#57 Rethinking Health in the New Year: Dr. Gary Soffer on Integrative Medicine

As we begin a new year and many are reflecting on their health and recommitting to self-car, this episode invites a deeper, more expansive conversation about what health actually means, especially for those living with food allergies, chronic illness, or caregiver stress.

In this episode, I’m joined by Dr. Gary Soffer, allergist-immunologist and integrative medicine physician, for a thoughtful discussion about the intersection of conventional medicine and integrative care. Dr. Soffer shares his path into integrative medicine, common misconceptions about what it is (and isn’t), and why approaches rooted in ancient traditions (breathwork, meditation, yoga, mindfulness) remain profoundly relevant in modern medical care.

Dr. Soffer's perspective offers powerful mindset shifts for how patients and caregivers can relate differently to their health, their symptoms, and the medical system itself.

Instead of the usual 3 Action Steps at the end of the episode, we concludes with three rounds of a gentle guided pranayama breathing practice led by Dr. Soffer. This short and simple exercise is a perfect way for beginners to learn a new practice.

Follow Dr. Soffer on Instagram @garysoffermd

Special thanks to Kyle Dine for permission to use his song The Doghouse for the podcast theme!
www.kyledine.com

Find Dr. Whitehouse:
-thefoodallergypsychologist.com
-Instagram: @thefoodallergypsychologist
-Facebook: Dr. Amanda Whitehouse, Food Allergy Anxiety Psychologist
-welcome@dramandawhitehouse.com

Transcript

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0:03

Welcome to the first episode of Don't Feed the Fear for the New Year. This is a time when many of us are refocusing on our health and our wellbeing. We are setting intentions, and thinking about what we want to do differently moving forward for those managing food allergies or other chronic illnesses, either for themselves or someone they love. Health can feel more complicated than a fresh start or a simple resolution. I am so excited to share with you one of the favorite conversations of mine that I've had on the podcast, yet a chat that invites us to consider that complexity of health more fully and hopefully a little bit differently. My guest today is Dr. Gary Soffer. He is the director of the Integrative Medicine Program and the Associate Program Director for the Pediatric Residency Program at Yale School of Medicine. Dr. Soffer Is nationally recognized for his work on the cross section of integrative medicine and allergy immunology. He has interest in food allergies, eczema, asthma, environmental allergies, and also sees patients in clinics for sickle cell and for integrative oncology. In this episode, we explore what integrative medicine actually means and what it doesn't. We unpack common misconceptions and talk about how practices rooted in ancient traditions like yoga, meditation, and breath work can complement modern medical care rather than replace it. Dr. Soffer also shares some meaningful mindset shifts around how we think about our health healing and our relationship with the medical system, As a gentle way to begin this new year, Dr. Soffer closes our conversation by guiding us through a pranayama breathing practice Thank you to Dr. Soffer for this great conversation and to all of you for joining me here as we begin the new year together.

Speaker 1:43

Welcome to the Don't Feed the Fear podcast, where we dive into the complex world of food allergy anxiety. I'm your host, Dr. Amanda Whitehouse, food allergy anxiety psychologist and food allergy mom. Whether you're dealing with allergies yourself or supporting someone who is, join us for an empathetic and informative journey toward food allergy calm and confidence..

Amanda Whitehouse, PhD 2:04

Dr. Soffer, thank you so much for joining me. I'm so excited to have you here on don't feed the fear for a New Year's episode.

Gary Soffer, MD 2:10

Thanks for having me. I'm really, I'm really excited to speak with you.

Amanda Whitehouse, PhD 2:14

There's so much that I wanna ask you about, but I thought this was the perfect time to have you on the show because this is the time of year when people are recentering and thinking about their health and their wellbeing. I would love if you could explain to us, what your background is in medicine and what exactly it means to be in integrative medicine. 'Cause I'm not sure people fully understand that. I think they mix it up with holistic and functional and,, all those different words that don't mean the same thing.

