The Flaw Of Seeing Health Only Through Lab Markers And Biochemistry with Dr. Mel Hopper Koppelman

Content By: Ari Whitten & Dr. Mel Hopper Koppelman

In this episode, I’m speaking with Dr. Mel Hopper Koppelman about her powerful and unique view of medicine, a context that I believe is much more effective than the conventional or even functional medical models we’re used to. 

I’m really excited to share this episode with you; Dr. Mel and I had a fantastic conversation that, if practically applied, points us in a new and much more effective direction for building true health.

Table of Contents

In this podcast, Dr. Mel and I discuss:

  • How some scientists and clinicians get stuck in the “biochemical weeds” instead of working from a bigger, more accurate picture of health, aka, first principles thinking
  • The 2 ways we can view lab tests (blood, stool, hormone, or even organic acid tests) and why most practitioners—even functional practitioners—get it WRONG!
  • Why even a “good” result on a blood test might not mean much for your quality or length of life!
  • Her favorite tool to practically address health imbalances and disease that fits perfectly into a big-picture paradigm
  • The 2 metabolic classifications Dr. Mel uses to help her patients based on her deep knowledge of traditional Chinese medicine…and why other medical models aren’t able to help people with chronic fatigue and similar symptoms

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Ari: Hey, this is Ari. Welcome back to the Energy Blueprint Podcast. With me today is Dr. Mel Hopper Koppelman, who is somebody I really just stumbled across. We became Facebook friends. I’m not even sure how. I started reading her posts out of the blue and became really fascinated and impressed with some of her thinking about health. I kept reading more and more of her stuff and continued to be very impressed by her original and very novel way of thinking about health. She has a background in all kinds of things from nutrition to functional medicine to traditional Chinese medicine to functional developmental behavioral neuroimmunology and many, many other fields.

She’s really a very, very widely read student, geek of health science. She knows a lot about a whole lot of dimensions of health science. What really most excites me is she’s somebody who thinks about health in novel ways, is really trying to put together different models, different scientific evidence, and research, and piece together new insights and ways of understanding and approaching health and attacking health problems. With no further ado, I’m very excited to share this conversation, Part 1, of what will be a multi-part discussion with Dr. Mel Hopper Koppelman. Enjoy. Mel, welcome to the show.

Dr. Mel Hopper Koppelman: Hi, thanks for having me.

Ari: I don’t know how we connected on Facebook, but somehow we did, maybe six months or a year ago or something like that. In my Feed, I started seeing posts from yours. I think I saw one and I read it, which is not common for me because I don’t really spend much time on Facebook. I read it and I was very intrigued and impressed by some of the things that you were saying. Your perspectives more than anything to me struck me as novel.

You struck me as an original thinker who was thinking outside the box, who wasn’t just another one of the typical sort of run-of-the-mill natural health or functional medicine types that was regurgitating whatever the latest thing you learned from your certification or the latest seminar or something like that from someone else. You were really involved in thinking originally and coming up with your own ideas and developing your own paradigm. I saw more of your posts, and I saw more of the same and more of the same and more of the same.

I’ve come to really respect and admire a lot of the perspectives that you have. I do this podcast; I think 50-50 in part because I want to share your knowledge with my audience. The other 50% is my own personal curiosity, wanting to explore your paradigms more deeply myself because they’re of interest to me. I like the way you think. In general, I like people who are trying to think in original ways. With that said, here we are. Welcome to the show.

Dr. Mel: Well, thank you. I’ve been a longtime viewer of your podcast. It’s very exciting for me to be here.

Dr. Mel’s paradigm of health

Ari: Awesome. Awesome. Let’s start at the meta-level. I’m a huge fan, as I think you are, of paradigm and understanding the importance of paradigm as the key thing that will determine how we understand a particular problem or how we understand health and longevity and energy and things of that nature more broadly. Based on how we understand the nature of those things, what we are inclined to do to build health or to solve health problems. With that said, and I know this is a difficult ask because you’d like to go deep, but can you give our audience a relatively succinct high-level sort of meta-level summary of your big-picture view paradigm of health?

Dr. Mel: Sure, I can try. I think the key is really trying to identify first principles of how things work and so that you can apply them to the problem that you’re trying to solve. In my case, it’s trying to help people recover their health or to help me recover my health or to understand if something’s likely to be helpful or not in terms of first principles or things that are just going to always be accurate. What I’ve found is that throughout my professional journey, my health journey, I was able to find some really great ideas and maybe they were more helpful than the status quo.

When I would bump up against areas where they weren’t working and say, “Well, what about this exception? What about this person? What about then?” It was hard to find answers. It required me to find bigger and bigger maps or different maps and figure out how to put them together. First principles thinking, which I think is fairly in vogue now, it just means that it’s the underlying basis of how things work. It tends to be quite simple. It tends to be true whether you’re aware of them or not. It helps you describe the context of what you’re trying to do so when something’s going to work and when it’s not.

