pleasantly surprised. They said, You know, first off, we asked, you know, what their home life is like, you know, what? Their home life? Are they married? Are they do they live alone? Do they have a nice relationship? Do they have children? What's their religious background? Do they are they into into spirituality? Are they you know, they practice any any type of religion? Are they open to this? And then they asked them about praying, which blew my mind that a Doctor Who and talk about praying and then they say, What is your will to live. And then we go to the patient. And I just think for showing the patient that for these doctors to show the patient that they really care about the patient, and then the treatment and they're going after treating the ailment, you know, they do all these first then go into treatment and they know where they are with that patient. Everyone's different. Everyone's different and sometimes it I don't want to ever give false hope but sometimes, you know, giving that hope and giving that extra pump like oh my god, my doctors on board my doctors is part of this and I think that's the thing I really enjoy About the integrative and functional medicine part of this, where they can incorporate. I'm a big fan of chiropractic, acupuncture, meditation, naturopathic medicine, the list goes on, you know, if you can do that. So in the same thing we did with your four pillars at the beginning of your bio, you know, I'm a fan of all those as well. In your practice, what are the common reasons people come to you? When they turn to cannabis therapy? What are they asking for? Are they are the is it a wide variety of patients that come in

Dr. David Gordon  15:35  
definitely a wide variety but they're no doubt some some things that kind of rise to the top, I think still, pain management is still far and away. Probably the most most common thing one, it's, it's probably the thing that's most talked about in the lay press and things like that. It's also one where other options are really poor, especially the opioid issues. And there's so much now press over the last five years about that. And so people are now knowingly afraid of it, whereas before they were just Oh, my doctor says this is fine. So I'm gonna go about it now. You no need to really do your own research to know the risks of opioids. People who are a little bit more knowledgeable start knowing about the risks of things even like Tylenol or ibuprofen, which are which are not small in any way shape or form. So pain management is certainly I think, still the top I would say the combination of mood disorders and insomnia if you kind of lump all those together would be would be you know, high up there, anxiety, depression, trauma, sleep, it all certainly kind of goes together. I'd say that category is prominent, and then you get into other you know, chronic diseases that you know, certainly overlap with that cancer is another big one as well people. Again, like yourselves, they certainly know there's a role for cannabis in cancer, even just in symptom management beyond the potential for its chemo therapeutic benefits. So really, they're not getting guidance from from their their primary oncology team most of the time, although there are areas where we're, that's where there's a little better guidance. But so those are probably the three three biggest but I would say there's no kind of conditions someone hasn't come in with a level.

John Malanca  17:25  
Yeah, nowadays. I mean, there's some conditions that really weren't around when you and I are probably in high school and college you know that are today I mean, I never hurt you know, you hear more about things today than you did back then maybe we're in the industry maybe that's why and working with a lot of people sleep you mentioned sleep sleeps important and I truly believe it's so a domino effect when you don't when you're lacking on sleep, everything else, you know, kinds of kinds of feel you're eating your depression, your anxiety, pain, a lot of pain patients find you know, when they don't sleep, you know, we have done a few podcasts on, on on pain, and you know, one Beth dosh and got Claudia Miranda sorry, Claudia, you know, they are doing a lot in the with the paint world. Beth has been working with us. She's a nurse in this industry, and she has fibromyalgia. And so it's something that, you know, she has a nurse, she just discovered cannabis about probably eight years ago, she was at a conference. And she stopped there with her mouth just dropped. Like, how come I never learned this. I've been a nurse for 2530 years. And so now she's incorporated that but she was such She's someone who battled fibromyalgia. You know, she gets up at three in the morning to get out of bed at six because she's in so much pain, knock on wood. And they were you know, I'm not in anything, you know, and I hope you're safe. So I don't see that side. What she has found in what she's both she and Claudia are working with is fighting for pain patients, not only here in the US, but globally. And you know, they find success in the positiveness of drug to drug interactions, you know, lowering the pain dose with the pain medications, and having you know, say a 25 milligram pharmaceutical product using cannabis, two to five milligrams in lowering the pharmaceutical product and getting the same amount. Same results I guess as a 25 milligram capsule by using a cannabis product giver mix and match with that I you know, I always tell people, don't do it by yourself. Make sure your your physician is involved. You know, so

