Dr. James Carter, the director of the Center for Functional Medicine at Cleveland Clinic, discusses his journey to functional medicine and his role at Cleveland Clinic. Dr. Carter is also a vascular medicine specialist and is interested in vascular health from a functional medicine perspective.

He talks about the vision and growth of functional medicine at Cleveland Clinic, including the development of specialized programs for women’s health, oncology, pediatrics, and cardiovascular health. Dr. Carter also discusses the importance of group visits and shared medical appointments in functional medicine practice. He shares his excitement for the upcoming Institute for Functional Medicine (IFM) Annual International Conference (AIC) and highlights topics he is looking forward to, such as bone health, mental health and pediatric nutrition.

Finally, Dr. Carter reflects on his decision to join Cleveland Clinic and expresses his enthusiasm for the future of functional medicine at the institution.
Check out this full conversation to learn more about:

  • A systems perspective that integrates biological systems with social context in patient care.
  • Educating medical students and integrating functional medicine into cardiology practice.
  • Understanding and overcoming resistance to change with patients.
  • A preview of Dr. Carter’s upcoming IFM presentation, and what he’s looking forward to learning from other presenters.
  • And much, much more!

Register here for IFM’s AIC event, occurring May 29-June 1, 2024. You can also register for VagusFest here, which is occurring on the evening of May 29.

Check out Lifestyle Matrix Resource Center’s new website to learn about their Group Visit Toolkits, tools to enhance patient compliance and more at lifestylematrix.com/membership.

Cleveland Clinic Functional Medicine Update | Episode 334

James Maskell: Hello, and welcome to the podcast. This week, we feature Dr. James Carter, who is now one of the leading physicians at the Cleveland Clinic Center for Functional Medicine. We have followed the story of the Cleveland Clinic and their functional medicine center right from the beginning. It’s been over 10 years, and this is the latest iteration. We talked about what’s going on right now at the Cleveland Clinic Center for Functional Medicine, the vision of what Dr. Carter is looking to take forward. We talked about the Institute for Functional Medicine’s Annual Conference. Really awesome half an hour and good news, great news for the industry that is looking for credibility and scale, and everything that partnership with the Cleveland Clinic has provided.

Thanks to the Institute for Functional Medicine for stepping it up. This episode is brought to you by the Lifestyle Matrix Resource Center. They have an awesome new website. If you haven’t checked it out, go and check it out. We’ll have a link in the show notes, goevomed.com/lmrc. All the cool things that they’ve developed there. The group visit toolkits, the educational curriculums, and tools for you to educate your patients. The website looks amazing. I’m really excited for you to check it out. Go to goevomed.com/lmrc. Thank you to LMRC for their ongoing support of the podcast. Thanks so much for tuning in. Enjoy.

Hello. So, a warm welcome to the podcast, Dr. James Carter. Welcome, Doc.

Dr. James Carter: Great to have a chance to talk to you again, James. It’s so nice to be here. Thank you for inviting me.

James Maskell: Well, I’m really excited to reconnect. It’s been a number of years since we have. Since then, you’ve made the journey from Colorado, where I think you were practicing before. You’re now at the Cleveland Clinic. We’ll get into that story. But I guess maybe let’s just start at the beginning. How did you end up, one, getting into medicine? Then second, what was your path to functional medicine, and being in a functional medicine sort of leadership role at this stage?

Dr. James Carter: Well, I grew up in Brooklyn, New York. I grew up in the housing projects of the Glenwood and Flatbush section of Brooklyn. My father was a New York City police lieutenant, and my mother was a public schools administrative assistant. Although that’s what I call her. She was called a secretary back then. I had this idea when I was 12 to want to be part of having an impact of this world becoming a better place. I was a science fiction buff, and I used to read about utopia. But I also liked history, and I used to read about Renaissance individuals who had multiple talents. So I always had this concept of systems thinking, and looking at a lot of different things, and wanting to be good at multiple things. In college I majored in sociology, because I was interested in small group interactions and resistance to change.

Eventually, I found my way to cardiology at the University of Chicago, and then interventional cardiology. Where I thought that now I had all the knowledge I needed to help people with traditional risk factors and non-traditional risk factors. All I needed to do was to put stents in and give them the right medicines, and they would do better. Then I started to pay attention to my patients’ stories about how they deviated from that, and found success by changing what they ate, changing how they exercised, relieving their stress, and removing toxins from their lives. I paid attention to that along the same time that I started to get ill myself, and kept going to well-trained multiple board-certified physicians like me, and couldn’t get better. That dual journey led me to functional medicine first by understanding nutrition, and then finding the Institute for Functional Medicine, which saved my life and changed my life.

