A broader perspective on health and wellbeing

Dr. Patrick Hanaway is a board-certified family physician with a medical degree from Washington University. Dr. Hanaway also leads the Covid-19 Task-force for the Institute for Functional Medicine. 

He spent a decade as the Chief Medical Officer at Genova Diagnostics. Following that he became the Chief Medical Education Officer for the Institute of Functional Medicine as well as the founding Medical Director at the Cleveland Clinic Center for Functional Medicine. He is the past President of the American Board of Integrative Holistic Medicine. In 2017, he won the Linus Pauling Award. 

As an initiated Marakame (Shaman) by the Hui-CHOL people in the Sierra Madres of central Mexico, he incorporates these healing approaches in his clinical practice. 

Patrick Hanaway on the Functional Medicine approach to Cancer, Covid-19 & the Microbiome


It was an honour to speak with Dr Hanaway, who is one of the world’s top leaders in the field of functional medicine. Below is a condensed version of our conversation, for the full version, tune in to our Wellness Journey Podcast. In this conversation we chat about:

  • What is Functional Medicine
  • As the Chief Medical Officer at Genova Diagnostics for 10 years, his approach to stool testing
  • Differences in testing available today and his recommendations
  • His experience with Stage 4 cancer, and his healing journey, incorporating a Ketogenic Diet, and the Functional Medicine approach
  • Functional Medicine approach to immune resilience and Covid-19
  • The Microbiome, including looking at how Psychobiotics can help with conditions such as depression and anxiety.
  • The importance of getting in touch with nature and its effect on the microbiome
  • His story of becoming an Initiated Shaman and the dream world
Wellness Journey Illustration by Niko.Wu

Functional Medicine

(02:26) – What is it, and what separates it from conventional medicine?

  • Instead of looking at the organ systems, the heart, the lungs, the skin, the gut, we’re looking at the overall function of the body.
  • There’s a function of detoxification, getting rid of that which is not needed. 
  • There’s a need for defence and repair, the immune system that is helping to keep order in things.
  • We’re looking to understand the root cause of what is going on for an individual
  • Those root causes may be intrinsic, related to lifestyle, nutrition, sleep, exercise, how we deal with stress, our relationships and connections
  • Or they may be extrinsic, maybe toxins in the environment, heavy metal toxins or mycotoxins

“It’s a dance of who we are in relation to our environment, and seeing how that environment bathes over our genes, and our unique genetic nature.”

Patrick Hanaway
  • We’re bringing all of these things into account and then listening to the story of someone’s life to be able to begin to break it down. 
  • What is your genetic predisposition, your family upbringing, or any potential triggers?
  • What are the factors that tipped you over the line when you started to have an imbalance and illness going on?
  • Treatments are personalised, they can use drugs, but oftentimes they don’t need them. 
  • They can use food, nutraceuticals – various ways to balance the sympathetic and parasympathetic nervous systems. 

“We find in the Western model, we have antihypertensives, antidepressants, antibiotics, all of these things that are meant to suppress the symptoms that are there. And when they get rid of the symptoms, the perception is that the disease is gone. But it’s not, we haven’t actually changed the landscape of the person we’ve just worked to suppress the symptoms, that’s insufficient for us to move towards health and well being.” 

Patrick Hanaway

The Evolution Of Functional Medicine

(08:02) – How has functional medicine evolved, and what drew you to it?

  • When I was in medical school, I was interested in all different kinds of approaches, every aspect of medicine was fascinating to me.
  • At the time I called it clinical prevention: how do we help people to stay well. The public health ideas then were interesting, but not sufficient to me. 
  • So I wanted to focus on how we look at wellness, how we look at using nutrition and the way we use all different kinds of tools to be able to help. 
  • I found that most people aren’t going to choose to optimise their wellness intrinsically. They turn to that after they start not feeling well. 
  • After they get some symptoms, they say, oh maybe I’m not going in the right direction here. And that becomes the motivating factor for them to change their behaviour. 
  • When I became a family doctor, I became more focused on prevention and wellness, but in the setting of taking care of sick people. 

Becoming A Shaman

(12:22) – Shamanism – Becoming an initiated Marakame of the Hui-Chol people.