Dr. David Gordon  19:53  
yeah, it's definitely it's I would say a lot of it is, is for me folks who are already on other pain therapies. You know, maybe opioids and saying, Hey, I'd love to get off or reduce them. And I say, Okay, well, let's, let's get this in into the mix, let's get you feeling better. And then here's a way you can, I can work with you to taper you can work with your primary Doc, I like the ladder, because I love it when patients go to their primary doctor and go, Oh, I'd like to taper down on my opioid pain medicine and the doctor like, I don't usually hear that very often, but I'm feeling great, I want to taper down. So it's a way to educate other Doc's. But even something you were saying before with fibromyalgia and sleep and and, and, you know, this discussion, this this kind of integrative medicine or discussion of what the bigger issue of the patient pain, such a great example of that. So if you just say, Wow, we want to look at pain, we want to look at your zero to 10 pain score. And that's the only marker we're going to do. And we just assume as physician, we're just going to be lying, because that's what you know, maybe the randomized trial looked at just your pain score. But when you look at a patient, they don't necessarily always say, Oh, my primary expectation, or my primary objective is just to have a lower pain score, their objective is to be with their grandkids, their objective is to go for high IQ, their objective is to have high quality of life. And so when you frame the discussion that way, you also then say, you know, I've had plenty of patients with fibromyalgia is a great example. They add cannabis to their mix, or some other integrative tool, nutrition, whatever that is. And after three months, they might actually say, like, Oh, my peak pain is still seven out of 10, or eight out of 10. But I'm sleeping better, my activities are better my moods better. And so technically, maybe we didn't actually reduce a pain score, but we clearly improve the health of that patient. And, and over time, you know, pain can get better. So I think some of that is looking at the big picture. And that's unfortunately, what randomized double blind studies don't do, they specifically don't look at the big picture, they specifically just take one variable, and try to make a direct line to one specific outcome. And that's valuable, especially in kind of acute illnesses. But for chronic disease, where people who have overlapping symptoms don't have direct, you know, single causes of those symptoms, it actually is really a bad type of studies designed to truly evaluate a patient. So I think Fibro is like a perfect example of, of how you need to look at a patient and really look at evidence based medicine and that true kind of big picture, you know, to the forest rather than the trees model. It's, it's, it's really in our patient's best interest to do it that way.

John Malanca  22:43  
Yeah. Because of Beth. I've learned so much about fibromyalgia. And what she goes through, you know, you know, on the outside, she looks like she's ready to run a marathon inside. She's, you know, her husband and family and kids and grandkids. Like, come on, pick it up. You know, you look great. You know, she just said she calls it the silent. I don't say silent killer, but silent. And invisible, invisible. Sorry, invisible pain. You know, on the outside. She looks fantastic on the inside, you know, just pompom and all the nerve endings are going, you know, she runs in and I don't know, if you run into this with your patients or in Colorado. She's over in the New England area. And they're pretty strict. Like her doctor. Now they're now doctors are being red flagged. Do you ever get any of these warnings from Doc? Are you part of that?

Dr. David Gordon  23:33  
Yeah. Well, I'm not. I mean, I know of it now. Yeah. And but it's, it's kind of almost funny, even funny, maybe not the right word. But I never used opioids really period like I couldn't even tell you in my 20 years of practice, how many new new opioid prescriptions I initiated period, even long before cannabis was part of my toolbox. Again, just being an integrative doc and working with chiropractors and acupuncturist and nutrition. I never needed them. So, even in the in 2014 15, when all the opioid crisis news was coming out, I actually was like, Well, what's his opiate crisis? I'm not familiar with it. I don't have any patients who are taking chronic opioids and realize the scope of the problem was so big. Now, when the the crisis kind of became elucidated. Yeah, now regulators are penalizing doctors who prescribed opioids and all these different things. So what you now have is patients who, who were started on opioids, basically given an addiction by the medical system, and now put into withdrawal by the medical system because now doctors are afraid to prescribe them. Sadly, a lot of those folks turned to you know, street opioids and heroin and, and it's causing, you know, literally life threatening consequences. So, I am now very much aware of some of the regulatory and the kind of the big picture of the opioid crisis, but for years I was oblivious because there There was never a need for opioids in my practice, despite seeing a pretty sick patient population, especially one with chronic pain, but it's just when you don't think pharmaceutical first when you think root cause first and when you think, what's the safest, least invasive way to treat someone, which are the hallmarks of both integrative and functional medicine? Yeah, it works. So you just don't, you just don't need you need the pharmaceuticals, usually, for the acute life threatening stuff. So yeah, there's people who get pneumonia, they need antibiotics, they're there. There's obviously other conditions where the pharmaceutical come in play, but if you're thinking pharmaceutical blast, most of the time, you're gonna get to your resolution before even needing them. So it's true for can antibiotics as well. I never had a antibiotic overuse, because I only use them in times when they were appropriate. And when you do that, they're not a problem. For

John Malanca  25:54  
the most part, you know, you talked about antibiotic, the mom, my mom's brother, my uncle had a lung infection, nothing to do with COVID. And she said, I said, How is these are great, they're going to put him on ready for this 145 day, antibiotic. And I said, Mom, you better get up some probiotics, you know, she's gonna rip 40 I mean, that's a long time 45 days to be on an ant to be on an antibiotic is that is that common?

