Listen to the podcast episode here: Weaving Integrative Medicine into Pediatric DPC
In this episode of the DPC Pediatricians Podcast, Phil and Marina explore how integrative medicine fits naturally within the Direct Primary Care model by discussing the distinctions and overlap between lifestyle medicine, functional medicine, and integrative medicine. Marina explains how integrative pediatrics combines evidence-based conventional care with complementary therapies while focusing on the whole patient and addressing the root causes of disease. They discuss practical strategies such as optimizing nutrition, sleep, movement, stress management, and appropriate supplementation, while emphasizing that DPC’s longer visits allow for more personalized care and shared decision-making with families. Using ADHD as an example, they illustrate how physicians can thoughtfully combine lifestyle interventions with conventional treatments when appropriate, ultimately encouraging pediatricians to expand their clinical toolbox while remaining grounded in evidence-based medicine.
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr. Marina Capella, two DPC pediatricians who are on a mission to share our love of direct primary care with you.
Welcome to another episode of DPC pediatricians. Today I am going to be grilling Marina quite a bit because I hear a lot about integrative medicine and integrative pediatrics and I think that there’s a lot of misconceptions out there on other episodes we’ve talked about how that is something that helps practices to stand out is a more integrative approach.
And so i want to help our listeners be less ignorant of integrative medicine and myself to be less ignorant of integrative medicine and so Marina as somebody that has done all of the work in developing your pediatric integrative practice can you first and foremost like define what integrative means to me because i get confused when we talk about the big three that come to mind of lifestyle functional and integrative and i feel like there are specific terms that i should be thinking about when i think about those but i don’t have a very good vision in my head of how to separate those out and I’m sure that there’s overlap but if we look at the venn diagram there are things that overlap and there are things that are specific so can you kind of define the terms as a starting place.
uh well first of all you probably already know a lot more than you’re giving yourself credit for secondly absolutely there’s a ton of overlap and this is still something i still get a little confused on the difference between functional and integrative medicine but yes you mentioned the big three lifestyle medicine, integrative medicine, and functional medicine.
Generally confusing for most people because like what’s what i think people often just use the terms interchangeably and partly it’s because there is a ton of overlap between those so first of all lifestyle medicine i will say is probably the most focused of the three lifestyle medicine is really talking a ton about nutrition first of all really getting good at understanding nutrition and its impact on chronic diseases acute illnesses how can we really modify diet to improve health but also they talk about other factors related to lifestyle movements and physical exercise they talk about sleep they talk about relationships and so really all
of those modifiable lifestyle factors that we can talk to patients about that can help them to feel more empowered about their own health and to really make strides in feeling better so that’s kind of how i understand lifestyle medicine and there’s a whole lifestyle medicine course you can take through the american college
of lifestyle medicine you can get board certified in lifestyle medicine it’s pretty that’s probably one of the shorter trainings it’s still extensive but it’s a shorter training and then there’s functional medicine which functional medicine covers basically all of the same things it gets more into
things like supplements into things like what kind of labs can we do to try to figure out i’m not an expert in functional medicine so take this part with a grain of salt and it still includes a lot of those same principles but it’s
a little bit of a wider umbrella than than lifestyle medicine okay and then on top of that there’s integrative medicine and i see integrative medicine as the biggest umbrella that really looks at all the stuff in modern medicine lifestyle medicine supplements labs and also embraces a lot of the stuff
that we sometimes consider woo-woo in the field of modern medicine so energy medicine things like homeopathy things like traditional chinese medicine ayurvedic medicine spirituality and so it really delves into lots of those things that we’re just not usually comfortable talking about in evidence-based medicine and it tries to take the approach of like maybe we don’t understand it
in as rigorous a scientific way as we can or we don’t yet understand it but humans have been using these modalities for healing for millennia and there are beautiful things that can come from it and when we’re truly trying to treat a person as the whole person it’s mind body emotions spirit right
