S02E01 – Gregory Kelly- Physician Health & Wellbeing as a System Phenomenon Part 1

Physician and Naturopathic Physician Product Formulator at Neurohacker Collective, Gregory Kelly discusses physician health and wellbeing as a system phenomenon in part 1 of this two-part series.

Watch the Video

Transcript

Speaker 1:
Welcome to Heart-Based Medicine’s Heart of Healthcare podcast, featuring Doctor Gregory Kelly, ND, Naturopathic Physician Product Formulator at Neurohacker Collective.

Dr. Jan Bonhoeffer:

Today I have a really special guest with us here. I’m really grateful and pleased and honored that Doctor Greg Kelly is with us today. Hi, Greg.

Dr. Gregory Kelly:

Hi. Well, thanks for having me.

Dr. Jan Bonhoeffer:

It’s a really great pleasure to have you here because you are a naturopathic physician, a naturopathic doctor, and you are the lead product formulator at Neurohacker Collective, and you are the author of the book Shape Shift. Maybe we’ll find time to come back to that in a bit. You have done multiple things. You have this amazing career, where you have been editor of the Journal of Alternative Medicine Review, and you’ve been an instructor at the University of Bridgeport in the College of Neuropathic Medicine, where you have taught advanced clinical nutrition and counseling skills and doctor-patient relationships.

Dr. Jan Bonhoeffer:

One of the reasons why we came into conversation, not only as Neurohacker was partnering at the Heart-Based Medicine Summit last year where we saw it in San Francisco, but specifically around doctor-patient relationships … You have a really, really interesting story to tell because you have both parts in you. You have this really scientific mind in you because you’ve published papers. That’s like, I think, 30-plus papers in PubMed, and you are specializing in this very scientific product of the development of nootropics with Neurohacker. And so, this is a highly scientific process. At the same time, you are really conscious of the importance of everything that is around the pills and what we’ve learned in terms of knowledge and scientific approach in medical school. So, really pleased you’re with us.

Dr. Jan Bonhoeffer:

I wanted to start our conversation with a very unique part of your biography because you told me that you actually went to the Navy, and I thought this was such an interesting element that we can actually learn a lot from as physicians. I wonder if you could just briefly outline what your experience was at the Navy.

Dr. Gregory Kelly:

Sure. The Navy’s definitely an odd background for a naturopathic doctor here in the US. I know when I went to naturopathic school in the early to mid ’90s, I think, literally, I was the only one that had been an ex-Navy officer. One of my classmates had been an ex-Air Force officer, and then there was a few people that, at that point, had way, way back in the Vietnam era been enlisted.

Dr. Gregory Kelly:

But, the Navy, for whatever reason, if you had asked me when I was 12 years old what I wanted to be when I grew up, I would’ve said, “I want to go in the Navy.” So, it was super concrete from a young age. What ended up happening at the tail end of my high school time period, I applied for a Navy scholarship, was awarded it, and so, they paid for my … It was an engineering degree at the time. When I graduated, the deal was you owed them four years of active duty and then two years of reserves, and you would go in as an officer.

Dr. Gregory Kelly:

I graduated in ’84 from an engineering school in Massachusetts and then came right to Coronado, which is in the San Diego area. It’s one of the big … They called it an amphibious base for what would be the equivalent of the officer’s basic training. So, it was about a six-month school. And then, was deployed onto a ship for the next … what ended up being just over four and a half years. And so-

Dr. Jan Bonhoeffer:

Where did you go on the ship for four and a half years?

Dr. Gregory Kelly:

I was on two different ships. The first one was in Hawaii, stationed at Pearl Harbor. And then, the latter one was a slightly larger ship, and it was in San Diego, which was where I started and ended my US Navy time, in the San Diego County area.

Dr. Gregory Kelly:

One of the things you and I talked about a little bit before going live was how the Navy, at least in that time period, so this was the Reagan years here in the US, has a lot of parallels to the medical system, time being one of the key things. What I experienced in the Navy was that, really, you didn’t have time to do your job well at that point because you had essentially more work than were hours in the day to do, and then, if you were out at sea, layer on top of that, that you had to stay on watch quite a bit.

Dr. Gregory Kelly:

My first job in the Navy, I was in the engineering department, based on my academic background, and there was only two of us that could stand watch. So, the way that translated is when our propulsion system was lit off … We were an esteemed urban ship, so when the boilers were active, there was only two of us that could stand that particular watch. And so, we called it 40th star, but what that meant is you were on watch for six hours, off for six, on for six, cycle, cycle, cycle-

Dr. Jan Bonhoeffer:

Tremendous pressure.

Dr. Gregory Kelly:

Right. And then, in addition to that 12 hours a day of watch, you still had to do your job and sleep and eat and ideally get some exercise and do all these other things. So, time ended up being this incredibly limited resource that you just didn’t have enough of to feel like you could do your job well.

