This week on the podcast, we have another episode in our New Models Series focused on the terrain theory with Dr. Maya Shetreat. Maya was on the Functional Forum back in 2017 in Guernsey. She talked all about plant medicine. In this episode, she talks about her journey with terrain medicine and how that concept aligned all her clinical interests and passions. We also talk about how terrain and community connections go hand in hand, and how functional medicine practices can use her insight to treat patients with the terrain theory mindset.
Highlights include:
- What terrain medicine is
- How to align bio terrain with the eco terrain
- How terrain medicine is all about connections with oneself, communities, and the natural world
- And so much more!
Resources mentioned in this episode:
James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.
So a warm welcome back to the podcast and back to the Evolution of Medicine platform, Dr. Maya Shetreat. Welcome, Maya.
Maya Shetreat: Thank you for having me.
James Maskell: Excited to dive into terrain medicine here today. When you first came on to the Functional Forum, I think one of the earliest Functional Forums talking about the microbiome and you had a book on the microbiome, then we went to Guernsey in 2017 and you were talking all about plant medicine and a wide variety of plant medicines. And over the last couple of years, being really focused in on terrain medicine. So let’s just start there, what is terrain medicine and why did that concept bring together all of your passions into one place?
Maya Shetreat: Yeah, I feel like my book, The The Dirt Cure was actually the entry point into the idea of terrain. And for me, terrain, it’s about a conversation. It’s the conversation that happens between the physical, the emotional, the spiritual. It’s the conversation that happens within our physical body between the microbiome and all of our organ systems and the food we eat and all of that. And then on the other side, it’s this external terrain, this eco terrain around us.
So when we’re talking about terrain medicine, we’re talking about how are we aligning our inner terrain, our bio-terrain, how are we aligning with the eco terrain that is around us? And we can be very expansive in the way that we understand it and we can be very technical, right? We can talk about the microbiome, we can talk about organisms, we can talk about soil and sun and seeds and food. And we have a lot of data for all the ways that we are in connection and in alignment with, or not in alignment. And I think that’s really what the definition of health is when that conversation is really happening in a good and balanced way.
James Maskell: So obviously, we’ve been hot on functional medicine as sort of an operating system for the future of care, because to a certain degree, it is educated by terrain theory or its terrain-ish. Where would you see there is divergence between functional medicine and terrain and where is there congruence?
Maya Shetreat: Well, I think the idea of balance is pretty fundamental to the idea of functional medicine and that is really not foundational at all in conventional medicine. So in that regard, I think that whole idea of balance or being in alignment, and I think bringing in the mindfulness and mind, body, spirit that functional medicine at least traditionally does is very much in alignment with the idea of terrain. I think places it may diverge, or at least I wouldn’t say maybe it hasn’t reached this point yet, is to really understand how much we are part of the world around us.
In other words, I think in functional medicine, we’re talking a lot about toxins, we’re talking a lot about getting your vitamin D through sunshine, we’re talking about making sure you’re having clean water, staying hydrated. These are all incredibly important aspects of terrain. But I think there’s this concept of this isn’t just a clinical relationship. We are very much a part of the terrain around us. And so we actually can’t be healthy without being immersed in the natural terrain around us and being engaged in that conversation, being in nature, getting dirty, being in the forest, having exposure to all different kinds of microbes, all of these different ways that we are really immersed in nature. I think we haven’t quite reached that.
Just as another example, we’re going to give people 20 different minerals in different supplements rather than saying, “Hey, we need to be talking about how we’re going to nourish the soil so that the food that we’re eating is going to be nutrient dense and we don’t have to go extract magnesium or extract calcium from other places. We can, actually have that in the soil and in the food that we’re eating.” Just as an example.
James Maskell: Yeah, absolutely. So for those practitioners who have come through a functional medicine education, what are typically the learning points that you find are most powerful then in adopting more of a terrain approach? And what are the blind spots in functional medicine practice that when ameliorated with a terrain perspective can improve patient outcomes?