Unknown Speaker  26:24  
Ah, it's it's really the place it's most common is bone infections. That's kind of the standard for a bone infection is six weeks of IV antibiotics. One infections are a little atypical, though, there are some what we call a typical infection, TB, mycoplasma. Some other things, maybe some fungal infections where longer is done. But again, when we go back to evidence based medicine, I'm gonna guess obviously, not knowing the details of the specific case. But I would bet money, that if you took the details of that case, and said, Oh, is there a randomized trial showing that, you know, six weeks or seven weeks of, of antibiotics is appropriate for someone, you know, with the bat, that background, my guess is, you wouldn't find that data. So again, not evidence based medicine based on what kind of the system is saying is true evidence based medicine.

John Malanca  27:22  
Yeah, and I don't know all the details either. So but when I just heard 45, that stuck out, like, Oh, my God, that's, that's, that's heavy duty on the gun, you know, I'm very aware of what I put in my body. And health and wellness is part of part of my lifestyle. And, you know, like I said, I'm not in pain, as well, as I was mentioning earlier, build a backup of what's happening to the East Coast. Not only the East Coast patients, but that are that are on the pharmaceuticals is, you know, they have a month long supply of their pain medication, and they run out on day 28. Because maybe, day 18 You know, there are so much pain they had to take to you know, and then when they go in there and day 29 To refill it. Now they're on the list, you know, the red flag list, and it just, it just, you know, I'm not in any pain, thank thank goodness. And so, but a lot of the patients that we work with on a regular basis are in pain, talk about cannabis and pain. You know, that was one thing that didn't help Corinne. And she would just, she's like, how's this not working with me? How I mean, in pancreatic is just a different different breeds. And she didn't want to have the pain medication. You know, she didn't want to have, she didn't want to have morphine. And whichever, you know, when you're at that stage, take this, take this, take this and it, you know, but she wanted us to go the natural route because that's all we've what we've always done is the integrative and functional and, and of way of life. And do you run into that where sometimes it doesn't work with patients in for pain?

Unknown Speaker  29:04  
Oh, yeah, I mean, I think for pain and for all conditions, there's there's certainly no best treatment or kind of the only treatment that works. I find with with pain issues, I think neuropathic pain or really the nerves are inflamed and hyperactive. I think that's where I see the best results. Also, with kind of central acting pain conditions, that's how we would describe Fibromyalgia where it is the nervous systems involved, but it's not one specific nerve. Like it might be with sciatica or diabetic neuropathy, things like that. So that central acting kind of pain condition, or the neuropathic pain condition, I think it's where it works, the best kind of arthritis where you've got bone just rubbing on bone, I think I've seen and had success with a lot of folks but there are certain times there where it's not in some of it is What their kind of body needs. You know, for example, if it's even though cannabis is a great anti inflammatory, there's other anti inflammatory regimens that might work more effectively. If someone's endocannabinoid system is really functioning optimally, and overall doing really well, adding more cannabis may not really support them as much because you're really optimizing the receptors. So there's patients where it doesn't work. And, and that's, again, the beauty of having one different options for folks and using combinations. But also time with with patients. Because when people say cannabis doesn't work, sometimes for pain, it may not be in current situation, because you guys are knowledgeable, able to try different products and regimens that a lot of people hear oh, cannabis is good for pain. So I took this one thing that didn't work. And they just say, oh, cannabis didn't work. Well, okay, this one product at this one dose in this one ratio didn't work. But cannabis is a big term. And so I wouldn't I tell people all the time, you know, people come in and say, Oh, cannabis hasn't worked for me, I'm like, well, cannabis, this product hasn't worked for you, we've got a lot of different options. And I think there's a big education gap both for patients and practitioners, we're so focused in our medical system on kind of single drug, single treatment. So it's easy to say ibuprofen, you only have a handful of dosages, that you know, one, one chemical, so you can kind of say ibuprofen works or doesn't cannabis is hundreds of compounds. And depending on the product, you use, different compounds, different ratios. So, so that's where we get more research to maybe fine tune the starting point. But we, you know, for I tell patients all the time, if you want cannabis to especially be your kind of primary Band Aid, you got to be willing to work at it for 346 12 months to try different products, you know, titrate, if you just want to come in and say, Oh, Doc, tell me what to take for pain. And I'll take it. And I might get lucky and say, here's what works. But I usually tell people, no, that's I'll give you guidance, but you really got to be able to do the work yourself and find the regimen that works. And I would say the patients who do that are willing to spend the time journal, take notes, spend three, four or five, six months. Work with me work with other educators, groups like yourself and others, they're going to do well. The ones who just want cannabis to replace a pharmaceutical and want the quick fix. Yeah, they might do well, we might get lucky. But I would say more often than not, that's not the case.