Dr. Gregory Kelly:

And then, what happened, it used to be the same back in the ’80s, that the Navy ate their young. The implication was if you were a high performer, in addition to your job, they would give you other accessory jobs to handle because they felt like, well, we can trust you to do it. And, if you did that well, then they would give you more. I know I had four additional jobs at some point as well. I was in charge of the weight loss program for the ship and the fitness program, and they called it the lock and key program, but all the secure keys, inventorying those. It just went on and on. And so, it was just this fascinating thing that everyone acknowledged, but no one had any solution other than, well, if you’re effective, we’ll just give you even more to do because someone has to be assigned this work.

Dr. Jan Bonhoeffer:

Amazing. Yeah. I mean, I guess every resident, every fellow will be able to associate with what you’re saying. You probably had a replay of this during your naturopathic training when you were in residency. It felt similar, probably.
Dr. Gregory Kelly:
Naturopathic training was a breeze in comparison.

Dr. Jan Bonhoeffer:

Okay. So, stop complaining, guys. Yeah. Well, interesting, because you’re working in a team, in a really contained area. You’re overburdened. Time is really a very valuable commodity, and you’re running at the edge of your capability. And, you know that if you’re not performing well, it’s not just that you don’t perform well, but the entire team will suffer. That is something that we very well know from healthcare as well. How did you deal with the fear and the uncertainty that you had to face every day?

Dr. Gregory Kelly:

Well, I think there was a few things that the Navy does well that there might, again, be some parallels. But, one, a lot of the daily decisions that people have to make are already made for you in the military. Again, this goes back to the ’80s. I can really only speak to my time in. But, what to wear, what your hair should look like, when you’re going to eat, what you’re going to eat, all those things have been pre-decided for you by virtue of being in this system.

Dr. Gregory Kelly:

One of the things I remember, a director of a lab here in the US, back in the late ’90s, talking about what he’d seen in natural killer cell activity testing. At the time, what had surprised him, or what he communicated to me and this other doc when we were speaking with him, was that a population that had tested out with better activity than he would’ve imagined were people in the military. My guess was that despite all the stressors, these low-level things were taken off the menu. Some degree of decision fatigue was eliminated by virtue of that. So, that was a positive. You just didn’t have to sweat any of those things.

Dr. Gregory Kelly:

And then, in terms of dealing with it, I think, for me, personally, that’s where I first focused on healthy eating. Pre-that, I had just eaten whatever someone put in front of me, literally. I was fortunate early on. One of the people I was in training with was into exercise and lifting weights, so he taught me the basics there. For my very first Christmas in the Navy, my parents sent me a jump rope, and I literally carried that jump rope for 20 years everywhere I went. So, I started a jump roping habit way back then.

Dr. Gregory Kelly:

And then, for me, there was some other things I did that weren’t particularly useful, but they were coping mechanisms. I think in that time period, in the US Navy, drinking was a pretty big issue. I think it’s been definitely dealt with much more substantially since then. But, it was an interesting time period in that mid ’80s because it was still close enough to Vietnam … I think of maybe as sort of a wild west time period, where then the Navy tried to modernize and integrate women into the service and other things. So, even while I was in, drinking went from somewhat of an old boys … like acceptable, to big trouble if you crossed certain lines.

Dr. Jan Bonhoeffer:

Yeah. I mean, this is very understandable. Under high pressure, we know this is the healthcare system as well. We know that there’s drug abuse. We know that there’s alcohol abuse. We know that there’s all sorts of behavior that is … living off the vending machine and rushing down coffee like crazy … We know that kind of unhealthy behavior or even addictive behavior is something common in the healthcare system as well.

Dr. Jan Bonhoeffer:

I was wondering, because what both systems, in a way, have in common, while being quite different, but something they have in common is that both tend to be quite hierarchical. As a regular foot soldier, if you like, you have very limited insight. Some of the things are convenient here, because decisions are taken off you, as you said. But, the other bit is that you’re actually exposed to uncertainty, and you don’t have really full insight. So, you need to trust this hierarchical system while being at your edge. Do you feel that this is a concoction where they feel like addictive behavior or the non-healthy behavior starts, unless you really make it a conscious choice to not go into it?

Dr. Gregory Kelly:

I think I would agree. When we don’t understand the why behind things, it’s tougher to buy in. And then, at least, my experience in the Navy, any new program that got put in place, it was a new safety program. There would certainly be a why you could agree to it, like this is important, but with no resources to do it, no new time added in, it just became frustrating, like I get this is important, but you can’t squeeze blood from a stone kind of thing.