Maya Shetreat: Well, in practice, I think there are a lot of functional physicians who are employing concepts around terrain. They’re saying, “Get outside and take a walk. Get some sunshine.” And so on. I don’t think that this is just not a part of it. But I would say from the standpoint of what I’ve seen in my practice, for example, or in the work that I’ve done, giving people that sense of…well, part of I think what terrain really offers people is, number one, you have agency. And maybe I’ll actually touch on for a moment here, if this is useful to you, I think we could talk about how the idea of terrain theory came about in terms of like Louis Pasteur right?
This is a very famous story that most people already know. But Louis Pasteur, the father of pasteurization, the father of germ theory, basically discovered this idea of these invisible to the naked eye microbes that are lying in wait at any given moment, ready to enter your body and grow out of control and maybe make you sick and maybe even kill you. That’s the sort of really simplified version of germ theory. And people talk about Beauchamp, but I also talk about Claude Bernard, who was the one who actually said cellular theory, which we also now call terrain theory, he’s the one who basically said, “You know what? These organisms, actually most organisms, the vast majority of organisms, exist in the body of a normal individual who’s not sick, who shows no symptoms, who’s healthy. And it’s really when that individual is in a state of imbalance that any organisms that might already be there normally can grow out of control.” And of course, at the time, Louis Pasteur won with his dominant theory.
And at that time, people were looking at things like sauerkraut and sourdough bread and yogurt as being contaminated because it had these bad bugs in it. Obviously we know a lot better now and, again, the story goes, and who knows if it’s true, that on his deathbed, Louis Pasteur, he basically retracted things and said, “Yes, it’s really not the microbe, it’s the terrain.” And so that’s how we kind of came up with this idea of terrain, rather than thinking about the disease, thinking about the individual who has the condition and how do we strengthen that person? And I think it’s a really empowering idea to feel like you have agency to strengthen your own terrain so that whatever may come your way, and that can be a physical, physical stress, a chemical stress and emotional stress, spiritual stress, anything that might come your way, and that’s just what happens when you’re a human being in a human world, that you’ll have the resilience and the capacity to navigate that without being totally knocked off the horse. You know what I mean? Or that if you are knocked off, you can climb back on.
So, I think, number one, and I know this might sound basic, but I think for a lot of people, just feeling that sense of agency around the idea of how you can strengthen and have a more resilient terrain is incredibly powerful and empowering and gives people a whole sense of control over their health that they might not otherwise have. So I think that’s a big piece of it in terms of being helpful to people. And then I think the idea, which this is an Indigenous idea with the teachers that I studied with, who really feel that physical health is a very downstream issue and that really the upstream issues are spiritual and emotional health. And that has to do with you being in good relations. In good relations with yourself, in good relations with the people and living beings around you and in good relations with the place, the land you stand on. And so that is actually, for most of my teachers and elders that I have studied with and study with, those are the fundamentals of health. And everything else grows out of that or is downstream from that.
James Maskell: Yeah, that’s really interesting and makes a lot of sense, too. I’m glad you mentioned the word resilience because 2020 was our year of resilience. This year we’re into the re-invention of medicine. And we’ll talk about reinvention in a minute. But on that conversation about resilience, surely there could be no more…I guess a frustration that I want to share with you about the year 2020 is I felt like we had almost as a society come to the realization that microbes were inherently good by and large, and that we needed to be healthy. I feel like maybe we’d got to a certain percentage of the population that realized that being in the dirt and all the things that were in your Dirt Cure. I feel like we almost made it there as a society to understand that, and then COVID comes along and all bets are off and we’re back to the hand sanitizer, we’re back just panic and we’re right back into like the germ theory mindset.