Gary Soffer, MD 2:39

Yes. You know, we can talk about all of those answers for about four hours, but, the, the quick version of it is I was really interested in integrative medicine long before I was interested in actual medicine. Um, when I was, when I was five. You know, I fell in love with the karate kid and started taking a TaeKwonDo class and learned how to meditate. And when I learned how to meditate, that sort of introduced me and opened me up to Eastern Philosophies. And then at 13 I got my first acupuncture session, and that was pretty transformative for me, and it all sort of unfolded from there. Um, I actually had a completely different career and zero intention of ever entering medicine. In fact, there are definitely people from certain points in my life who would laugh pretty hard if they saw me now as a physician. Um, and, and I, and, and the journey was a little long. So I walked, I worked in the music business for about five years, didn't know what I wanted to do with my life. At the time, I sort of did an assessment of, of my values and what I was interested in and also like how do I shoot for the stars? I'm 25, this is maybe my last opportunity to shoot for the stars, which didn't turn out to be true 'cause I'm constantly shooting for the stars. But, um, but I thought it was, and I thought I would pursue the last thing that anybody would expect me to pursue, which was medicine. And luckily, I, I fell in love with it. You know, part of it had to do with me caring for, for a cousin who was in the hospital. Part of it had to do with a conversation I had with my uncle, who is also a physician. It sort of exemplified in the story that I, I asked him about medicine and he said, you don't want to do this. The field is going south. It's, it's awful. And the way they treat doctors. And after, you know, a couple of minutes of ranting, I turned to him and I said, but would you do anything different with your life? And he got this big smile on his face and he said, no. He's like, I think you should do it. And so I volunteered and I shadowed and, and I, I was lucky enough to fall in love with it. Um, but the original interest of integrative medicine had always been there, and I carried that with me in my pursuit of of medicine throughout my journey. Um, and it showed up in different places. It showed up, you know, in teaching meditation to my, my fellow medical students or spending a year in India in between medical school and residency. But eventually, as I dabbled in it, I was, I was finally able to pursue a fellowship in it. And that's one thing that people don't realize that, that there's a, there's an approved fellowship for integrative medicine, and it's a two year training program, so it's a very specific thing. Uh, it is distinct from functional medicine, and we can talk about that. Certain things fall within its umbrella of integrative medicine. But, but not everything. You know, I, I always sort of rely on the NIH's definition of integrative medicine because I think it's, it's really beautifully done. And so they distinguish it from alternative medicine, complimentary medicine, and then finally integrative medicine. They define appropriately alternative medicine as, as an alternative. You're, you're, you're going elsewhere. These are my patients who I treat with cancer, who go, you know, to another country for unapproved treatments and they receive infusions of something, um, and they come back. Then we have complimentary medicine. These are my patients who may be getting their chemotherapy or maybe having their food allergy, but also going for acupuncture or learning to meditate. The key word that the NIH uses to describe integrative medicine is coordinated care. And so when people like me show up in the hospital, our job is to bring all of those pieces together in a coordinated way so that we're having these open dialogues and these, these conversations, our patients are already using these things. And so we want, if we wanna pretend to turn a blind eye to it, that's up to us. But, but ultimately it's not what's best for the patient. So I think integrative medicine shows up in many ways and, and for. Everybody, it's a little bit different. There's a massive toolbox I get to pull from. And so for some people it might mean yoga and meditation. For other people it might mean diet and exercise. Everybody's different. But the ultimate goal is how do I make this patient feel better? The goal isn't to cure the disease always, but it's simply just how do I make this patient feel better? And I think. So much of disease is experience. I mean, you know this, right? Like you live this. We have our food allergy patients who just live with it. They're fine. They're living day-to-day lives. They figured it out. They're safe. They're not, they're not cavalier about their disease, but it's part of who they are, and they navigate life just fine. And then we have. Many of our patients who are paralyzed by it, many of our families who are paralyzed by it, their entire life, their entire identity becomes about this. And this is where integrative medicine comes in because it's about how do you experience the disease? And you know, maybe it's a little dependent on how many food allergies you have, how severe your reaction is. But ultimately that's not my experience. I have kids with single food, food allergies. Who have a much poorer quality of life than kids I have with multiple food allergies. So that's where integrative medicine really shows up for me is, is how do we experience the disease? How do we make people feel better?

Amanda Whitehouse, PhD 8:50

That's a great answer. I wasn't expecting the, explanation to be so beautiful. There's a lot of factual information in there too, but, such a great framework. To ask someone about how they experience their disease and to focus on that, many of the people who are focused and their experience being defined by cure, outgrowing, when we're talking about food allergy specifically and you're framing it in a completely different way, which is what actually helps people to feel better and to live better and healthier.

Gary Soffer, MD 9:16

Yeah, that's the goal.

Amanda Whitehouse, PhD 9:18

So what does it look like for you, your day-to-day work?

Gary Soffer, MD 9:21

Mm-hmm. So, I mean, it depends on, on which aspect I'm working in. So I, I have a very independent cancer. Integrative medicine clinic. I have a very independent pediatric sickle cell integrative medicine clinic, and then I have my, what might be perceived to be fairly conventional allergy and immunology clinic. But I think where integrative medicine really shines is actually not in those independent clinics, but, but in my allergy immunology clinic, because so much of integrative medicine is about a lens. So if I'm seeing patients with allergic rhinitis, my lens is not a stuffy nose. It's not itchy eyes. My lens is sleep. That's the integrative medicine lens. I'm thinking about sleep because I know that patients with allergic rhinitis have more cognition issues. They have higher rates of depression, they have higher rates of suicidality, higher rates of ADHD. But if I'm going in with this lens of sleep, I'm thinking holistically, right? That that term has been destroyed by a certain industry, but that's really what it means. I'm thinking about the patient holistically. I'm thinking about their mental wellbeing. I'm thinking about their sleep. I'm thinking about their health as a whole, but I'm thinking about it through their nose, right, through their boogers, through their stuffy nose. And, and that lens is also what's sort of allowed me to watch patients. Come off of a DHD medications. Like, I'm not saying that's the answer to a DHD, I don't want anybody to misinterpret me, but, but I do wanna say that, like, if we're thinking about these things. We're thinking about the values that families are coming into our office with, then we can treat the patient very differently. Food allergies the same way. I am a huge, huge advocate of food challenges. I do very, very high level food challenges in my patients, and one of the major reasons why is. Well, there's a lot of major reasons why, but I'll use it. I'll use it from, from your world. You know, Maslow's hierarchy of needs, right? If we think about food allergy from the perspective of Maslow, hierarchy of needs, we're talking about safety and security, right? That's, that's at the bottom. We're talking about belonging, social and emotional belonging. We're talking about food. All of these needs that we have as humans. Not just as food allergy patients, but as humans aren't being met often because of our food allergy. So that's one lens. The other lens I'm looking at is, if you look at the top nine allergens, they're all anti-inflammatory foods. They're all really healthy, nutritious foods. And so if I can get my patients to eat them, I'm automatically putting them in a healthier diet category.