  • I was called to work with the Hui-Chol people in the Sierra Madres, in Mexico. It’s fascinating, because I was never really interested in that. 
  • So I went on a vision quest. I knew I was very clear about what I had to do. During five days of fasting, meditating, and reflecting. 

It became very clear that I need to understand this approach to healing that uses the connection to the natural world, and really emphasises the deep aspect of listening and connecting to that which is unseen, and being able to listen more deeply. 

Patrick Hanaway
  • And so that has become part of what I do, and part of my approach with people who are interested in that. 
  • For myself, Shamanism is something that is a daily practice. It is going to specific places and connecting to them and deepening my relationship, and I’ve been doing this for 19 years. 
  • It is about deepening the relationship to the world around us so that I can better hear and be of better support to the people I’m working with. 

Understanding Dreams

(16:36) – How Dr. Hanaway understands and interprets dreams.

  • My dreams were sort of signalling that, despite never meeting or going to see the Hui-Chol people, that this was something that just felt very, very important to me. 
  • I look at my dreams and help use them to guide me to understand what the steps are that I need to take in the world. 
  • When I’m listening to the dream world, it’s a part of our world also, and being able to consider that everything, everything in my dreams is related to my life. 
  • All the projections that I have of all the different characters, I’m considering, what’s that part of me, and what is this dream teaching me about what I need to listen to, and how I need to move. 


The Role Of A Shaman

(17:46) – What is the role of a Shaman, and how are they meant to help you?

  • A shaman is a guide, it’s someone who is walking along your path of healing with you to be able to help you on that journey. Doctors have played that role in the past, in other cultures, they’re sort of the role of the healer as priest and the healer as fixer. 
  • The shaman, the spiritual guide, is someone who’s helping you to connect to what is your meaning and your purpose in your life? 
  • We sit in a time of a pandemic, and people are like, what’s going on with our world, and yet, we’re seeing these new ways of being able to relate to each other, to connect to each other to bring ideas forward, that haven’t existed before. 
  • The resilience of the human spirit and the ability to be able to find ways to be able to connect and relate, are just amazing. 
  • I work with not just the physical aspects of what’s going on, but really the emotions, how we play in the world. So those emotions that relate to happiness, compassion, sadness, grief, fear, anger, there’s just a dance of those emotions that are happening all the time within us. 
  • When we look at a three-year-old child, we see a move through those emotions really quickly, but not be attached to them. 
  • But as adults, we tend to become either attached or averse to particular emotions, oh, anger, I’m never going to be angry. 

“Don’t not cry. If you have something that’s grieving, a dear friend, or a family member dies, grieving and offering sadness is actually an acknowledgment of how much that person touched you in your life. That’s a good thing. It’s important to do that.”

Patrick Hanaway
  • So these are some of the kinds of approaches as a Marakame, and as a physician, those are important things to consider as well, because those may be limiting factors that allow someone to move back towards wellness, back towards balance. 
  • There’s different, if you will, acupuncture points in the world and different energetic places that we connect to and resonate with, and they bring up certain energies for each of us as individuals, and you know, listening to that, like, there’s something there.
  • You don’t have to figure out what it is right now. But, hold that, and scrub it and know that there’s some meaning there that is yet to be revealed. 


Emotions and TCM

(23:41) How can we use TCM to understand our emotions and treat our ailments?

  • When I was in medical school, I had the opportunity to be able to study more from an internal medicine standpoint, and then using electro-acupuncture.
  • I wanted to study acupuncture more deeply, it’s not how my career unfolded, but what did unfold was an opportunity to learn about the five-element perspective of traditional Chinese medicine.
  • It’s using the diagnostic approach of five-element Chinese medicine and doing a pulse-taking in that way, and understanding the imbalances, and working with the meridians, but then not using acupuncture, but using plants and using the plant spirits to be able to help move the energetics through the meridians. 
  • Frankly I was a bit sceptical of that, and then from a teacher Eliot Cowan, I found out, wow, it works. And so that was part of my deepening into recognising the value of the shen cycle and the co-cycle in the five elements as the movement from fire to Earth, to metal to water to wood. 
  • Those five elements also relate to the Mandala, they relate to the fire being in the centre, and the fire of transformation, which is very much a shamanic view that there are four directions with fire in the middle. 
  • There’s the interplay that’s going on with the fire, like the immune system and the inflammation, relates to the gut, the aspect of earth, our gut, and what’s going on with our gut microbiome, are a manifestation of what our connection to the world is what we eat, what we breathe, and what’s happening in that view. That connects to the water, the sense of fear and awe in our presence. That connects to the wood, which is around boundary setting, flexibility, but it can be anger as well.