And that was frustrating to me because I guess I had kind of witnessed the journey over the last eight years as it went from something that was only being talked about at an ACAM conference and in a few practitioners to now the Functional Forum and my experience through that, to then in the last couple of years before COVID hearing random people that had no connection to the functional medicine world tell me about how you needed to train your immune system by getting dirty and all these kinds of things. I was like, “Wow, the hygiene hypothesis has made it out to like the 51st percentile of the community.” And then it just felt like the door was like totally slammed back in our face.
Maya Shetreat: Yeah. I feel that frustration. I share that frustration. But I would also say this, and I think this is even relevant too, is compassion is not very hard, just to make a parallel analogy. It’s easy to be compassionate to people you already like and love. It’s when you’re challenged, that’s really the question of if you can show compassion, right? How intact is your practice of compassion? And I would say similarly, I agree with you, it made its way, people were embracing it. Even for my book, it was on NPR, it was in The New York Times. It was really making its way around, the idea of dirt and soil and microbes and all these things were on the cover of Time magazine people really talking about it.
But I think the real question is, can we apply these ideas? The real test is can we apply these ideas? Can we put our money where our mouth is and apply these ideas when we’re confronted with the idea of a scary novel organism? And I think all the data that’s coming out is showing that our gut microbiome really matters. Our exposure to sunlight really matters. And these are the things that are absolutely the most pivotal in determining if someone is going to have good resilience in the face…even if we’re talking about COVID right. Even if we’re talking about the data that we’re seeing about that. So can we actually really apply that? Can we really stand by these principles? And that’s going to really tell us if this can…can we really stand by it? I think I’m seeing a lot of people, even in the functional medicine world, in that panic that you’re talking about. Even people who really understand these principles and know the science. So can we really hold onto these and can we really apply them, is going to be the big question.
James Maskell: Yeah, absolutely. So I think one of the things you brought up there that I think is really important is how these lessons will be taken on into medicine. And so last year was all about resilience. Before we go into thinking about the reinvention of medicine around terrain theory, what would you say are some strategies that come from terrain theory that you think have the biggest leverage for building internal resilience?
Maya Shetreat: Yeah, I think that one of the biggest pieces of the idea of terrain is understanding that everything is connected and that we are all connected. So it’s kind of, I think, taking in the idea that…I’ll give you an example as just sort of understanding our relationship microbes, it’s not just take your probiotic every day, it’s getting out into the soil, it’s eating that sauerkraut it’s spending time in the forest and all these different things. And part of the reason for that, terrain is something that’s complex. So just as an example, spending time in the forest; part of what we look at in the Terrain Institute is understanding, “Okay, you’re being exposed to the microbes. What are those microbes doing?” Part of what those microbes are doing is they’re communicating with your mitochondria. And how are they doing that? Through things like quorum sensing, ways that microbes talk to microbes. And the reason why is because your mitochondria evolved from microbes.
So it’s sort of understanding these nested relationships because when you’ve got these microbes, these diverse, different microbes from being out in the soil or being in the forest or being around…for me, I keep chickens. That actually has been transformative. And I could say why I think that’s a really important medicine for people and all the different ways it can be. But it’s like you’re getting a diverse exposure to the microbes, changing your mitochondria. Your mitochondria are talking to your nucleus and it’s changing how your hormones are being produced or your neurotransmitters, or all kinds of different things are changing in terms of your gene transcription because of your relationship between the microbes and the mitochondria. And what’s happening when you’re outdoors, or let’s say, when you’re with the chickens, like for me, I keep chickens. I live in New York City. You’ve seen my chicken coop, which now there’s a whole second chicken coop.
And why is that important? Why is that part of terrain medicine? I don’t think there are a whole lot of doctors being like, “I’m going to write you a prescription that you should keep chickens.” I’m probably pretty minimally unique in that particular category. But part of why is, okay, so you know where your eggs are coming from. I don’t eat my chickens. So I know where my eggs are coming from. I know that my chickens are healthy, what they’re eating, what they’re drinking, all of that. When I go outside to gather eggs, I’m sharing a microbiome with those chickens. And actually, as long as you’re not whatever…I mean, you’re being basically healthy in the way that you do it, you actually do want to share those organisms because that goes back to that hygiene hypothesis question that people who are in urban apartments versus on traditional farms have much more diverse organisms. And that’s actually what gives you that resilience, that healthy terrain, especially in the face of any other organism that might come your way.