Dr. Gregory Kelly:

That same type of frustration is something I’ve seen with doctors and health professionals in the US, where there’s just essentially someone outside of their practice … Maybe it’s an insurance company, or maybe it’s their board … comes up with this good idea and says, “We’re going to now do this,” but without considering what’s that going to mean to the person that’s implementing it? Did we give them more time? Sometimes it sounds like we will, but rarely does that end up happening.

Dr. Jan Bonhoeffer:

Rarely is the case. Yeah. And so, what happens, you’re coming from this high pressure environment where it’s hierarchical, and you’re dealing with pressures, and you find, more or less, healthy ways … in some departments, more healthy, in other areas, less healthy ways to deal with this. And then, somehow, a shift happened when you decided to actually become a naturopathic doctor.

Dr. Gregory Kelly:

Yeah. What ended up happening … About a year, year and a half before I get out of the Navy, I had at that point decided that I was going to definitely get out. I was already doing a few healthy things, and when I got out, for lack of a better way to describe it, was that I was just going to get rid of everything and just travel. I would’ve said, “I’m going to be a gypsy,” if you’d asked me. Literally, I think that was the word for it. And, it occurred to me that to do that well I needed to be able to take better care of myself.

Dr. Gregory Kelly:

And so, my last definitely year in the Navy, most of my free time was focused on what we would now think of as alternative medicine, like learning a little bit about acupuncture, a little bit about herbs, a little bit about … Well, I started to do yoga and became a vegetarian at that point. And so, for me, it was interesting in that last year, having transitioned from much more like the heavy drinking, much more normative surface line officer, to someone that was starting to get into meditation and yoga and a lot of things that, frankly, in 1988, were not particularly well known even outside of the Navy.

Dr. Gregory Kelly:

And so, when I got out of the Navy, my goal, really, or my main interest was what does health look like? I had learned enough to know that there was this … Let’s just call it disease management. There was this super cool system that I superficially interacted with, because my ship would’ve had a corpsman, so the equivalent of a nurse. Some of the bigger ships I was on … Well, the bigger ship I was on had a doctor, and so, I had a lot of confidence in them and their ability to take care of the problems that came up on the ship. But, my overall understanding of medicine was fairly naïve. If you’d ask me somewhere in that time period, “What does a medication do?” I would’ve just said something like, “Well, you just take the pill, and it goes in and fixes whatever would be broken.”

Dr. Jan Bonhoeffer:

Fair enough. Yeah.

Dr. Gregory Kelly:

It kills whatever needs to be killed. I didn’t have any in-depth understanding of how medications work or really what the medical profession did. And then, in my search for taking care of myself, I just stumbled on, wow, there’s entire other ways of thinking about health that are worth exploring, and, ultimately, that led me to the naturopathic doctor road.

Dr. Jan Bonhoeffer:

So, you were out to understand the science of healing, of health, and you also looked at the signs of shifting.

Dr. Gregory Kelly:

Yeah. For me, in that transition from a normative maybe officer … I was not ever normative because I was one of the few that exercised and ate well. But, to someone that was a little bit more extreme, what had happened for me is my dad … super busy executive. But, during that time period, I essentially created a really loving relationship with my dad that hadn’t existed before. There was other things like that, that had created what I would think of as a shift inside me. So, things like becoming a vegetarian, getting into yoga, were just now almost a natural part of the new me, where drinking on the weekends was more a part of the old me. That shift in essentially my identity is how I tend to think of it, happened somewhat spontaneously for me. I think of it a bit like the story of Saul on the road becoming graced by spirit and changing his path. And so, that same thing happened.

Dr. Gregory Kelly:

One of the reasons I went into naturopathic medicine, it seemed like they at least had a little interest in that shift, where at least in my looking into it, the more traditional MD or DO path, not so much here in the States at that point. And so, I would’ve said one of my key interests would’ve been that, what you’re calling Heart-Based Medicine, but that my body, what’s that part of us that can create magic if we tap into it and shift some orientation to a relationship with other people, to ourselves or to the things we’re doing?
Dr. Jan Bonhoeffer:

Yeah. When this became clear to you, when this became really the center of your attention, that was also the time when you started to appreciate health as a system phenomenon. You knew how to eat well. You knew that there’s more to the pill goes in and fixes something. So, the individual and personal health became clear. But, then, you realized very soon that, actually, health is a system phenomenon. You’ve seen some aspect of this during the military, and then, as a naturopathic doctor and really looking at your own environment, you had a possibility to really expand that view and start building on this view of complex system health regulation. Can you explain to me a little bit on this?

Dr. Gregory Kelly:

Well, I think in a big picture … Let’s talk about the bigger system, so the Navy. Since I ate well and exercised, I was the natural fit to be in charge as one of my accessory jobs, in charge of both the weight loss program, and then, what was somewhat of its sister program, which was the Navy had a physical fitness standard. Still does. But, it wasn’t particularly hard. I think it was run a mile and a half in a certain amount of time, do a certain amount of push-ups, sit-ups … pretty basic stuff, like what you’d imagine for a military physical fitness test. My recollection is we administered that twice a year. There’d always be a subset of people that didn’t make one or more of the standards that then you’d have to work with to pass. I think if they failed three in a row, then it was grounds for discharge. So, there was a lot of motivation.

