What if the future of cardiology requires looking far beyond cholesterol numbers?
In this live Evolution of Medicine Podcast episode from the Institute for Functional Medicine Annual Conference, James Maskell speaks with Dr. James Carter about the changing landscape of cardiovascular care and the growing role of functional medicine within major healthcare institutions.
Drawing on his experience as an interventional cardiologist and leader of Cleveland Clinic’s Center for Functional Medicine, Dr. Carter explains why inflammation may be a more important driver of heart disease than many traditional risk factors. He discusses the limitations of relying solely on LDL cholesterol and risk calculators and highlights the importance of assessing inflammation, lifestyle factors, environmental exposures, gut health, and social determinants of health.
The conversation explores the power of listening to patients’ stories and how personal experiences, stress, trauma, and social context shape biology and influence long-term health outcomes.
James and Dr. Carter also discuss innovative care models including shared medical appointments, community-based health programs, church partnerships, and teaching kitchens designed to improve access to preventive care and lifestyle medicine.
Additional topics include brain health, dementia prevention, interdisciplinary collaboration, healthcare transformation, and the future of functional medicine within large healthcare systems.
The episode concludes with Dr. Carter’s vision for creating a healthcare model that combines scientific rigor, compassionate care, and whole-person medicine to improve health outcomes at scale.
About the Guest:
Dr. James Carter is an interventional cardiologist and serves as Director of the Center for Functional Medicine and Vice Chair of Clinical Services within the Department of Wellness and Preventive Medicine at Cleveland Clinic.
After spending much of his career in community-based cardiology practice, Dr. Carter returned to academic medicine before being recruited to lead Cleveland Clinic’s functional medicine program. His work focuses on integrating functional medicine principles into large-scale healthcare delivery systems while improving access to preventive and whole-person care.
Dr. Carter’s clinical and educational interests include cardiovascular disease prevention, inflammation and cardiometabolic health, lifestyle medicine, shared medical appointments, community-based health initiatives, and the integration of functional medicine within conventional healthcare settings.
He is a leading advocate for addressing the biological, environmental, and social factors that contribute to chronic disease and believes that understanding the patient’s story is essential to delivering effective healthcare.
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About the Host:
James Maskell is a healthcare entrepreneur and founder of The Evolution of Medicine. For over 20 years, he has worked to scale functional medicine through community-driven models, group visits, and practitioner infrastructure. His work focuses on moving medicine upstream – toward prevention, lifestyle intervention, and systems-based care.
Social Handles:
Website: https://www.jamesmaskell.com/
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Instagram: https://www.instagram.com/mrjamesmaskell
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LinkedIn: https://www.linkedin.com/in/jamesmaskell
Youtube: https://www.youtube.com/FunctionalForum
Evolution of Medicine™ Mission Partners:
TrueNeura: https://truneura.com
Fullscript: https://goevomed.com/fullscript
Big Boost Marketing: https://goevomed.com/bigboost
Freedom Practice Training: https://goevomed.com/fpc
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Transcript:
How would you say, how would you rate the degree to which these functional medicine ideas are permeating into, like- Uh- … the core of the Cleveland Clinic, which is the cardiology program? I don’t know. I don’t know if I could rate that yet. Okay. It’s still a work in progress. Uh, there’s enthusiasm for it, and I’m not going to say that everyone’s enthusiastic.
You know, it- it’s hard to change. Yeah. And especially when the change has been so hardwired for 10, 15 years- Yeah … reputations have been made from it. But it’s just, we’re just practicing good medicine. Yeah. And patients come to us because they have questions, they have concerns, and what they’ve been told is not consistent with what they’re reading.
Yeah. And so we take the time to explain the biology to them. Some of my patients still end up taking pharmaceuticals as part of their healthcare goal. Yeah. But I tell them the truth about all of the literature. Lifestyle is still the most important thing. Sleep is paramount. Stress management is key.
Connections, doing things for others, all those things. And is that, is that kind of care in the Cleveland Clinic Center for Functional Medicine, or is that kind of care further afar and, and making it into the other parts of other care? It’s, it’s making it to other parts. Cool. Our women’s health gro- program is growing.
