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Dr. Daniel Kinderlehrer: “There needs to be more emphasis on disease prevention ”

There needs to be more emphasis on disease prevention — coaching patients on proper diet, exercise, sleep habits and so on. Unfortunately, these issues cannot be separated from politics — our health is also dependent on being able to make a livable wage, so we need to increase the minimum wage, support child care, maternity leave and so on. […]

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There needs to be more emphasis on disease prevention — coaching patients on proper diet, exercise, sleep habits and so on. Unfortunately, these issues cannot be separated from politics — our health is also dependent on being able to make a livable wage, so we need to increase the minimum wage, support child care, maternity leave and so on. Living in poverty and experiencing racism, homophobia, and misogyny have serious impact on our biochemical pathways. Our present health care system is mainly about disease care. Perhaps insurance companies can incentivize healthy activities by giving lower rates based on individuals’ lifestyle, just like car insurance rates dropping if you haven’t had an accident. Wouldn’t it be nice if some of these activities were community based — like sports, line dancing, gardening, races. And community building can also occur with organizing around environmental clean-up, bringing food to the housebound, and helping in soup kitchens. There are few activities that are as rewarding as helping others.


As a part of my interview series with leaders in healthcare, I had the pleasure to interview Daniel A. Kinderlehrer, MD, author of Recovery from Lyme Disease: The Integrative Medicine Guide to Diagnosing and Treating Tick-Borne Illness. Dr. Kinderlehrer is a nationally recognized physician with expertise in the fields of nutrition, allergy, environmental medicine, Lyme disease, and the healing of mind-body-spirit as a unified whole. His integrated medical practice in Denver, Colorado, focuses on the diagnosis and treatment of tick-borne disease.


Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

I want to do everything possible to alleviate the scourge of Lyme disease. In August 1996, I had the sudden onset of a high fever with shaking chills, drenching sweats, and aching all over. These symptoms lasted 2–3 days but recurred on a weekly basis and then morphed to sleepless nights plagued by intense anxiety. I consulted with a friend and colleague who ran some tests and found that I was positive for Lyme disease. However, when I went on appropriate antibiotics, I did not get better. After a month we repeated the tests and they were even more conclusive for Lyme. Then I put a call in to an international Lyme “expert” in Boston, and presented my case. The conversation went something like this:

“You do not have Lyme disease” he told me.

“Why not?” I asked.

“Because if you did, you’d be better by now,” he responded.

“ What about the tests?” I asked. “They were clearly positive for Lyme disease.”

“False positive”, he responded. “The tests were wrong.”

“Well, what do I have then?” I asked.

“Something else,” was his response

This was my introduction to the Lyme wars. This “expert” was categorically wrong when he said I did not have Lyme disease, but he was correct that I had something else, a tick-borne coinfection called Babesia. Sadly, there is still conflict in the medical profession regarding the existence of these infections. It took a long time to recover, with many bumps in the road, but I learned a lot along the way and forged a commitment to help others suffering from these terrible infections, and hopefully not go through what I went through. I am hoping my book can open the minds of physicians as well as help patients.

Can you share the most interesting story that happened to you since you began your medical practice?

A while back, pre-Covid, I was having dinner with neighbors, both of whom are doctors. One is an emergency room physician and the other is an allergist/immunologist. I was making small talk and asked them, “How was your day at the office?” They both answered the same: “Boring, same old patients.” I don’t have boring patients. They have all been through some real misery, usually for years, but every one is different, and they each require medical detective work to sort out the multiple imbalances in their bodies. So I can’t really come up with “the most interesting story” regarding my medical practice, since all my patients every day are interesting. I can tell you what is most rewarding is when a new patient who is non-functioning because of his or her severe fatigue, brain fog, depression, pain and multiple other symptoms and recovers to a happy, active life. The best is patients who spent many of their teen-age years on the couch, too miserable to function, and who are now successful college graduates. I had a 20 year old patient who wanted to become a professional hockey player until he got bonked in the head and was suffering from impaired cognition, allegedly due to the traumatic brain injury. After treatment for Lyme and confections and some hormone imbalances, he made a full recovery and he decided to become a doctor. He has now graduated medical school and is in this third year of an orthopedic residency.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

I confess that in the practice of medicine, mistakes are not usually funny. On the one hand there are small mistakes that are unavoidable, and the most important thing is to acknowledge the mistake, apologize, and learn from it. On the other hand, avoid big mistakes at all costs, it could mean someone’s life.

