Michael: Welcome back to another episode of Doctors Living Deliberately. Hi Arpita. 

Arpita: Hey Michael, how you doing?

Michael: I am doing great. Super excited for another episode, and today we are gonna be talking about integrative medicine. I'm gonna be honest, I don't really know that much about integrative medicine. I was you know, trained in traditional, allopathic medical school and kind of went straight through. And it really wasn't until I entered the coaching space and started being exposed to just different ideas within medicine that I started to hear a lot more about it. And it's definitely got me curious. What about you, Arpita, do you know a lot about integrative medicine?

Arpita: I would say honestly, no. I have learned a little bit from our friends and colleagues also that we met through the coaching world who had completed fellowship and training. And that's actually one of the places where I met our guest for today. And I know my husband is currently in a program for the integrative medicine fellowship as well to learn this whole kind of incorporated way of practicing. And I think the word integrative medicine kind of describes it, where you're literally integrating so many different things. 

So I'm excited to introduce our guest for today. She is a friend and a colleague that I was lucky enough to get to know a lot better a couple months ago. Her name is Dr. Siri Chand. She has had a lifelong interest in mindful living. And that's really kind of what she has incorporated for the basis for long-term vitality of mind, body, and spirit. She's completed her residency in internal medicine at the Mayo Clinic back in 2005, and she's board certified in internal medicine, integrative medicine, lifestyle medicine, and hospice, palliative medicine. So there's a lot there. I had to read that because I couldn't remember all of 'em. She has deepened her studies on health and healing by becoming a yoga instructor, raiki master and has participated in a two year program in Ayurveda at the Ayurvedic Institute in Albuquerque and in India. So she is like worldly and well educated and well informed. So I'm super, super excited to have her on with us today, Dr. Siri Chand, say hello. 

Siri: Hi. Greetings everyone. And I always like to joke. I'm in the 47th grade, so that's, that's pretty much what it boils down to. I love to learn. And you know, really never stopped that process of learning. And so my educational pathway and board certifications really reflects just an ever deepening exploration and curiosity about what, what is this? What makes us tick and what keeps us healthy, and what takes us off the path of health? And I think that's how I've become a expert at integrative medicine within the context of that journey. 

Arpita: Yeah. Totally. Well, I think, you know, really to help our listeners, I know I kind of said it in the dummies for 101 version, but how would you eloquently describe to somebody who's never really heard of this? What is integrative medicine?

Siri: Well, I think the beautiful concept that's contained within integrative medicine is it's really the promotion of health through how you live your day-to-day life. And it initially, lifestyle medicine was not a known specialty. So of course back when integrative medicine was sort of first getting its name, which many would credit Dr. Andy Weil, who's at the University of Arizona with being sort of the grandfather of that movement. And what he recognized was in the early seventies that there were components of the medical education that were stepping outside of what indigenous and healing systems had known for millennia. And sort of lasering in on modern technology and integrative sought to really use both pathways, meaning draw from the experience of millennia of our people that have come before us and incorporate modern innovation. And it's actually not that easy to incorporate that much education into the curriculum. And so many schools have a 40 hour integrative curriculum that's been adopted from the fellowship. And that curriculum really focuses on nutrition, exercise and exercise prescriptions, how to counsel people on restorative sleep, how to manage stress and lower stress, how to talk about smoking cessation and drinking cessation, and the power and prominence of community and from the integrative standpoint this is really in the Ayurvedic study that I did as well, we appreciate that this daily routine, this daily commitment to health walks us towards health or away from health and many components of the standard American diet and lack of movement and you know social isolation are actually independent risk factors predicting poor outcomes as we age anywhere from increased risk of heart disease to increased risk of dementia.

So, there's many of these components that we can kind of look at that unfortunately just aren't built into the standard medical visit. I credit it really to time. The model really demands that you have more time and build relationship and intuitively, most late, mid to late stage physicians have an a natural relationship to integrative medicine because they're good people and they've seen over time that certain things need to change for people, a bad marriage, a bad job, poor housing access to community. These are things that actually create a lot of internal generative forces that I think awaken intuition for people to be wiser in how they, all the micro choices they make every day and our cultural narrative doesn't really give us the pass card or the passport to health, it's really one that sort of walks us in another direction of, well, if you get sick, there'll be a pharmacological solution. And integrative medicine really wants to put empower people and partner with them in that journey to revitalizing themselves. So once you've sort of looked at lifestyle pillars, some circumstances you'll be able to taper off pharmaceuticals, which a lot of people likes, you know, integrative medicine isn't for everyone. Some people say, I just wanna stay on my prescriptions and whatever other interventions are needed to solve my medical problem. 