We’ve, we have a lot of, uh, strong relationships with, uh, GI, geriatrics, pediatrics. We have functional medicine psychiatrists as part of our program. We have functional medicine OBGYN, uh, specialists. So we, we believe in collaboration. Yeah. We’re not trying to show that one way is better than the other, just find a way to take care of patients to the best of our ability.
Yeah. Hello, and welcome back to the Evolution of Medicine podcast. We are here at the Institute for Functional Medicine’s annual international conference, and we are speaking to leaders and innovators, people who have been spreading the message here, uh, at this conference. And I’m super excited to have back on the podcast Dr.
James Carter. Uh, if you have been following along for a long time, you know that Dr. Carter has a pretty significant role at the Cleveland Clinic, we’re gonna talk about that, but also did an incredible lecture today on cardiology and the evolution of cardiology, which we’re gonna talk about as well. So Doc, welcome back to the show.
Thank you very much. Thanks for inviting me back. So remind for the audience your journey to get here and the role that you have at the Cleveland Clinic. Well, I started out as an interventional cardiologist and spent most of my time out in private practice and community-based practice. Then went back to academics in 2017, went to a major university, then I was recruited to Cleveland Clinic to direct the Center for Functional Medicine.
Nice. Since we last spoke, uh, I was promoted to an additional role as vice chair of clinical services for the Department of Wellness and Preventive Medicine. Yeah. So our functional medicine program is within the wellness department. Amazing. Well, look, I wanna jump into… I, I’d love to learn what’s happened since, ’cause I know always things are happening.
But I wanna just dive straight into your lecture because I’ve been speaking to a number of clinicians who were there, and they were like, kind of like, “Finally, this is being talked about as a topic,” because I know the evolution of cardiology has a lot of factors to it. So share, can you share a little bit about sort of the main thrust of the talk and, um, how you see this sort of evolution of cardiology?
The, uh… Thank you for engaging me about this. It’s, uh, it was nice to get that type of feedback. People came to me after the presentation and expressed the same thing. And so I’ve, I’ve been reflecting on what resonated, and I think what, um, really moved people was the emphasis on the humanity of the work.
Mm. Uh, how it’s all about our own personal narratives and our own stories, and importantly, those stories affect our biology. And showing that, that integration of social context intersecting with biolo- biologic vulnerability- Mm … and biological pr- um, promise is what functional medicine can address. Yeah.
So I tried to show that from the perspective of patients who are coming in, they have a story to tell. Someone’s not listening to the story, so they put them on a treatment that actually doesn’t make sense for what they actually have presented with. That’s interesting. Yeah. Yeah, I love that. Well, um, tell us a little bit about, you know, obviously Cleveland Clinic is known for its cardiology.
That’s sort of like the, the fundamental piece. And what I understood from, from the, from the talk is that there are elements of what’s important to a healthy heart that have been sort of debated, and that there’s a sort of a, a re-reckoning in this, in the field of cardiology about what causes heart disease.
And I’d love for you to, to share some of, um, what you shared because I think that there’s a number of people in this community who, when they’ve come to functional cardiology, have been made aware of a different set of factors that affect biology. One, you know, uh, biology and story being one, but also, like, when you get down into the, the biochemistry, there’s some, there’s some unusual factors, should we say.
Well, the, the important thing is that everyone’s trying to do the best they can- Yeah … to help the patients. And for a lot of reasons, um, a lot of cardiology care has been, uh, simplified For the purpose of finding a way to reach as many people as possible- Mm … to guidelines and risk calculators. Yeah. Uh, even though the evidence doesn’t really show that that’s effective, the incidence and prevalence of cardiovascular disease across the globe continues to rise, continues to be a burden.
Yeah. And the reason for that is because we’re not treating all of the risk. And, um, my presentation used, uh, papers and scientific articles, uh, that were peer-reviewed from major cardiology journals and major internal medicine journals. So Journal of American College of Cardiology, Lancet, and Journal of American Medical Association.