Amanda Whitehouse, PhD 12:15

I'm thinking about Maslow. My brain is often a, a little tangent about that for listeners who aren't familiar, Maslow's the guy who talked about, we need our physical needs to be met first and our safety needs, and then so on and so forth, and up from there. And he added a category before he died he talked about self-transcendence and that is. Perhaps a, a piece of, your work and how you frame things and, mindfulness and some of these things that are really science-based to me seem to go to that added level

Gary Soffer, MD 12:40

Because self-transcendence is the ability to see past self. And when your disease becomes identity, your disease becomes all of you. It's really hard. It's really hard to feel active in a community. It's really hard to feel in service. Some of the best patients I've met are the ones who are working within the food allergy community because they've been able to transcend that identity of me and create an identity of us.

Amanda Whitehouse, PhD 13:10

that's beautifully said. I love that. My brain is also on the sleep thing because as a psychologist, I used to do, preschool and special education

Gary Soffer, MD 13:17

Amazing.

Amanda Whitehouse, PhD 13:18

intervention. Um, and so, you know, a lot of kids were being referred for behavioral stuff and obviously I had a very different training but I ended up diving into so many of the different. Things that I could refer kids out to, like your kiddos. Four, before we talk about ADHD, let's check his sleep. Let's check if there are airway issues, any kind of allergic diseases and things like that, I'm curious on your take on that overlap

Gary Soffer, MD 13:39

think they, they, they're, they're not overlapped. They're, they're enmeshed. They're like deeply enmeshed, right? Like, it's not this, it's this, you know? It's, it's back to the point that we were talking about before is how we experience disease. It's so different across the board, but there are changes that we can make. So for example, another lens is asthma, right? I see a lot of patients with asthma. I'm not thinking about coughing and wheezing. I'm thinking about an ability to exercise. And what does an ability to exercise mean? It means that I can play with my friends, I can go outside, I can. All of a sudden my, the experience of my disease completely changes by, by the inhaler that I'm using a simple, simple intervention. So that's the other point, is I'm using conventional medicine, right? I'm using inhaled corticosteroids. I'm using intranasal corticosteroids. I'm using those medications, but with a very different mindset and a very different approach.

Amanda Whitehouse, PhD 14:41

How receptive is the rest of the medical community to this approach and this perspective?

Gary Soffer, MD 14:45

So, I mean, I, I'm definitely dealing with a lot of prejudice.

Amanda Whitehouse, PhD 14:49

Mm-hmm.

Gary Soffer, MD 14:50

I think once they hear me out and they understand what I'm saying and the position I'm coming from, listen, you can't only blame conventional medicine for its take, right? There's a lot out there from integrative medicine that's concerning. Concerns me. It shows up in my clinic because I'm one of the few who has both training, you know? Um, so there's, there's reason to be cynical. There's reason to be skeptical. But I will say it's often exemplified when when I go to publish a paper that's strictly food allergy versus trying to publish a paper that is integrative medicine. The amount of editor comments in the integrative medicine from from the editors, dwarfs, dwarfs when I submit a paper about food allergy. So, yeah, it does. So it, it just doesn't get treated with an even hand. We, in integrative medicine, we tend to use this term evidence informed, right. Rather than evidence-based. And I really like that term a lot more, even though it has some room for manipulation. I, I like the term because it sort of admits that, okay, we don't know enough yet and people get very uncomfortable with this term. Until I remind them of how we handled early COVID, right? Like people were taking zinc lozenges. 'cause that might help people were elbow bumping because maybe that would help. I was sitting outside of my apartment with Clorox spray spraying down every piece of grocery that I had. We were just doing our best based on what evidence was available and we were doing it within this. Framework of risk benefit, right? And, and we can say cost benefit or burden benefit because certain things are not risky. Like, you know, going to meet with an energy healer, that's not risky. But if you're spending thousands of dollars to meet that energy healer, that may be a burden to you. Um. Integrative medicine, we tend to focus a lot more on the safety of things in the sense that, and the burden of things in the sense that like if, if this is safe, right? But it's not like totally evidence-based. There's not a big randomized control trial on it. We can talk about why that's really hard in integrative medicine to do anyway, but if there isn't a big randomized control trial on it, but it's safe and not burdensome, let's try it. Let's see.