Antibiotics & Its Effect On Our Microbiomes

How increased use of antibiotics are affecting our microbiomes and the loss of diversity, and the importance of getting in touch with nature and its effect on the microbiome.

Within the functional medicine framework, and with any kind of holistic framework, you know, there are times where the tools that we have, like antibiotics can be useful, just that we find that they’re overused, maybe, 10 fold too much, and they’re being used in raising animals to be able to help increase the weight and the fat content of animals. 

And so we also get antibiotics not only prescribed, but through many of the foods that we eat. In fact, 85% of the antibiotics used in the world right now are used on animals to be able to help help them grow, which may be problematic, which is why we talk about, eating organic foods are eating, eating, if we’re going to eat animal products, eating animal products that are organic, and that haven’t been exposed to those antibiotics. 

Then in terms of clinical practice, I find a lot of infectious diseases, maybe viral in origin. When someone has a fever, we don’t assume that it’s related to a bacterial illness. When we look and we see how that person moves with their immune system, and can they, you know, over a couple days to a week be able to take care of it by supporting their immune system, if they can’t, if they have continued problems or if they deteriorate. That’s the time when antibiotics are to be used.

  • Using antibiotics that are specifically targeted to where the problem is, and only when it is necessary.
  • What we use are called broad spectrum antibiotics, those will tend to have a broader effect on wiping out the gut microbiome.
  • When we use a specific antibiotic, then that can be used to target where the imbalances are, where the infection is and to treat it.
  • When we use antibiotics, I always recommend that we use something that goes along with it as a probiotic. 
  • Most probiotics are other bacteria. The probiotic I recommend is a yeast made from brewers’ yeast. It’s called saccharomyces boulardii. Boulardii is the strain saccharomyces cerevisiae strain boulardii, which was developed in France in the late 1800s, and we’ve shown that this can help to prevent antibiotic-associated diarrhoea. 
  • Recent work by some of the premier microbiome researchers at the Weizmann Institute in Israel around Sagar and his team have demonstrated that probiotics afters may actually delay the recovery of the normal flora, so that’s raised questions about that.
  • For me, it’s led to a change in my clinical practice over the past few years, where I’ll use the probiotic that I mentioned, Saccharomyces boulardii, when I’m giving antibiotics, but after that, my focus is on prebiotics. Those are the elements that are going to help feed the beneficial bacteria in the gut. 
  • Some of the newer tools that I mentioned, of the sample taking of the gut microbiome called metagenomic sequencing, whether you use shotgun sequencing and can tell the 300-plus different species that are present in you, or in me, they’re different from each other. 

“I like to say that the biodiversity in our gut, it’s different in Paris than it is in New York, than it is in Hong Kong, than it is in Cape Town.”

PATRICK HANAWAY
  • People all have different microbiota, the ones who live inside and don’t go outside, the ones who go outside, the ones who go to the park, etc. 
  • Researchers Alan Logan and Susan Prescott in Australia call it Global dysbiosis, talking about the overall imbalance that we have going on because of the loss of diversity in the natural world
  • An interesting side note, that the indigenous people represent 5% of the people on the planet, they steward 20% of the land on the planet, that land holds 80% of the biodiversity of the planet. That’s pretty fascinating to think about in terms of when we are in a right relationship with the natural world. 
  • People all have different microbiota, the ones who live inside and don’t go outside, the ones who go outside, the ones who go to the park, etc. 
  • Researchers Alan Logan and Susan Prescott in Australia call it Global dysbiosis, talking about the overall imbalance that we have going on because of the loss of diversity in the natural world.
  • An interesting side note, that the indigenous people represent 5% of the people on the planet, they steward 20% of the land on the planet, that land holds 80% of the biodiversity of the planet. That’s pretty fascinating to think about in terms of when we are in a right relationship with the natural world. 

Pyschobiotics

(42:39) The Microbiome, including looking at how Psychobiotics can help with conditions such as depression and anxiety.

