This week I host Dr. Robert Kornfeld, a true pioneer in functional podiatric medicine. We chat about some really cool and fun stuff—so please join us on this week’s episode.

Essentials of Diagnostic Ultrasound

Dr. Kornfeld is a 1980 graduate of the New York College of Podiatric Medicine. He was awarded the “most outstanding student” in the field of ambulatory foot surgery by The Academy of Ambulatory Foot Surgery.

Fellow – American College of Alternative Medicine

Board Certified – American Association of Integrative Medicine

Diplomate-College of Physicians – American Association of Integrative Medicine

Diplomate – American Board of Alternative Medicine

Diplomate – American Alternative Medical Association

Board Certified – International Society of Homotoxicology

Certified Life Coach – Transformation Academy

Introduction to Dr. Kornfeld and How he became interested in Functional Medicine. [03:32]

  • Around 1985, Dr. Kornfeld developed a medical problem.
  • He went to his medical doctor who gave a prescription but didn't seem to do anything or gave him side effects.
  • He went to another doctor who wanted to give the same prescription which left him frustrated.
  • He was recommended to a holistic doctor and it turned his life around.
  • He was told how he was responsible for the condition he was dealing with.
  • They had a conversation about epigenetics, which is diet, lifestyle and environmental influences and started following his recommendations.
  • It completely got rid of his condition; it made him feel more vital and healthy.
  • It took him about a year to change it all around.
  • He started going to seminars with MDs and DOs.
  • He learned an enormous amount of stuff that really opened his eyes.
  • He started using it mostly to prevent post-operative complications.

“The healthier his patient was before surgery, the better the outcome would be.”

  • He started finding a lot of the patients resolve and never went to surgery.
  • He started getting a lot of patients coming in who were failed by traditional approaches.
  • His practice converted to a chronic pain practice.
  • He started bringing it into the practice in 1987.

“We have to understand how to create a differential diagnosis; how to do whatever we have to do to get to the actual diagnosis.” [06:49]

  • Nobody talks about the underlying mechanisms.
  • Fundamentally, understanding why a patient crossed that morbidity threshold, and went on to pathology is critical to understand.
    • It can be wildly different than everybody; it's not the same.
  • Medicine is designed as one disease, one treatment, or one disease, one drug or one class of drugs.
    • When that drug causes some side effects, you switch to another drug which hopefully doesn't cause a side effect.
    • It really doesn't look at the person overall from a global standpoint.
  • Shortly after using it in practice, Dr. Kornfeld started talking on a radio show which was broadcast on a station in New York.
  • Everybody should know that the repair of injured cells and regenerated cells depends on a healthy immune system.
  • He got heavily into studying human nutrition and diet and what it took to unburden the immune system.
  • We've got three quarters of our immune system sitting in the gut.
  • With refined carbohydrate garbage, preservatives, and chemical flavorings and colors, it misdirects the immune system.
  • The repair and detoxification of these injured cells comes from primary inflammation.
    • If that pathway is not efficient, for whatever reason, the body will then default into chronic inflammation to protect; it cannot repair.
  • With cortisone and NSAIDs, we suppress the pathway that's protecting those cells; they're not pathway specific.
    • They interfere with detoxification, especially with long term use of NSAID which can cause liver toxicity.
    • They are fibrolytic; they may weaken the tissues we're trying to fortify.
    • They get in the way of the process of repair.
  • He started looking for ways to stimulate that primary inflammatory response.
    • Initially, he did it through nickel homotoxicology; it is an injection technique that's derived from the philosophy of homeopathy.
    • Little by little, he started looking at nutritional medicines and herbal medicines.

“How do we support the human body's ability to stay healthy? We've got to understand what constitutes homeostasis.”

  • If the body can repair, detoxify, replace the cells, and replenish what's used up, we're in trouble.
    • That's why we have these chronic pain patients.