Amanda Whitehouse, PhD 17:33

I feel like all of medicine and all of science is. Evidence informed, not based, because it's constantly changing. We're constantly questioning and challenging, and reevaluating or getting more information and, and at any moment we're just doing the best we can with that knowledge that exists at that moment while continuing to learn more. Right? Isn't

Gary Soffer, MD 17:52

You're preaching to the choir on it? Yeah. I mean, yes, yes, but because we're using. Ancient wisdom or traditional wisdom or indigenous practices, pieces like that. For some reason, there's a lot more skepticism about its value,

Amanda Whitehouse, PhD 18:14

Because they haven't been subjected to the rigorous scientific RCTs

Gary Soffer, MD 18:19

not only because they haven't been subjected to it, but because they may not necessarily fit the paradigm. So acupuncture is notoriously impossible to study for lots of reasons. Some of it is practitioner dependent. Some of it has to do with what is believed to be these, these energy channels through our body. Some of it is, it's almost impossible to create a control for acupuncture. Some of it is because there's different traditions, so you get, you know, lots of heterogeneity from study to study. But for many of my patients, it's an incredibly valuable tool and it's been very helpful for some of their symptoms.

Amanda Whitehouse, PhD 19:02

Talk more about why it's difficult to establish that. Scientific background, or proof, I guess is the word that people want, I think it's a tricky word, but, why are some of the other, traditional more ancient techniques difficult to demonstrate proof for?

Gary Soffer, MD 19:20

I mean, the first, the first part of it is, is the logistics, right? The funding. There is not a lot of funding for this. There's also not a lot of training and research to pursue this type of research. The next thing is, is just journal support, academic support for it. It's, it's, it know. It's not great. It's, it's not great. I'm lucky to be at an institution that supports it and is very good to me with it, but beyond my institution, there aren't many that are so supportive of it. But, you know, the, the other piece of this is I've never had a patient leave with the same plan for my integrative medicine clinic. It is so individualized. What makes us tick? What makes us feel better, and what I love is that I get to pull from this giant toolbox, but that means that I can't distill this down to a molecule, which is what people want to see. It means that I can't take a rat and do the same thing to it, which is again, how, how our research system is set up. So it makes it really, really challenging to study for, for many, many reasons.

Amanda Whitehouse, PhD 20:32

Yeah, I think about that a lot in terms of, um, how. As we were talking about how medicine typically works and how siloed, each different specialist and in which area of the body they're treating, and that word holistic, which we talked about being problematic, but it seems to me like anything would be difficult to tease out one particular aspect

Gary Soffer, MD 20:50

Well, you're,

Amanda Whitehouse, PhD 20:51

working for

Gary Soffer, MD 20:51

you're a psychologist. I think you, I, you know. CBT is probably the most evidence-based intervention, and it doesn't work for everybody. It doesn't work for a lot of people,

Amanda Whitehouse, PhD 21:03

Yeah.

Gary Soffer, MD 21:04

other things do. And when you start getting past the specific physiology spaces of a human being, the research gets murky.

Amanda Whitehouse, PhD 21:15

Mm-hmm.

Gary Soffer, MD 21:16

okay with that murkiness. I enjoy that murkiness. I suspect you love the murkiness too,

Amanda Whitehouse, PhD 21:21

I love it.

Gary Soffer, MD 21:22

But our, our, our, our medical system, our scientific system isn't set up to feel comfortable with that murkiness, even though it's there and undeniable.

Amanda Whitehouse, PhD 21:33

Right. Well, I have two things that I'm excited to ask you about that, one of those I wanna touch on is a lot of, um, skeptics of the mainstream medical, Complex as they might call it. Say that the reason that this stuff isn't more researched and there isn't more funding behind it is because of the power of pharmaceutical companies and who stands to make money from what, and I'm curious, as someone who has their feet in both of those worlds, what do you think about that piece of things?

Gary Soffer, MD 21:59

I think, you know, corporate interest and influence on medicine is undeniable, you know? We definitely do our best to, to separate ourselves from it, you know. Um, I remember running around one of our conferences looking for pens, and I was very specific not to grab any pharmaceutical pens for, for a session we were holding. Mm-hmm.

Amanda Whitehouse, PhD 22:28

Mm-hmm.

Gary Soffer, MD 22:29

which was tough,

Amanda Whitehouse, PhD 22:30

Mm-hmm.

Gary Soffer, MD 22:31

you know? Um, it's, it's there, it's present, it's prevalent. Sometimes, not always, but sometimes it's a blind spot for us. Uh, I don't think they're wrong. You know, I don't think they're wrong. Maybe I sound like a conspiracy theorist when I say that. I'm not convinced that we're ever going to find the cure for anything again, because the interest in keeping patients on chronic medication. Far outweighs the interest in giving them a single medication and letting them live their life. So I, I don't think they're wrong. You know, I do think the extent of which they believe that it exists is wrong. Right. The massive conspiracy, the conversations about doctors making money to give vaccines. I mean, pediatricians are some of the lowest paid physicians in the world. You know, these are people, some of them who have a million dollars in debt going into a field that really, really does not match. How much they've already invested into it. So those narratives need to go away. There needs to be a middle ground, right? There needs to be a middle ground in all of medicine, and I think that's where integrative medicine really thrives, is that there is a middle ground, there is, there is a space that we can all sort of live and dance in and we can both, we can all be a little uncomfortable in that space. Right. That's okay. It's okay to be a little uncomfortable in that space, but there needs to be a middle ground because our patients are desperate for these interventions and they're going elsewhere.