really embracing this really big umbrella of like holistic modalities it’s and the way i explain it to my patients when they come and they’re like what’s it i mean they don’t know what integrative means then i describe it more as holistic on my website i say look it’s taking the best of modern medicine and blending it together
with age-old traditional healing modalities like mind-body techniques like herbalism right and so that’s kind of how i explain it in a really simple way to my patients
that is really helpful and i’ve seen all the different things i’m in some of the different facebook groups and i’ve never had it explained so succinctly of oh okay that makes sense when i think about like i think that lifestyle i feel like i have a general idea because it’s in
the title really like adjust your lifestyle functional versus integrative has always been confusing for me and my read on that is that functional is a lot of like biochemistry often lots of lab tests yes lots of like lab tests that insurance doesn’t cover and that are expensive
and like hair samples pee poop all sorts of blood amino acid tests and all those sorts of things and then i now feel like i have a better understanding of where integrative falls in that as looking at not just the body and like the biochemistry and not just
the lifestyle approaches of like get more sleep you know eat better those sorts of things but it takes like the whole picture and integrates more on the spirit side and i always think back to so i went to ymca camps as a kid and was a camp counselor for ymcea
they have like the triangle that is spirit mind and body and i’m always still like hold
so lifestyle and functional tend to focus more on the mind body in that triangle that you just discussed and integrative i feel like really does a good job for practitioners who actually embrace it to also add that spirit component and it’s interesting because it opened my mind to a lot
of this energy medicine stuff homeopathy for example is a form of energy medicine homeopathy a lot of people think the homeopathic medicines are just like herbal medications or natural supplements right but homeopathy actually has a long history and it’s based on something called dilutional principle where like let’s say you’re using chamomile
because you like chamomile has herbal plant medicine properties that are useful to calming the nervous system and the gut right and the guy who developed homeopathy actually said well energetically the more you dilute the substance the more potent it gets and from a scientific perspective that makes no sense because you actually study thank you
for saying that you study you studied some of these compounds that are sold as homeopathic you know remedies and there’s no bioactive substance left in some of these depending on how much they’ve been diluted but the guy who developed homeopathy truly believed from an energetic medicine perspective that dilution increased potency and people in
that homeopathy world truly embrace that belief and just like we can run a randomized control trial on a new cholesterol lowering medication and half of those people get placebo and some of those people like a placebo are going to improve that’s kind of what’s happening i think in the world of homeopathy that’s
the best sense i can make of it that is that our minds are very powerful if we believe that something is going to help us then sometimes it does help us and so when i encounter families who really want to use homeopathy i don’t fight it i just say wonderful
and if you have your kid ever needs something else in addition to that then let’s i’ll let you and right hopefully be open to that but yeah this whole world of energy medicine including reiki i’ve taken some courses in reiki some of the myofascial release that i do like while i am working on
a child it’s not just about the physical maneuvers of helping with their neck restrictions it’s also about sending love and positive intention and and doing my own grounding techniques to clear my energy field so that i can be present and as much of a healing force in their lives as i can be so
and also allowing the voice of intuition to speak through me of like sometimes ideas my mind and like they’re brilliant ideas and they’re i like i don’t always give myself credit for them it’s i think that there’s a higher force helping me along so yeah integrative blended well with me because i really like embracing that part
of healing well and i think that anyone that’s been at one of your lectures where you’ve done the hypnosis can attest to like your power of healing and the way that you’re able to with your energy and with your voice and with the way that you you carry yourself and and yeah
do that that like we can see when we can feel i mean you can see just to see the room after the last mastermind where you had done your clinical agnosis how powerful that is yes i know i got
if you missed the last mastermind i did the talk on using clinical hypnosis in kids with anxiety and i really felt like the right tack to take was to make it an experience instead of focus too much on the facts and the details which do exist and i am working on a bibliography
to send everyone who attended but uh yeah it was really powerful because i led the group this group of i don’t know probably 50 60 people in the room through these two hypnosis and of course you didn’t have to participate if you didn’t want to want
