Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Spore-Based Probiotics with Kiran Krishnan: Rational Wellness Podcast 71
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Kiran Krishnan, microbiologist, talks about the benefits and research on Spore-based Probiotics with Dr. Ben Weitz. 

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Podcast Highlights

5:49   When Kiran was researching which strains of probiotics are most effective and have the most research, he kept coming back to the spore-based bacillus species. Because these probiotics are encased in a spore, they have the capability to survive through the acid in the stomach and the bile salts and the pancreatic enzymes in the small intestine.  This is why most other, non-spore-based probiotics are killed by the time they end up in the colon.   

6:59  The difference between soil based and spore-based probiotics is that most of the bacteria in the soil have no benefit for us in our gut as probiotics.  Only a few of the bacteria in the soil are bacillus species and have endospores and these are the ones that can survive the trip down our digestive tract and are native to our gut.

9:35  If you do a Google search for spore-based probiotics, mostly negative articles come up that claim that they are new and that there are very few studies on them.  This is the opposite of the truth. Some of the spore-based probiotic strains, like bacillus subtilis, have been used in most of the world (in Europe, Asia, and Latin America) as prescription drugs since 1952 and have thousands of studies on them. In fact, if you go to Pub Med you’ll find that some of these bacillus strains are the most well-studied of all probiotics.

15:32  Kiran explained that it is interesting to note that most people think that the strains like lactobacillus and bifido bacteria that you see in most conventional probiotics are the natural strains found in our guts. But this is not true, since the particular strains of lactobacillus acidophilus in the stores are different than the strains found in your gut.  Many of these strains were first pulled out from a human volunteer 35 years ago and since then, they’ve been growing in a factory and the strain has completely changed and has adapted to life in the factory. And each of us have a unique set of bacteria strains that we first got from our moms.

18:26  Like conventional probiotics, spore based probiotics do not permanently colonize the gut. They do colonize the gut and adhere to the wall and outcompete bad bacteria, but they only last about 20-21 days. Then they form spores and leave the body through defecation and then find another host through being eaten in some dirt. Our primitive ancestors were consistently eating dirt since they could not wash their food before they ate it, so they were constantly getting exposed to these bacilli. Not only do these bacilli crowd out pathogenic bacteria, but they increase microbial diversity in our gut.

22:15  I asked when we do a stool analysis on our patients, why don’t we see these bacillus strains listed as commensal bacteria?  Kiran answered that some of the panels will list bacillus subtilis under dysbiotic flora due to a misunderstanding. The resolution of some of the tests is not good enough to easily pick out the exact species and since we often have over 1000 species in our guts, but the tests usually do not list more than 15 or 20 commensal species, so they are not really a good representation of what’s in our gut. Stool tests that use culture are not very accurate, since 98% of the commensal bacteria are not able to be cultured in vitro outside of the body.

26:51  Bacillus subtilis produces a number of antimicrobial compounds that help get rid of pathogenic bacteria, including H. pylori. During World War II when the German army was in North Africa many of the troops were dying of dysentery. They noticed that when the locals would get sick that they would consume dried camel dung and that would cure them, so they started to do the same thing. After the war, they studied this camel dung and isolated the bacillus subtilis from it and in 1952 a German pharmaceutical company patented it as the first probiotic treatment for dysentery and gut infections. The bacillus gets into the gut, does quorum sensing, which is the ability to read the other bacteria signatures, and and produces more than 20 different antibiotics to precisely kill off specific pathogenic organisms.

30:31  One study has shown the bacillus clausii strain to be effective against IBS/SIBO.

37:03  These bacillus endospore probiotics produce various nutrients in our guts. Bacillus subtilis produces the enzyme nattokinase, vitamin K2-7, methylated B vitamins, and CoQ10. The bacillus indicus produces 12 different carotenoids: alpha carotene, beta carotenene, astaxanthin, zeaxanthin, lutein, lycopene, all at RDA levels and they will be absorbed 100%.