John Malanca  32:48  
You know, it was us You said sciatica. That was the most pain I think I've ever been in my life. You know, and I know my body and I'm a big into chiropractic and acupuncture massage, and I could not adjust personally adjust myself and I did acupuncture, massage, chiropractic, stretching did everything. I mean, I would have given a trillion dollars to get rid of. I mean, I went down to Costco but Icy Hot packs, you know, my back shot on golf balls, tennis balls, baseballs just to do that. And one day, you know, I went to I said, You know what, I'm a big fan of the inversion tables, and I went and bought one. And I would hang on it, hang on, hang on it and one day just totally released. And I have I have sold more, more inversion tables that people's like, inversion table, go go try go try it nowadays, you get some great ones for, you know, 150 200 Rs, back in the day, it was like the TVs you know, you know, 1000 $1,200 for TV, you know, like this size. And now you go to Costco and get, you know, 75 inch for under $600.

Unknown Speaker  34:06  
When you bring up a great point, both kind of the beauty and to some extent the curse of integrative medicine when when you approach the world of hey, I know there's a lot of things that can help not just this narrow dogma of what we're taught in medical school, it opens up the possibilities, so many different tools, so many different treatments. So that's a beautiful thing. And especially if you're struggling and hey, I've tried this, I've tried this and now boom, I finally tried something that works. So that's the beauty of it. The curse is is is where people start and that's, you know, obviously the most one of my biggest jobs and kind of what I do a lot in my career is I learned as much about the patient as possible. I learned as much about the research as possible that's out there. I learned about all these tools and then say, Alright, here's where I think we should start because I could pick from dozens of different therapies. And, and you know, not everybody has the time and the money to try 30 different things. So it's, it's beautiful that there are so many options for patients. But when you really do personalized care and integrative medicine, it's a challenge to have so many options. You know, as I say, it's a lot easier. When I first started my practice, and I practice what we commonly call up to date medicine up to date is the like a medical online textbook, where it just tells you, here's how you treat every condition. So you just follow every algorithm structure. Now, it's really easy to do that, I mean, I stopped doing it because it didn't work. But but it's super easy to be very conventionally trained outpatient physician, because you don't really have to think you just kind of plug in a diagnosis and spit out the treatment, integrative medicine is a heck of a lot harder, because you have to not only learn about all these different therapeutic options, but then you have to make decisions on what's going to be best for that patient sitting in front of me. And so, again, beauty and accursed when we go down this path, both for patients and practitioners,

John Malanca  36:07  
you know, and I like that, that that the integrative and functional approach is kind of like a full fully. You know, you have a lot in your arsenal, you know, and that's that's how, like I knew earlier you spoke about sometimes it's not just a quick fix, which a lot of us, you know, want nowadays, but stick with it and stick with it with anything, you know, even, you know, working out, you know, or getting on a you know, losing weight becoming getting on a diet, you can't just automatically think, Oh, I'm going to try did this diet for four days, and I haven't seen anything, stick with it. Stick with it. Same thing with cannabis, finding that sweet spot, finding that product and not all products. And hopefully one day, we'll get that point where you'll say you have cancer, take this, you have diabetes, take that you have sleep issues, take this because not all, you know, the perfect thing was when CBD popped out. And in those, you know, well known companies and everyone, you know, jumped on because the media said, I mean, I can't tell you how many families I speak with on a regular basis just because it worked on one child, I have other families that every time their child took that product they would throw up. And then they would actually try another product. You know, it doesn't just because it worked for this person doesn't mean it worked for you. And they they move products. And it works. You know, the child's not having seizures anymore. So don't What do you say about that? Because I have you know, I don't want people to get frustrated, it's not working. It's not working. It's not working? And it's sometimes you have to like anything in life. You have to you have to change it up. Yeah, I

Unknown Speaker  37:45  
think I definitely see that. And I would even argue that I don't, I don't think we'll ever get to the point no matter where we're at with legalization. And Greg, you know, scheduling cannabis, I don't think we'll ever get to the point where if you have diabetes, this is what you take. Or if you have this condition, this is what you take. Because that's simply at least for chronic diseases. Yeah, never works. I mean, that is our single biggest failure in conventional medicine. It's not actually that using Pharmaceuticals is bad. It's the one size fits all approach that we just slap a label on you and say, This is how we treat that label. I mean, that in a nutshell, is the complete failure of chronic disease treatment in not just the United States, but really Western countries as a whole. And so if we just put cannabis, even if we said we're gonna put $50 billion into cannabis research, everybody can, it's completely legal. Yeah, we're gonna get better information. And that would be great. But we're still if we just put cannabis in this model of one size fits all therapy, based on a diagnosis, we're gonna fail. It doesn't mean we don't do the research, because what I like to say is all the research in diabetes or in this type of cancer, it tells us where to start. So if we can narrow our starting point down, I think that's what the research is valuable for. But for every single patient and every single issue, we still have to have this range of where we work because, again, diagnoses for chronic disease. Again, this is a fundamental difference in functional medicine and conventional medicine. The diagnosis really isn't that important. diagnoses are important for life threatening or even life threatening, but for acute illness. You know, it's very important to know if you have chest pain, whether it's a heart attack and aneurysm or a blood clot or pneumonia, whatever it is, that's very important because the treatment is very specific and different for each condition. But if you have cardiovascular disease, for example, the chronic disease that might lead to just pain or a heart attack, everybody's cause for cardiovascular disease is different. So if each treat everybody the same just saying, Oh, it's all cholesterol, it's all blood pressure, and you just use a handful of treatments there, you're gonna miss the boat. So kind of what I tell patients is try to kind of have that let's step back and let me explain this philosophy to you. If you just worry about the label, and what's the right treatment for that label, you're going to fail, because the labels are arbitrary. You know, for the most part, they are created for billing and insurance purposes. And half the time the labels are just Latin for what the disease symptoms are. So someone comes in like, Oh, I'm having burning in my, my feet, I'm having all this pain and they come out of the doctors aren't so proud of themselves, I got diagnosed with peripheral neuropathy. And they're so proud to have a diagnosis. Now I'm like, Oh, really well, well, that's just Latin for your nerves are bad. Like, well, you knew that when you walked in. So I've used that as an opportunity to really kind of educate on what I just said that the diagnosis should only be the starting point, if, if it's that one size fits all for your label, you're gonna fail. So you always have to be willing to try different things and see what's best. And no amount of research will get us past that.