to well i mean you’re supposed to close your eyes and i’m not very good at closing my eyes so i’m just peeking and a typical lecture 10 15 are actively engaged listening and nodding another 30 to 50 are on their computer like multitasking for you i mean everybody is just locked in and nobody’s
on their computers nobody’s checking their phone they’re just listening and taking it in so you do get full credit for you know getting active participation um in that and it is really powerful before we go can i just ask a couple of questions like when when you are seeing a two-year-old for their checkup
how and obviously this is dependent on what issues they’re facing but typical two-year-olds are there specific things that you cover with every two-year-old much like we would cover like the bright futures things for for a two-year-old pediatric visit are there specific things from an integrative approach that are kind of standard that you make sure and cover
with all parents of two-year-olds when they come in and have all the typical kind of two-year-old complaints yeah
i would say that like for your average family who’s not because i attract people who are just they just want a regular pediatrician right they want someone who spends more time right so for my typical family i’m doing all the stuff that right that i did in my other practices
and what i’m doing is i’m just spending more time talking about sleep i’m talking about nutrition and delving a little bit more into like gut health i’m also paying just more attention and making sure that i read the energy of the family and relationships closely because sometimes they may not divulge something but i might get a sense
as i read things vibrationally that there’s something going on and i might it might lead me to ask a certain question which then takes us down the path of a certain conversation around whatever is going on in the life in their life so sometimes it can just be about a simple conversation about
baby is still waking up six times at night and using mom as a pacifier because baby’s sleeping either closely from receiving a crib right next to parents and so i might read like the mom is more tired than she should be at this stage and like let’s have a gentle conversation let me open
the doors let me give her permission to talk about how she really feels about that and if she’s ready to make changes or if she’s not ready to make changes and so i think overall it’s just a little more attention to the things that all
of us talk about already but where the integrative really comes in is when there’s a unique problem and so it could be something like a kid has an ear in fact like ear pain or an ear infection and if i know that this family wants the more holistic approach
then i will especially lean into like hey maybe you don’t want to jump to antibiotics right away that’s totally fine that’s actually the standard of care nowadays and let’s do some garlic oil let’s do some omt techniques and let me teach you a massage around the ear to help open up that
that eustachian tube right and drain fluid and so i’ll go over those things that the family can do and it doesn’t have that much time super simple but it gives them something to do while they wait for hopefully that hair infection to self-resolve and then what i do i mean i’m still
a moderate evidence-based pediatrician and so i will say hey if it’s not getting better after a certain amount of time then it’s time to turn to antibiotics and i try to really assuage all the their concerns because some of my families are really crunchy and really hate the idea of antibiotics and so i’ll try to say hey
if we do it together with a probiotic and this is how to time it and this is how to these are foods you can give your child after to really help restore their gut health and fermented foods this and that so yeah i think a lot of it i’m doing the same thing
that any other pediatrician is doing but maybe putting more attention and intentionality into certain subjects and then also when issues arise offering those integrative approaches when it comes to more complex kids that’s when i really say hey like what about let’s do hypnosis let’s do teach you tapping let’s do mindfulness
or breathing exercises let’s do some body work let’s do this collection of herbs for a while like that’s where it really comes in handy
that makes perfect sense that was gonna be my other clinical quandary was like for an ear infection or something like that which i think most pediatricians hopefully nowadays are like let’s see if we can avoid antibiotics and pull these other things are just watchful waiting
or ibuprofen although i mean obviously all kind of those sorts of things and then let’s see if we need to get to that point but i think a lot of families are very open actually i think all families are open to avoiding antibiotics as much
as they can but if you pair it with you here’s some other things that you can do that may be a benefit in the meantime then i think that helps to get buy-in both right now of hey here’s the things that you can do
and also you did those things and it hasn’t gotten better or it’s getting worse and so now we do need to turn to western modern medicine because we want to make sure that there isn’t a bad sequelae or something along those lines