   



Kiran Krishnan is a microbiologist and researcher on Soil Based (Spore-based) Probiotics and designed the formulation in MegaSporeBiotic from Microbiome Labs. https://microbiomelabs.com/   https://microbiomelabs.com/products/megasporebiotic/ 

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.


 

Podcast Transcripts

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness Podcast, bringing you the cutting edge information on Health and Nutrition from the latest scientific research and by interviewing top experts in the field. Please subscribe to the Rational Wellness podcast on iTunes and YouTube and sign up for my free ebook on my website by going to drweitz.com.   Let’s get started on your road to better health.  Hello, Rational Wellness Podcastors. Thank you so much for joining me again today. And for those of you who enjoy listening to the Rational Wellness podcast, please go to iTunes and give us a ratings and reviews so more people can find out about our podcasts.

Our topic for today is spore-based probiotics. Probiotics as most of us know are live micro organicisms, usually bacteria, but sometimes also a fungi and other organisms that naturally grow in our colon, the rest of our digestive tracts, and other areas of our body. There’s increasing evidence that the healthy bacteria that live within us are crucial to our health for so many reasons, including for immune function, the production of various vitamins, cardiovascular health, brain health, we can go on and on about all the amazing benefits of probiotics for which the researches is proliferating.  Today, we’ll be talking about a particular category of probiotic, known as soil-based probiotics that contains one or more species of bacillus, such as bacillus subtilis. Despite the fact that most of the probiotics on the market contain the more conventional species like lactobacillus acidophilus and bifidobacteria, spore-based or soil-based probiotics have actually been around for a long time, and have actually been studied quite a bit. Today we’re going to be speaking with microbiologist and researcher, Kiran Krishnan, who has been doing a lot of research on these spore, soil-based probiotics.  Thank you so much for joining us today, Kiran.

Kiran Krishnan:                  Thank you for having me. It’s a pleasure to be here and always fun to talk about bugs, and dirt, and probiotics.

Dr. Weitz:                           Exactly. Tell everybody to eat some dirt, right?

Kiran Krishnan:                  Exactly. Go back to nature, back to nature.

Dr. Weitz:                           Exactly. Before we get into some of the technical questions, can you tell us a little bit about your background and how you became interested in soil-based probiotics?

Kiran Krishnan:                  Yeah. I’m a microbiologist by training and I did a lot of research work. University of Iowa is where I came from. When I was at the University, I focused a lot of my research work on virology, on viruses, studying viruses. In fact, I got to work on HIV vaccine project with using live virus. I worked on some … But then I also ended up working on a project on E. coli. E. coli such a fascinating organism in many ways we know our gut is heavily populated with E. coli. It’s a common commensal bacteria, but we also know that there’s the E. coli that causes disease. And so when people hear about E. coli, they immediately think that, when there’s numerous, very beneficial, healthy E. coli species in your gut. In fact, if you’re trying to eradicate it, it would actually cause way more problems and than any benefit.

This dichotomy of having the species that are typically talked about in a negative way, like E. coli, versus the reality of them being actually really important beneficial is what drew me into the realm of probiotics where I wanted to focus on organisms that theoretically from a microbiologist standpoint would be very beneficial. But the perception in the market was that there’s something bad about them or unknown about them. That brought me to the bacillus endo spores. The bacillus endospores really was a set of probiotic strains that we came across doing probiotic research for a large multinational. I had a research company which I still do have and we still do some research trials through that, but we were hired by a large multinational to study the probiotic industry for them, study the products that are on the market, look at the way products that develop, they’re formulated. Does it make sense to be refrigerated versus non refrigerated? Do we need 100 billion, or 50 billion, or 200 billion? Do we need 17 strains or five strains? And there’s so much variety out there in the marketplace.  They wanted us to figure out what is really backed by science and what is really the right approach to probiotic use, and we came back to these spores, because we started looking that … We found that the vast majority of products in the market didn’t really have any scientific substantiation to them. There wasn’t any studies that showed that 100 billion CFUs was better than 50 billion, or that 200 billion was better than 100 billion. There’s no dose dependency in that way. There was also no studies that showed that 15 strains is any better than seven, or five, or three.