I mentioned the concept of how we feel, and that there’s, there’s an interrelationship between what is termed now as the gut brain microbiome axis. I think that’s actually a little bit misnomer, because it’s really about the gut microbiome, slash brain access, the interrelationship that goes on. 

So what we find is that 10 times more information comes from your gut up to your brain than from your brain to your gut, and where it goes in your brain on area called the insular cortex, a part of the cortex that is around analysis is it’s giving the metabolites from the bacteria that are present, it’s coming from the the hormones that are generated, it’s coming from the inflammatory cytokines, it’s coming from the nervous connections all within the gut. 

So our brain is kind of getting constant input about what’s going on and the terminology in English that we use things like gut feelings, or you know what’s going on in my gut or I’m, I’m feeling like, there’s something that I’m that I’m feeling and we often will when we say feeling will hold our stomach or abdomen, because that is a driver. So that information goes into the brain and it connects to our centres of memory and emotion. And it’s from there that it drives what’s happening hormonally.

  • APC and Cork, Ted Dinan, have been talking about the idea of psycho-biotics. Psychologically acting probiotics, probiotics that are specifically being given that can show an effect on how we deal with stress, what our mood is, are we depressed, how anxious we are, and research has been done first in mice and now in humans. That demonstrates specific probiotic strains that will be able to affect anxiety and will be able to affect depression, and will be able to affect how we deal with stress. 
  • It’s a targeted approach, we deepen our understanding of psycho-biotics and then go to say, what are the foods that are going to help those bacteria to grow as part of our normal environment within our gut. 
  • When I’m looking at prebiotics, I’m thinking about foods, like chicory, things within the land and artichoke and garlic and onion, those kinds of things. Some people can tolerate them, some people can’t. 
  • I’ll also use prebiotics that are powders off the shelf, we’ll use Acacia root powder, it’s very effective, I’ll just lactones, I’ll use fructooligosaccharides, I’ll use inulin, I’ll use modified citrus pectin. At this point, I’m really working to empirically try different things with people to see what brings balance to them. 

“What I used to say was, I’d like someone to take nine portions of fruits and vegetables a day, and when you look down at your plate each day, at least once you should see five colors of different kinds of vegetables. I just eat the rainbow.”

Patrick Hanaway

Covid-19 And Uncertainty

(1:00:35) Functional Medicine approach to immune resilience and Covid-19.

You know, one of the things that we have found, with the emergence of the Covid-2 virus and the infection that’s occurred is that, it’s had an impact. And, many people have said, Oh, well, there’s nothing that can be done. And yet there is so much that can be done to be able to support our immune system so that it is actually resilient. And that is able to deal with, you know, strongly meeting what’s happening.

  • How do we deal with the uncertainty of what is going to happen. If we went to even one year ago from today, from one year ago, today, no one would ever have guessed, the world would be shut down in the way that it has, and the degree of movement, it really differentially very different in the United States and Western Europe, then in Asia, or in Africa, in terms of the the progression of the of the infections and the severity of the infections in what it’s happened to our way of relating to the economy.
  • I want to highlight this aspect of uncertainty. And that, you know, from the bigger perspective, nothing is ever certain, you know, that is how our life is as human beings, you know, we can get a phone call and our life can change in a moment.
  • My father had cancer and how that changed his life in my life, or the phone call that I had cancer and how that changed my life and my view and my priorities and what I ate and how I moved in the world.
  • This concept of uncertainty is part of what we’re seeing with the natural expression of the SARS-Covid virus and how it’s moving through the world.
  • Resistance, Resilience and Recovery, you know, in in times of a pandemic, you know, to be able to help highlight what could be done, and those are the things that we still say should be done even as we’re preparing to get vaccines and we’ve done research now and we have a dashboard that’s available that gives people a big view of all of the vaccines that have been have gone through phase three trials and been approved from Moderna and Pfizer bio and tech, from AstraZeneca and Johnson and Johnson, the viral vector vaccines, including Sputnik five, or Sputnik V
  • COVID, SARS-CoV-2 really, as a virus, the fear of, you know, it’s created a lot of reactivity in our world, and how do we deal with fear? How do we deal with the uncertainty of what is going to happen? 
Wellness Journey Illustration by Niko.Wu

Stage IV Cancer And The Functional Medicine Approach

(1:08:07) Dr. Hanaway’s experience with Stage 4 cancer, his healing journey, incorporating a Ketogenic Diet, and the Functional Medicine approach.