The first principles for health

Ari: Okay, and what are first principles maybe for people who are unfamiliar with that term?

Dr. Mel: Yes, it’s the simplest basis of understanding something, whether it’s a person or a machine or a problem that when we might start off with the details or we might start off with what we can see. That’s an example. When you keep zooming out and you keep asking questions, the first principles are going to be like, “This is how it always works. If you find an exception, then you might need to rethink what you thought you understood about that system.” To give you some concrete examples, because I think a lot of confusion in health comes from us being really focused on the microscopic, which is not really where the first principles live. The microscopic exists and it can be helpful sometimes.

The first principles exist really where the things that we can see. To be honest, one field that provides a lot of really helpful understanding and information is looking at things ecologically, ecology. With ecology, you’d be thinking about temperature, for example, is something hot or cold. Is something dry or moist? is something bright or dark? Really simple. That gives you a lot of really useful, big-picture information. Those things are always going to be relevant and true, right?

Ari: Yes.

Dr. Mel: Life evolved on Earth, on a sunny planet with water and soil. We’re getting, again, some first principles, and those things are always going to be true. They’re always going to be relevant. One thing I found when I got very stuck in the weeds of biochemical pathways is that if you can’t bring back what you’re looking at to those things I just mentioned, light and temperature and soil, you might not understand it as well as you hope.

Ari: I absolutely love the last part of what you just said there. Something that’s a thought I don’t think I’ve ever heard anyone else express, but it’s something that I’ve really zeroed in on, especially in my recent writing for my upcoming book, as being of central importance. I would pretty much classify, and I don’t want to be mean here or sound like I’m opposed to conventional medicine or something like that because I’m very appreciative of many aspects of conventional medicine, emergency medicine, and antimicrobial drugs and things like that and many other areas.

However, I would put most of conventional medical thinking in the conventional medical approach to chronic disease in the category of what you just described there as being fixated in the weeds of biochemistry and not linking it back to some of these first principles. For example, the conventional medical paradigm isn’t grounded in a paradigm of evolutionary biology and evolutionary health, which is not just a small flaw, it is a fundamental flaw.

In my view, you cannot understand health without looking at it through an evolutionary lens. I think that has a lot to do with those first principles you’re describing. I also think that there’s a huge amount of people in natural health and functional medicine circles who are also in the weeds of biochemical pathways who are not linking it back to first principles.

Dr. Mel: I would agree with that. I definitely myself made the same error for many years. That’s how I’ve ended up where I am because it can be fun to study those pathways and it’s interesting and it’s not irrelevant, and there’s a fun trail there. I think part of it is that when we get into lab testing, we’re getting into quantification, and that gives us a certain level of certainty. We all have a need for certainty. It can calm fears, and it can make us feel confident. Especially, as a clinician, you’re trying to do the best for your patients. In people, especially with complex chronic illness, they’ve got layers of things going on. They’ve got mixes of patterns. It’s confusing. If you can use numbers, it feels like it’s grounding.

It gives you this, I would say, an illusion of grounding, where you can point to something with certainty. The problem is, because it is really divorced from the first principles, it’s a false sense of certainty. It’s not grounded. It’s actually very disembodied. Another thread of what you were saying about how mainstream medicine is very, and a lot of functional medicine and integrated medicine, I think is maybe a little too over-enamored with lab tests, is that not only is it completely divorced from an understanding of evolutionary biology, but part of the fundamental premise is that they intentionally remove context in studying it.

Evolutionary biology is like, let’s say, the meta-context. It’s like the key context. A double-blind, placebo-controlled, randomized trial is coming from a worldview where we are stripping away context in order to study something, even though context actually provides most of the impact of what you were studying. It’s almost like a mental health problem in the research literature at large, that most people aren’t aware of. They just go in, and they read, not realizing that this is based on some pretty big flaws before we sat down to do our research.

Issues with lab-testing

Ari: Yes, I love the way you just explained that. Let’s explore this lab-testing thing more deeply because I feel like it’s an area where so few people really understand what you were just alluding to there both within the general population and I think among practitioners. I think that there are huge numbers of practitioners, as well as the general public, who have been indoctrinated into the idea that when we use these tests, when we look at a blood panel, a comprehensive blood panel, a comprehensive hormone panel, and organic acids tests, and microbiome tests, and whatever other tests you want to run, food allergen tests, and so on, food intolerance tests, that we are getting a really, really comprehensive view of human health and what’s going on in the body.

That all of this data, I think we imagine that we are looking at the totality of what can be measured in the body. We have this really complete picture of all the physiology and biochemistry that’s happening inside that body. I think what’s become more and more apparent to me is two dimensions. One is that many of these tests are actually highly inaccurate. You and I have had previous discussions. For example, I shared some of my microbiome tests with you from three different companies.