The importance of the gut microbiome. [12:10]

  • We understood that the gut flora is responsible for feeding the immune system.
    • They ferment complex carbs into short chain fatty acids, which is the food of the immune system.
    • Everybody that was chronically inflamed was put on a probiotic.
    • We tried to get all the refined garbage out of their diet.
  • Understanding the full gamut of the microbiome didn't exist back then.
  • Barrett’s practice have gone into more functional medicine.
    • He has realized that the patient is not just a peripheral nerve down at the end of their lower extremity but are riddled with neuroinflammation
    • They won’t be able to do too much until the neuroinflammation gets suppressed.
  • Kornfeld was aware that what he was discussing was totally foreign.
  • He sat with his patients and educated them the importance of a healthy diet.
  • He explained how the immune system sits mostly in the gut and it's constantly trying to figure out what's coming in.
  • You're going to get a whole completely different gut reaction to what's happening.
    • That sets the stage for chronic inflammation where patients he had didn't cooperate.
    • Grossly, it was the diabetics that wouldn't let go of their carbs.
    • If he was aware that nothing was changing, he invited that patient to go somewhere else where they can get intervention rather than a holistic approach.
  • Most people were receptive because most are feeling somewhat desperate.
  • In the early days, he was still taking insurance.
    • People were sitting in the waiting room because he was trying to educate each patient.

The power of educating your patients. [16:27]

  • If you're able to educate the patient, they're able to conceptualize it which makes adopting those things much better.

“You can do whatever you want at it but if the mechanisms are still going on, everybody's pouring water on the smoke while the fire is still burning.”

  • One of the things that gets the patients on board conceptually is continuous glucose monitoring.
    • With a Dexcom G6 on them, and they have ice cream, they see the little warning bell go off because their glucose just hit 180 or 185.
    • There is a lot of response to metrics.
  • Doing a lot of lab work can also help because it's important to quantify what you're doing.
  • Some patients were taking 60 supplements because they heard a radio show or read an ad; that's the surest way to kill yourself.
  • When you're pumping in tons of nutritional medicines and antioxidants, your digestive system gets lazy with all this predigested nutrition coming in.
  • When you eat food, it doesn't get digested as quickly.
    • It often gets digested incompletely, which sets the stage for a leaky gut.
    • The circulating immune complexes kick off an inflammatory process.
    • If you take too many antioxidants, they'll convert to a free radical.
  • The thing that went wrong in the early days of holistic medicine was doctors saw there was money to be made in dispensing nutrients and supplements from their office
    • People got over prescribed their supplements.
    • They're supposed to supplement, a sound, healthy diet for human beings.
    • Supplements should not become a replacement for medication.

Genetic testing of the gut microbiome. [19:57]

  • There are so many people with genetic mutations that have things that predispose them to degenerative conditions over time.
  • The vitamin deficiencies are really common through SNPs.
  • All these different genetic mutations, which are single nucleotide, can set the stage for so many problems.
  • One thing that most podiatrists deal with is the MTHFR.
  • Combine epigenetics and genetics to build protocols to get patients out of trouble.
  • You have to know what you're dealing with before you can really treat it.
  • A full complement of SNPs on chronic pain patients is almost always where problems are found.
  • The gut microbiome becomes critically important; we want to analyze what's going on a on a microscopic level
    • How many pathogens there are
    • How many healthy gut flora exist
    • What's the balance between them?
  • Understanding what goes on in the gut is about as close as you can get to touching the immune system.
  • All things start at the gut because it makes more serotonin than your brain does.
  • Serotonin is really not the major neurotransmitter
  • 7-10 years ago, no one talked about the gut-brain axis.

A patient came to Dr. Kornfeld with a 17-year history of bilateral ankle pain. [23:52]

  • Imaging and blood studies were negative.
  • Patient had been on painkillers for years
  • Had been to physical therapy 100 times
  • Patient had a bag full of orthotics
  • Hundreds of cortisone shots
  • The guy was not better
  • They started with a diet journal to see the connection between food and the immune system.
  • Patient had three cups of coffee in the morning, a couple sodas during the day, and 3-4 glasses of wine at night.
  • Kornfeld can't treat the patient until he’s properly hydrated.
    • He started adding water to his diet; in the beginning the patient’s body's is not going to know what to do with it because he’s compensated to living without it.
    • That's their starting point.
  • Patient was on eight glasses of water a day and feels better now.
  • One of the things to know you're dehydrated is when you're not thirsty, because your body's trying to figure out how to live without water.
  • They were at the point where they can actually start figuring out why the patient is in chronic pain.