I can say with certainty that that’s true. Then I tried to figure out how to wrap that into my interventional cardiology practice. I was also a wound care doctor, so I would have patients come in with these wounds that they would have for a decade. After this education, looking at things from a systems point of view, integrating their biological systems with their social context, miracles started to happen. My team would be amazed that all we had to do was change what people ate and how they viewed the world, and they would heal. I kept doing that work, and started educating medical students at the University of Colorado. Writing curriculum on nutrition, weaving functional medicine into our preventive cardiology lectures and small groups. Eventually, I guess that word got out, and Cleveland Clinic reached out to me and recruited me to this present role.

James Maskell: Well, I can see a lot of reason for crossover there. One, obviously cardiology background, Cleveland Clinic, world leader in cardiology. Two, the functional medicine obviously with the Cleveland Clinic Center for Functional Medicine, and an investment in functional medicine. Then obviously the group stuff. I know that’s been a key part of what’s happening there. What is your specific title now at Cleveland Clinic?

Dr. James Carter: I’m director of the Center for Functional Medicine, and I’m the Pritzker Foundation endowed chair in functional medicine. Which gives me the opportunity to use philanthropic dollars for research and education and community engagement. We recently were granted funding from the American Heart Association for a food as medicine study that we designed. So we’re doing a lot of exciting things now.

James Maskell: That’s great. Well, yeah. Give us the sort of state of the game of functional medicine at the Cleveland Clinic. What’s happening now? How far has it spread, and what is the current footprint of functional medicine in that organization?

Dr. James Carter: There’s an overwhelming desire and support for functional medicine as an assistance based medical practice. That’s what we are, and that’s what we are doing here at Cleveland Clinic. It’s quite exciting. We have so many brilliant minds here at Cleveland Clinic, and we have a global reach. Wherever I go, there’s excitement about what we do here. How we look at the whole picture of a patient, and how we align the care for them. But we also are at an academic institution, so we have opportunity to show how to do this in a way that is scientific and sustainable and reproducible.

We may not do all the things that, the most new things that have not been proven yet. We might hesitate a little bit with that, but we will craft proper research questions around that and study it. So we’re quite excited about that. We’re building multiple programs, a women’s health program, an oncology program, a pediatric functional medicine program. And our Heart, Vascular & Thoracic Institute program that’s called HARMONY. Where we’ll be focused on functional medicine principles to help people recover from cardiovascular procedures and surgeries.

James Maskell: Wow. Well, I’m excited particularly about the pediatrics and oncology. Because I know those are two of the most conservative specialties, wouldn’t you say? As far as they haven’t taken on functional medicine principles as rapidly as say cardiology or psychiatry, because of the acute nature of the harm that can happen in children and cancer patients?

Dr. James Carter: Well, we are focused on preventing harm. It is the number one thing that we are looking at, making sure that we’re not harming anyone. I’ll have to say that our pediatric department and oncology department have been enthusiastic about it. Those institutes are embracing us. They just would like us to be able to explain what we do, and I think that’s fair. They want us to work with them and collaborate. So our goals are collaboration. Our goals are to have impact. We can’t have impact if we don’t connect, and if we don’t collaborate with our colleagues. And we collaborate not just with other specialties and specialists, but with patients and families and communities. That’s what we do.

James Maskell: Beautiful. Well, one of the most exciting things I think that has come out of the Cleveland Clinic functional medicine project so far is the Functioning for Life group model. Obviously, I know that had the potential to create a lot more scale to the efforts. Where are we with that, and how far have the group efforts made their way out? Obviously, the pandemic didn’t do a lot of good with getting people in rooms together, but hopefully we’re bouncing back?

Dr. James Carter: Yeah. There’s a number of important things to share about that. This is not in particular order, it’s just how it comes to my mind. The American Heart Association grant was partly written based on the experiences of the shared medical appointment format. In fact, that’s woven into the research grant. So we’ll have a medically tailored meal arm, and a medically tailored meal plus arm. Where they get a shared medical appointment with a lot of that same type of approach that we learned from Functioning for Life. And compare that to a weightless control in an underserved population that has high risk and low opportunities.

There’s great enthusiasm across the Cleveland Clinic enterprise for shared medical appointments. It’s ratcheting up and elevating. And we are bringing out multiple versions of that for these special projects like women’s health, for example. We’ll roll that out very soon. There’s a lot of excitement for that program. We’re tweaking it some, because some of the content needs to grow over time, as you can imagine. But it’s still a foundation for us to find a way to get people together, to have that type of group learning and lifestyle modification that’s encouraged by the culture of being together.