Dr. Gregory Kelly:

What would happen, as the person in charge of getting these people that were fairly sedentary, so that they could pass these physical requirements, I would get tasked with exercising them, but without being given the time from the system, like from the ship, at this point, to make that happen. And, what ended up happening, a lot of the people that struggled to meet these physical standards were actually among the best-performing sailors at their jobs, because they didn’t exercise in part because they were really dedicated to work. They were workaholic personalities.

Dr. Gregory Kelly:

And so, the weight standard was somewhat similar. The Navy menus back when I was in were largely the same as what was put in place in World War II. What I was told by the person that ran the mess hall, is what we would call it, that the studies that were done, decided during battle-type pressures like World War II, a sailor would need to eat 4,000 or so calories a day. So, the menus were all designed to achieve that. So, they would want people to lose weight in a setting that was essentially feeding lots of food, most of it of relatively poor quality, where people were sleep-deprived, doing rotating shifts, so body clock dysfunction, and largely sedentary because your exercise options out at sea were very limited. And so, this system wanted one outcome, in-shape sailors, but everything the system had created was working against that.

Dr. Gregory Kelly:

What would classically happen is a new sailor arriving on a ship from boot camp would be in great shape, but a year later, not so good. I’ve done some work in corporate wellness, too, and the same thing. The head of HR will want one outcome, but without changing the corporate system, the environment to better achieve that. So, that’s one system.
Dr. Gregory Kelly:

But, then, I think, us as humans are complex systems as well. And so, that idea or the driving question, what does health look like? In my efforts to answer that, I just kept stumbling on things that … Let’s take body temperature as an example. My early naturopathic time period, if you had a low morning body temperature, I think 97.5 or below, they would want to diagnose with you hypothyroid, like the Broda Barnes approach and put you on glandular thyroid. And so, my first morning temperature was below, and here I was … I biked in and out of work. I did all these healthy things. I’m like, “This doesn’t make any sense to me.”

Dr. Gregory Kelly:

So, I started looking into temperature, and I ultimately wrote a two-part article on PubMed on it. A healthy body temperature should be less than that in the morning, but then should be much higher in the evening because I’ve got a really robust circadian rhythm. That’s one area of complexity of these biological rhythms. And then, on variability, when you see that type of … what I think of as a stock market signature, that’s a signature of a non-linear system, hence a complex adaptive system. So, in looking at what does health look like, it became impossible not to see that health looks like a complex adaptive system and that something even as simple as body temperature, it matters when you measure it before you can even attempt to get any meaning from it.

Dr. Jan Bonhoeffer:

Yeah. This is so interesting. There’s a whole wealth of points you’re making here. One, I mean, I was just thinking I’ve worked in a lot of hospitals, and I was wondering whether there was ever a health standard taken, even in a lifetime. It’s interesting. Cab drivers need to share that they don’t work more than eight hours. Soldiers are being tested for fitness standards and health standards. At least, that’s the attempt for all the system failure that might go with it or the shortcomings of the system that might also be there. At least there’s an attempt. I haven’t seen any hospital or any place where doctors would actually be held to a certain nutrition standard or health standard or behavioral standard. It’s interesting. It seems like healthcare professionals just know these things well.

Dr. Gregory Kelly:

Well, again, the Navy did some really great things. One of the things … Hearing on a ship was super important because you’re around a lot of sources of things that could damage your hearing. So, the navy, even in the mid ’80s, had really advanced hearing standards to monitor that and make sure that, as much as possible, people were protected. A lot of what the Navy did was designed for safety and to, I think, somewhat selfishly … They knew if people stayed in and retired, they were going to be paying a pension to these people for the rest of their lives. So, they wanted healthy sailors, both in the Navy, but as they left the Navy, it was also important. So, the Navy, I think, in a lot of ways, even in the ’80s, was further along than we tend to be today.

Dr. Jan Bonhoeffer:

Yeah. And, you emphasized … So, one is this system health attempts and shortcomings. I guess we see this in our hospitals and our healthcare systems, as well as we probably still see it in other systems, such as the military. It seems to be an ongoing challenge that would merit to be addressed. You also mentioned the individuals or the wonder, the miracle, of how complex the system is and how to regulate the complex system such as our body. And, your life brought you to work with Neurohacker. One of the key elements of what I feel is really intriguing and interesting about Neurohacker’s approach is that this is not so much one small molecule that changes one receptor switch to do something different, but you’re actually really taking a complex system approach. Tell us a little bit about what got you into Neurohacker and how you became the lead product developer.