John Malanca  41:13  
So So you know, I'm always the first to say that cannabis is not the Golden Pill, the golden ticket. And so do you tell that same approach to cannabis isn't is not always enough to treat the problem?

Unknown Speaker  41:26  
I don't say it's never Well, yeah, I guess I would say it's never enough to treat the problem, it might be enough to get rid of the symptom, though. So if someone comes in with insomnia, cannabis might be enough to get them a great night's sleep without adding anything else to their regimen. Well, it likely be a permanent solution for years or even more than months, probably not. Because if you get if you don't treat the root cause the symptom is going to persist or a new symptom will come up. So there are very few people whose sole issue is is cannabis deficiency. So there are some folks who have endocannabinoid deficiency, at least we think, and so maybe cannabis might be a great long term option without changing much. But even in that situation, we'd rather feed the endocannabinoid system, we'd rather make our own system function again, not just replace it. So there's always going to be something more because you have to treat the root cause or eventually that symptoms coming back or other symptoms are going to develop. So it's again, I look at more, I use the term cannabis as a gateway. I don't know if we talked about it, when when we chatted on the previous show. I mean, certainly cannabis has been called a gateway drug for for decades. And the research really shows that not to be the case, but I still see it as a gateway because cannabis introduces these concepts to people very well, like here's a short term fix. But it's going to introduce the concept that we have to do more to treat the underlying condition or when people start learning about the endocannabinoid system and about how balance works, and how homeostasis works and how all these other bodily systems work. That really opens your eyes up to how to treat patients effectively. And so it's I'm able to go from, here's why cannabis isn't a treatment for all these different diseases or the treatment for all these different diseases. But here's an explanation of why how cannabis can be part of the picture for so many different diseases because it's creating balance and homeostasis. So I, I kind of turn it around and say, Yeah, cannabis is not your sole fix. But cannabis is a great gateway to understanding how you can get to that fix while getting some short term symptom improvement.

John Malanca  43:43  
Isn't that must be the greatest feeling as a practitioner just to see here, a patient call you back and say,

Unknown Speaker  43:52  
Dr. Dave,

John Malanca  43:53  
I slept. I haven't slept for years. You know, and I get those calls. You know, you refer me to Dr. Dave, and he put me on, you know, a regimen of cannabis for sleep. And I'm sleeping or my pain, I don't feel pain. You know, even my mom was like that, you know, she was someone that I would never ever expect her to use cannabis. And she started seeing all her girlfriends from church or wherever, using it for sleep or whatever. And so I remember, you know, call every morning, good morning, and every night, good night, you know, a couple of times throughout the days check in and I remember one time I cried, and I were sitting there and I was talking to my mom and she said Can I ask you some of this? Yeah, I'm on speaker and she said, Just cannabis worked for sleep and pain. You know, she was a tennis player. And I said, Yeah, why she was cuz I've been taking these little pieces of popcorn every night. And I was saying, and I remember Chris pushing me like Be supportive be support or like, I mean, telling you how your mom's that might. Yeah. And is it working? She's like, I'm able to move like this and that. And it was funny. She didn't tell my brother for like three months, my brother said, Did you know mama Diego's? So, I love that story. And And now, I mean, she's our walking billboard of, you know, all her friends, like, you know, I have friends from high school that call me up and say, hey, I want to thank you. My mom's using cannabis because you and your mom, like, don't blame me like, he's like, No, we've been having trying to have this conversation with her for years. And and I said, you know, sometimes it takes an outsider to talk to to share this with their loved one. Before the family members do that, you know, have have given them the the approval to do that. I wasn't asked you you being a physician as well. And in your practice, at least out here in California and other states. A lot of people aren't are voting doctors. Now they because they you're talking about legalization. And now what are we 35 states, medical 15 states recreational and not everyone's going to go into the doctors anymore. They're going straight to the dispensaries and they're coming back with five or six different products I have anxiety will take this I've sleep take this, I have, you know, eating issue take this. that frustrates me because I work with so many patients that cause a, you know, I have all these products and I work with a lot of seniors as well. I don't want to be taken advantage of I don't want to give anybody any false hope. But I truly believe medical professionals and practitioners should be involved. Um, has your I know you're kind of in the heart of this in Colorado. Has that put a dent in your practice at all? Or is it just your your binder there for so long? That it's common?