James Maskell: One of the things that was really exciting about a previous podcast that I recorded was seeing that innovation making its way in maybe the hardest, if not the hardest to reach population, maybe the hardest to change population, which is men and older men. How would you say that project is going, and what is some of the ways that you found to create change in a change resistant population?

Dr. James Carter: Yeah. Many people are resistant to change, and there’s a lot of elements to that. If you take in the whole context of their living, you can find a path. We’re going to develop a women’s health program first, but we are going to develop a men’s health program as well. Our goal is to be inclusive. As you point out, we want to make sure…we can’t innovate if anyone’s left behind. It’s not innovative if anyone’s left behind. So we will expand those programs as well. That ties into our other big initiative that’s around the corner, which is healthy aging, because everyone’s interested in that. We’re going to continue to build our programs for that, using functional medicine and functional medicine principles.

James Maskell: How much of your time is spent seeing patients in the center, and how much of it is masterminding the rest of all of this?

Dr. James Carter: I spent about half my time seeing patients. I just finished clinic a couple hours ago. It’s quite exciting. The patients are great. They come with a lot of concern about how to live in a more healthy way. We do have to sometimes set expectations, because there’s so many voices that they hear out in the world. Sometimes, they think that 100 tests and 50 supplements are going to be the way for them. So we have to try to let them understand that there’s potential harm in that. But it’s a great, great practice. We have a huge waiting list. We have hundreds and hundreds and hundreds of patients trying to get in.

James Maskell: Yeah, I can imagine. Just so I’m clear, the Cleveland Clinic is serving businesses across Ohio, right? And then obviously other people can come in. You’re working to serve patient populations that are employed. Then what other kinds of patient populations are you working with in the center?

Dr. James Carter: We’re looking to serve everybody. We have a regional presence here in Ohio. We have a national presence in Nevada, in Florida. We have an international presence in Canada, and in Abu Dhabi and London. We want to be inclusive. So we’re trying to find a way to do that. These special programs we’re doing out in the community are designed to also have a reach to a lower socioeconomic group. Again, not everyone can afford 20 supplements, so we have to…that’s why we focus on food first, first steps first. It’s one of the things that come up sometimes in conversations, frankly, with new patients. Sometimes, they haven’t really assessed how they’re going to do their first steps, and they want to jump ahead to second, third, fourth steps. It’s very, very important for sustainable health to do the core things first that functional medicine teaches us.

James Maskell: Absolutely. Yeah. The bottom of the matrix, right?

Dr. James Carter: The bottom of the matrix. What are we eating?

James Maskell: And the center of the matrix-

Dr. James Carter: And the center.

James Maskell: The mental equivalent of that, right?

Dr. James Carter: So much of the visit is spent on that, evaluating mental, emotional and spiritual. A lot of it is designed to help patients reimagine their relationship with sleep, food, exercise, movement, stress, relationships. Sometimes the only thing I prescribe is to go out and volunteer for somebody.

James Maskell: Yeah, absolutely. That makes a lot of sense. I love that. Just in my own personal world, just the health of my father recently, I realized how much of his journey from here on out was going to be in the context of his own growth. Because it was going to take a moment for him to realize how to participate. I think that’s a test for everyone. Well, also I’m excited. I mean look, at a 10. You moved from Colorado. I think you moved from Colorado to Cleveland. How do you feel of your decision at this point?

Dr. James Carter: I love it. I’m thrilled. I am working harder than I have in a long time, but it’s great work, great people to work with. We have an unbelievable team of brilliant doctors and advanced practice providers here, and a brilliant team of caregivers. Our front desk is great, our support is great. And we have a lot of growth ahead of us. We’ve recruited several physicians who are on their way here to join us. We have three new ones coming, and we’re going to keep expanding and growing. We’re very excited about how warmly we’re being embraced. This new direction for functional medicine here, academic medical center focused on the science of systems thinking.

James Maskell: Beautiful. I love that. Well, look, the next time that we’re going to hang out is going to be at the IFM Annual Conference, which is coming up in Las Vegas. The 29th of May is the kickoff, or the pre-event, and it starts on the 30th of May. I understand you’re going to be participating in a panel. Can you give us an update on what you’re going to be talking about?

Dr. James Carter: It will be a great conversation about what we’ve learned doing functional medicine in an academic setting. I have great perspective about that, because I did it first in a setting where there wasn’t full embracing of what functional medicine is and what it can be. Then coming here to Cleveland Clinic, where there was some understanding of what functional medicine is and can be, and an opportunity to work together to move that forward. That’s what my part of the discussion will be about, but the conversation will be about academic medical practice and functional medicine.