As it turned out, it was pretty much all marketing. When we dug deeper into what types of strains could really make a significant difference in the gut with measurable clinical outcomes, we kept coming back to these spores. Because the biggest thing about them is they have the capability to survive through the gastric system, so that passage through the stomach acid, the small bowel with the bile salts, which are very strong antimicrobials, and then even the pancreatic enzymes in the small bowel, that passage kills 99% of the bacteria that are used as probiotics.  The vast majority thinks that dying these are getting through and it’s my tendency to always look at evolutionary biology for answers. So in my view, they were designed to be able to get through the system and go and function in the gut. Because of that, my inclination was that they would play a significant role in the gut, and as we’ve been doing our studies and looking at all the other studies that have been done, our inclination was sure that these are significant players in the gut, in the microbiome.

Dr. Weitz:                            Just to clarify. Can you explain what the differences between soil-based and spore-based probiotics?

Kiran Krishnan:                  Yeah, that’s really important. I’m so glad you mentioned that because a lot of people are familiar with soil-based organism products. There have been a few prominent products on the marketplace in the last decade or more. There is a significant difference between a soil-based product and a spore-based product. Soil-based product is typically a product that has a whole bunch of bacteria from the soil that are typically not very well characterized. They have some genus and species mainstream, but these bacteria aren’t very well characterized, and then they put them in a capsule and utilize them as a probiotic.  The problem with that is the vast majority of bacteria that live in the soil really don’t do anything for us in the gut as a probiotic. Their job is in the soil. Their job is to break down plant matter, fix nitrogen for the roots, break down decaying animal matter, and so on. Now, exposure to them can be beneficial, because it up-regulates the immune system as it’s moving through, but those bacteria also die in the stomach, die in the small bowel, and you put them out 12 hours later. Now, spore-based organisms are unique in that you do find them in the soil. But the spore-based organisms actually live in the gut.

The difference is they use the soil as a vector to transfer from host to host, so when they leave the body, when they know they’re going out into the outside environment, they will cover themselves in this spore coat, which is basically a protein calcified coat that protects them from the elements outside the body. That allows them to exist indefinitely in the outside environment until they get swallowed again by a human or another mammal. They pass through the gastric system with this armor-like coating around themselves. The moment they get past it and they get into the small bowel, they will actually break out of this spore coat and become a live functioning probiotic cell.  When we were looking at the environment for answers to probiotics, we basically went and refined it and dialed down to the types of bacteria in the environment that can actually survive the journey of being swallowed and then function as a probiotic in the gut. That’s how we came across these spore-based organisms as being more than likely the ones that will do most of the probiotic function.

Dr. Weitz:                            When you go on the internet and if the average person just does a search on Google for spore-based or soil-based probiotics, even if you put scholar in parentheses, there’s not a lot of good research that tends to come up. I saw several articles including one that looked like it was written by somebody from Scientific American claiming that there’s only one small study and there’s really no research on these things.  Then I went to PubMed and you put in some of the specific names of the spore-based probiotics like bacillus subtilis, and you find out there’s thousands and thousands of studies there. What is the story about these spore-based probiotics. How long have they been around, and is there really good research on them?

Kiran Krishnan:                  Yeah. And I’m glad you bring that up, because I get that question a lot from people, because the vast majority of people, like you said, when they’re researching something, and the word research is a loose term when you use Google, right? When they’re researching something, they will go into Google and they will type it in and see what the first … Usually they’ll read only the first three or four things that come up. One thing that’s important to note about Google is that the first few things that come up aren’t based on their relevance or their accuracy in any way at all. It’s really based on the people who are behind it, doing good search engine optimization, so they’re back linking that link to many different websites and so on, and they’re putting a lot of content on the blog.

