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“Gradually and Then Suddenly”
Inside your body, the process of silent damage has already begun. The disease the will kill you has begun its inexorable march.
In 1929, they asked Mark Twain how he became bankrupt. He replied, "Gradually and then suddenly."
The Law of Entropy states that everything in the universe is constantly moving from a state of order to a state of disorder. From order to chaos.
Your body, thus, according to the law, is in a perpetual state of decline. It’s falling apart at this very moment.
This is an image from the book “The Road Less Traveled” by M. Scott Peck. Peck, a psychotherapist, uses the law to demonstrate how to build mental health. The upward arrow of humanity is used to demonstrate how it takes energy and effort to improve. All water flows downhill unless we scoop it into a bucket and carry it up hill. We exert energy to overcome the law of entropy. This is what Longevity Medicine is.
This is a model that constantly shows up at Saint Bartholomew, our chronic pain clinic. A large percentage of our clients have “idiopathic pain.” Pain of unknown origin.
They have no idea why they are in pain. No one does. Not the dozens of doctors, specialists or spiritual healers that our clients see before them can come up with an accurate diagnosis.
Entropy, of course, is the diagnosis.
They didn’t do any one thing wrong. They didn’t get into a car accident and hurt their back. They just slowly found themselves in this mess.
Gradually, and then suddenly.
They have slowly drifted away from optimal. Even the best of us, with enough drift, will find ourselves with some broken parts.
Traditional medicine is trained to be reactive. To look at the symptom. If you are experiencing knee pain, you go to a knee specialist who is looking at the knee. But what if the knee is not the problem. What if it is two decades of declining biomechanics? No traditionally trained physician will catch it unless they have exerted their own energy to overcome their own entropy to look deeper at the situation.
Longevity Medicine
Longevity Medicine is a deep evaluation of the entropy that is happening and will inevitably happen in all our bodies. It is measuring the velocity of that entropy and providing effective solutions for slowing that down.
Longevity physicians preach the power of healthspan over lifespan. See the above chart. Notices how it’s simply a process of controlled entropy. Just trying to slow it down.
They make marginal claims about actually helping you live longer, rather the focus is on living better
The Business of Longevity
When I left professional sports in 2017 and began working with the general population, arguably the most alarming thing about the traditional medical practices was the business side of it.
In my book, Athletes Heal Faster, I wrote about the brutal realities of working with insurance providers while trying to actually care for the client. Here are three of the most important.
Insurance based practices are set-up to fail.
Each and every detail, big and small, that an insurance-based PT makes is heavily scrutinized by the insurance company.
Simply put, the insurance company doesn’t want to pay the fee and the doctors have to make sure they do.
If they put the wrong thing on your form when they submit it for approval, the insurance company has NO PROBLEM telling them that they ain’t paying for it.
This requires the therapists to try to squeeze, bend and mold your REAL diagnosis into something that the insurance company will pay for.
I’ve had a number of friends in the insurance-based Physical Therapy business drag themselves into my office after work, in desperate need of a beer and panicked that the insurance companies didn’t accept their diagnosis and they aren’t going to get paid.
Let me ask you a question. Do you want your “specialist” worried about giving you a diagnosis that will get him paid? Or do you want them to tell you what’s really going on?
Remember I told you how the first trend I noticed with my clients was that they had been to “all the specialists” before they wound up in my office?
Well, the second trend I noticed was that everyone who decided to go with an insurance-based specialist instead of my cash-based practice, ALWAYS ended up back in my office.
Like I mentioned above, insurance-based practices make it REALLY hard to get the result.
Technology is advancing every day and modern medicine is quickly generating some of the most incredible treatments our world has ever seen.
Too bad you’ll never get to use them…
…at least not at an insurance-based practice.
Those dusty old insurance companies don’t want anything to do with those shiny, new modern treatments.
They want the antiques.
They want the same stuff we did in the 1800’s.
If the Physical Therapists DARE to put down an edgy new technique on your treatment plan, the insurance company will deny them so fast and keep their payout locked inside of their bank.
But you wouldn’t want those incredible new techniques…right?
You’d prefer to get your treatment from an 1800’s medicine man…right?
Oh, did you think I was done with all of the BRUTAL realities of working with an insurance-based PT?
Those insurance companies…those cheapskate insurance companies will do everything in their power to NOT pay the therapist.
You know that now.
But even after the PT bends their diagnosis to make the insurance provider happy…
…and after they put together an antiquated treatment plan likely used by Abraham Lincoln…
…the insurance company will pay the therapist as little as possible.
How does this affect you…the patient?
Well, it becomes a numbers game for the PT. They’ve gotta see as many patients as humanly possible just to make a decent living.
Ahhhh, nothing says relief like an insurance-based Physical Therapist churning and burning through patients so they can afford their Chipotle bowl for dinner.
Insurance-based Physical Therapists have a strict limit, usually 10-15 minutes to see their patients before sending them off to an under-qualified aide who will put them through some run-of-the-mill, cookie-cutter exercises for the next six months.