Unknown Speaker  46:53  
It's definitely common and and I think Colorado from from my experience talking to folks has a lot of the same problems that California has that it's kind of a free for all. I think we're Colorado's done the best and obviously being the first to kind of recreationally legalize it, I think areas we've done done great is quality. Like I feel very confident in the quality of products that people can go buy at a dispensary. So I think we've done very good there. Where we've done poorly though, is the medical focus. And when we went recreational, I don't want to quite say it destroyed the medical framework. But it certainly put a big dent in it. And that medical framework wasn't great to start with. Because most of the physicians who are given out med cars didn't know what thing about cannabis and you know, factory. But even now, since RX gone into play, I don't know the numbers off top my head, but I think it's something like 90% of sales in Colorado are on the rec side. And Colorado also has to separate from the seed. So when you plant a seed in the ground, you have to say whether it's a med plant or a rec plant, which is one of our absurd rules. So there's no there's no value for most of these companies growing medical flour because they know the sales are going to be on the rec side. So So it's basically push people out from physicians that even want to go there. And then of course, the mainstream so to speak, medical community doesn't want anything to do with cannabis. And then even when you go on the med side, half the doctors they talk to don't know anything about cannabis. So there's been no medical focus. I mean, I often see patients when I'm just doing some med cards. And I say, oh, you know, here's some information or do you have any questions and I go, I didn't know I was allowed to ask questions. I've gotten this my six year getting to med card. And I've known way more than the doctor every time I come and that's, that's a problem.

John Malanca  48:58  
It happens out here. I mean, I call the same thing. So I have my recommendation. What do I do now and that's frustrating, because we get these calls every day. And I just think of a doctor or a medical professional is going to write a recommendation for patient a lot of times with the seniors give some guidance because the one that we always hear is Yep, if you have any questions or we'll see you next year for renewal, and I just think if you're they're not getting the information from the dispensaries no disrespect to dispensaries but you know, I'm not a medical professional. They're not meant to in most cases aren't medical professionals. They don't know if they're diabetic, they don't have a heart arrhythmia and then other medications are on and again it's not just a one size fits all or the daily special start selling these lines and shading the recreation I hope everyone makes a billion dollars in this world and industry. But do it the right way. And in just in I've seen the recreational market push out some great doctors that have had to close their practices down. You know, maybe they had one or two offices, and now they're down to one office. Now with COVID doing stuff like this, they had to close their, their their final office down and down, you know, so it's, it's changed and hopefully stuff like that change do you still see patients face to face are you kind of doing stuff?

Unknown Speaker  50:22  
Right now I've just been virtual, although I was doing a fair amount of virtual before the pandemic started. And these issues, I would say, for me, personally, they haven't impacted me greatly, because the bulk of my time these days isn't patient care. Whereas three years ago, you know, 95% of my professional world was patient care. Now, I do much more teaching and education and kind of working with folks. So I'm not reliant on on patient care to kind of sustain. It's more of a select, you know, folks by referral or find me in or hear me on talks like this. So for me personally, but yeah, some of the other good high quality cannabis physicians that I know in Colorado, that you know, patient care is really there, their whole business, they've definitely been impacted. And again, it just creates a cycle. If you have people starting cannabis without guidance, or with guidance, just from an untrained dispensary worker, well, then they're going to have more risk of side effects or problems. And that creates a negative image, they're going to have less likelihood of success. And that also creates this negative image. And it kind of feeds back into a lot of the false propaganda that's been out there about cannabis for 7080 years, someone who just goes to the dispensary and they say, oh, yeah, here's all these concentrates, you know, and now someone using way too much are having side effects or builds up a tolerance. And it doesn't work. I mean, it just creates this, this false cycle if you don't get good education and guidance, and certainly I'd like physicians to be a part of that. But there's still a whole bigger world of good educators that don't have to be physicians. And so I'd rather see us collectively, kind of identify who those groups are, whether it's, you know, nonprofits like yours. And there's some other great nonprofits that really do good quality cannabis education, you know, help people connect with physicians in certain situations. So I don't think everything has to be kind of physician only, and then the physician disseminates. But I think we need to have some, you know, acknowledgement of, or, you know, here's, here's folks who are really putting out good information. And that's, that's kind of what I do is I kind of go around when I learned and I'd have good information learning groups like yours that I can direct patients to, because maybe someone doesn't want to, you know, they can't use insurance for these types of things, because it's not really fit in. And if someone's going to need six months, they probably can't afford to see me every two weeks for six months out of pocket, certainly not these days with with the economic issues going on. So I think we have to utilize all the different groups, and really the folks who are, you know, I guess, we like to say doing it the right way, which obviously is up for debate, what's the right way, but usually when I talk to somebody, I get a pretty good Gestalt, at least if they share my philosophies, and, and if they share my philosophies, that just becomes kind of part of my circle of, of where both I can work and educate people through but also I feel comfortable referring patients, family members, friends and whatnot. So I think I want to see that network grow. And I think physicians are a major part of it, but I don't think they're the only part of it.