You could see mass disparities from literally the same fecal sample in what these different tests were saying was present in my microbiome or not present in my microbiome, massive differences, which tells you, “Okay, well, what does any of this data mean? How do I know I can trust any of this data or any of it is giving me any sort of legitimate information?” Whereas if you only looked at one of those tests, your brain would be inclined to think, “Well, this is exactly what’s going on in my microbiome.” You wouldn’t have those two other sets of data to make you go, “Oh, I wonder if that first test was actually totally inaccurate, and none of that stuff should be trusted.”

That’s one dimension is realizing how widespread the issue of inaccuracy and lack of repeatability of these tests are. The second dimension is realizing that there’s so much more going on in the body than even what these tests are mentioning. It’s like, I don’t even– I’m trying to think of the proper analogy to express this, but imagine you had a giant, let’s say, mountain, covered in trees, covered in a forest.

It was at night, and you had a spotlight on just the bottom right section of this. You saw a group of 10 or 15 trees, and you were like, “Okay, now we understand everything that’s present here, but you were missing 90% of the mountain that’s there. You were convinced that this little piece of the forest was the entirety of what’s there. That’s what I feel like is going on, but what’s your take on this?

Dr. Mel: Oh, boy, you’re touching on a subject that’s very close to my heart. Again, this is coming from, very hard-won personal experience of doing lots of lab testing, doing lots of study. I did a six-month internship on one lab that was a metabolomics lab that’s 200 markers, and we were just focused on that. 90% of the information or the interpretation is not even written on the report. Then I’m going off into PubMed.

Believe me when I say, there are layers and layers and layers of false assumptions that lab testing is based on. Once you start to see them because it’s not that tricky, I can explain quite a few of them, then you start to shrug your shoulders and go, “What’s the point?” Just to say, I haven’t completely abandoned lab testing, but it’s just not the cornerstone of my practice anymore. They need to be used with an abundance of caution.

Ari: They’re not being used with an abundance of caution.

Dr. Mel: They are not. No, they’re being used with this sense of certainty. I want to make sure that I say that the antidote to that is being able to learn how to see with your eyes better. A lot of people don’t have a better alternative, that if they’re coming to functional medicine from, let’s say, mainstream medicine, and that’s maybe even a step in the right direction if they’re coming to functional medicine from other clinical areas where they haven’t been taught how to gather tons of information by looking and smelling and listening and all of those things, then they’re flying blind a little bit, and the lab testing is what they have.

Let me give you some examples to illustrate, some of the problems. One comes from this really great paper. It was written by the European Scientific Committee, I think around 2015. There was this group that was put together to basically answer the question for the European government, are dental amalgams safe, mercury fillings. This committee of scientific experts concluded that they absolutely were not safe.

The European government completely ignored them and continued to recommend them. This group published this position paper that really everyone should have a copy of because it’s written really well. They summarized the data. One of the things that they say is that not only is body burden of mercury, and the way you determine body burden of mercury is on autopsy. You have a dead person, and that’s the way to measure mercury in a person. Obviously, we don’t want to do that for our patients or for ourselves.

Body burden is linearly correlated with the number of amalgams that you have and the time you’ve had them, but body burden of mercury is not at all correlated with blood levels of mercury, hair levels of mercury, or urine. There’s no relationship, which is absolutely, mind-blowing. I run mercury tests in my clinic. I tend to run a try test where you’re taking samples from blood and urine and hair. This is the most accurate test on the planet. I still believe it aside from autopsy. Of course, it is the most accurate, and it’s not telling you–

Ari: Why don’t you just take it on autopsy?

Dr. Mel: I know, I know. It’s a tough sell. I was having trouble with the marketing.

Ari: Most accurate way. Just do that.

Dr. Mel: I’m like, “Most accurate way.” I was having trouble with the marketing and then repeat custom. Basically, there’s no relationship between the amount in the blood and in your brain and kidneys and bones, which is where it’s ending up. That’s not a small point. That’s a big point. What it’s telling us is that what’s happening in the blood is not always often, I don’t know, not enough people are asking this question. What is the relationship between what is in the blood and what is in the body? We maybe don’t know the answer to that. Another example is that there’s an inverse correlation between the amount of calcium in your hair and the amount of calcium in your arteries so direct inverse relationship.

That’s not a small problem. Another not-so-small problem is where reference ranges come from. In conventional industrial medicine, reference ranges will tend to be where 95% of the population falls. That population is the population of a specific lab. Just like with your poo being sent off to different labs, if you send your blood off to different labs, they should be coming up with the same numbers ideally. How they classify that, whether that’s normal or high or low is actually going to be very different. That’s going to determine whether or not you end up on medication, that sort of thing. That’s crazy.

Then what I’ve found over the years is that functional medicine’s answer to that is to just tend to use more narrow ranges. They’re basically like, “Oh, this 95% thing’s too big. Let’s just go here.” From my perspective, that’s not evidence-based either. Really, if we’re going to try to do this, then what I propose is that we should be using very large samples, studies based on large samples that are calculating usually all-cause mortality, and see where the risk is lowest. Those exist for a number of markers.