So you’re eating healthier food, you’re getting more microbes. And then there are all these other things that are related to terrain, which are like the way that you’re in alignment with actually other living beings. And that may seem nonclinical, but I’m actually writing right now a whole scientific lecture for my terrain students on the science of morphogenetic fields, morphic fields, which scientist Rupert Sheldrake wrote about. And the whole idea of what’s the science of telepathy? So there are all these ways in which we’re creating connections, electromagnetic connections, morphic connections, as well as the things that we can easily observe right now, like being exposed to microbes, eating those healthy eggs and egg yolks from chickens that are out in the sun and eating good scraps and insects and all of that.
James Maskell: Yeah. I’d love to just ask your thoughts on community as terrain, given what you just said there about telepathy and morphic fields. It feels to me that one of the reasons why community-based interventions like group visits tend to outperform or are being improved to perform individual care is because you’re resetting and actually structuring a way for groups of people to come into communion with each other. And that possibly some of what you just shared explains the mechanisms on why those sessions outperform and why social stress is such a driver of chronic illness.
Maya Shetreat: Yeah, I think it’s incredibly relevant, actually, these ideas of…well, first of all, before we even talk about morphic fields, we can be talking about electromagnetic fields, which we understand through the work of the HeartMath Institute and many other things, that we have this electromagnetic field, which is influenced by the electromagnetic field of those around us. And that we have these combined electromagnetic fields, whether it’s with the chickens you’re keeping or the other people in your group visits or whatever it may be. So I think absolutely that there are these ways in which we share something that is measurable actually, but it’s not necessarily visible to our eyes. We have to measure it by different instruments.
But I think when you’re talking about things like morphic fields, I do think that’s incredibly relevant. Morphic fields are the idea of these sort of elastic connections that exist between families. That a family can be connected in a time and space. And then be distant in time and space and still have this connection that can last a very long time. And it can happen between people and their pets. They think that that is a part of why swarms and herds and all different kinds of schools of fish are able to operate as macro organisms. So I think you’re absolutely right, that the idea of community is about actually these kinds of social fields, where we are deeply connected and that it influences us and it influences our health and wellbeing. I think that’s absolutely true.
James Maskell: Yeah, it’s really interesting. So I’m just thinking back to Dr. Jeffrey Geller, who I interviewed for the first ever podcast on the series that I did on group visits. And he was talking about how in his very first group, it started off as like a type 2 diabetes group. But after a little while, six months, a year, they sort of exhausted all conversation about how to reverse type 2 diabetes and they were all doing healthy behaviors. And it turned into like a salsa dancing group and a gardening club. And so, if you think about it through the lens of what you just shared, what you’re really talking about is a full-spectrum terrain intervention, where you’re having personal community, reconnecting with other people, and then almost supercharging that experience by now gardening together where you’re getting the microbes from the garden. You’re also getting your hands in the dirt. You’re also exercising by bending down here and there. Could there be a more broad-spectrum intervention than a gardening club?
Maya Shetreat: Yeah, no, I think incredibly so. I think what you’re describing is, in a sense, what our ideal could look like. And I would add something to that, which I think is a really critical part of what I teach about in the Terrain Institute and what I think is a critical part of terrain medicine. And that is the exchange that exists between you and your own self-care, you and the people around you, you and the natural world. So part of what I think our offering is, and this is part of what actually keeps us healthy, is to not just be taking from the terrain around us, to not just be like, “Ooh, I’m going to get out of it the food I grow. I’m going to get out of it time in the sun.” Or whatever.