But we also have come to appreciate, I guess both of you are probably in the same zone of career as me, that some pharmaceuticals over time actually have a pretty significant impact, even seemingly innocuous months, like proton pump inhibitors, right? We're looking at changes, increased risk of pneumonia, kidney disease, and bone fractures. So, you know, again, there's this kind of quality that people are saying, is there another way, if I'm suppressing a symptom or looking at it this way, could I look at my reflux by changing things simply? Changing my diet, eating less at night, elevating the bed, perhaps some yoga and stress reduction. All these different things might come into a treatment plan. But it's really difficult to be nimble quickly in that, so it's not been sort of mainstream. Then from there, if the lifestyle measures are needing more support, you might advance into other healing systems such as traditional Chinese medicine, Ayurveda which is from India, and that can also include body therapies, botanicals, and kind of some more abstract things that don't feel as comfortable to us, obviously with our training background. But I always say that these older systems are sort of very elaborate case studies, if you will, millions of case studies that created a trajectory of understanding. And so that's kind of how I see it.

I think just to add one caveat, it often has sometimes a bad name. So for example, if you go into the hashtag into social media integrative medicine, you'll find people making claims that are not necessarily with the same educational background. They may be harping on a particular supplement or a particular gadget that's gonna solve every problem. Anyone worth their salt knows that healing is a arduous, multifactorial process. And there's no quick fix. There's no fools gold. So I think unfortunately, the name has sort of been conscripted by people that don't have as altruistic ambitions at heart. They are often seeking financial gain by that. So it, it's a little difficult. I think there might have been some better management around terminology and language early on that the opportunity was missed. But anyway, that's kind of my slightly longer than elevator speech on integrative medicine. We're on the 85th floor now, so 

Michael: And so, so talk a little bit about like how did you find integrative medicine and like, how has it changed life for you? Like, what does your life look like? It sounds like you had a pretty traditional internal medicine training. And then, and talk to me a little bit about the evolution from there. 

Siri: Well, interestingly enough, I actually was exposed to integrative medicine in the nineties in college. And other, if someone has heard me speak before about this, I had developed I think just really severe anxiety when I was pre-med, but unfortunately it impacted my whole body. I, my cycle stopped, I had very poor digestion, I had headaches. I wasn't sleeping. And I was like, wow, this doesn't feel right. You know, this is not normal. But I didn't have a background in my family of herbal medicine or stress or yoga, anything like that. I had a very traditional suburban, went to a magnet school for high school that, you know, put a lot of pressure on us early on. So I actually went to the student health clinic. Now, this is a true story and I always say there are these sort of happy accidents that happen in life, and I think perhaps it was like a Non PCP type person rotating through the clinic that day, fulfilling some requirement. And he was pretty much like, yeah, no, I don't wanna deal with this at all. So he basically handed me a prescription for phenobarbital, which in hindsight is just, I'd never even known anyone to do that. Like, he just figured this would calm the, the nervous tension that was in my system. And like I say, no, there are no accidents in life and it was just outrageous enough. I knew enough about medicine at that point to say. There's no way this is the right answer. 

So I pretty much, you know, I've always had a little bit of audacity and I pretty much walked out of the office and I was like, eh, gonna leave the RX there because definitely does not sound like a good idea. I went to a small, like metaphysical bookstore, picked up a book on nutrition and started experimenting with different diets and stress reduction, learned yoga and Qigong. In college and then I actually thought about becoming a naturopath. But at that point in time, this is the early nineties there the educational process isn't as robust as it was now. And I was a science person, went to a science high school, biology major. So I took a little bit of time. I ended up getting a master's degree. I don't know if it's in there, but then I went on to medicine. But I had already by that point started studying yoga, mindfulness, nutrition, the power and value of community, and that really just stayed in parallel with my career. It wasn't exactly an awakening once I was in medicine. Hopefully that clarifies, and I think that a lot of people who are drawn to integrative medicine and I, again, this is so unique, not everyone, but a lot of them had some healing crisis of some kind within their own body, mind, or spirit. Their thoughts weren't where they wanted them to be, their health, their physical health. Perhaps they had an existential crisis and they said, I don't know. This medicine is actually what I thought it was. And so they sort of just start expanding that outer circle of what healing looks like.