Mm. And I was able to show that we’ve known for a long time that inflammation is more important than lipids. Mm. Uh, we have evidence for that from 1990s. Wow. Um, and I was able to show that we now, you called it a re-reckoning, that’s a interesting word I’ll think about. Mm-hmm. Um, but now an, an understanding that, uh, we have to look at more than just LDL cholesterol because there’s still this residual risk if we only look at LDL.
Yeah. The highlight would be that even in people who have been on statins to lower their LDL, if they have, uh, measures of inflammation present, their risk remains high- Yeah … for cardiac events. What are some of the key biomarkers that you might look at to go a little bit deeper into the actual risk related to inflammation?
Well, even before the biomarkers, um, I think it’s important to be present for patients to listen to their context of living. Yeah. I, I was not trained to do that. I was trained to go into the clinical space with a set of questions. But it’s very important to understand what people are doing, what they’re exposed to, because there’s risk from that.
There’s risk from environmental exposures, from stress, um, from lack of green space, all those things, and there’s a lot of data on that. Then beyond that, um, to understand the biology is imaging to see if there’s signs of plaque in any way you can to show whether there’s atherosclerosis, and that depends on what’s available to you.
And then going beyond, uh, fasting lipid profile, which is an inadequate, uh, measure of risk. It’s just something that I, I just don’t understand, uh, why anyone would think the data shows that, because it doesn’t. And, um, there’s much more to it than a fasting lipid profile. Digging into particle number, particle size, but most importantly, signs of inflammation.
Are they eating a pro-inflammatory diet? And do they have inflammatory markers elevated? Do they have signs of impaired gut health when you talk to them? And are there markers of impaired gut health in your laboratory testing? Yeah. Super interesting. So I know one of the, one of the things that I interviewed someone at the Cleveland Clinic about, I can’t remember the, the timing or the details, is one of the ways to sort of engage particularly, like, African American men early on was to go out and do these group visits, right?
In these different areas as a way to engage maybe earlier than you might engage to actually come in and, and be with a doctor in a normal system. How is that process going and, and do you feel like that is still a way to get in a little bit earlier to those populations? It’s absolutely still a way. We even have a poster, uh, presented, um, this week showing that we did a pastors program and a shared medical appointment, and, uh, leaned into the concept that, uh, pastors in churches are, uh, committed to health promotion.
Yeah. And teaching them about health so that they could teach better was the concept, so we did two pilots of that. Uh, we still have shared medical appointments as part of our practice and a- and there’s an excitement about, uh, a teaching kitchen that’s opening soon. It will be open the end of this year, and it’s at, uh, one of our community centers located in a, in a, uh, a diverse neighborhood, and we’re going to use that as a, of a, another way to engage and connect with people, understand their cultural, cultural beliefs, their preferences, teach them about, uh, nutrition, show them how they can make some substitutions that will maintain their joy of eating and won’t, uh, be dismissive of their, uh, culture.
That’s awesome. How would you say, how would you rate the degree to which these functional medicine ideas are permeating into, like- … the core of the Cleveland Clinic, which is the cardiology program? So I just wanna take a minute to talk about the incredible mission partners that we have here at The Evolution of Medicine that have made this possible.
So first and foremost, I wanna thank- Fullscript and Fullscript Journey.
So Fullscript’s been an amazing partner for 10 years. We only pick partners that can help us achieve our vision and help you achieve your practice vision. And Fullscript have been an incredible partner for a decade, but their new offering Journeys, this is why we called it The Evolution of Medicine Journeys, is allowing practitioners to combine the relationships that they have with the newest technology to sell direct-to-consumer lab testing, and use it as a funnel to bring into your practice, and it’s a game changer for the whole industry.
So go to goevomed.com/journeys, and you can get started on building the Journeys for your practice, an optimal way into your practice. We’re gonna have some conversations about it. This is a game changer. Next, Genova. Genova, um, have been fans of The Evolution of Medicine for a long time. We’re big fans of them, and they now have a lot more specialty testing.
They have a lot more tools, and it’s a key part of, uh, understanding the body ecologically. So go to goevomed.com/genova to find out more. Come on over here and I wanna show you about the other mission partners. You know, if you’ve been following us for a while, you know that these are organizations that we trust, that add a lot of value.