Dr. Gregory Kelly:

All right. Really, the main thing that attracted me to Neurohacker Collective was Daniel Schmachtenberger, listening to him on some podcast. But, then speaking to him, it was funny. I think when I put my resume in, say, noon on a Wednesday, and around 9:00 that night I got a text from Daniel. It just showed up, like, “Hey, I’m Daniel from Neurohacker. Can we talk?”

Dr. Gregory Kelly:

I’m like, “Sure. Whenever.”

Dr. Gregory Kelly:

He’s like, “Great. I’ll call you in 10 minutes.”

Dr. Gregory Kelly:

By the time we hung up that night, I was like, “Wow. I really want to work with this person.” I’d been fluent in the dietary supplement industry, I would say. I’d been a student rep in ’95-’96 for one of the big professional companies in the US, and then worked for them full time for a year and then part time while I was in practice. And, I taught clinical nutrition to naturopaths. Daniel was the first one that started to talk about how important it was to approach supplementation from a complex systems approach. And so, he had me, literally, on that call.
Dr. Gregory Kelly:

I think complex systems is not how we tend to think of things. There’s a few principles I feel like are really important. Whether we want to become experts in complex system science or not, I think it behooves us all to understand a few basic principles about how these systems behave because, ultimately, whether you say complexity of science or quantum physics or any of these models of science, their goal is to predict how things will behave.
Dr. Gregory Kelly:

One of the core things of complex adaptive systems is that adaptive, so this idea that things like going to learn and literally change the rules as the game is played, that’s super cool. That allowed that ability for my system to do that when I was in the Navy, let me survive in a system and job that was, frankly, tough. Sleep deprivation, body clock stress, time periods where we had hostile ships with their missiles locked on us … You could go on and on. That ability to adapt is what allows us to survive and thrive in time periods.

Dr. Gregory Kelly:

But, I think even something like adaptation is poorly understood. So, my base case is that the human mind/body is going to try to adapt to literally everything. What that means to me is that if I was to see a study on supplementation, and a good thing happened after five days, and it happened after one month, I’m not going to assume that same thing’s going to move in a straight line and still be happening six months later or a year later. My base case is the opposite, that all else being equal, we’re going to adapt to that.

Dr. Gregory Kelly:

What you routinely see in supplement studies is that, often, the results after six months are less good than they were after a month. And so, to me, that’s the classic … Okay. You just saw some degree of adaptation. And so, what we at Neurohacker Collective do when we look at studies, we look at individual studies and ingredients with this eye towards, okay, there’s going to be a tendency in all likelihood to adapt. Can we start to tease it out in the studies that exist? When you start to look at things in that manner, some things that were confusing start to come into, I guess, better clarity.

Dr. Gregory Kelly:

That would be one of the core principles.

Dr. Jan Bonhoeffer:

Yeah. The way that you’re developing the product and the way that you go about the research is really a collaborative approach, right? You call it the collective, but there’s also a really collaborative way at looking at this. In the product development team, this is not a team of pharmacists. You actually have a highly interdisciplinary team developing these products. Can you tell us a little bit about that?

Dr. Gregory Kelly:

Yeah. We actually have a really small internal team. But, then, we have a lot of what we think of as subject-matter experts. So, we’ll maybe be working on something that would be in the pain category coming up. I know I have a lot of enthusiasm for it, especially something post-exercise. We already know people that are affiliated with the collective, that that’s their expertise. So, when it comes to that project, we’ll start to link up with them and share our thoughts on research, but start to get some feedback from them.

Dr. Gregory Kelly:

And so, what we’ve been fortunate to do, and I think a lot of this also goes back to Daniel, is he’s just really someone that builds deep networks of smart people, and has convinced them to be in some way linked in with the collective. We’re firm believers in that we is smarter than me. We’ll do a lot of the things to make them contributing easy, but we really value those contributions.

Dr. Jan Bonhoeffer:

Yeah. Amazing. This is a very agile approach in how you can come up with different products. I mean, from the world that I’m coming from, I would expect when you’re talking about system design and complex system science, I think, in my mind, it goes like equals big data. Equals large numbers, and to my surprise, from what I saw on the website is the project that is called N Equals One Project.

Dr. Gregory Kelly:

Yeah. I actually put this in a presentation. I did a symposium, I think around 2007. But, the idea of data distribution. And, I think beta blockers are a really great example of this. I haven’t tried to stay abreast of it, but around 2010, when I last looked at this, the average weight gain for beta blockers was trivial. One, two, three percent. And so, if you put a patient on a beta blocker and they come back a month, six months later, and say, “Hey, Doc, I gained a bunch of weight. Could it be because of this new med?” The tendency will be, “Well, let me look that up. No. That couldn’t be because of this medicine.”