so i think it makes it much easier to meet parents where they’re at or where they’re and say hey i got you i understand that you have some worries about this here’s where i would start and then here’s where i would go
yeah and i think you you yes you hit the nail on the head there that like i meet people where they’re at and i think most of us try to do that anyway that’s like a mark of a good pediatrician right i think i would just say
that i have more tools in my toolkit that i’ve added over time that when either the family doesn’t want to turn immediately to modern medicine or they just want the vast majority of my families are not rejecting modern medicine they just say they also want the other stuff
together and the prevention and the the more holistic viewpoint well i think
that i had brought that up at my talk at the mastermind too was like if you can meet them where they’re at then it makes it much easier to get them to the point of accepting the western medical advice my example at my talk was
the child with adhd and okay like i can tell from the waiting room with my door closed that this kid is going to benefit eventually from a stimulant but i’m not going to lead with that because then the parents are going to leave
and they say all they wanted to do is medicate and blah blah blah blah we’re going to start with cleaning up his diet we’re going to start with screens we’re going to start with checking his labs and making sure that we don’t have low ferritin or something along those lines oh that feels like the right approach
to me doc this is what i’ve been wanting and then we’re going to try those things okay we made some progress but it’s only like 10 or 15 and we’re still struggling with these things now i think that we should enter the discussion because we’ve optimized these other things around medications
and you’re you i mean yeah the the ferritin helped 10 but the the the methylphenidate helped the other 80 i’m not surprised there but but you have met them where they’re at and it has given you the opportunity to practice these other skills to expand what you’re able to offer to see what works
and what doesn’t work you give it some time you meet parents where they’re at and it feels great and it feels great to help not just that like i can i finally tricked them into getting them on the medication that’s not what we’re aiming for here but it’s we employed all
the different things that are available that have evidence behind them that work that that we can do and it helps parents feel so much more comfortable with that
so yes exactly i’m so glad you mentioned that story because it’s true and and i that’s what i would do with a kid with adhd too is i i read the vibe of the family coming in really well and it’s like okay where are you at what are you afraid
of like what are your goals like what do you think you can reasonably do and we have that long conversation to truly understand where are they at and what are they ready for what are they not ready for and tread carefully and uh and the time really helps with that of course um
yeah i’ve definitely had some families that they eventually they eventually turned to medicine but they did it at a time and in a way where they felt more confident just like the story you shared i think it’s
a big part of shared medical decision making too like what works because sometimes i mean even in my previous practice it was like guys i think they need therapy and they’re like we can’t afford it we don’t have time for it okay well
then we’re going to take a different tack like i figured out what’s going to work for you right now and what’s not going to work for you and now we can pivot and figure something out yeah well this has been a great discussion um i’ve learned a lot about integrative approaches
and kind of how to parse all those different things that we see online out to to understand better how you approach that and so as one last reminder if you ever want some specific help we do offer consultations for pediatricians that are in dpc that are considering dpc that just have an idea that they want to
so there are consults if you go to dpcpediatrician.com you’ll find how you can book one of those and then marina also has a ton of courses and other ways that she’s able to help in addition to the free getting started guide there’s a ton more resources tools trainings on dpcpediatrician.com so that you can find
and help stay unstuck get the help that you need get the support that you need to start and grow and love your pediatric practice absolutely and we we hope
to be doing another virtual summit this year too in case you were not able to join the live mastermind that happened recently so keep a lookout and be on our mailing list for that so you find out when it happens hopefully sometime this fall is that still on
the books phil we’re still yeah i mean we haven’t i was just thinking about
that we need we need to get on that well last year we planned it and put it together in like a month and so this year we’ll we’ll have we can do it again it was wonderful it was wonderful it was great so yes i am glad that you put that out there and uh the accountability
of everybody that’s listening right now exactly now
when is this thing yeah all right thanks everyone for listening until next time