What you find is that it doesn’t correspond to the industrial medicine range, and it doesn’t really correspond to the functional medicine range. To add another layer is that for most markers, they really should be different for men and women. That’s also not a small point, because it’s not. Basically, if we’re not understanding where it should be, then we can’t really say if it’s good or not if we’re not accurate there. That’s another problem,

Ari: Yes. I think what you said about some of these, looking at the relationship between some of these markers and mortality; it’s also become apparent to me that so many of the markers that are being looked at don’t even have any data as it pertains to mortality. Yet, they’re being portrayed with this grand sense of importance, like, “Oh, yes, we have–” There’s an assumption built in other words, that just because you ran a test and you got back some data and you found some abnormality, that, that abnormality must be really important and must be in some way related to maybe your symptoms.

Whereas I think the reality is if we were able to, going back to that analogy that I gave, if we were able to measure all of that mountain, we would probably find if there’s one abnormality present, if we measured lots more stuff, if we have the capability to, like let’s say, the more next generation of testing with metabolomics testing, we’d probably find dozens of abnormalities in many different systems of the body.

Dr. Mel: 100%, and really what we’re finding is that our understanding of cellular biology is changing based on metabolomics and that– I know that you’re a big fan of Bob Naviaux’s work as am I. He’s a great thinker. He has an encyclopedic knowledge of metabolomics, of pathways, of genetics, and all sorts of things. What you find is that you get these global changes. Metabolomics is a way of measuring changes of everything at the same time. What’s really interesting and exciting is that when you look at that, what you’re seeing is actually, wait for it, the changes in hot and cold, winter and summer.

There’s increasing amount of metabolomics studies being done on, for example, Chinese herbs, which are classified by temperature amongst other things. When you look at hot herbs, they increase summer metabolism. If you look at hot patterns, usually in mice, it’s the same thing. If you’ve got cold patterns, it’s the reverse. They were zoomed in on these individual markers. Maybe people were running dozens or hundreds. We’ve got like 20,000 proteins.

Then people are looking at metabolomics like I was looking at an ion panel with 200 markers thinking, “If I just keep looking at this, I’ll know exactly what to give a patient.” I’m looking at fatty acid pathways, and I’m looking at– I’m like driving myself crazy. I’m like, “Okay, you’re missing this co-factor and this is happening.” There isn’t an understanding of really the bigger picture is that the cell danger response is an exaggerated summer metabolism.

Does biochemistry matter?

Ari: Mel, before we get into summer and winter metabolism, which I think will require some greater explanation to our audience for people to get where you’re going with that, let’s jump back one step to just this thing you were just alluding to with going down this vast complexity of analyzing these biochemical pathways. I personally feel like that pursuit is endless. The level of complexity is endless. Every day, there’s more layers to that story emerging. I feel like it’s a legitimately impossible task for any human to really master that level of, in-depth biochemistry of so many different mechanisms.

More importantly, what I’ve found in doing the thing that you were just describing is analyzing this and that pathway. Then, “Okay, based on this understanding, it’s a quick digression.” When you actually delve into this on a very detailed level, especially some of the more emerging pathways and things like that, you realize that there’s conflicting views. There’s different studies that find different things and not every study is even showing the same consistent finding. Let’s ignore that aspect of things. Let’s just say we have clarity on all this complicated biochemistry.

We start thinking along the lines, which is really sort of an allopathic way of thinking, that when we understand things at the most micro level possible, here’s this biochemical mechanism. Here’s the dysfunction present in it, that when we can intervene on that micro level of biochemistry of, “Oh, this pathway must be dysfunctioning. If only we add this chemical, this synthetic chemical, or this natural chemical, either a drug or a supplement,” let’s say, that it will change the biochemistry of this pathway and alter and fix the dysfunction that’s present.

I have explored that in such great depth over such a long time, and I have found it so lacking, so ineffective that there is almost no correlation between the degree of in-depth biochemistry knowledge that a person has and the level of results of how much they can help you improve your health. If anything, if we include conventional medicine in the mix, there might be an inverse correlation.

Dr. Mel: I would say probably an inverse correlation. I think what’s important to remember is that there are genetic diseases. There are important errors in metabolism. There are genetic diseases where you have a single point mutation; where you have a typo in the genetic code, and that leads to an illness you can see with your eyes. That’s bottom-up causation. The problem is that just because that exists doesn’t mean that’s usually the case. Actually, that’s like the rare, rare exception, but that’s the thinking that’s being applied to everything, or to everyone. This is the problem that people need to remember. It’s not that it’s never true; it’s that it’s sometimes true but usually not.

Ari: Yes, and just to put numbers on that to make it even more concrete, it’s less than 1% of illness that are true genetic illnesses and over 80% of the chronic disease burden are diseases of nutrition and lifestyle.

Dr. Mel: Exactly that. Just so people have that context and awareness is that I think one of the bigger meta problems in modern times is that people are not– it’s tricky to know when something is true. People want to know if it’s true, and things are usually true sometimes, right?