And so you'll find that many integrative docs have gone through some type of internal healing on any of those levels, and sometimes all three. So they have a certain compassion empathy towards suffering as well, because they themselves have been the patient practically or not. So, you know, maybe they've kept it inside, not told anybody how much they're struggling, which I'm sure you both know as coaches, physicians are very good at, we will persevere and suffer on far beyond what I think many others would put up with.

Arpita: I think part of it, it's interesting to hear you like, speak how it kind of unfolds. Because I know specifically with our family, with my husband, his dad passed away from Louie Body's disease. And so immediately when that diagnosis was made, he became very much so astute to how is my diet and how is my lifestyle impacting my tendency to develop the same thing? Is there gonna be a tendency, a propensity for me to have the same issues? And so I think that I remember back to that, that that's when he started looking into all of it and learning more about it. And immediately he was, you know, trying different dietary changes and doing some supplements, not the, like you're referring to, where it's out of control and with ulterior motives in a sense. But and then despite even doing that, he didn't have a great improvement. He started having some of that brain fog and the muscle aches himself. And I remember going through thinking I'm doing everything I can to be better and I'm not getting better. And you know, that's also part of the beauty of coaching where you recognize this is burnout. Let me go and start working with a coach maybe to help me get through this burnout, get outta the burnout. And through that process, he started recognizing even more about the other options with the integrative medicine and how that whole mind body, you know, healing really, is what makes a difference and it's significant changes once he started implementing some of those things for himself. 

So I guess my question is, you know, again, coming from the dummies, me, I'm referring to myself, not to Michael Hersh, is there a difference even between functional medicine, lifestyle medicine, integrative medicine, and if so, what are they, like? Is there a, a bullet that you can say this is what defines each one to separate them?

Siri: Well, lifestyle medicine really just looks at six lifestyle pillars, whole food plant, predominant diet. Moderate exercise every week, 150 minutes, eight hours, restful sleep, daily relaxation, removing harmful substances, regular connection to positive people. So that's like your first circle, inner circle, like all three fields agree. And some would put in spiritual, financial health into that. Some would put thought work into that. If you expand the circle, there's a lot of overlap between functional and integrative. 

Typically functional has a more of a purview of probably pending physiologic processes that we are not fully clear we understand yet. So, hormonal detoxification, mitochondrial health, there's a lot of innovation that's happening within science that ought, I forget the conservative estimate, what does it take 20 years from the bench to practice? So the functional medicine is really looking at detoxification pathways, hormone health, inflammatory pathways, glucose regulation, these kind of things that perhaps the science isn't fully vetted, but there's some directionality and some predictive process that's come through their end of a hundred versus, you know what, we like 500,000, right? We like to see big numbers before we can say, so the labs are oftentimes a important part, but they also do both specialties, also do very in-depth histories, which can even go as far back as birth history or look at adverse childhood events scores. So the role of trauma. And so in many ways functional medicine has a lot of overlap with integrative. 

I would say where integrative starts to pull away is that integrative is also including, and some functional medicine doctors include these in their purview. So again, it's a little tricky, but integrative medicine also includes indigenous and whole person healing systems that have actually radically different perspectives on how healing happens, and that's things like traditional Chinese medicine and Ayurveda, which would be a whole other conversation how we could conceptualize the overlap. But these are systems that basically look at trends and patterns within the body based on our early healing ancestors you might say observation of nature externally and observing nature internally, noticing trends that perpetuated patterns over thousands of years. And also massage therapy, body therapy, OMT energy medicine, which of course is at the outer edge of what everyone is comfortable with in allopathic communities. But we know we're energy, we are inherently vibration and frequency. And so connection to nature. Is a big part of integrative medicine. It just depends who you talk to bottom line, some of the functional docs will say, well, I do all of that. But it's a, it's a definitely a different training process and different certification process. And I would say that the functional fundamentally just has a stronger reliance on what I consider sort of pioneering biological, biochemical processes that they're looking at.