Freedom Practice Coaching. Um, I have been sup- supported by them since the beginning and, you know, so many of the issues that practitioners face in building a successful practice, scaling a successful practice, come down to having the right support with people who have been there and done that. Go to goevomed.com/fpc.
Um, BigBoost Marketing. Uh, Uli and his team are the best in the business when it comes to really understanding how to market your functional medicine practice. Go to goevomed.com/bigboost and see how they can help you. And then what you’re gonna be hearing a, a lot about is the formation of clinical networks.
And ultimately, TruNeura is our first effort at that, which is to build an integrated clinical network, combining independent practices from across the country into a network that can reverse cognitive decline. And if you go to goevomed.com/truneura, you can get a demo. You can see what it means to be part of an integrated clinical network.
That’s mentorship, that’s software, and that’s making it easier for you to get incredible outcomes in a disease state where there are no other options. So thanks to our mission partners. Let’s get back to the content
I don’t know. I don’t know if I could rate that yet. Uh- He’s still a work in progress. Got it. Uh, there’s enthusiasm for it. Mm-hmm. And I’m not going to say that everyone’s enthusiastic. Um, you know, it, it’s hard to change. Yeah. And especially when the change has been so hardwired for 10, 15 years- Yeah … and reputations have been made from it.
Um, but it’s just, we’re just practicing good medicine. Yeah. And, uh, patients come to us because they have questions, they have concerns, and what they’ve been told is not consistent with what they’re reading. Yeah. And so we take the time to explain the biology to them. Some of my patients still end up taking pharmaceuticals as part of their healthcare goal.
Yeah. But I tell them the truth about all of the literature. Mm. Uh, lifestyle is still the most important thing. Sleep is paramount. Stress management is key. Connections, doing things for others, all those things. And is that, is that kind of care, uh, in the Cleveland Clinic Center for Functional Medicine or is that kind of care further afar and, and making it into the other parts of, uh, other care?
It’s, it’s making it to other parts. Cool. Um, our women’s health grow- program is growing. We’ve, we have a lot of, uh, strong relationships with, uh, GI, geriatrics, pediatrics. Mm. Uh, we have functional medicine psychiatrists as part of our program. Uh, we have, uh, functional medicine OBGYN, uh, specialists. So we, we believe in collaboration.
Yeah. We’re not trying to show that one way is better than the other, just find a way to take care of patients to the best of our ability. Yeah. I’ve spent the last year or so really involved in the sort of the world of, uh, of dementia and, and Alzheimer’s, and it’s been amazing for me to learn from so many, uh, incredible functional medicine clinicians who are showcasing the relationship of the vascular system to the brain and how everything’s connected.
You know, it’s interesting that it, it, it’s like in a certain way you can’t just permeate one, one, uh, one organization or one specialty because the whole point is the interconnection of everything. The whole- Um, I’d imagine if that, that is both a blessing and a curse in institutional change. Uh, it’s, it’s, uh, it’s an opportunity Yeah It’s an opportunity, and we work very closely with other specialties because of that.
And we have brain health programs in our department. We have shared medical appointments for brain health, and that’s really been taking off. Yeah. Um, so we are tr- trying the best we can to pull it all together. Uh, we think it’s, uh, necessary. We think it’s an imperative, and we’re dedicated to it, and we’re dedicated to doing it within our model of care so that we can reach as many people as possible.
It doesn’t mean I have anything against those who are, you know, doing it for people who have the money to spend every month or in these packages, but we’re trying to reach everyone. Amazing. Uh, so as you look forward now, you’ve got this enhanced role. You have the functional medicine delivery, you have the group visits, you have all these other pieces.
What do you– as you look out into the future, what are your sort of hopes and dreams for what is possible in the future of your tenure at the Cleveland Clinic? My hope is that people would listen to your podcast and say they want to come and work within our program and practice good medicine, and take care of many people as possible.
Uh, if we get that, that could be MDs, DOs, um, uh, advanced practice providers, all different types, physical therapists, chiropractors, acupuncturists, whoever is dedicated to that type of model to try and seeing that through. Usually they have a personal story. They have a, a father or brother or cousin or mother who needs care in a pa- an insurance-paid model, and they want to help grow that concept so that we can spread that word.