Ari: Yes.

Dr. Mel: It’s not that people are wrong; it’s just more about understanding the context.

Ari: Right, so I agree with that, and thank you for adding that. Let’s say, and this is generally the assumption that I’m talking about, is that we’re talking about the 80% plus of the chronic disease burden that are generally caused by lifestyle factors. Within that, which are the major killers, things like heart disease and cancer and dementia and obesity and diabetes, and so on, and many more, even things like sarcopenia and frailty and death by accident are largely related to this. Within that, I find specifically that the pursuit of trying to correct dysfunctional biochemical pathways is highly ineffective.

Dr. Mel: Completely agree, and like you say, it may have no correlation with outcomes, and it may have an inverse correlation with outcomes. It’s really a matter of being too zoomed in on a pine needle on that tree in that corner that you were looking at. One of the things that I noticed, because in my studies, I continue to see what’s being taught in functional medicine. Part of my journey, after I studied Chinese medicine, I knew I wanted to do an internal medicine, and I’m nerdy and into biochemistry.

My mom was a medical doctor and a medical researcher. My grandfather was a chemist, and his brother was a top chemist at Yale, and all this, so I wanted to do that. Part of my course correction and going down that path and seeing that there’s no the other is then swinging back to what I was talking about before about ecology. The metaphor I use is like, “I’m not a gardener yet. I want to become a gardener, but I’m not a gardener.”

I know that when gardeners look at land, they are able to get a lot of information just by looking. We’re like, “Oh, how do that? Are you a witch?” It’s like, “Well, no, I can just see.” Whereas me, I can’t do that. If we’re not using that power of observation and common sense and our ability to see with our eyes, it’s like we’re running in and just doing a soil sample and then trying to base all of our decisions on that. Where I’ve swung back, one of the, I suppose, solutions to this problem is, first is to learn how to use our senses and become embodied and be able to gather that information. It’s not esoteric and it’s not woo-woo.

It’s actually when we study those ways of knowing, they’re actually very, very sound. If we’re using, for example, our sense of smell to get information about a patient, they are now analyzing the aerobiome coming off of people and how that correlates to their skin microbiome and to the chemicals coming off of it. It’s just somebody who’s trained their nose to be able to detect that and get useful, which is really helpful. There’s nothing woo about it. The course correction there for not using microscopic information to make all of our decisions is, that I’m increasingly falling in love with herbs, which work at this level.

Ari: With what?

Dr. Mel: With using herbs with this ecological understanding, to me, is the antidote to using individual synthetic nutrients to try to manipulate these pathways that if we can see that someone’s hot, we can use herbs that help the body to get rid of heat. If we see that someone’s damp, which a lot of people are, which is like having biofilms and dysbiosis and candida overgrowth, we can use herbs that help clear that, which is just a little bit different than using herbs that are antimicrobial. Those are still looking at that reductionist level and sometimes they’re a mismatch. There’s this added context that’s missing again. I think part of what keeps people moving in this direction is they don’t have somewhere to go.

Summer and winter metabolism

Ari: Yes. Okay. Let’s assume that the listener has no familiarity with traditional Chinese medicine and that model of health and these terms that you’ve used a couple of times now of if someone’s hot or cold or damp or summer metabolism versus winter metabolism. Begin to explain that to the audience in a way that speaks to them as though they haven’t the slightest degree of knowledge on any of that terminology and what any of that means.

Dr. Mel: I can do that, but what I want to also point out is that the beauty of it is that they do have an understanding of this. This is innate. You already know what I’m talking about, not because of any sort of specialized knowledge. This is knowledge that illiterate grandparents, in different cultures have. It doesn’t require a degree. It doesn’t require PubMed. Children understand this. I want to point that out. I want to tie it into what you already know that most people know that if they are hot, their heart’s going to be beating faster, even if they’re not a doctor or an acupuncturist, or a naturopath. It’s really about reclaiming things that are obvious.

Part of the problem of a system of medicine that intentionally removes context from study also creates a little bit of a war on common sense and basically says, “You think this because that’s what, but actually often what isn’t true. You don’t really know better anyways.” That’s a fallacy. We’ve got all these Greek and Latin fallacies to throw at you. That’s why we’re going to do this randomized study to find out what’s really going on. That’s a big mistake. If you are a person at home with no medical training, you might want to reclaim things that you already knew to be true and were told that you didn’t have any right to know that everything is specialized knowledge.

When I say summer metabolism, let’s direct our attention to things that you already know. In summer, if you go outside, depending on where you are in the world, there’s going to be more activity. The plants are going to be out. They’re not going to be dormant. Things move a little bit faster. It tends to be brighter and lighter. It tends to be warmer. It’s really in many ways not more complicated than that. Now we’re back to first principles again. In the winter, it’s darker, it’s colder, it’s stiller, it’s more frozen. It’s all of these things. We can tie this back to– this is our birthright. This is what’s going on whether we’re connected with it or not, and whether we are aware of it or not.