What I came to find out when I started looking into what is the market saying about the bacillus spores and finding all of these unfavorable write ups which, and I’ve read through vast majority of them, they’re all blatantly inaccurate in how they describe organisms, how they describe the microbiology of things, how they describe the microbiome and so on. I started digging into why are these out there, where are they coming from, and then you come to find out that many of these things are from companies that sell conventional probiotics and they basically pay people to put up articles about competitive types of probiotics to try to gain market share. And in fact, that was the main reason why we were hired by the large multinational company to do the research on the probiotics because they were looking at going into the soil-based or spore-based area and we’re seeing a lot of this misinformation on the web and wanted us to give them an overall real scientific review.

Now, when you look at the real science, which is like you said in PubMed and places where you can actually find scientific studies and papers, you’ll find thousands of research studies on bacillus subtilis. It is well known in the world of microbiology. They’re two of the most well studied bacteria in the world. We know more about these factor than any other bacteria that’s ever been discovered, and that is E. coli and bacillus subtilis. Bacillus subtilis is one of the most utilized bacteria in microbiology research. We use it in all different ways as bacteria transferring genes to another bacteria or as a way of testing things to grow on and exclusion media, all kinds of stuff that we do in directed evolution we use bacillus subtilis. It’s one of the most well known bacteria that have ever been discovered.  The thing about the spores is they have been in the prescription drug market since 1952 in Europe, Asia, and Latin America. In two thirds of the world, the spores have been prescription drugs for well over 60 years. Their use is actually far wider and greater than the vast majority of probiotics that we’re familiar with in the US because they’ve been used in hospitals, clinics, doctors offices and so on as prescription drugs. And when you start looking at the number of studies that are behind the spores, it’s staggering. These are some of the most well studied organisms on the market with respect to their probiotic function in the gut.

Dr. Weitz:                            That’s really amazing, mind blowing. I don’t think most people are even aware of that. To just clarify, these spore-based probiotics are typically forms of bacillus bacteria including bacillus subtilis, bacillus indicus, bacillus coagulans, bacillus clausii, whereas the conventional probiotics are species like lactobacillus acidophilus, bifido, Saccharomyces boulardii, these are the conventional probiotics.

Kiran Krishnan:                  Yeah, and I would actually put Saccharomyces more in the bacillus subtilis category, closer to that. Saccharomyces is a fungal probiotic, but when you look at the environment we would actually naturally pick up Saccharomyces from the environment, because you naturally find it on the outer skins of fruits and things like that, that our ancestors and early humans would have just consumed on a regular basis. Same thing with the spores. Our ancestors got huge amounts of exposure of the spores just by living on the earth, eating dirt, not sterilizing their environment, drinking water out of rivers and streams. These are ubiquitous organisms in the outside environment. So as humans, we naturally gain a huge amount of exposure to them.

It’s interesting to note from a microbiology standpoint, the things that we consider to be conventional strains like lactobacillus acidophilus, reuteri, bifidobacterium, and all of these that you see in 99% of probiotics. Out there, people say, well, those are the natural strains. The difference is the versions of lacto and bifido strains that you see in products are not the native strains in the gut. Even though they have the same name lactobacillus acidophilus, your lactobacillus acidophilus that you have in your gut, my lactobacillus acidophilus I have my gut are completely different than the ones that you find in the products in the stores. Those are not native strains to the gut. Not to say that they don’t have any benefit of the gut, some of them do, some of them do up-regulate the immune system, can control diarrhea, and things like that. But this concept that those are native commensals strains is totally erroneous, because they’re not.  The moment you pull out a strain like that from a human volunteer, 35 years ago, whenever they first isolated the strain, and since then they’ve been growing it in a factory, the strain has completely changed. It’s adapted to life in the factory than life in the gut. And as it is, we all have a unique set of lactobacillus and bifidobacteria in our microbiome anyway, right? No two individuals have the same distribution of those types of bacteria and our type, our version of the bacteria we got from our mom, and she got from her mom, and she got from her mom, and so on. Even identical twins born in the same mother will have up to 50% difference in their microbiome.  All our strains in our gut are completely unique. And so to think that the lacto bifido stuff you see at the store on the shelf are natural native bacteria, they’re not out there. They’re outside bacteria just as much as any of the bacteria are.