Once we can show it in a, a big, uh, place like Cleveland Clinic, everyone could follow. Is there a tension between sort of leading the revolution in terms of functional medicine coming into institutions and, and wanting to do that versus, you know, executing on the commitment of the Cleveland Clinic to the population of Cleveland?
Like, is there a tension there, or is it all part of the same, same? Part of the same. Okay. The values of Cleveland Clinic are aligned with our values. Yeah. Um, we, um, we believe very strongly that we can shape the future, um, by, uh, working together as a team and, um, and leading with kindness and care. So if we do those three things, we will reach our goals, and those are the same things we believe in in functional medicine.
So we, we feel pretty aligned with the Cleveland Clinic values. Amazing. Well, I wanna tell you a funny story, ’cause I had an interaction this year that you’ll like e- exactly in the context of what you just shared. So, um, I get an email one day, and it’s from a recruiter, and they say, “Hey, there’s a position.
We think you’d be a good fit for it. Are you interested in finding out more?” So I’m like, “Yes. Let’s see what this is.” So they send me a message, and all I can say is that it is the email that I have received that I felt the most validated in my whole career. It was like, “We’re from the Cleveland Clinic. Um, we saw that you visited the Cleveland Clinic Center for Functional Medicine.
We see the work that you’ve done in Evolution of Medicine and New Health,” and all these kind of things. And it was like reading someone has been paying attention to my whole career, and is… it is, it is validating all the things that I’ve done. And there’s this role coming up at the Cleveland Clinic for, like, the Center of, like, Digital Innovation, and we think you’d be perfect for it.
Here’s the salary range. This is what it is. And I’m like, “Oh my God. Look at this.” I look at the bottom and I see this recruiter guy, and I look him up and I’m like, “This is a real guy.” Go back and forth and we have this conversation, and then it hits me, like I look at it and I’m like, “This is coming from a Gmail account.”
Like I don’t– I think this might be a bit- Oh no. … and I’ve been like essentially AI scammed. Now, what I don’t know is how they were ever planning to make money from this. It wasn’t like they said, “Hey, well, send us $5,000 and you’re in for this thing.” But I was saying to my wife like, “Hey, what do you think?
Like should we move to Cleveland?” Oh, that’s all. So I got AI scammed. I don’t even know what the point of the scam was, but I guess there’s enough information out on me in the world that I get these, you know, that I got this email. I thought you’d get a kick out of it. It was a… ’cause, uh, because, uh, yeah, it was a, it was a funny moment to imagine, um, start to like that night I went to bed just imagining, oh, am I gonna fly to Cleveland once a month or whatever.
But look, uh, uh, I think, you know, just it has been actually an amazing thread through the evolution of medicine. You know, Dr. Hyman announced the project in 2014 on like the first proper episode of my show. We went and toured there when the center was up, and now obviously keeping, keeping up to date with it, uh, through being on the project and seeing you at the, at the IFM.
Um, yeah, where, where should p- if practitioners are interested and inspired to go and do it If I give my own endorsement, like, my feeling is that at this moment of the functional medicine revolution at the Cleveland Clinic, a five-year stint at the Cleveland Clinic Center for Functional Medicine as a physician or otherwise would set you up for an incredible career.
Right. Because ultimately what you see is the seeds of what’s happening now blossoms into something amazing, and I think that that’s an amazing place to be. So I think if I was a early-stage physician wanting to learn the clinical stuff and have credibility for the rest of my life, that would be a good place to come.
Where should people go if they wanna find out more about it? Well, the other option is to have a career there. Yeah. So we have some brilliant people who- Come for five years and stay forever … plan to stay. Yeah. That’s right. So, uh, they can check out our website and, um, and, you know, just search us and look us up and, um, reach out to me through you if they can’t find- Yeah
the website. And, uh, we have a lot of opportunities for people who have, even people who have particular areas they want to focus on. Mm. We have opportunities for, to do that with the Functional Medicine Foundation. Um, I agree with you that some want to come and just stay for a few years, uh, but we are looking for people who understand the value of, um, being part of the Cleveland Clinic enterprise for their whole career.