Ari: Concretize that further and say, what would a person who’s more in summer metabolism look like? What kinds of signs or symptoms might they exhibit or personality traits, and the same for being in a winter metabolism? Is that the same as saying hot versus damp?

Dr. Mel: Those are really, really great questions. Summer and winter are more natural timing, so they’re happening. If someone’s hot, that may or may not be appropriate, and damp, again, it depends if it’s appropriate for the timing. What might in summer? In summer, people tend to be more energetic, overall. They tend to be more social. They tend to move around more and there’s more warmth. Then in winter, you get the opposite. What I was starting to allude to before is that we have this cycling, or there is this cycling going on that we’re along for the ride for. Every 24 hours, the sun goes up and the sun goes down. We have day and night.

Then every year, every trip that the Earth makes around the sun, depending on where you are in the world, you have summer and winter. If we look at what can go wrong when Bob Naviaux is talking about the cell danger response, which is a three-step process that any cell goes through if it’s injured, or infected, or stressed. What he’s found is basically this is like a bigger amplitude or a bigger summer response, inflammation. You have warmth and then you have fire. It’s big warmth. It’s big fire. If that goes on for too long, you get damage. Then conversely, we can also get stuck in winter.

This is something I would also love to talk about because people who are stuck in winter are the people who tend to get missed by everyone. This is, they’re not inflamed; they’re under-inflamed. They’re not aging too quickly; they’re maybe aging too slowly. They will tend to be told by conventional medicine that they’re really healthy, their blood pressure is nice and low, their heart rate’s nice and low. Meanwhile, they’re depressed. They have no memory. They can’t poop, and all this stuff.

Ari: This is like the typical maybe chronic fatigue syndrome case.

Dr. Mel: Exactly right. It very well could be. That’s someone who’s, again, going back to natural principles, sometimes when we look at first principles, I’ve found, and I don’t know if this is true for you or in general, sometimes it’s easier to understand things if I look at an animal versus humans. Well, one thing that happens in nature is that some animals hibernate, and that happens in winter. That’s a different physiology. Part of that physiology, things slow down, blood flow to a lot of different parts of the brain slow down. We’re not optimized for standing up.

What happens in chronic fatigue? In chronic fatigue, which is a little bit, people can be different within that umbrella, but a lot of problems happen from not being able to stand up or sit up. Why is that? Because the platform has gone into hibernation mode. That’s really what’s happening. Again, we’ve zoomed out. We start at the chemistry. It’s really confusing. In general, if we start in looking at the microscopic, we’re not going to find the patterns by starting there. We do actually need to start with some understanding. The fact is that we all do have some understanding. We’re just been told we’re not allowed to use it when we’re studying things, which is maybe a little bit of a mistake.

Ari: Okay. What else should people understand about summer and winter metabolism? What are the keys to, “Well, you know what? Maybe we’ll go here if this might help to add another layer to it.” You’ve mentioned Dr. Naviaux’s work, the cell danger response. How does that overlay with the idea of summer metabolism and winter metabolism?

Dr. Mel: Well, I was going to say, “I believe that he’s written it in his paper.” In his, I think it was his first paper on the cell danger response in 2014; it was before he had discovered these three distinct steps with these checkpoints. What he had discovered was a summer and winter metabolism. I think that sometimes that gets a little bit left out because it’s not highlighted in his newer papers, but it’s definitely part of his current understanding. The cell danger response, which is based on looking at how thousands of metabolites move, choreographed by the mitochondria, it’s a biochemical rediscovery of summer and winter, hot and cold. We’re back to first principles again.

Ari: Yes, interesting. Okay. Let’s say someone is stuck in– let’s say someone’s prone to being overly hot and being in summer metabolism. What would be good for them?

Dr. Mel: That’s a great question. I’m going to reframe this a little bit, actually, if that’s okay. One of the places where I feel like, because everyone, there’s so many people out there doing such great work. Where we need to zoom out is that functional medicine and industrial medicine is pretty much only focused, and they are missing all the people stuck in winter.

Is functional medicine mostly focused on summer metabolism

Ari: Say it one more time. Functional medicine and industrial medicine are only focused on?

Dr. Mel: Functional medicine and industrial medicine are pretty much only focused on excess summer metabolism, inflammation, right?

Ari: Yes.

Dr. Mel: They are saying, “Everyone’s inflamed.” When we looked at the most common diseases, what you rattled off, obesity, cancer, all these inflammation, these are all excess summer metabolism. All of the advice that’s being put out there for everyone is really for that group. It’s all that anti-inflammatory stuff and, breathe slowly and, de-stress and all of that stuff. Really who I more want to speak to because they’re the people who are getting missed are the people who are stuck in winter metabolism because those are the folks who are being told that their blood pressure is nice and low.