Dr. Weitz:                            Interesting. Now, we’ve learned that despite the fact that a lot of people don’t necessarily understand this, is probiotics don’t typically colonize the gut. They’re just temporary visitors there. Even though sometimes functional medicine practitioners will do a stool analysis and see that the person is low in a particular type of probiotic and may have the person ingest a product that has that particular species and even strain, those that you ingest actually are just there for a short period of time.  Now, we know that they help with developing a healthier microbiota, but they don’t permanently colonize our gut. What about sport based probiotics? How do they work?

Kiran Krishnan:                  Yeah, and you’re right that they don’t permanently colonize. Most of them just kind of move through like food does. Spore-based probiotics are interesting because they are designed by nature to leave the body, spend some time outside, and then come back in through the oral route, so through being consumed. They are perfectly adapted for that type of cycle, leaving through defecation and then re entering through oral consumption. Now, they do survive through the gastric system. They do get in the gut, and they do colonize, but as it turns out, they are transient in a way that they only colonize and stay within the gut for about 20 to 21 days. And when we initially discovered that, through some of the research we were doing, we were actually surprised, but then when you think about it, it makes complete sense.

The question I had in my mind is okay, if they’re so good at colonizing, meaning they’re really good at attaching and out competing bad bacteria and kind of changing the environment that they exist in. Why is it that they don’t just stay? Why do they leave? Well, two reasons. Number one, it’s we’ve developed this long term symbiotic relationship with them where we provide them a home and then they basically clean up the home for us. And in order for them to get transferred from host to host, to propagate themselves, they actually have to go out into the environment because they use the environment as a vector to transfer from host to host. And when you look at epidemiological studies and other types of environmental studies, they find that these bacillus spores are found in every corner of the earth and have been for millions of years.

Glacial ice core studies, for example, where they put long pieces of cores of ice out of glacial ice that measure few million years back into the Earth’s atmosphere, they found these spores in high abundance in the Tibetan plateaus in the South Pole in the North Pole. They’re virtually everywhere. And the way they get around is they use the environment, the air, the wind, the water to transfer to all of these regions. They need the environment as a vector to move, and so that’s one of their motivations coming out. The second thing is our ancestors if you imagine, would have gotten huge exposure levels to them on a regular basis. And if they never left at some point, they may be too many of them in the gut. What we want to do is promote the diversity within the gut and not have too many of any one species and so they’ve designed their own threshold level in the gut that they will not exceed. If any given area of the gut exceeds a certain threshold level of these spores, they will sporulate and they will leave.

Once they achieve what they think is their healthy balance, they will just continue to leave at the same rate that they’re coming in. And that’s very interesting, because as it turns out, once they get into the gut, one of the big effects of having these spores in the gut is a dramatic increase in diversity of the rest of the microbiome, and that’s never been shown with other probiotics. No one has ever published a research study showing that when you add any of these other conventional probiotic products, that it actually has any impact on the diversity or the population of the microbiota. We are submitting a paper for publication this year, showing that when you add the spores, in some cases, that almost doubles the diversity of the rest of the organisms.

Dr. Weitz:                            Wow.

Kiran Krishnan:                  Yeah. They get in there, and they affect change so much that they increase the growth of all of these underrepresented beneficial organisms.

Dr. Weitz:                            Interesting. How come when I get a stool sample back, that functional medicine based stool analysis that looks at the range of commensal bacteria, I don’t typically see these bacillus strains listed among them?