Amanda Whitehouse, PhD 24:26

Mm-hmm. I love that point. And I think as you mentioned earlier in the conversation, people who are interested in this, I'm sure you have a self-selected group of patients, but they're already seeking these things out anyway. Right. So, you know, they're, they're doing their own research. And of course we, we know that stereotype too, of our doctors rolling our eyes at us because we come in with an idea in our head or, or something we wanna try. Um, but why not work with, if they have an interest in something, it seems like that's your mindset and a different mindset. They're motivated to try that thing. Why wouldn't we encourage, you know, if it's not harmful, as you mentioned before.

Gary Soffer, MD 24:59

Yeah. Yeah. I mean, let's keep an open mind and let's see what makes, again, let's see what makes patients feel better.

Amanda Whitehouse, PhD 25:08

I can't, resist asking. Um, because you mentioned about that, you know, skepticism that we'll ever find a cure to anything and in the world of food allergies specifically, which is a lot of my audience. We are getting excited because we are having more treatments. We are feeling like we're finding out more and more. But the more I hang out with all of you physicians and learn about the research, the more complicated it's getting, right? 'cause we're learning about the role of the microbiome and it's very clear and yet very, complex. So what are your thoughts on that specifically as far as will there ever be a cure to food allergies

Gary Soffer, MD 25:37

I mean, I hope

Amanda Whitehouse, PhD 25:38

a prevention?

Gary Soffer, MD 25:39

I, I hope so. I hope so. You know, um, I'm not convinced it'll come from a pharmaceutical company necessarily, you know? I, I, I could give a shout out to a wonderful organization called Fasi, FASI, that is really living on the edge of food allergy research and pursuing questions that aren't always, you know, permitted in other spaces or aren't always given grants for. Um. Because I think they're thinking outside of the box. And so if it's gonna come from anywhere, it's gonna come from organizations just like that one. Um, but you know, in terms of the microbiome, right? Like that, that's a question I get all the time and every day my take on it is like, we don't even know the tip of the iceberg with the microbiome. I don't think we even know the snowflake on the tip. Of the iceberg of the microbiome, like we are so far from understanding this thing, and this is where integrative medicine gets it totally wrong. Like you can go on social media and find a thousand people who have deemed themselves microbiome experts, but anybody who is actually studying the microbiome will be the first to tell you. How far we are from actually being experts in this and actually understanding this. Um, it's, it's a big, big universe that we are just starting to get our heads around. A fraction. A fraction. So, you know, in terms of microbiome though, this is where integrative medicine is great. Right. Where it can be great is there's so much traditional wisdom about microbiome that we're not utilizing enough, right? So fiber, which is a great prebiotic, helps support healthy gut bacteria. We know that, but we've been eating fiber for thousands of years, so it can't be bad for us Fermented foods. Right. This is something that we should be incorporating in every child's diet as early as possible because this is really where people nurture their microbiome. So that's where I sway patients because I really think that's where the wisdom is, is more fermented food in your diet. Get away from the pill mentality. You know, the pill mentality is really conventional medicine mentality. And let's go back to what keep kept people healthy, which is fermented foods and, and other things like fiber rich diets, fruits, vegetables, grains

Amanda Whitehouse, PhD 28:24

Time outside, time in nature. You hear kids who play in the dirt and have their hands in the dirt, their microbiomes are more,

Gary Soffer, MD 28:30

Yeah, so some of that's, yes. Some of that's extrapolated.

Amanda Whitehouse, PhD 28:34

Okay,

Gary Soffer, MD 28:34

We'll be, we'll be careful about how we present it, but, but one of the, one of the most interesting studies about microbial exposure is this study of the Amish and the Hutterite. So really to make it quite simple, the Amish and the Hutterite are genetically almost identical, and they, they stay within their communities. They marry within their communities so that, so that genetics has not changed much over time, but the big difference is how they farm. So if you go to an Amish farm, it's exactly how we imagine it. There's a, there's a horse drawn plow and you're sitting there and you live on your farm and the dirt comes into the house and the animals are right next to the house. And so you end up with this rich, beautiful, microbial diversity who writes actually farm in a very conventional manner. They have big, you know, big, you know, agriculture, um, industry style setups. And the big difference between the two of them, if you look at them clinically, if you look at who they are is asthma rates are really quite low in the Amish community and they're really quite high in the hooter right community. And then if you take the house dust and apply it from the Amish and compare it to the hooter rate, and you take that house dust and you apply it to mice who are engineered to be a little more allergic. The same thing happens. The same thing happens. So I don't wanna extrapolate too far. I certainly want my kids to play in the dirt. I certainly have dragged them to farm after farm, you know, which they've gotten to hate a little bit, but they enjoy some of it. But, um, but, you know, but, but that's it, right? That risk benefit ratio, like I'm, I'm making evidence informed decisions in how I raise my kids based on this sort of thing.