What do you think made your medical practice stand out? Can you share a story?

When I finished my training in internal medicine, I didn’t want to open a regular practice. Internists treat chronic problems but generally don’t cure anything. My mother, who was food editor of Prevention magazine for 25 years, was forever extolling the benefits of good nutrition — I was raised on no sugar, whole wheat bread, dark green lettuce and vitamin C in the 50’s — so I opened a practice called Nutrition and Preventive Medicine, hoping to learn as I go. Back then we were called holistic docs, and there were not many of us, but we learned from each other. What happened is I ended up seeing people who had fallen through the cracks, people with chronic complaints that mainstream medicine was not helping. This led me to develop expertise in nutrition and environmental medicine, since so many of these people suffered from food sensitivities. Suddenly I was curing people with chronic headaches, fatigue, gastrointestinal complaints and arthritis by putting people on elimination diets. Because I was always looking for the underlying cause of complaints rather than treating symptoms, I had an active practice that drew from a large area. Now we are known as integrative or functional docs, but back then we were few and far between.

Here’s a story from the old days. A 45 year old woman came to my office complaining of daily migraines — she would wake with a headache. She would keep them at bay by taking 6–8 Excedrin daily. Excedrin is a combination of aspirin, acetaminophen (Tylenol) and caffeine. I asked her if aspirin alone helped her headaches, and the answer was no. Acetaminopen alone did not help her headaches. If she took aspirin and acetaminophen pills at the same time, they did not help her headaches. Only Excedrin did. I explained to her that her headaches were triggered by withdrawal from caffeine, and she needed to stop the Excedrin cold turkey. And I warned her that she would probably experience the worst headache ever, which is exactly what happened. We brought her into the office and gave her injections of demerol. But after three days off caffeine she became headache free, and would wake feeling so well she would go for a run.

Chronic illness is invariably multifactorial, and I enjoy the detective work of sorting out what is out of balance. In my search to understand underlying causes of illness, I also studied energetic and spiritual healing. I studied with Barbara Brennan for four years, Kabbalistic healing for three years, Sufi healing for two years, and body centered psychotherapy called Guided Self Healing. These trainings helped me understand how trauma can impact us on many levels, and how important it is to provide a safe space for my patients and uncover belief systems that can hinder recovery, such as feelings of unworthiness. I spend a lot of time with my patients and get to know them quite well.

What advice would you give to other healthcare leaders to help their team to thrive?

Each patient has a story to tell. It is important to give them the space and unhurried time to tell it, and to validate their experience. It is important to really care — you can’t fake that; if you don’t care, patients will sense that and you are in the wrong business. It is important to communicate, explain your thinking, and enlist patients with decision making. It is important to be available to patients when they have questions, and respond in a timely manner. It is important for patients to feel the health practitioner is working with them as a team. And it is essential to give patients reason to hope.

Ok, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

The U.S ranks poorly on so many fronts — think child poverty, food insecurity, education, mortality, let alone Covid deaths. I believe in capitalism, but I also believe in strong governmental regulation of industry so it serves the greater good. We don’t have that. We have corporations that spend millions of dollars on lobbying, so the pharmaceutical companies and insurance industry can charge outrageous prices and CEOs make tens of millions of dollars annually while their employees may not even make a livable wage. How would it feel if your church or synagogue’s first priority was to make money, and second to provide spiritual support and succor? Well, medicine is big business, with a green bottom line. I believe doctors start out as idealistic and well-intentioned. But in practice they need to adhere to to the dictates of their group practice, which is owned by a big corporation, that determines how to get the biggest payout from insurance carriers. Primary care practitioners may see 40–50 patients daily, spending 5–10 minutes with a patient. That can work for a sore throat, but not for chronic illness. I spend about three hours with my patients on their first visit, and follow-up visits are one hour on average. The bottom line is that our low ranking health care system is emblematic of a distorted set of values that has overtaken the United States, that prioritizes financial gain, and exalts the individual rather than our collective well-being. Wouldn’t it be wonderful if we all understood that our well-being is enhanced when everyone else’s is as well?