James Maskell: Beautiful. I love that. I’m excited to come and check that out. We’ll be there with the cameras. What else are you excited about for this year’s conference? Vegas is obviously new for a lot of people. But outside of the location, what are you excited about that you’re going to see at the conference?

Dr. James Carter: I have a lot of patients who are coming worried about bone health. I think it’s tied into the concerns about healthy aging. So I’m excited to hear what’s new, and what we should be incorporating to help men and women. I had both today, just as a coincidence, who had osteoporosis. One man, like you’re saying, the need for men’s health, multiple fractures from falls. How do we help someone like that? Very, very interested in the new epidemics that are on our way, right? The mental health, but also the fatty liver, fatty pancreas. What should we do to prevent that, and how do we help patients who already have some evidence for that? As we talked about before, we can’t forget about the kids. What are we going to do about pediatrics? There’s going to be some exciting sessions on how to prescribe and utilize nutrition for pediatrics, particularly those who are struggling with mental health problems.

James Maskell: Beautiful. Yeah, I love that. Well, I’m excited for all of that, and I want to just give it a special mention. There’s some exercise stuff that I think is really critical there. Dr. Gabrielle Lyon, she’s been a sort of a leader in the field of, what she calls muscle-centric medicine. Dr. Stacy Sims is speaking about exercise-related tools, such a critical part. I mean, even going back to COVID, seeing the difference in outcomes between people who exercised and didn’t. Even on an infectious issue, it’s critical. It’s a critical part of the bottom of the matrix, and I’m excited for that. Just a bit of a plug here as well. We always do, at the Evolution of Medicine, we do the pre-party. So on Wednesday night, the 29th, the night before the conference starts, 7:00 till 9:00, we are going to be doing VagusFest, a celebration of the vagus nerve. We’re going to be diving deep for practitioners.

We’re going to learn about the vagus nerve through an experience of healing and toning the vagus nerve. So it’s going to be fully participatory, fully engaged. If you want to find out more about that, we’ll have that in the show notes. I am super excited for that. Look, I guess what I want to say is my efforts in spreading functional medicine have had a very interesting intertwining with this Cleveland Clinic project, Dr. Carter. On the first episode of the Functional Forum that we actually got the streaming to work…because the first couple, it was a time where it didn’t really work, and streaming used to be hard in 2014. Dr. Hyman flew in from Cleveland, and announced the whole project on the show. I think that was an amazing moment for us, because it was like, people now…what is this show? Why is Mark talking at it? That was amazing. We had the opportunity to come with the camera—

Dr. James Carter: Yeah, I saw that.

James Maskell: ….in 2018, and do the video. That was really fun because I was, it’s amazing to see how you can—

Dr. James Carter: It’s a remarkable place.

James Maskell: …from the ground up. Right, exactly. The farmer’s market, and all the other things that go into creating a healthy ecosystem. It’s not just about the medical care. You have to create that. Then obviously the group side of things, really inspired by that. Just seeing that as an obvious next step in where functional medicine has to go to really scale. I guess I just want to salute you for stepping into it, and now taking it into all these other places. It’s been amazing to see the evolution of it. I’m excited that you’re at the helm, and I look forward to following the progress and the growth. Just a really exciting moment for the industry as a whole to see the progress at such a storied institution. I’m grateful for that.

Dr. James Carter: Yeah. It’s a great place to be. And I’m looking forward to AIC, to get to talk to other people around the country and around the world. I’m a vascular medicine specialist also. I don’t know if I told you that. So one of the lectures that I’m very interested in seeing is talking about vascular health from a functional medicine perspective, and being more precise in what we do from Dr. Druz. I’m looking forward to all of it. I’m looking forward to what we’re going to do together in Cleveland Clinic, and how we can impact the world in the sustainable way.

James Maskell: Beautiful. Doc, thanks so much for making time. It’s been great to have you here at the Evolution of Medicine podcast. I look forward to seeing you in a couple months in Las Vegas. In the meantime, thanks so much everyone for tuning in. This is the Evolution of Medicine podcast. We’ve been talking about the Cleveland Clinic Center for Functional Medicine. We’ve had Dr. James Carter here. Thanks so much for tuning in, and we’ll see you next time.

Thanks for listening to the Evolution of Medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools, like the Group Visit Toolkit. That’s goevomed.com/lmrc. Thanks so much for listening, and we’ll see you next time.


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