Yeah. Uh, we’re a global enterprise. We have, uh, clinics a- in, um, a footprint all over the world, so there’s a lot of opportunity for growth and even change when you want a change. There’s a brain-specific entity, right? Is that right? Yes. Can you tell me a little bit more about that? Well, we’re expanding that in Nevada.
We have, uh, shared medical appointments, uh, for that, and we’re, um, you know, growing that part of our program. It’s very exciting. You know, people are clearly concerned about brain health, and, uh, we’re using a similar model to, that we use with the women’s health. Yeah. So we’re using that type, that type of model to keep growing, uh, what we do and touching as many people as possible.
Amazing. Why do you keep coming back to annual conference here, apart from giving your lectures and keynoting? What is it about the conference that, that lights you up? Uh, this time I wanted to, um, see what talent was out there that I could, uh, convince to come and work for us. Okay. That’s the truth. Yeah.
That’s, that was my main motivation. I did enjoy doing the presentation, uh, but I want to keep my, uh, understanding of what people are looking for in practice. They don’t think what we’re doing is possible. That’s part of why they’re gravitating to doing this, their own little, uh, practice niche, and they don’t think it’s possible in an insurance-based model to provide good care and feel valued and feel productive.
Yeah. And we believe there, there’s a way to do that. Yeah. Uh, well, you’re proving it out that there is a way to do that. And, uh, yeah, I think I was really excited to see, you know, uh, on the main stage at the very beginning, talking about community as medicine, group visits, those kind of things. You know, this is, uh, proving that these kind of models can, you know, take it into different places Well, thank you so much for being part of the group.
I hope that, uh, if you hear this, you get in touch and come and, uh, be part of the revolution over there. There’s a long way to go for us to transform healthcare, and the Cleveland Clinic has been on the cutting edge of bringing these ideas into conventional medicine at a place with credibility, impact, data.
Uh, it’s a very, very important project. And, uh, Dr. Carter, thanks so much for- Nice seeing you … the presentation. Yeah. Good to see you. Good seeing you. So I just wanna take a minute to talk about the incredible mission partners that we have here at The Evolution of Medicine that have made this possible. So first and foremost, I wanna thank- Fullscript and Fullscript Journey.
So Fullscript’s been an amazing partner for 10 years. We only pick partners that can help us achieve our vision and help you achieve your practice vision. And Fullscript have been an incredible partner for a decade, but their new offering Journeys, this is why we called it The Evolution of Medicine Journeys, is allowing practitioners to combine the relationships that they have with the newest technology to sell direct-to-consumer lab testing, and use it as a funnel to bring into your practice, and it’s a game changer for the whole industry.
So go to goevomed.com/journeys, and you can get started on building the Journeys for your practice, an optimal way into your practice. We’re gonna have some conversations about it. This is a game changer. Next, Genova. Genova, um, have been fans of The Evolution of Medicine for a long time. We’re big fans of them, and they now have a lot more specialty testing.
They have a lot more tools, and it’s a key part of, uh, understanding the body ecologically. So go to goevomed.com/genova to find out more. Come on over here and I wanna show you about the other mission partners. You know, if you’ve been following us for a while, you know that these are organizations that we trust, that add a lot of value.
Freedom Practice Coaching. Um, I have been sup- supported by them since the beginning and, you know, so many of the issues that practitioners face in building a successful practice, scaling a successful practice, come down to having the right support with people who have been there and done that. Go to goevomed.com/fpc.
Um, BigBoost Marketing. Uh, Uli and his team are the best in the business when it comes to really understanding how to market your functional medicine practice. Go to goevomed.com/bigboost and see how they can help you. And then what you’re gonna be hearing a, a lot about is the formation of clinical networks.
And ultimately, TruNeura is our first effort at that, which is to build an integrated clinical network, combining independent practices from across the country into a network that can reverse cognitive decline. And if you go to goevomed.com/truneura, you can get a demo. You can see what it means to be part of an integrated clinical network.
That’s mentorship, that’s software, and that’s making it easier for you to get incredible outcomes in a disease state where there are no other options. So thanks to our mission partners.
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