Dr. Gregory Kelly:

What I found in one of the studies that I was looking into beta blockers is that you had about 10% of people that have massive weight gain, and then it was that long tail. The average doesn’t capture those outliers, basically, is what it boils down to. And, my dad would’ve been one of those people. He was put on beta blockers, gained a lot of weight, eventually had sleep apnea. Not to say that the beta blockers did all of these things and that some degree of it wouldn’t have happened, but since there was no acknowledgement that some small subset that would have these outlier weight gain events from it, there was not ever a consideration to take him off that medication. Yet, he would routinely be told by his doctor, “Dick, you got to lose weight. You got to eat less, or do these things.” His system wasn’t able to do that between the sleep apnea and the beta blockers and the job stress and other things.

Dr. Gregory Kelly:

I think that’s where the system comes in, right? My dad would be an N of one. He seemingly was one of those outliers with beta blockers, where he was affected much more negatively in terms of his shape or weight. And, the doctor, super well intentioned, great doctor in the Boston area, gave him advice that frankly just wasn’t relevant, like, “Richard Kelly, eat less, exercise more.” If it was that easy, then you wouldn’t need someone to be telling you to do that.

Dr. Gregory Kelly:

My dad commuted close to two hours each way to and from Boston, ran a 5,000 person engineering company, super high performer. But, time to exercise wasn’t on the menu. He would eat whatever my mom served for dinner. I don’t really remember him ever eating breakfast on weekdays because he’d always be in a rush to get the commute started. So, when I think of N of one, it’s that system. My dad, being a complex system, with all of these different pressures that are squeezing him, and trying to then work on which of those things can we navigate? And, some we can’t, right? It wasn’t on the menu to not-

Dr. Jan Bonhoeffer:

Yeah. I guess, in a way, that’s where a large part of medical research is going right now, to recognize that scientific progress is made in the outliers and not so much in the mean. That’s where we recognize individual differences. Some over respond, some under respond, some have some side effects or adverse events that we’re mindful about and that we want to understand better. Rather than brushing it away because it doesn’t show up in our regular means and standard deviations, they actually still might be real.

Dr. Jan Bonhoeffer:

And so, we’re going into the precision or personalized medicine direction, which isn’t really yet recognizing complex system thinking. It’s still kind of … Okay, you are that individual that has this molecule transcribed a little bit different, so, therefore, you might not benefit from this drug. It’s more like a targeting exercise. Who benefits from our single molecule preparation, for example?

Dr. Jan Bonhoeffer:

Whilst you’re taking a different approach. You’re taking an approach where you recognize that every human being is an adaptive complex system, and how can we do this? How is Neurohacker drug development different from, I feel like, the … I’d say the usual small molecule development?

Dr. Gregory Kelly:

I mean, one, I think, from the one drug, one mechanism approach … And, that’s an oversimplification, but I don’t think that’s something that MDs created. That’s something that the system created. That’s what is needed to get new drugs approved. I’ve seen a few studies combining … And, this was for anti-aging, but in a model organism, like worms, flies … combining microdoses of lithium, and I think it was rapamycin and then one other medication, and that each on their own had a trivial increase in longevity, but that combination, working on different pathways, made it a huge change. Now, that’s not to say that would happen in humans. Frankly, it’s unlikely that it would. But, that system approach, being able to work comprehensively on interacting pathways and processes, at least, in that experiment, produced much more favorable outcomes.

Dr. Gregory Kelly:

My belief at this point, and I guess time will tell as science evolves, is that we would see that much more with even approved drugs, that if we could, rather than studying something in isolation, studying how things interact, make much more monumental shifts. But, instead, what tends to be the case, is we’ll have this drug for this one thing, let’s say beta blockers to decrease heart rate, but then not with, I guess, an understanding that, well, what might that do for someone with sleep apnea? Or, what about that 10% that are that average number just doesn’t mean anything, that these are people that seem to, for whatever reason, gain a lot of weight?

Dr. Gregory Kelly:

So, that’s where that N of one, this understanding that … And, biohackers, they say, “Your mileage may vary. Your result may be very different than mine.” One of the other principles that comes out of complexity theory is this idea of history dependence. So, anything I was to do today is somewhat going to be … My response will be colored by everything I’ve done before, where in outside of complexity theory, it’s assumed that all of those differences from before can be largely ignored, that they’d be more in the noise category. In my experience, they aren’t.

Dr. Gregory Kelly:

To separate me out from my Navy history wouldn’t be possible. My response to things now, having eaten pretty well for close to 40 years, exercise for 35 of that, anything new introduced into my system, my system has a degree, I think, of resilience because of all these good things I’ve done for a long period of time. Where someone who had lived a completely different life during those years, I wouldn’t bank on them responding the same way that I do. They may, but that’s where I think this complex systems approach, thinking in terms of the core principles, gets rid of some of the surprises. Or, not gets rid of them, but prepares you for when they happen.