Amanda Whitehouse, PhD 30:31

Let's talk about the other benefits of time outside and nature and sunlight and all of those things from a, holistic perspective,

Gary Soffer, MD 30:39

Yeah, I mean, you should do all of it, right?

Amanda Whitehouse, PhD 30:42

right.

Gary Soffer, MD 30:43

It's, it's all good. You know, I mean, I know there's a lot of influencers out there talking about like early morning sunlight and its impact on, you know, your brain. And, you know, I think first of all, at, at, at the most basic level, just being outside and away from our screens is deeply valuable. And I really don't think you need to be a scientist to figure that out. I think you just need to be a human and know how it feels to scroll for an hour versus go hiking for an hour. You know, I, it's, it's very overt and in front of you. Now, if you get down to the molecular level, which you can with plants, I mean, plants are releasing these, these compounds. They're called biogenic, volatile organic compounds, and these are things that actually have anti-inflammatory effects. If you look at them in a Petri dish, again, we're gonna extrapolate a little bit. I think it's an okay extrapolation. These are things that support our immunity that are good for our immune system, just simply being outside. So it's not just the beauty of nature, it's not just the sunlight. It's not just the biogenic, volatile organic compounds that you're breathing in. It's captures all of it in this one experience of, of you know, what you can call wellness.

Amanda Whitehouse, PhD 31:55

Again, it's one of those things that if we try to pull it apart, we destroy it. Right? But the whole is larger than the sum of its parts, I

Gary Soffer, MD 32:01

I, I think that's exactly it. I think that's exactly it.

Amanda Whitehouse, PhD 32:03

Yeah. What are some of your other favorite, things you do like to pull in for tools for your different clients that, that you do feel are evidence informed or that do have value, for a lot of your patients?

Gary Soffer, MD 32:15

So, I mean, you know, we, we talked about some of them already. We, we didn't talk about things like yoga and meditation and MINDBODY practices, which are incredibly important. You know, there's 30,000 different types of meditation and so there's gotta be one. That works well for you. For me, it's really just about consistency and sticking to the plan, um, and. I personally love yoga 'cause there's just so much there between the physical movement, the breath work, and then if you really dive deep into yoga and its philosophy, it just has even more to offer that go beyond the postures or the asanas, um, in how we live our lives and, and who we are. Um, but I think, you know, with meditation, people tend to over complicate it. It's, it's a pretty easy practice. It's just simply about maintaining focus, whether that focus is on your breath or maintaining that focus on a mantra. And the idea is not to not lose focus. We all lose focus. We're all gonna, our brains are gonna fly. It's really just about bringing our focus back to whatever point of focus we've picked out, again, whether it's breath or bodily sensation or something like that.

Amanda Whitehouse, PhD 33:34

Right.

Gary Soffer, MD 33:35

think these are really, really important tools that, that we need to ground us, to center us, to bring us back. Um, and then, you know, there's, there's about a thousand more integrative interventions that we can talk about. There's so much in the integrative medicine community about self-help. And I think the most valuable tool that I've seen is helping others, I think it's just so often overlooked how we serve our community, how we serve each other, you know, how we meet the world with a little bit more humility. There's so much healing that takes place in the act of being there for other humans.

Amanda Whitehouse, PhD 34:23

Yeah, that makes me think of something that I talk a lot about. there are many, many factors that go into how helping others, is beneficial. But that human connection is so central to our nervous system's sense of safety.

Gary Soffer, MD 34:35

I could talk for years about human connection, the importance of human connection. Um, it's, it's the value in things like support groups. It's the value in things like aa, but it's also the value in, you know, look, there's, there's benefit here in social media sometimes too.

Amanda Whitehouse, PhD 34:54

Mm-hmm.

Gary Soffer, MD 34:55

We talk a lot bad about social media, but I was a weird kid in high school and I didn't know any other weirdos like me, but there were a lot, there were just other places. And so social media is particularly good at finding that community for people, and that's probably a space where it's underutilized. Um, but we can use technology to. You know, these, these classic ideas of of community.

Amanda Whitehouse, PhD 35:30

It does connect us. It gives us communities where we couldn't find them before. So. you talk to patients about how to use it effectively or what to avoid? What would you say?