Michael: Yeah, that's incredibly helpful because I know I hear these terms thrown around so much and I have not had a really clear understanding of the differences and the nuances. So I really appreciate that explanation and I'll also say I really appreciate how you kind of commented that this can be different or maybe even a little uncomfortable for people with a traditional just pure allopathic background, which, which is me, right? So, you know, this is different, but I've really enjoyed kind of learning about these kind of different types of medicine, these different modalities and how they can interplay. You know, as I've seen the impact of, of kind of the thought work on my own life, it kind of opens up well maybe there is, you know, the possibility that some of these other things could be beneficial in my life as well. And so for those of you that are listening and curious, you know, it, it's okay to be curious and to start like, looking into these things and, and seeing how, how it may fit into your life. And so, to that end, I was gonna ask you, if somebody is curious about these things, do you have a suggestion on where somebody starts so that they don't get completely overwhelmed? Because there's a lot here, right? 

Siri: Yeah, there's a lot to unpack. It just depends where they are in their career. So if you're a medical student, there are interest groups. If you are a resident, there are some residency programs that have the integrative medicine curriculum in them. You can Google that. There's a consortium. If you are an attending and you wanna bring curriculum, you can reach out to this consortium that has the curriculum. If you're sort of in a practice and you're kind of have a, a moment where you're like, gosh, is there more? There are a number of fellowships that one could connect to. There's also conferences that look at all different aspects. There's an anti-aging group. There's the functional medicine group, integrative medicine, food as medicine. Any of those conferences would be a great chance to see if it feels like you're a tribe. You can go to coaching conferences too, meaning get into the vibe of the group. It's sort of like you're going on the subway to a different city together. It's like, oh, does this group feel like people you wanna have as your colleagues who you could connect with and who you feel a sense of community with? Because each of the communities all have their own vibe, all have their own flavor, and even draw in their own particular types.

And so I really have appreciated giving people the opportunity to just explore by going to conferences first and I challenge them, talk to five strangers, ask them how they're practicing, what brought them to the field, where do they wanna go, and see if their answers wake up a part of you and you know, spark something inside of you. And that then is sort of like a cookie crumb trail to follow. The thing about it is that you could go do a fellowship, but you'll never stop learning once you have sort of opened the, the Jack in the box of lifelong learner, you'll just never stop because there'll always be this new facet of, or peace of oneself to look at from our consciousness, our thoughts to our physical health, to our spiritual health, to all of these interconnected webs that we create as we go through life. And so, you may find you resonate with a body of knowledge for a while and then you kind of go in another direction and that's okay too. The challenge is integrating it back into a standard clinical practice, and I think that's where I've been putting a lot of focus in the last couple of years is how I didn't really get good mentoring or coaching. I was just sort of winging it and being as outside the box as I was, it was really tough and had various opportunities for leadership and creation and programs, et cetera. And ultimately, I realized that the biggest key is feeling that sense of autonomy to practice medicine in a way that feels ethical, evidence informed, you know, thoughtful and time is the biggest factor in that. And so I've been helping younger career physicians figure out how to have their own practice, which I think feels almost impossible, but it isn't. That's the beauty of it. It can be very, very difficult and painful to take these principles and try to superimpose them back into your practice as it was. Especially if you don't have any flexibility for time, it becomes almost like a accelerator for moral injury and burnout.

Arpita: Yeah, totally. And I mean, to go back to your one point, like when I first started hearing about this, you know, we are so set in our ways, in a sense of traditional allopathic medicine that immediately my brain goes to that's woo. And you know, I know about Ayurveda from my culture, but it just was not something that I would even consider as truly organic evidence-based medicine. And so that exposure over time and that ability to kind of like open my mind a little bit and just consider, be curious about what else is out there, what else could possibly be beneficial to us that we're not even considering because were so traditional in our path. And I think that is what's kind of enabled us to, or me to be able to say let me just look into this. It doesn't mean, it's not gonna harm me in any way to go and learn about it. If I like it, great or if I like parts of it, I'll take what I like and I don't have to apply all the pieces of it, and that that's a huge, I think a huge revelation just to recognize that, that we don't know what we don't know.