John Malanca  53:44  
Yeah. You said debate and the debate. This one always comes up. You know, I want the medical part of the well I don't say medical I always say medical part of the plant meaning versus recreation. A lot of people say I want the medical part which is CBD, recreation THC. That's not where I was going with this. But the difference of medical grade quality cannabis versus recreational quality cannabis, is there a difference? Or is it just taxed differently?

Unknown Speaker  54:11  
It's not in Colorado, there's no difference. I can't speak for other states. I don't think there's that's why I was asked in Colorado in Colorado. Literally usually the plants are growing side by side in the dirt and one has a barcode on it that says mat and one has a barcode on it that says rec so in Colorado, no you can walk into any dispensary and feel I think pretty confident of quality. And other states again that that since since there's no of course oversight, federally, every state is doing its own thing. So I don't know necessarily product quality in other states but in Colorado No, there's no mid quality, direct quality. The differences here are just taxes, which is pretty substantial like almost 25%

John Malanca  54:59  
say one time all We were there. And you know, next thing you know, is 100 something dollars. They're like, we just grabbed this. They said, Oh, you're out of state, I think it was 22 by 25%. Tax. And so a lot of patients asked me that, and I said, you know, in Colorado, as far as I know, it's get met people get a medical car, same thing in California, get a medical card to help on the taxes, but the product is safe. So you write in recommendations? How easy is it for a Colorado resident to come in and get a medical card? And how easy is it for a non resident Colorado resident coming in to get a medical car because a lot patients we work with on a daily basis, live in illegal states. And I say you know, before you become a cannabis refugee, go to a legal state, you know that you're able to go in there and see if this even works. Colorado, you know, a lot of them are coming from, you know, most states that are illegal are closer to you than they are to us. And so I was direct direct them to Colorado. Is that something that an out of state patient can get a medical card, we're California, it used to be the way you can have a US birth certificate

Unknown Speaker  56:14  
to get you know, in Colorado to actually get a medical certification, being able to go to med dispensaries. And the benefits that come with that you have to be a Colorado resident, you have to have a Colorado driver's license, I definitely see and consult with people, either who are living in Colorado but not yet residents are live in other states and certainly can give guidance. And again, in Colorado, if you can get past the cost issue in the taxes, there's no like I said, most sales are on the rec side. And there's a lot of good quality companies that don't even sell on the med medical side because again, it's more profitable. So you can still come in for a consultation if you don't earn a Colorado resident and purchase good quality products on the recreation recreational side here. If you are a Colorado resident, I usually say there's no downside to getting your Med card, because it just gives you more options. If the products you want are available on the med side. Well, then it's gonna save you money and make it easier for you. Likewise, a lot of dispensaries they don't always publicize it, but a lot of dispensaries will give medical patients a discount. So if you're a rec only dispensary, you don't have a med side, often that you might give a discount of 1015 20% to a medical patient. So it's always I think, worthwhile to have the card and then for documentation as well. But in Colorado, again, quality's the same. So if you're a resident, great, get a med card. If you're not a resident, you still can get good education and still get all the products you need. Hopefully, well, at some point, I think we will what most of us would like to see is everything be unified. There's no meta rec dispensaries or meta rec products. There's just one dispensary. And if you have a med card, you have these rules. If you don't have a med card, you have different rules. But it's all the same way. It's all the same door, it's all the same product. And it's easier for our for companies to to streamline their growth. So we've been trying for that for a while. But you know, there's a lot of things we've been trying to do in this industry that makes sense for for the patient, but you don't always make sense for for whoever's making the rules.