They’re also being told all of your problems are caused by inflammation, so you should be taking curcumin and whatever the general recommendations are. Even to the point, actually, I’d say like there’s a lot of researchers out there that are focused on longevity, which is interesting. It’s an interesting time to be alive. I would say that all of the findings for increasing longevity are pushing people away from summer metabolism towards winter metabolism. To give you an interesting example of how that can go maybe a little bit too far, recently in Siberia, due to some thawing, they found a worm like a nematode that was 42,000 years old that reanimated.

Ari: Wow.

Dr. Mel: That’s a 42,000-year-old animal that’s alive right now. That’s winter metabolism that talk about longevity. The blind spot, there’s an assumption, “Well, increasing longevity is good. We’ve discovered that we can increase longevity if we do this. Therefore, everyone should do this and this is a good thing.” If you have someone who’s watching and their blood pressure is low and they tend to be cold and they’re trying to do all these things to help themselves, if they follow that advice, they’re likely to feel worse. It’s really hard to find anyone to explain why.

Ari: Yes, very interesting. Personal anecdote, I’m wondering if you might have some insight into. When I moved down to Costa Rica several years ago, I started getting this weird thing on my hands where I would have little blisters that would come up, particularly between my fingers and to some extent on the palms of my hands, a bit in between my toes as well. Nowhere else in my body. It’s actually something I’ve had on and off since I was a kid. I remember seeing these little bumps on my fingers when I was a little kid as well. Eventually, I realized that this was something called dyshidrotic eczema. It only really flared up after I moved to Costa Rica.

I spend a lot of time outdoors in the sun, at the beach, surfing. It’s hot here, obviously hot tropical sun, playing tennis and doing other activities outdoors and working out as well in the gym. I spent like two years in pursuit of trying to figure out what the hell is causing this thing on my hands. I explored all kinds of things. Maybe it’s food intolerance. Maybe I’m allergic to eggs or dairy or something like that. Maybe it’s something to do with my gut microbiome. That’s what prompted me to do all that gut microbiome testing. I did comprehensive labs of all kinds to figure out if there was something going on in me that could explain this.

All the functional medicine doctors I spoke to had no idea what was causing it or how to fix it. After years of being frustrated with that avenue and trying to figure out, running so many different experiments, “What the hell is causing these symptoms on my hands, these little blisters?” I discovered something really interesting, which is that the most effective thing for me to do to eliminate it is a cold plunge.

That when I cool my body, particularly when I’m overheated, like after playing tennis for two hours in the hot sun, if I go into a cold plunge and if I put my hands in the cold plunge, especially, if I maybe even do that a couple of more times a day for a minute or two, and if I air condition my office during the hours I’m in here, as opposed to allowing the hot air from outside in and just being in here and sweating, it completely goes away and seems to be a function of literally being too hot in my body, that my body starts getting these little blisters in the palms and particularly the hot part of my hand.

That’s also something people who are genetically prone to sweating a lot through the palms of their hands, which I am, are more prone to this condition, and being in a hot climate or being in the summer makes you more prone to this condition. Also getting it in the wet and dry, like going in the ocean and then drying out or going in the pool, which I’m also doing very frequently. Those two things. I have the perfect storm of factors to generate this condition. I figured out how to completely eliminate it by essentially just cooling my body down for a period of the time and not being overly hot, which is, I think, lines up very much with what you’re describing here.

Dr. Mel: 100%. You’re using a first principles-based– sometimes the other term I use, which maybe might be a little bit confusing to people, like physics-based. What I mean by that is at the level of humans where we’re looking at up and down and hot and cold, just simple, really, simple that you’ve found a solution that’s based on temperature, which is going to have an effect on your blood flow and on the inner systems of your body and how it warms and cools itself. Also that the trigger is climate, which a lot are. There are certain things where, no, this isn’t a panacea, but for some people who are ill, if they move to a different climate, they would be well.

Ari: Yes.

Dr. Mel: That’s not always possible, and that’s not always the case. Also what I want to quickly say as well, though, is that it doesn’t follow that everyone’s going to benefit from a cold plunge. That’s this other layer that I see because there are people out there who basically say that everyone should do it. Going back again, to these people who are stuck in winter metabolism, oh, boy, they’re going to feel worse. Another piece of context is that I love the way that you’re using the cold plunge because you’re in Costa Rica.

You’re outside in the hot, it’s likely going to be beneficial for you. If you look at, for example, like Finnish people, they will tend to alternate a cold plunge with a sauna. What I see happening is people who live in temperate climates who I’ve heard that cold plunges are good, and actually, they’re doing themselves a lot of harm. it’s just physics; it’s not personal. The cold doesn’t care, and the hot doesn’t care. You’re alive and you’re in it.

It’s really about being better at asking the questions like, “Okay, who’s this going to be helpful for?” We can run experiments as well. We can use those questions as a starting point for like, “Is this likely going to be a good direction to go in?” For you, you’re super active. You’re somewhere hot. Your condition is worse for heat. There’s all sorts of reasons why that’s a good thing for you to try. Whereas for other people, it’s like, “There’s reasons not to try that right now.” You have to be at a certain level of health to be able to counteract the effects of cold.