Four years ago, I felt a lymph node on my neck. It was hard, and it wasn’t painful. And so as a physician, I’m like, Oh, that’s not a good thing. You know, like, if you get a sore throat, you have a lymph node that swells up from the infection and you touch it and it’s kind of sore. You know, that’s a normal inflammatory immune response. I had it checked out, I was really scared and the doctor biopsied it and said, It’s nothing. There’s, you know, just pay attention to it. And so for the next year and a half, I did and it never changed. 

But then I noticed that there was another lump a little bit farther down on my neck. That was bigger, and that was not tender. And I had it evaluated and it was determined to be a cancer that was on my larynx, an aspect of my voice box and, and that it had spread to the lymph node in both sides of my neck, and so when cancer starts one place and then spreads to another or spreads around in the body, that is kind of the definition of a stage four cancer, it’s not isolated anymore. 

So stage one cancers are pretty early stage two cancers are localised. Stage three cancers are beginning to spread, and stage four cancers have clearly spread to other parts of the body. And so, getting that diagnosis now, about two and a half years ago, was one that was, you know, it changed my life. And different emotions would come up, even as I talk about it now, that, you know,

I first had to come to terms with. Do I want to live? Or do I want to fight this? And, and it may seem like, well, of course, and yet there was a part though, that was like, wow, you know, this is a big deal.

Patrick Hanaway
  • So I began a journey, right then and that journey, you know, included, you know, meeting with the oncologist and finding out what the current treatments were in meeting with a radiation oncologist then getting evaluated and talking to doctors. 
  • A colleague of mine in the integrative medicine field, I talked to him and his wife and realised Oh, if they’re shooting x-ray at my throat, I may not be able to eat and so I’m gonna have to get a feeding tube. And then in considering that and recognising oh, dietary, knowing dietary aspects are important and you know, choosing to do a ketogenic diet.
  • I learned later and actually found I had the data at the time, I was just too overwhelmed to assimilate it, you know that ketogenic diets are particularly helpful for cancers that are getting radiation therapy, not every cancer is going to be benefited from a ketogenic diet but some are, basically we’re starving all the sugar taking all the sugar away, so the cancer cannot grow.
  • Another aspect and really critical aspect was my my work as a more coming and going and receiving energetic healing, shamanic healing, traditional healing at the beginning of that time as well, that helped me to find balance and it also helped me to really deeply ask my my friends and colleagues for help and you know, help me to see where I’m where I’m stepping in correctly in the world. And this is a very humbling process and you know, in doing that and going through, you know, several months of pretty intense therapy, every radiation therapy every day. But being able to be supported by my family and friends and community allowed me to not have a lot of the severe side effects.
  • Now, I know from the Japanese data on forest bathing that, you know, it increases the anti-cancer properties of the immune system, you know, and I found that out afterwards. I sort of knew some of these things, but it was like, what the unfolding of the journey was, for me to be able to deal with the uncertainty of, I don’t know if I’m gonna live or die through this process, but I’m gonna do my best and I’m gonna listen, and I’m gonna learn, and, you know, that’s what I’ve done.
  • I have to bring awareness to my own health and well being. And that ebbs and flows, honestly, you’d think, okay, I, maybe I figured the lesson out, and I got it.

There’s still a lot of emotion in the sharing of it and I’m glad to be able to share it, I think it’s important. But there’s, it’s not a cure, it’s not beating cancer, it’s not being heroic, it’s just listening and moving in a way that is helping me to connect with my authentic self and my humility, or being humble about, you know, my place in the world and then helping others to be able to do this so it’s an ongoing journey.

PATRICK HANAWAY
Book Recommendations from Patrick Hanaway M.D.
  • Food Rules: An Eater’s Manual – Michael Pollan

    Buy Now
  • Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues – Martin J. Blaser

    Buy Now
  • Staying Healthy With The Seasons – Elson M. Haas M.D.

    Buy Now
  • Studies:

    The Functional Medicine Approach to COVID-19: Lifestyle Practices for Strengthening Host DefenseMinich and Hanaway, 2020 

    Editing assistance: Justin Chan

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