The importance of diet and nutrition. [26:08]

  • Every patient that shows up in your office with pathology needs to be educated.
  • There's parallel tracks that set this up, but one is training.
  • It's not part of the regular training in allopathic school or podiatric medical school.
  • One of the problems is the way the system is designed.
  • There's just not enough time to really do the job because this takes time.

“It's amazing how the body's an incredible machine if we just give it a chance and put the right fuel in the gas tank.”

  • If someone gave you Ferrari, you’d probably put the premium gas. Your body is a machine, think of it as a Ferrari and it's the only one you're going to get. Put the best fuel in it, put the best oil in it, and really take care of it.
  • It's one of the most powerful medicines we have.
  • In our day and age, a great majority of the population is under chronic stress for different reasons.
  • Chronic stress sets up adrenaline neurotransmitter reactions.
    • The number one thing when you're in danger of being eaten by the predator, your body pumps out cortisol which helps deliver the sugar that's sitting in your cells back into the bloodstream for rapid energy; you could fight the beast or run away.
    • If you're under chronic stress, you've got free sugar that's feeding pathogens in your body.
    • If you're diabetic, it's making it more difficult to manage your diabetes.
  • Secondary actions that occur: neurotransmitter reactivity to chronic elevations and adrenal hormones.
  • We have to learn to address mechanisms by looking at adrenal hormones and neurotransmitter levels.
  • Many people were walking around with excitatory neurotransmitter levels that went through the roof that’s why they couldn't sleep.
    • If they couldn't sleep, how are they going to repair?
    • Most of homeostasis occurs in that state of deep sleep.
  • One of the problems we have in medicine today is that it's super specialized.
  • We've got to understand the whole person.

The four pillars of health. [30:50]

  • Food is one of the most powerful drugs that we have.
  • Management of stress.
    • Example of stress is when you're wearing a CGM, you may be in a fasting state, but you get into a little stressful situation and you can see that glucose rise.
    • You're under stress even when you may not think you're under stress.

“Stress is a silent killer; it's so insidious.”

  • Barrett was advised to try taking his blood pressure throughout the day.
    • He learned that his blood pressure was the lowest in surgery.
    • That's his mental quiet time because he’s so focused on it.
    • Distractions were put away and he’s not getting hit by information from 20 different angles all at one time.
  • Stress is one of the most difficult things to manage.

Getting off refined sugars and sleep. [35:14]

  • Get the patients off refined sugars because that tells the brain that you're in danger.
  • As soon as there's a simple sugar that shows up in the bloodstream immediately as it passes through the intestinal lining, that's a problem.
  • Many patients will say just getting off sugars helps their stress level.
  • The important factors to understand is that what happens in chronic stress changes everything.
  • If you've escaped the beast that wants to eat you, and you're hiding in the bushes, that's my metaphor for chronic stress in the bushes.
    • You can't go out and feed yourself because the beast will see you and devour you.
    • You have to preserve energy.
  • Cortisol has a direct inhibitory effect on basal metabolic rate by pushing down thyroid function.

“If you have a patient in chronic stress, that has a decreased metabolic rate, their ability to repair is diminished.”

  • You can't get into the deep reparative layers of sleep.
    • The body ensures that by elevating your excitatory neurotransmitters.
  • Understand what the quantitative levels are of adrenal hormones because that can lead to hyper vigilance; that leads to some bad chronic syndromes like RSD and CRPS.
    • Most put it under the heading of CSS, central sensitization syndrome, where every sensory impulse goes to a pain receptor.
  • We have patients that are literally healed in their foot, but are still in severe pain.
  • Targeted amino acid therapy was developed by a bio scientist named Rafael Kelemen.
    • It fills the amino acid shortfalls for things that are low
    • It dampens the ones that are elevated with simple herbal nutrients.
    • People will sleep better
    • Stress levels come down
    • Digestion improves.
  • People should not be taking 40 supplements, because their digestive system needs to work again.