You are a “healthcare insider.” If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

I actually think of myself as a healthcare outsider. My patients have seen dozens of mainstream physicians with either no answers or wrong answers, and they are consulting with me because I am willing to think outside the box. I see people who are chronically ill with tick-borne infections, and they are quite ill. But these illnesses cause widespread inflammation with impact throughout the body. The way in which Western healthcare is set up, any one of my patients with complaints of fatigue, headaches, sleep issues, joint pains, and depression will end up seeing a handful of docs including a neurologist, a sleep specialist (usually a pulmonologist), a rheumatologist, and a psychiatrist. These docs are like the blind men and the elephant, since none of them see the whole patient. My wife suffered the acute onset of chest pain and paralysis of her left leg and was admitted to the hospital where the cardiologist described evidence of cardiac stress, but thankfully no damage. I asked him what the connection was with her neurological impairment, and he said he doesn’t deal with the nervous system. I asked the neurologist the same question and received the same answer — she didn’t deal with the cardiovascular system. Isn’t that astonishing? These two specialists, experts in their fields, were not interested in understanding what event led to a simultaneous cardiac and neurological event, as if it were not all connected. But this is Western medicine, with each subspecialist interested in their single organ system and not in the whole patient. This reductionist attitude is appalling and does not lead to good healthcare. It is up to primary care doctors to put the whole picture together, but they have neither the time nor the expertise.

There needs to be more emphasis in medical training on integrative medicine, seeing the whole patient, with more understanding of functional issues, not just disease. For example, most patients who consult with a gastroenterologist have some sort of GI discomfort, issues with defecation, etc. Mostly the GI docs look up and look down, and if they don’t see a tumor or ulcer, diagnose irritable bowel syndrome (IBS). Even worse, when they can’t think of other options, they recommend protein pump inhibitors to decrease stomach acid, which has serious long term consequences. But what they don’t do is ascertain if the stomach is making adequate hydrochloric acid, is the pancreas excreting appropriate enzymes, is the bowel flora normal, is there overgrowth of bacteria or yeast or parasites, or does the patient have food sensitivities? Eighty percent of patients seen in gastroenterologists’ offices are diagnosed with IBS — but most all have functional disorders that when properly addressed lead to resolution of symptoms.

It has taken a long time for doctors to appreciate how much psychological stress can impact our physiologies. What is still not well appreciated is how organic/physical issues can impact our mood and behaviors. There is a wealth of data on infections leading to eating disorders such as anorexia nervosa. Celiac disease, low thyroid and heavy metal toxicity can cause depression. Tick-borne infections often cause anxiety, panic attacks, depression, irritability and rage, even bipolar disease and psychosis. These patients are referred to psychiatrists but doctors need to learn how to properly evaluate these patients so they get appropriate care. A colleague of mine and I did a pilot study of ten adolescents at a residential treatment center suffering from major depression and anxiety. They were too ill to live at home or go to school. These ten kids were selected at random, but six out of ten had evidence of tick-borne infections, and nine of the ten had evidence of brain inflammation probably caused by infections. Four of these kids had suicidal ideation and one had made serious suicide attempts. Suicide is now the second most common cause of death in the adolescent population. How many of these kids are suffering from undiagnosed infections and brain inflammation?