Dr. Jan Bonhoeffer:

It opens our eyes, doesn’t it? Yeah. It’s interesting that the current trial design, in an attempt to simplify reality so that we can somehow get the idea that we’re getting our heads around it, that this oversimplification, starting at day zero of the trial and ending at … I don’t know … day 90 of the trial, and we’re not looking what happens before and after, that seems like really a good way to start things off. But, it’s about time to change that.

Dr. Gregory Kelly:

Yeah. I mean, I don’t think that there’s that many things, in terms of how humans respond, that are particularly well-suited to a bell curve. As an example, we have a product, Qualia Life, that recently we got data back on nine people that took it for four weeks. We measured NAD and some other metabolites, both after five days and after four weeks. Now, not placebo controlled, small sample size, so all those caveats aside. But, on average, it doubled NAD plus. Pretty cool, right? Quite frankly, we’d have been happy with a 70% increase instead of 100%.

Dr. Gregory Kelly:

But, even in that, the average loses a lot of nuance. I tend to think of super responders. My dad was a super respondent in a negative way to beta blockers. We had two people that their levels went up four to fivefold. We had a few people that only went up 10 to 30%. So, the average doesn’t particularly tell you something meaningfully about how the individual responded. Even in that nine people, you see that variance.

Dr. Gregory Kelly:

I love where you can see how the data displays, because what routinely I expect to see is that you’re going to see a subset of super responders, people that literally, whether it’s exercise or supplement or medication, they get what you hoped for and more. Then you get, usually, a bigger group of good responders, and then, which essentially get the result that you would expect, you’d typically go get a small group that are non-responders. It just didn’t work for them, which is fine. I think, because of genetics and the history dependence and all kinds of things, that’s expected.

Dr. Gregory Kelly:

And then, I think you can also get a small group that are penalized, that this thing that worked really great for some people was a negative for you. One of the things I know we do at Neurohacker Collective is when we look at … Say we send a new product we’re developing out to test 70 people. We expect those four bands, essentially, and we hope that we do a good enough job designing it so that we get a much higher percentage of super responders than we would’ve expected, based on just a generic response, and that we have largely eliminated the negative responders and that we’re prepared to live with. There’s going to be some that just didn’t benefit. That’s how complex systems work.

Dr. Jan Bonhoeffer:

Yeah. It’s nice. This is very honest. I’m just thinking, wouldn’t it be, in this [inaudible 00:44:26] one idea, rather than comparing two different groups with each other, where you always have this issue of are they really matched well enough? Are they really similar and comparable enough, and how much of them might measure bias that we’re actually looking at, particularly because you’re looking at fairly short acting substances, and if you don’t go into six months, and then you get into adaptation, but if you do short intervention, stop, stop short intervention, it will be really interesting to document the change in system regulation by a trial design that is like a self-controlled case series, where every person is its own control, just yet you create risk windows and control windows. So, there’s a challenge, de-challenge, re-challenge situation.

Dr. Gregory Kelly:

Yes. Yeah, that’s-

Dr. Jan Bonhoeffer:

Have you tried that?

Dr. Gregory Kelly:

We’re in the early stages of designing a study for our Qualia Night product, which is our evening nootropic, one that supports calmness in the evening and prepares your body for sleep, and ideally helps our brain work better the next day, because our brain does a lot of cool work while we’re asleep, and making sure that we’re our best heart-based selves that next day. And so, one of the things we’ll probably do for the pilot study is we’ll have people act as their own controls. We’ll put them on the product, have a washout and then maybe have them on a placebo, and then vary who’s on the placebo first, who’s on the washout first, that type of thing. But, yeah, that’s a really fair trial design and one that often can be handled in a more efficient manner than a different style of study.

Dr. Jan Bonhoeffer:

Yeah. Nice. Well, that sounds really exciting. You mentioned the word nootropics. That’s what Qualia Mind is like, and Qualia Sleep. So, just help me understand. Just a few years ago, I had no idea what nootropics are until I learned about Neurohacker. So, maybe just could you help some of our audience who are in my position?

Dr. Gregory Kelly:

Sure. The best analogy I’ve heard is the movie Limitless that came out about eight or nine years ago. In that, the main character took this pill that just allowed his brain to work much, much better. He was just a phenom. And so, nootropics would aspire to that. They’re obviously nowhere close, but they’re essentially the categories of compounds that help our brain with things like focus, concentration, executive functions, social cognition like empathy, and those types of things. Some of those are related to the building blocks, like the amino acids that we need to make the compounds that facilitate some of those. Some of them are lipid molecules, that our brain is by percent, the most lipid of any tissue in the body.