John Malanca  58:30  
Yeah. And it's disappointing. Like you said, you know, rec door, you walk in the main door, but you have a recreation door or the medical door, other states, Massachusetts, you know, they will keep an allotment of product for their med patients that they run out with their recreational patients. And a lot of patients don't want to get Are you in the system, when you get a wreck medical card, like the DMV system. And so I think a lot of

Unknown Speaker  58:57  
not DMV. Least Colorado, in Colorado. I mean, the not being an attorney, I can't I might miss up rule in general, the only thing that's come up is concealed carry. So Colorado has concealed carry law. And I definitely have heard people who who want to have a concealed carry generally we recommend they don't get a medical card because that whoever deals with concealed carry permits, I think can crack into the database there, which is a problem in its own right. But that's the way it is. Other things there are people who just don't want to be part of the system and that's their general philosophy, but I don't think that's really a huge it's not a huge concern of mine. So I mean, I've had doctors and lawyers, other professionals who have met card to have never had problems or concerns. So really the only one that's come up is concealed carry

John Malanca  59:55  
or even owning a firearm. You know, a lot of Montanans you know, we're hunting Coloradans were hunting as a way of life you know, they can't have both they, you know, federal federally illegal they they're they're having a firearm not concealed carry but just having a firearm you know, they're they're breaking federal law and I think now the the, the application says do you use cannabis? Are you cannabis patient? Yes or no, this is a this is a legal document and so I think that's why a lot of people don't want to be in the system and what's going on in our world right now. I think a lot of people just want to stand back and, and not being anyone system. Each and it's funny as as throughout our podcast, you're not even saying si ri Siri. Mike, my iPhone has been popping on. I haven't even

Unknown Speaker  1:00:48  
I'm worried to know what might be showing up on an iPhone. Yeah. Yeah, I mean, it's it's pretty horrific stuff that obviously happened yesterday. And but it's, I would say for those of us in the cannabis industry, for those of us who have certainly no cannabis history, and criminalization history. You know, we've already seen the damage of what certain philosophies can do to people and lives and the differentiation and social equity and racial inequity. So kind of the events of even yesterday, I think, for those of us who are embedded in the cannabis space, don't aren't aren't sadly that surprised. I mean, that's, that's more of a sad state of our of, of our country. But we've been criminalizing people trying to do what they need to do for their health and well being for for decades. And we've kind of again, say, this is the this is the way we say you have to follow. And if you don't go down this path, you're a criminal or you're an outcast, and, and you have no rights. And so we're kind of used to this, this. These problems, I guess, I would say and sadly, I wish I would be shocked by some of the bad news that comes out. But um, not so much because I think it's a way of life. For those you know, who know cannabis history? Yeah.

John Malanca  1:02:18  
Yeah. You know, and my shock factor is kind of numb these days. You know, it's like, I don't wanna say Nothing surprises me, but sometimes it doesn't. I don't know if if things that have happened in my life recently with passing and what's happening with with government and laws and seeing patients and so hopefully, things do get better. How do people find you?

Unknown Speaker  1:02:44  
Best way for people to find me is just my website, four pillars denver.com. It's the number four, and then pillars p i ll, Ars denver.com. That's, that's my website. So if someone does want a consultation, easy to schedule from there, if they just want cannabis education, I've got links to talks like this that are done links to podcasts, links to lectures, there's some some nice cannabis one on one lectures, if you want to spend anywhere from 20 minutes to an hour just learning the basics of cannabis. There's there's recordings there. And so that's certainly the best place all my social media tags are four pillars Denver. Yes, four pillars, Denver, although my social media presence is modest, at best, and maybe at some point, I'll expand but probably not. Those resources are out there. Certainly the links when I'm on, you know, shows and things like that. So either WW dot four pillars denver.com, or just four pillars, Denver, as far as most social media platforms,

John Malanca  1:03:50  
I'll make sure I put all that stuff up there. And you do have some great articles on there and some graphs on your website, too. So if you haven't had a chance to take it, take a look at Dr. Dave's website. Any closing words for audience?

Unknown Speaker  1:04:05  
closing words? There's a lot of we're recording this on on January 7 2021. So there's a lot that I could be said about I'll just reiterate that. That really, I think cannabis, not just an integrative medicine in general. It's, it's, it's a different paradigm than what we're taught. And I think we we have to acknowledge that kind of what we're taught and the dogma in so many areas is frankly inaccurate. At best, it's inaccurate and at worst, it's it's just completely destructive for for so many different people, whether it's again, you know, when you're talking about what we're taught in terms of our history and social equity issues or dangerous to people in terms of what the standard of care is, which is harming a lot of people In medicine, so I think cannabis is a great example of of that, of that harm that can come if you just follow a set dogma that really doesn't listen to the facts and doesn't listen to the science. And so get your cannabis education, get your education and integrative and functional medicine, but recognize that's just a gateway to kind of acknowledging that the deeper layers of what's out there in our culture, and the more you learn, and the more you acknowledge, the healthier and better off you'll be, but the more able you'll be, you'll be able to help others as well. So I'll leave it at that.

John Malanca  1:05:35  
Forward education is key. I appreciate you Dr. Dave Gordon, and great to see again, and I thank you for taking time to be on my show, once again. So everybody, this is John Malanca, with United Patients group, be informed and be well and wishing you all a blessed and safe and happy day. And, David, thank you so much. Absolutely. Thanks

Unknown Speaker  1:05:56  
so much for having me.

John Malanca  1:05:57  
We'll see you again.