Sleep monitoring and getting better sleep [38:06]

  • Go to bed at the same time every night.
  • No stimulation; you can't watch TV while you're trying to go to sleep.
  • You can't be on your cell phone or computer while you're trying to go to sleep.
  • The room has to be completely dark.
  • Low doses of melatonin at dusk seems to make a huge difference because that's really when it's properly secreted.
  • That leads to release of serotonin that helps everybody become more tranquil and low blow themselves off to sleep.
  • A lot of the people are so hyper stimulated from all of these excitatory neurotransmitters
    • When they get into bed, they're listening to music, they're watching TV and they're reading a book all at the same time.
    • The lights are on
    • That's not going to bode well for healthy homeostasis
  • There's also temperature.

How do you work with the exercise pillar? [40:56]

  • Make sure that patients are not going to do something that's going to hurt them.
  • What Dr. Kornfeld has found successful is slowly working them toward an exercise regimen.
    • It works 95% of the time.
    • When getting on the exercise bike, start by riding it for 60 seconds. Followed off by 2 minutes the following week, and 3 minutes the next.
    • There's a slow build up.
    • They're not going to wind up with lactic acid problems in their muscles and complain about pain
    • It's not overwhelming; it teaches their body to slowly start moving again.
  • When putting these patients on aggressive aerobic, that throws off an enormous amount of free radicals.
    • If their body can't manage it, we wind up with trouble.

“Keep the exercise level consistent, but moderate.”

  • Stop creating metabolic byproducts from extreme exercise.
  • Hydration is a big part of the problem.
    • Whatever water exists in nature, run it through a filtration process, and just drink water.
    • There's a million different waters out there, but water is water.
    • We need H2 That's what we need.

Discover why a patient has what they have before treating the symptoms. [43:59]

  • Patient’s body needs to be healthier and more cooperative with the process of healing.
  • This isn't a magic bullet approach.
  • One issue that we have no control is the air we breathe.
  • We can control everything we can control.
  • We are bombarded by EMF.
    • What we have is a major problem because cellphones have added an enormous amount of radiation exposure to us.
    • It's almost like getting an X-ray every day.
    • It’s hard to tell if there's a way to control it and make sure that the patient has the best possible ability to adjust and detoxify with all of this.
  • The human immune system is devolving; that should be close enough for major concern.
  • EMF is a big problem; It's everywhere and we can't escape it.
    • It's been shown to create a degradation of cell membranes which leads to degenerative change.
    • It will definitely affect mitochondrial function.
    • Patients who have lower output of ATP, lower energy stores, lower ability to pull things from their cells when they need it, are going to struggle.
  • We do have supplements that enhance mitochondrial function but there's a lot of things that cannot be controlled right now
  • Many of the environmental scientists are raising red flags that politicians continue to ignore.

Optimizing the human vs. optimizing the animal. [47:13]

  • Many times Dr. Kornfeld use protocols that support the immune function.
  • There's a big push to regenerative medicine now.
  • Statistics on amniotic allografts, PRPs, and prolotherapy, are nowhere near as successful as what Dr. Kornfeld sees.
    • That PRP still needs a healthy, efficient immune system to get the best bang for the buck.
  • When you optimize the human, there may be conditions left that are then that much better treated with traditional methods.
    • Now you've got a recipient that can receive versus a recipient that's unable to receive that cellular upregulation and subsequent regeneration.

“We had to get the recipient better tailored to receive that treatment.”

  • Kornfeld did step away from traditional Podiatric Medicine a long time ago.
    • At a certain point in time, he had a teaching institute and wanted to educate other podiatrists.
    • This was about 20 some odd years ago when everybody was more interested in becoming top notch surgeons.
    • They didn't want to feel like they were doing holistic, maybe that made them feel like they were chiropractors.
    • Maybe the genre of that music wasn't ready back then, but it's now getting to a stage where more people are wanting to listen because they get it.
  • You can put a CGM on somebody, you can monitor their sleep, the data is there.
    • These are real things that you can measure.