Gary Soffer, MD 35:39

I mean, I think in person is always better than social media. And so it's not a zero sum game of one is, one is bad, one is good, and there's a spectrum. But if I have my choice, I'm gonna tell people to go meet in person. You know, I think the, the biggest issue in, in our social landscape right now, and I'm not the only person saying this is, is the algorithm, right? It's, it's completely moved us into a space where we're validating our own thoughts. Where we're validating our own opinions. Um, and it's sort of, it's man, I mean, it's not sort of, it's completely manipulated. It's completely manipulated to make us believe what we wanna believe even more. And we've lost nuance. We've lost middle ground. Um, so I think, you know what's nice about some social communities online? Some not all. Is that you can have conversations, that you can have dialogue, that you can ask questions, that they become safe spaces for people who feel like outliers in their community who don't fit in. And when it's used for that, which isn't often, which isn't the, the, you know, the going standard, but when it's used for that, it can sometimes be really, really good. Um, but I, you know. I don't wanna tout the benefits of social media. I, I'm fairly not a fan of it. Um, and I think what I'm trying to do on my account personally is to find that middle ground. To, to make people feel a little bit safer, to make people feel a little bit less judged about their decisions and the approaches that they take, um, that they're not failing, that there is space for them. I was talking yesterday about, it's sort of a great example because I saw a social media post by very, very, you know, prominent influencer talking about vigorous exercise. There's a big study now that vigorous exercise, one minute of vigorous exercise is equal to four to nine minutes of moderate exercise. Clearly vigorous exercise is the way to go, and it's like, whoa, whoa, whoa. They said it's as good as four to nine minutes of moderate exercise. So it doesn't mean you have to do one minute of vigorous exercise. It means you can do one or the other. Yeah. You're gonna have to, if you wanna do moderate exercise, you're gonna have to do it longer. That's fine. But there's a middle ground, there's a space that, that, that welcomes everybody. And, and I think integrative medicine really creates that space to say, there's, there's something for you here. There's something that's gonna get to you where you want to go.

Amanda Whitehouse, PhD 38:31

I don't know nearly as much about some of the cultures that many of these traditions come from, but I know that they are not similar to us in terms of more is better and faster is better, and that value that is reflected in that interpretation of that information. We have that skewed value in our society that I don't think is reflected in a lot of these traditional cultures.

Gary Soffer, MD 38:52

Uh, I don't think it's reflected in a lot of cultures in the United States either. Right. I mean, I, I worked in the music business for five years. It was like an industry of excess, right? More and more and more and more and more. And then I ended up spending about a month in the north country of Minnesota. These were people who valued, you know, this was pre. Social media ish, but these were people who valued their snowmobiles and valued going ice fishing on the weekends and valued their time at church or giving back to their community. And I will tell you, they made a lot less money than anybody I knew in the music industry and they were infinitely happier. So, so yes, nobody in poverty e xperiences a lot of joy because they have so much burden on them. But there's also a space to say that that more is not necessarily gonna make you happy. And I think I see it. I've seen it in a lot of these cultures. I've seen it in the Himalayas, right? Some of the most generous people I met, some of the most welcoming people. If somebody walked past my home, I would never say, come in and have a cup of chai. I'd say my first year. What are you doing here? How can I help you? And I don't mean that to actually help them. Like I mean it in the obnoxious,

Amanda Whitehouse, PhD 40:14

Right.

Gary Soffer, MD 40:14

you know?

Amanda Whitehouse, PhD 40:14

furrowed when you said it. Yeah.

Gary Soffer, MD 40:16

exactly. You know, but here, people who lived on dirt floors welcoming us into their home for a chai.

Amanda Whitehouse, PhD 40:23

I appreciate you pointing that out because I think it's the, it's the culture that's maybe the loudest or the most noticeable here in, in our society. But you're right, there are pockets of all sorts of different values and, communities that, that are not accepting that and that are living in different ways. I can't resist since you brought it up again. Before we run outta time asking you more about your time in the music industry, because, we've connected, um, you know, and, and noticed that we have a lot of overlapping music, um, interests and I think music is so powerful both in, like connecting people and the effect that it has on our nervous system. So I selfishly, I wanna know a little bit about what you did and, and what that was like, but also then your take on music and how it affects us.

Gary Soffer, MD 41:05

Yeah, I mean, what I did is, is just about everything. I mean, I can still. Tell you every coffee order of every person on the floor of the record company. Um, but, and I can tell you exactly how the Xerox machine worked, but what I eventually worked towards was, was scouting bands. It's a, it's a position called a and r, if anybody knows what that means. It stands for Artist and Repertoire, but it's basically you're the guy who scouts the bands and, and is the bridge between the band and the record label. Um. That's, that's what I did. That's what I pursued. And, um, I did okay at it for, for my job and, and, and what I was doing. And I was, I had some success with it, but ultimately, you know, it, it wasn't fulfilling me. I was really lucky that my boss was very involved in social justice and social justice work, prison reform and drug reform and stuff like that. And at some point I just realized that I liked that stuff way more. Then, then the music. Um, it was tough to see the commodification of something that you really love so much too, that it, that at some point it becomes a business and it becomes a job. And it was a passion for me. It was something that I, you know, I held sacred and, um. It that's not met in the way that the industry is run. So for some it is. I mean, you know, I'm not saying everybody in the music industry doesn't love music and everything's a commodity. Like I certainly know plenty of people who, who are really all about the music. I think for me, ultimately, the thing I'm most passionate about, and I've said this a few times, is the human experience, how we experience our lives and. There are very few things that match both music and medicine in the human experience. They're both pretty intangible, but quite tangible, and they connect people in ways that you'd never expected. I mean, you know, I'll never forget being at a concert and having a random person just crying on me, you know? And. The same has happened in clinic spaces as well. There's just a vulnerability that both of them bring out in the human experience that I think that's where the overlap is. I think that's what works for me,

Amanda Whitehouse, PhD 43:37

Oh yeah. That's just gorgeous. I'm, I'm just a little sorry about it. Um, you know, thinking about what it is about both that kind of, like you said, the vulnerability, there's some kind of a trust, you know, obviously there's a trust. We're placing our providers, and then as you're talking about it, I'm thinking about I can go to a room full of strangers, we're all connected because we like this same music, and therefore we let down our walls in a way. we're vulnerable. And it's not weird if a stranger is crying on

Gary Soffer, MD 44:03

All right.