And then you mentioned also about helping newer physicians start out. I, again, know you very kind of personally from that standpoint because this is a huge change when you have, especially subspecialists, I think they're in their mode of training for what they're putting out there. Not in training, but what their practice of what they're putting out there and offering to patients. And then, you know, how do we incorporate this new. Idea, this new way of considering practicing and offering these services and benefits to our patients in a way that's complimentary rather than just separate. So I think it sounds like that's what you're working on kind of helping physicians do as well, who are shifting their model for how they practice and what they're practicing.

Siri: Absolutely. And it includes a lot of thought work because as you aptly pointed out, you know, we wanna stay in our lane, we wanna maintain our license, we don't want board actions, we don't want our peers judging us. Like all those thoughts are rolling around as you're bringing in this knowledge set that you're like, oh, dang it. Yeah, this feels true and right. Oh, but it's not the standard. It's not what everyone else is doing. You know? It creates a lot of internal friction because you're trying to navigate even, I'm sure both of you have found even existing as coaches and people are like, yeah, tell me about that. And you're like, no, no, you don't understand. This stuff is amazing. Changed my life. I'm like happy, I didn't ever think I could be happy, you know, I mean, or whatever lens it is a landing for one. So I think this is a really important, it's really just important to understand, and even within integrative medicine, someone might then go on to do particularly studies in Ayurveda, or particularly studies in body work, massage or yoga or Chiang or tai chi or botanicals. There's a lot of drug botanical interactions, so if you're gonna incorporate botanicals into your practice, you wanna do it wisely. You wanna do it thoughtfully, and so many people don't. They need to do a deep dive even past the fellowship and study with people that are very knowledgeable and there are interestingly physicians that are very knowledgeable, and once you sit down with them, you're like, dang, that might be one of the smartest clinicians I've ever met. 

My Ayurveda teacher was that way. I never met a brighter physician in my, in my life, honestly. And I don't know you two that well, but you know what I mean. Like I, I mean this guy, Dr. Lad, he was trained in Ayurveda and Western. I've just never met a brighter physician. I've never met a more thoughtful healer. And so you realize that people that really dedicate to this study, they're not just flippantly approaching it. Very often they're taking this lens of investigation, assessment, verification, pulling disparate ideas together to try to create something that's more thoughtful, that's more oriented towards mitochondrial health, circadian rhythm health, hormonal health, brain health, inflammatory health, blood sugar regulation health, like, there's a lot of nuance and a lot of miracles happening in here that our education is just barely, we just barely understand it.

Arpita: Barely scratching the surface, but well, this has been very, very enlightening Dr. Siri Chand. I was so thankful and gracious that I got to meet you and really get to know you in depth. And I look forward to future conversations with you. Tell us a little bit about, or tell our audience a little bit about how they can reach you and what's the best method if they wanna learn more or if they wanna reach out to you for assistance with their programs, 

Siri: Well one thing I also will mention is that I love helping people who are a little bit off that beaten track find their marketing message and their branding and their design to really bring their vision and their voice forward. And so they can reach out to me through my website, drsirichand.com and then for everybody else who are like, I am not doing that, I have a bunch of content that centers around sort of approaches to lifestyle that are pretty doable, actionable and primarily for me, focused on food. I love to eat. I love to cook, and I love being at farmer's markets and in nature and at farms. So I just kind of highlight that connection with nature. And a lot of the work that I do. There's a Facebook group. If people wanna join, they can find that on the list in the show notes. And of course most of all my social media handles are doctors spelled out Siri Chand. 

Michael: Excellent. Well, you are absolutely an example of a doctor living deliberately, and we are going to have in our show notes links to your website and your social media handles. And, you know, just to also highlight for you that on your website you've got a blog, you've got recipes, so all the things that people that are interested in learning more about you and what you do, a fantastic resource. Dr. Siri Chand, thank you so much for joining us. We so appreciate you here on Doctor's Living Deliberately. Thanks for coming. 

Siri: Oh, so grateful to be here and I'm so excited to see what you're creating. The community and conversations are so valuable.

Arpita: Thank you. 

Michael: Thank you so much and looking forward to our next conversation. Take care. 

Siri: Absolutely. 

Michael: Bye. 

Siri: Thanks.