We are now witnessing a tsunami of autoimmune issues. Those nine kids in the pilot study had autoimmune inflammation in their brains. I believe the tendency to autoimmunity is due to cumulative stresses that have altered epigenetics over the past century. When we talk about genetics, our DNA changes over millennia in response to natural selection. But there are proteins that sit on our genes that turn them on and off — i.e. epigenetics. And when these proteins are altered they impact the next generation. There are literally thousands of stresses that alter epigenetics, such as nutrient deficiencies, toxin exposure, obesity, anxiety disorders, traumatic stress and PTSD that effectively get handed down to the next generation. Babies are not born with a clean slate, they are subjected to the accumulation of stressors from their ancestors. And these epigenetic issues cause immune dysregulation and autoimmunity. We can start by cleaning up our environment and our diets, to prioritize quality of life over quantity of income. There are so many changes we can make that would improve our health and well-being, and that of our children’s.

If I were God and could make one change that would have a significant impact on our health and well-being, it would be to cut sugar out of our diets. There are so many reasons why sugar is bad for us, like heart disease and diabetes and obesity. The second would be an emphasis on community, since so many Americans are isolated and depressed. As a society, we are no longer experiencing belonging.

What concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

There needs to be more emphasis on disease prevention — coaching patients on proper diet, exercise, sleep habits and so on. Unfortunately, these issues cannot be separated from politics — our health is also dependent on being able to make a livable wage, so we need to increase the minimum wage, support child care, maternity leave and so on. Living in poverty and experiencing racism, homophobia, and misogyny have serious impact on our biochemical pathways. Our present health care system is mainly about disease care. Perhaps insurance companies can incentivize healthy activities by giving lower rates based on individuals’ lifestyle, just like car insurance rates dropping if you haven’t had an accident. Wouldn’t it be nice if some of these activities were community based — like sports, line dancing, gardening, races. And community building can also occur with organizing around environmental clean-up, bringing food to the housebound, and helping in soup kitchens. There are few activities that are as rewarding as helping others.

I’m interested in the interplay between the general healthcare system and the mental health system. Right now, we have two parallel tracks, mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

I am actively engaged in educating psychiatrists on the mental health issues associated with tick-borne infections. This occurs in all age groups. Children who have Lyme disease often present with anxiety, obsessive-compulsive disorder (OCD), depression, irritability, tantrums out of control and violence, oppositional behavior and declines in school performance. If this is recognized and properly treated early, then they have their entire lives ahead of them. Psychiatric complaints often top the list of symptoms in adults with persistent Lyme disease. The most common cause of death in patients with Lyme disease is suicide — that’s how severe the depression can manifest. Anorexia nervosa is a serious and sometimes fatal disorder, and it is often triggered by infections. In the answer to question #7, I described a study in which ten adolescents were at a residential facility because they were so depressed they could not hack it at home or go to school , and nine of them had evidence of autoimmune brain inflammation.

How would you define an “excellent healthcare provider”?

I suppose an excellent health care provider combines a strong knowledge of medicine with compassion, open-mindedness and good listening skills.

Can you please give us your favorite Life Lesson Quote? Can you share how that was relevant to you in your life?

“If I am not for myself, who will be? If I am only for myself, what am I? And if not now, when?”

This ancient wisdom is from Rabbi Hillel as quoted in the Talmud, and I believe it is relevant to us all.

Are you working on any exciting new projects now? How do you think that will help people?

On March 16, 2021 my book will be released: Recovery from Lyme: The Integrative Medicine Guide to the Diagnosis and Treatment of Tick-Borne Illness. This is the culminations of four years work that details a comprehensive guide for physicians to evaluate and treat patients with complex illness, but it is written in lay language that will also help patients become empowered in their health care. I think this book has great potential both in training physicians and empowering patients.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

My inspiration comes from seeing patients, and the gratification that comes from personal interactions that lead to their recovery. I enjoy writing, and am engaged in writing articles for peer-reviewed medical journals. This requires a deep dive into the medical literature, which is always illuminating.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

I confess, I don’t perceive myself as a great influencer. I do my best to help my patients, one at a time. But if there was one message that I think would do the most good, especially in polarized times like the present, it would be to “Be kind.”

How can our readers follow you online?

I suggest my book’s website: Recoveryfromlyme.com

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