The problem we have with this health care delivery is if you are accepting insurance, and you've got 6070 patients coming in every day, it won't happen. [50:23]

  • Kornfeld walked away from insurance 23 years ago, because he wanted to be this kind of a doctor that he is now.
  • It’s a matter of self-preservation.
  • Barrett found himself spending more time treating the computer than the patient.
  • Barrett thought if he’s going to be the kind of doctor he wants to be, he has to get the word out there and started doing this radio show.
  • Going direct pay means people aren't going to find you in their little book of participating doctors and you've got to have a social presence.
    • There's work involved in building a direct pay presence.
  • If you have a compelling reason for people to come and pay you, they will.
  • In addition to the doctors who hate the system, patients hate the system too.
    • They don't like sitting in a waiting room for three hours.
    • They don't like having a three-minute visit.
    • They don't like waiting four to six weeks to get an appointment.
  • On a first visit, Dr. Barrett could deal with patients for 60 to 90 minutes with every question they've ever not been able to ask.
    • Barrett have time to listen to an answer.
    • His relationships with his patients has grown very deep and in many cases personal.
  • There's a downside to this: there are many people that don't have the means that would love to come.
    • Insurance companies still won't pay for anything holistic or natural, rather than a handful of things.
    • It's a paradigm that is attractive more to the people with means than the people without.

Have you noticed any change in the dynamic of the patient? [55:23]

  • If patients are paying out of their own pocket, they are more motivated, more compliant, and more interested.
  • It starts to become a lifestyle for them; this isn't just a short term protocol.
  • When you're able to have a recipient that you're not in a rush with that five-minute office visit, it's much more fulfilling for them and also for you.
  • The way the system is it doesn't allow us to ultimately make people better.
  • Physician burnout is at an all-time high right now.
  • There aren’t any statistics or studies to support this statement but the advent of the EMR, when it was first coming about was proffered that this is going to end all of our problems.
    • It'll be transparent, you can communicate from one system to the other
    • That's just not true; it’s the opposite.
    • You spend more time when you need to find out one little thing.
    • Just as soon as you get the dashboard learned, they upgraded and they changed the dashboard.
  • A survey of 5000 physicians where about 34.8% admitted to physician burnout.
    • Almost 50% were able to be diagnosed and classified as depressed.
    • The bigger issue is that physicians are getting more involved with alcohol, substance abuse, and unfortunately, suicide.
  • The practice of medicine isn’t to be blamed, but on what's happened to the practice of medicine.
    • Insurance companies basically took over the standard of care and dictate everything.
    • They decide if they're going to pay you or not, because they are the ones holding the money.

 How the healthcare system is skewed against physicians. [1:00:13]

  • These young doctors are coming out with $300,000-$500,000 in student loan debt.
  • This was a universal situation where it's not just one specialty, it's across the board.

We may be the only business that cannot calculate your cost of goods.

  • One of the frustrating things is that people are out there doing a great amount of work and then 30 days-90 days later, that wasn't pre-authorized, or a reason for them not to want to pay you.
  • At the same time, the premiums are going up.
  • This whole thing got out of control.
  • We're not the brokers of our business anymore; we are just a pawn.
  • Patients know when they come, they have to come with payment.
  • When you deliver value, it's valuable.
  • In insurance, everything is based on time.
  • When Dr. Kornfed would come in in the morning and see an enormously crowded waiting room, he thought he was successful.
    • In reality, he just became a pawn of the insurance companies.
    • His stress levels went through the roof.
  • Kornfeld is glad he made the shift.

If you are interested in Dr. Kornfeld’s functional medicine course you can contact him at:

Chronic Foot Pain Center

551 Port Washington Blvd.                    127 E. 56th St. 4th Floor

Port Washington, N.Y. 11050                 New York, N.Y. 10022