Then that goes into one of your, I think one of your favorite questions about hormesis that for some people, going into a cold plunge, for example, or exercise or all these other hormetic stressors, it’s going to trigger a response in the body that’s going to increase health. For other people, it’s going to decrease integration. It’s going to make things worse. It’s about getting more yet discerning and being able to be like, “Okay, so when is this likely going to be helpful? When should we try this? How do we know if it’s working?” That sort of thing.

Can you age too slowly?

Ari: I’m trying to think, where should we go from here? There’s one thing you said that’s an interesting idea, which is you said in passing that some people might be aging too slowly, that there’s so much focus on people aging too quickly and how do we slow down aging, but that there’s a subset of people who are, from your perspective, aging too slowly. What does that mean?

Dr. Mel: That’s a little bit of a jumping-off point into looking at something called polyvagal theory, perhaps. Maybe some of your listeners are familiar with it and some of them are not. Just to give a little background, most of us tend to think, if we think about it at all, of the nervous system having a gas and a break. The sympathetic system would be the gas and that’s associated with stress and the parasympathetic nervous system would be associated with the break, and that would be calming us down.

Then it follows that a lot of the advice is that we’re all too stressed, and we’re too hot, and we just need more break and to calm down. It’s a little bit more complex than that. There was a researcher, or there is a researcher named Stephen Porges, who’s been studying heart rate variability and the vagus nerve and basically the nervous system, since the 1960s. What he found was a little bit of a paradox, which was that if your heart is beating, with a little bit more dynamics to it, then that’s a sign of health and it’s a sign that your vagus nerve is working a little bit stronger.

When he was doing research in the neonatal intensive care unit, I think in the 1970s and 80s, as babies became more distressed and were entering more of a danger zone, their heart rate went from very fast to very slow, where there was a danger that it might stop, but also that they were able to tell that the vagal tone was actually increased, not decreased. That variation was increased and not decreased. This was a bit of a paradox.

That led him to explore and really realize that the vagus nerve has two components to it. This is also based on evolutionary biology. I’m not going to dive too deeply into that right now, but it’s an important first principles part of our understanding that we have a gas pedal, which is the sympathetic nervous system. We have two breaks. We have a gentle break and an emergency break. The gentle break and connection and relaxation and all these good things, but the emergency break is triggered based on life threat.

It’s related to going into winter metabolism. That will because you to age more slowly because you’re in a bit of a suspended animation, but it’s, I would say, pretty terrible quality of life. You can feel dissociated. Your body’s breaking down. It’s really just a last resort. That would lead someone to age more slowly. That would lead someone to look better on labs because they are exhibiting in many ways the opposite of what they’re looking for, which is all of these inflammatory metabolic diseases.

Ari: Fascinating. Mel, I wonder if this might be the best place to leave it for today. I know we have a lot more to explore, particularly resting heart rate and heart rate variability, which ties into what you were just talking about with polyvagal theory there, and I suspect probably hours more of content that we could discuss. Let’s do a part two, and we’ll reconnect in a few days and pick up where we left off. We’ll release these as two podcasts, and who knows, maybe a third one will follow. Let’s keep exploring. I’m fascinated by your paradigm and your way of looking at human health. I’d love to keep exploring this with you. Does that sound good?

Dr. Mel: I’d love that.

Ari: Wonderful. Awesome. Well, thank you so much. This was a fascinating discussion, and I look forward to catching up with you again in a few days.

Dr. Mel: Thank you. I really appreciate it.

Ari: One last thing, Mel. Let people know where they can find you if they’re interested in working with you, getting in touch with you, your services, products, anything like that.

Dr. Mel: Sure. Most of my work where I’m helping people is over at Did I get that right? I have two groups. One is for people with complex chronic illness. I help people all over the world. It’s a fantastic group program. It’s really cool. You can come in for free, actually, for a little while, hang out, ask me any questions about your health before deciding if you want long-term mentorship. Then I have a second group for practitioners.

Those are for people who want to learn how to use this in practice, but also there is actually a significant number of practitioners with their own health problems who have struggled to figure out where to go. It’s really for people like me a few years ago to get themselves healthy and learn these first principles so that they can be a healthier version of themselves and apply what they’re learning to their practice.

Ari: Beautiful. Thank you so much. I’ll send you an email and we’ll figure out the next time to connect for part two.

Dr. Mel: Thank you. I appreciate it.

Ari: Thanks, Mel.

Show Notes

00:00 – Intro
00:30 – Guest intro – Dr. Mel Hopper Koppelman
04:58 – Dr. Mel’s paradigm of health
06:15 – The first principles for health
12:17 – Issues with lab-testing
24:24 – Does biochemistry matter?
32:55 – Summer and winter metabolism
41:50 – Is functional medicine mostly focused on summer metabolism?
50:49 – Can you age too slowly?


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