Strike #1: They have to bend their diagnosis to make the insurance companies happy.
Strike #2: They can’t give you the best new treatments or they risk not getting paid!
Strike #3: They have to rush you through your session and get you into the hands of an unqualified aide just to afford to stay in business.
Three strikes and you’re out!
And I’ve still got four more strikes to tell you about!
About a decade ago, I began seeing physicians break away from this model and into the cash-based practice model which allowed them to spend more time with each client, dive deeper into their medical needs and actually provide a level of care that made them proud to wear the white coat.
This is the backbone of Longevity Medicine. Every longevity-focused physician I have interacted with has shared with me some variation of the same story. They were frustrated by the limitations of the current model and how they felt they couldn’t adequately treat their clients. So they made the jump.
Dr. Kat Léger: Extension Health NYC
Dr. Léger was introduced to me through a client a few years ago and her drive, impressive work ethic and motivations stuck with me over the years.
We invited her to be a guest on the podcast to share her unique story and give listeners, particularly female listeners a running start when it comes to tackling their health and preparing for longevity.
Here’s a rundown of everything you will learn in this conversation:
Why perimenopause starts at thirty five and why almost no one is telling women this
What estrogen and progesterone actually protect - bones, brain, cardiovascular system, metabolic health, muscle
The difference between what your PCP checks and what advanced diagnostics actually reveal
Cholesterol, LDL, and why ApoB is the number that tells the real story
How visceral fat creates metabolic dysfunction even in people who look completely fit
The high achieving skinny fat problem - why a resting blood lactate panel matters
Zone two training, resistance training, and why muscles are the longevity organ
GLP-1 peptides - what they are, what they were designed for, and where the current wave has gone wrong
Why going on a GLP without resistance training means losing muscle, not just fat
Hormone replacement therapy and bone health - what the research actually says
Why protein intake for women is non-negotiable and how much you actually need
Why lifting heavy is not going to make you look like a man - and why you have to do it anyway
We are Learning Just How Powerful Diet, Sleep and Exercise Actually Are
Back in my early days as a young strength and conditioning coach, during the first or second year of my career, I attended a summit in New York City hosted by Equinox, where they had various speakers across various disciplines.
One of the speakers was Dr. Terry Wahls. Dr. Wahls was a physician from Iowa who had been diagnosed with multiple sclerosis.
Like everyone else, she followed the traditional medical pathways for treating the disease. And what she saw was that the velocity of her entropy massively increased following this diagnosis. In other words, she was getting a lot worse quickly.
It wasn't long before she was completely bedridden and completely frustrated with her new condition. She decided to take her treatment into her own hands and begin researching alternative solutions.
She began looking into each of the drugs she was prescribed and trying to identify what exactly it was trying to improve in her body. She took that information and found a way to achieve the same result through food.
To say that the results were impressive would be an understatement. She completely reversed her symptoms. She left her bedridden days behind and even elevated to the point where she was running 5Ks.
In reading her book, you will quickly appreciate the intensity of this diet. It is not easy, but what you will also see is the power of real food and just how far off the traditional diet that most of us consume actually is from fueling our bodies completely.
Her TED Talk is worth watching:
The takeaway point is that there is an unbelievable amount of power that resides in the simplest of solutions. Diet, sleep, and exercise are massive levers that all of us have access to that profoundly affect our physical health.
In 2020, I put on a virtual seminar for strength and conditioning coaches where we had one of the speakers discussed his experience with Alzheimer's and taking a similar approach after his mother was diagnosed with the disease.
You can watch his entire presentation here:
Saint Bartholomew and the 4 Levers
Our entire philosophy at Saint Bartholomew revolves around this type of medicine. There are four systems of the body that contribute significantly to health, pain, and performance:
Posture and Breathing
Strength
Energy Production
Central Nervous System Control
Our philosophy surrounding chronic pain is in the cumulative entropy of these four systems. More simply put, over the course of five, 10, or 20 years, these systems have slowly been drifting away from optimal.
When was the last time that you meditated?
When was the last time that you did a threshold conditioning session?
When was the last time that you properly warmed up?
Most people's health habits are mediocre. Even the most dedicated gym-goer is completely unaware of the intricacies of the human body and what it truly takes to keep it functioning at an acceptable level.
The average person who comes into our clinic for an assessment scores a 35% out of 100 on their initial diagnostic. A passing score, in our opinion, is an 85%. That gap is the difference between chronic pain and health.
This is a real screenshot of a first-time assessment score at Saint Bartholomew
When you approach medicine and chronic pain through this perspective, it is not difficult to see where the body broke down. In fact, many medical mysteries can and will be solved through this perspective.
Every day, we see clients who have chronic pain that was previously thought to be unsolvable doing things that they were told they would never do, by looking at the body as a collection of systems and training the body to improve all of them simultaneously.
Connect with Dr. Kat Léger
Watch the Full Conversation Here:
Instagram: https://www.instagram.com/kathleenlegermd/
Extension Health: https://extension.health/
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