Kiran Krishnan:                  Now, some of the tests will, but some of the tests will list them under dysbiotic flora. When you look under the dysbiotic flora category, they’ll show bacillus subtilis, which again is just kind of misinformation and inaccuracy. And they don’t look for any of the other bacillus species. They just don’t know enough about them. There’s a lot of issues with stool testing. The ability to be very accurate with stool testing is really poor. Recently, the head of the American microbiome research which is based out of University of California in Davis, University of California, Davis, Rob Knight, he heads up American gut project. He’s a top microbiome researcher in the US. He came out with the papers and findings that the type of sequencing that’s used in pretty much all of the commercial stool testing systems is incredibly inaccurate.

The resolution is really poor is the problem. You can get down to this genius level, but you really can’t get down to the species level that accurately, so it’s very hard for those tests to identify all of the different species that could exist in the gut. And then their relative abundance as well. That’s another problem because you could have 1000 different species or 1500 species in your gut, you don’t get a stool test report back listing 1500 different species bacteria. You might get 15 or 20 that show pluses and minuses. It’s not a great representation of what’s actually going on in the bowel to begin with, and so certainly it doesn’t pick up on the vast majority things that actually in the bowel.

Dr. Weitz:                            Does it matter if we ordered a stool test that’s culture based versus PCR based?

Kiran Krishnan:                  No, it doesn’t matter because the culture based ones are severely limited because 98, 99% of the commensal good bacteria in your gut are not culturable in vitro outside of the body. They’re really hard to grow them because they’re strict anaerobes. The moment you pull them out, they start to die being exposed to oxygen. The PCR DNA based ones still use something called 16 S sequencing, which is low resolution and you can get a lot of false negatives. Just because it doesn’t show it on the test doesn’t mean it’s not there.

The other issue with the stool sample is the bacteria in the stool is not homogeneously distributed, right? That 15, 20, 25 grams sample that you’re taking is not a representative sample of the rest of the microbiome because you’re just looking at what’s in that sample. If you had taken a sample from a few inches away, it could look completely different. And you’re also looking at bacteria that’s being shed. Not necessarily bacteria that’s sitting in the mucosal well attached proliferating. The other thing is if you look at the manual for the stool testing, you’ll see that even in their manuals, they say that stool tests are representative of the micro flora and the distal colon. So it’s really a distal colon sample and it’s a snapshot in time of the distal colon. It doesn’t tell you anything about the ascending and transverse colon, it doesn’t tell you anything about the small bowel and so on.

It can be a tool to use. I in particular like the functional side of the stool test when you can look at things like short chain fatty acid production, secretory IgA, fatty acid degradation products, protein degradation products, that gives you a little bit more insight into what’s actually happening in the bowel. The microbiota component, what backers there, and what’s at high level, what’s at low level. That stuff is still very much in its infancy, and it’s almost never used in clinical trials for that reason, because it’s really hard to make any sense of it.

Dr. Weitz:                            Wow, interesting. Interesting. In some of the reading I did, I understand that bacillus subtilis strains can produce a variety of antibiotic, anti microbial compounds that can help crowd out potential pathogens in our gut including H. pylori. Can you talk about that?

Kiran Krishnan:                  Yeah, actually there’s an interesting story behind that, and the way this was discovered is actually, that’s where the interesting story comes from. During World War II when the German army was in North Africa and they had a whole campaign in North Africa, the vast majority of German soldiers were dying of dysentery because of the food and water in that part and their bodies weren’t used to it, their guts weren’t used to it. But they also noticed that the locals when they would start to get sick, what they would do is they would look for dried camel dung and they would consume the dried camel dung, and that would basically heal them of the gut infection. They took a bunch of this dry camel dung back and started studying it in Europe to figure out what is it within the dried camel dung that was curing the dysentery and they isolated the bacillus subtilis strain.

The bacillus subtilis strain from further research that they did was shown to have this capability of getting into the gut and then doing something called quorum sensing, which is the ability of bacteria to read other bacteria signatures, and they can find pathogenic or unfavorable organisms. They’ll sit next to them, and they’ll produce upwards of 20 different antibiotics to kill off that organism. But it does it in such a precise position manner versus when you think about taking an antibiotic prescription, which is like an atom bomb for your microbiome, right? It basically kills everything and it kills everything very quickly. And so, this is like a precision SEAL Team Six type of attack to those pathogenic bacteria. From that very research in the late 1940s, by 1952 a big German pharmaceutical company launched the first probiotic treatment for dysentery and gut infections from that work and that product is still in the market today. It’s been over 60 years and it’s still prescribed and used because it’s so effective.