But it’s actually giving back. And what we give back is actually joy, wonder, gratitude, appreciation. And we know how beneficial all of those things are for our health. But this is a big part, basically being in community, dancing, dancing and being with music, caring for ourselves, gardening, all of these different pieces, part of what we then offer back, what’s being generated there, is actually a sense of gratitude, appreciation, and joy. And that is I think really, really fundamental to the benefits of terrain medicine.
James Maskell: Beautiful. Yeah. I love that. Well, that takes us on to my last segment here, which is that 2021 for the Evolution of Medicine is really about the reinvention of medicine. And this podcast is in a series of kind of new models. And I think that for many people who are listening, who have been part of our community or seeing the themes that we’ve built on over the last seven years, we see that obviously terrain medicine, one way or another, needs to be the dominant form of care for human beings to survive and avoid chronic illness and thrive. And so I guess practically, I’d love to just get your thoughts on this reinvention of medicine. Post-COVID, now we’re at a point where medicine has to be reinvented because ultimately we’ve seen how terribly it’s performed under stress. And so tell me a little bit your thoughts on the reinvention of medicine, what that means and how we can get there.
Maya Shetreat: Yeah, I think it’s such a beautiful transition from what you just talked about because I think terrain medicine is definitely about connection. It’s about relationship. It’s about community, both with yourself, with people and with the natural world and all living beings, really. So what does that end up meaning? I mean, it’s sort of like well what if we were prescribing dancing and music to people? What if we were actually creating a container for that kind of experience as part of? Or doing art? I’ll tell you, one of the most therapeutic things that I did during COVID, this whole period, whatever, of 2020, was I made a decision I wanted to make bad art. And what I meant by make bad art was just I got art supplies and I don’t really care if that what I make is good or for other people to look at. And I started just spending time creating spaciousness for myself.
And I think there are all these ways in which we can do that, whether it’s in nature, whether it’s different practices in our lives. And I think we kind of underestimate that in medicine because it doesn’t sound important enough or clinical enough. And I think that there are all these ways in which we start incorporating creativity, really thinking about the physical terrain, the emotional terrain, the spiritual terrain, a creative terrain, and an ecological terrain, and incorporating that into a plan for people and holding space for that. That’s why I think that story that you said was so beautiful because it ended up being a salsa dancing club and a gardening club. What if that was really some of the most profound medicine to create resilience in people? You know?
James Maskell: Well, I would just say, to answer your question, which is not really a question, “What if?”, but like it is. So let’s just act from that point. And ultimately in my book, The Community Cure, the fundamental baseline level of care for everyone were these empowerment groups. And we’ll be hearing a lot about the social determinants of health. And that’s a big phrase now that a lot of people are talking about, which ultimately just means poverty, right? That’s really what we’re talking about when we’re talking about people having these social determinants of health. And the most efficient model for solving these social determinants of health is the Jeff Geller empowerment group visit model, where you work with people for an indeterminate period of time. Like this doesn’t stop after a few weeks, these groups continue in some cases for 10 or 20 years, but it molds over time.
It starts with a group of people coming together to try and reverse their type 2 diabetes as a group. But over time, those relationships persist, and people start to determine, “What do we want to do together?” And yes, it can turn into gardening and salsa and whatever. But one of the biggest things that came out as well was that if you really want to create cohesion in a group, you need them to work together on a project. And that is what I think you were talking a little bit about creativity there. And I think that you have all the fundamentals and these empowerment groups for everything that you’ve spoken about, incorporating all areas of the terrain. And then the terrain itself is being magnified through that process as well. And I think that that’s a reasonable way that this could really roll out to many, many people and solve some of the biggest issues and hurdles that we have.
With regards to art, I happened to live in COVID lockdown with a very, very prolific seven-year-old artist, my daughter, who is doing art every day. And I would say that certainly didn’t come from my side of the family. So I put myself in a position of making a lot of bad art as well. And I can agree that it was very therapeutic. And certainly I can imagine art class being done in community being a very therapeutic, creative, and stimulating and healthy experience.