Amanda Whitehouse, PhD 44:04

because you have some shared experience, even though you're strangers.

Gary Soffer, MD 44:08

It felt so right at the time, you know, like, it, it, it, it felt natural and human. I think when, when you allow vulnerability to show up in the clinic space, it changes the whole patient doctor experience. Um. I'm gifted that from music, right? Like I played music, and so I had to be vulnerable. I had to welcome the vulnerability of others into my space. It became something that I became comfortable with long before I decided to be a doctor.

Amanda Whitehouse, PhD 44:39

Well, I can't help from my professional perspective, thinking of the role of emotions and comfort with emotions, right. And, back to mindfulness, being able to sit with and be present with difficult emotions, and that's what music is. And it sounds like that's a big piece of, practicing medicine the way that you're talking about it too, um, seems like the same skill or the same capacity that I don't think we really are taught how to develop.

Gary Soffer, MD 45:04

Yeah, I don't think, I don't think we're taught to develop it either. Um, but it can be developed is the point. It's not, it's, it's not an inherent skill. It's a, it's, it's a quality that can be nurtured and taught and, and learned t hrough these practices that we're talking about.

Amanda Whitehouse, PhD 45:24

Yeah. We'll have you back for sure. And there's so much more to ask,

Gary Soffer, MD 45:26

let's just do something fun. Let's just end on something fun. How does that sound?

Amanda Whitehouse, PhD 45:30

sure.

Gary Soffer, MD 45:31

So you wanna, do you, you wanna do a little breath work exercise?

Amanda Whitehouse, PhD 45:35

Absolutely. I would love that.

Gary Soffer, MD 45:36

This is one of my favorite. It's pretty well known at this point, but, um, but it's been transformative for a lot of my patients and it's called a 4 7 8 breath. Um, we breathe in through our nose for four seconds. We hold it for seven seconds and we breathe out through our mouth through eight seconds. And just like a triangle, we do it three times. Would you let me guide you in it?

Amanda Whitehouse, PhD 45:57

Absolutely. Can I be nerdy and have you, before you guide us through it, will you explain a little bit of the science behind why that works? I know that the emphasis on the exhale is a big part of the 4 7, 8 breathing

Gary Soffer, MD 46:09

So it's, you know, really, I, I don't want to give too much scientific credibility to it, and I'd rather give traditional credibility to it, right? So it comes from the yogic tradition, it's pranayama breathing. There's plenty of science behind, activating our, our autonomic nervous system and activating our parasympathetic nervous system in these breath work exercises that they can be very calming. There's, there's evidence that oxygenation shifts with all of these breath work exercises, but, but really the honor goes to the traditional practice, which is pranayama breath.

46:46

Perfectly said. Thank you for that. And I think this will be a great way for us to end the first episode of the New Year. Usually I end the episode with three action steps, so why don't you guide us through it and instead we'll just end this podcast episode with three rounds of pranayama breathing.

Gary Soffer, MD 47:03

we gotta give credit to Andrew Weil, Dr. Weil, for for it though. I mean, he gives credit to somebody else, but you know, as part of the lineage, I'll give credit to him.

Amanda Whitehouse, PhD 47:13

Okay. Fair. Fair. Yeah. Thank you for sharing

Gary Soffer, MD 47:15

Yeah.

Amanda Whitehouse, PhD 47:16

Thank you so much for being on the

Gary Soffer, MD 47:17

Thanks for having me. This was fun. Okay, so close your eyes. And this is obviously not just for you. It's anybody who's listening to the podcast. Just sit in a comfortable place, try to let your feet feel grounded on the floor and your hands grounded on your knees. And just connect for a second and when you're ready. You'll breathe in through your nose for four seconds. Hold for seven seconds and breathe out through your mouth for eight seconds. So let's begin in 2, 3, 4. Hold, 2, 3, 4, 5, 6, 7. Out, 2, 3, 4, 5, 6, 7, 8. In. 2, 3, 4, hold, 2, 3, 4, 5, 6, 7. Out, 2, 3, 4, 5, 6, 7, 8. In 2, 3, 4. Hold, 2, 3, 4, 5, 6, 7 out. 2, 3, 4, 5, 6, 7, 8, and then just slowly come back into the room when you're ready and you might feel some tingling some lightheadedness, and that's normal.

Amanda Whitehouse, PhD 48:49

Lovely. Thank you for that.

48:53

the content of this podcast is for informational and educational purposes only, and is not a substitute for professional medical or mental health advice, diagnosis, or treatment. If you have any questions about your own medical experience or mental health needs, please consult a professional. I'm Dr. Amanda Whitehouse. Thanks for joining me. And until we chat again, remember don't feed the fear.