Dr. Gregory Kelly:

So, there’s all these different substances that our brain … I’ve heard the term brain-essential nutrient. In general, things that can cross the blood-brain barrier, that would be found in the diet. Part of the reason is they’re brain essential. Our brain has decided these are important enough that I’m going to let them through. And so, making sure, even when we get enough of those in our diet, that helps our brain work better.

Dr. Gregory Kelly:

To me, nootropics is that category of any of the compounds that can make our heart or our brain work better. What’s interesting is some of those new compounds make our muscles work better or our heart pump more efficiently because those three tissues all have in common that they use a ton of energy, much more so than other tissues. So, cholines as an example, there’s Alpha-GPC, and so, the cholines are often seen in nootropic stacks or combinations of ingredients, and super important for the brain, but there’s been a few studies now on Alpha-GPC specifically for sports performance. And so, again, our muscles and our active tissues tend to have more commonalities than often we think of.

Dr. Gregory Kelly:

So, funny even in the supplement world is you have ergogenics, so compounds for sports performance, and you have nootropics, compounds for our brain. How frequently the same compound could easily be put in both categories. Or, something like creatine that’s been a staple in the ergogenic world since the ’90s is now increasingly being studied for mood and for cognition.

Dr. Jan Bonhoeffer:

How interesting. What a novel … Mitochondrial energy regulation that affects the different systems working together in a flight-or-flight mode, in terms of sleeping well and performing well. But, at the same time, this is not so much about a stress. Nootropics are not stress inducers. But, to the contrary. They are actually aiming to increase resilience.

Dr. Gregory Kelly:

Correct. Yeah. A lot of the herbs that end up being in the nootropic category come out of Ayurveda or Chinese medicine or those systems and tend to be what we think of as adaptogens, so things that help us to tolerate and respond better to stresses of all types, which makes sense. Stress … I guess my simple story is the brain and our heart work as well as the energy available. And, energy ends up being utilized, per our discussion, primarily a really finite resource. And so, things that allow our tissues to do more with that energy or improve mitochondria and make more energy tend to do everything from make our focus better, but also empathy.

Dr. Gregory Kelly:

One of my experiences taking Qualia Mind personally … And, again, your mileage may vary. Your experience may be completely different than mine. But, about six to seven weeks after I started taking it, I was driving home from work one night. I was about 25 miles from the office where I was living, so I would routinely be in some degree of traffic on my drive. And, it just dawned on me, like, huh, traffic doesn’t seem to bother me like it used to. And then, I started to pay attention and notice I was essentially just a much kinder version of myself at the end of the day than I remembered being two months ago. So, I felt like patience and what I think of as the social cognition skills, empathy for others, being able to be more in touch with my own social and emotional reactions to things, just was more accessible to me.

Dr. Gregory Kelly:

While Qualia Mind wasn’t designed for that, I think somehow it improved my brain’s efficiency and my heart’s efficiency. And so, I really felt like a better version of me was showing up both at the office, but usually it’s at the end of our day where we’ve exhausted all our mental energy that the worst version of ourselves shows up. And, it’s not a testament to our character. It’s just we’ve exhausted that part. I think, for me, something about the Qualia Mind seemed to be adding resources into that and allowing a better version of Greg to show up. So, it’s one of the things that I still love about taking that product.

Dr. Jan Bonhoeffer:

Fantastic. Well, thanks a lot, Greg, for showing up, for being here, fully wide awake and-

Dr. Gregory Kelly:

Sure.

Dr. Jan Bonhoeffer:

… with so much compassion and dedication and love for what you do. What an amazing journey. Thank you so much for sharing your journey, just sharing your personal learning through to the appreciation of how complex systems work from your own experience, to actually now designing products that help create a system regulation that, as you described from your own experience, clearly goes beyond a small molecule enzyme switch somewhere, what actually seems to create an overall sense of health that goes way beyond what might be the indication.

Dr. Gregory Kelly:

Yeah, absolutely. I think that’s a core part of Neurohacker Collective. Our goal is to upgrade humans. We want that. Our goal, whether we have the solution or we can point people to other people that are developing awesome tools, techniques, technology, we want everyone to be able to perform better and to be better versions of ourselves.

Dr. Jan Bonhoeffer:

Wow. Beautiful. Next generation industry, next generation pharmaceuticals. Thank you so much-

Dr. Gregory Kelly:

Well, my pleasure.

Dr. Jan Bonhoeffer:

… for doing what you’re doing and for taking the time to be with us today. I hope we’ll see you soon because we have another topic that we want to explore together. But, we won’t say what it is right now.

Dr. Gregory Kelly:

Great. Well, thank you.

Dr. Jan Bonhoeffer:

Well, thanks a lot.

Speaker 1:

This has been a Heart-Based Medicine production. Thanks for listening.