Maya Shetreat: Well, and I think what you’re talking about, James, is really co-creation, right? These groups, these community groups coming with a project, or having some kind of goal, which can shift over time is all about these micro communities and co-creating those communities. And I think one of the things that I just think is really fundamental is that it involves not just humans, that it’s something which can be greater than that. So for me, when I’m teaching people about it, I’m teaching them how we connect to microbes, how we connect to trees or plants or animal teachers or ancestors. For me, it’s something more expansive. But I think the fundamentals are absolutely there. And I will tell you that in my community of students, I’ve observed exactly what you’re describing; this bond, this incredible bond, which has shifted and changed. But these people are very connected and it informs their health on every level. So it’s a very beautiful thing to behold.
James Maskell: Well, tell us a little bit more about the Terrain Institute, because I know that this is sort of your main gig right now is educating providers on this terrain way of practicing. And what kind of practitioners are showing up and what does the program look like?
Maya Shetreat: Well, the program is actually a six-month program where we do a deep dive into all aspects of terrain. And it’s not actually just for practitioners, which is I think is one of the most important co-creative parts of it. Because for me, I think we’re in such a place right now of really we don’t even know some of the most important questions to ask. We always want to go straight to the answers. And I think we do have some of the answers. But I think the most important part of this process right now is that there is a certain amount of unlearning that we have to do and getting into beginner’s mind. So even though there are certain things that each of us might be experts in, we need to let go of that expertise for periods of time and be in an environment where we can look with new eyes and so that we can learn to ask the best questions.
And for me, that’s how you engage with the unknown. Which we are in the unknown. There are a lot of things that we know to be true. And then we also have to learn how to apply them. So this process is really…we have all different kinds of professionals coming together and looking at basically a conversation between the science and the sacred. I’m a big science geek. So I love incorporating a lot of science and I definitely bring it in. But I also like bringing in a lot of Indigenous wisdom, a lot of ancient wisdom. So that’s kind of the marriage that happens throughout the six month program. And people are certified at the end to bring in these terrain concepts into their practices. And so we’ve had actually professors, we’ve had lawyers, we’ve had many, many different doctors, nurses, healthcare providers, and it’s been incredible. It’s a really incredible experience of lectures, meditations, rituals, and community. And that’s been really huge.
James Maskell: Beautiful. Well, look, I want to acknowledge just the work that you’ve done to put your…when you first came on to talk about The Dirt Cure back in 2015 on the Forum, just that now putting that into action in a scalable way into the world is awesome. And I also want to acknowledge everyone who’s listening to this who, to whatever degree they are, are really pushing forward these ideas of terrain medicine, whether it be as a provider practicing functional medicine, whether it be as a community organizer, as a family member, as a father, as a mother, as a sister, I think there’s so much that we can do. And I think, ultimately, the solution to this problem doesn’t rest inside the medical system being reinvented. Medicine becomes reinvented by everyone participating in this co-creation. And so to whatever degree you are participating and would like to participate and co-create, I think all bets are off as far as what is possible.
If you’d like to learn more about Dr. Maya Shetreat’s program, the Terrain Institute, we’ll put all the details in the show notes so you can find out about it. Maya, thank you so much for being here as part of the Evolution of Medicine podcast. And thanks for continuing to do your work in the world. I’m excited about…we actually met way before the Functional Forum, I remember, even two years before I think we had lunch and you were sharing your goals really within pediatrics, I think, at that point and the difference that you wanted to make as a pediatric neurologist. And it’s amazing to see, not just that evolve, but also now you evolve and to see where this journey has taken you.
Maya Shetreat: Well, thank you. It’s been a pleasure to evolve and co-evolve with you. I think we’ve both grown a lot and I’m really excited with all the projects you’re doing as well.
James Maskell: All right. Thank you so much. This has been the Evolution of Medicine podcast. I’m your host James Maskell; we’re talking about terrain theory. Hope you’ve enjoyed it. Look forward to the next episode. Thanks so much for listening 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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