Dr. Weitz:                           That’s amazing, and you just hear all these spore-based probiotics, they’re new, they just came on the scene, we hardly know anything about them. It’s pretty much the opposite.

Kiran Krishnan:                  Absolutely. They’re the most widely used probiotics in the rest of the world, and they’re using it in the medical setting, not even so much in health food stores and things like that. Their use has been very well documented because they’ve all been prescription drugs, and as prescription drugs, we know that there’s something called post market monitoring where all the adverse events and all of the negative issues that could about when a product is in a health food store, you might never know about it. But when it’s a prescription drug and doctors managing it, those are all reported and it’s all made public.  The fact that these strains have been used as prescription drugs for over 60 years and there’s so few adverse events or reports to them is really fascinating. It means that their level of safety and efficacy is unparalleled.

Dr. Weitz:                           I understand that there is at least one study using these spore-based probiotics for IBS/SIBO.

Kiran Krishnan:                  Exactly, yeah. In fact, bacillus clausii, one of the species that we work with in our product MegaSpore has a great published study showing that the bacillus clausii can reduce the overgrowth of organisms in the small bowel just as well as any antibiotic can, but it does so in a way that doesn’t disrupt the rest of the microbiome.

Dr. Weitz:                           I understand that you helped design and formulate the strains in the MegaSporeBiotic?

Kiran Krishnan:                  Yeah, exactly. When we came across these bacillus endospores and started to really understand their value in probiotic therapy and also manipulation of the microbiome for favorable outcomes, we saw that on the market in the US there was really only one strain that was marketed and used widely and that was bacillus coagulans. And then bacillus coagulans strain and product had actually been in the retail market for 10 years or so at that point. It was the one and only used one, but then there’s so many other useful spores that we went ahead and created the first multi spore probiotic product on the market and that’s the MegaSporeBiotic product.

We made that available only through physicians and health practitioners because it requires education. The product is really powerful. It has a lot of therapeutic benefit.  It’s really stuff that only healthcare practitioners, physicians, can understand and convey to their patients. And so we made it available only through physicians.  Now, we’ve engaged in a significant amount of research because in our view, when you have a multi spore product, and assuming you have the right spores, and they are in spore form, and they can survive through the gastric system and do colonize.  And that’s something important to talk about because there are differences among spores as well.  I’ll mention that after this part.  But what we saw was there could be significant therapeutic benefit to having a multi spore product. And as it turns out, we published our first study on the multi spore product in August of last year.

We have completed five other studies this year, which are all being written up right now and submitted for publication. And we have five or six other studies going on at the same time. In total, we’ve got 12 clinical trials either completed or ongoing on the multi spore product. From what we’re seeing so far, it’s quite fascinating, and our goal has been the moment we formulated this product, was to quickly become the most well researched probiotic formulation on the market because we want to dispel these myths. We want to dispel these nonsensical assumptions that are being made out there and we want to show through research that these spores have such important and significant functions within the gut. One thing I want to mention, so then, now we’ve seen other spores coming out and we’ve been testing them, so other companies are saying, “Hey, we want to do a spore product too and they’ve been coming out.  What we find is that there’s a couple of issues with the types of spores that they’re selecting. Number one, their spores are not completely in spore form in the product, right? That’s part of the technology that it took us almost seven years to develop was, when you grow these bacteria, they’re not in spore form. When they’re in spore form, it means that they’re metabolically inactive. They’re not multiplying, they’re not doing anything really, they’re just kind of sitting there inertly waiting to be consumed, to come out of this spore state, to becoming a live, functional, vegetative bacteria. When we were growing them in a fermentation tank to multiply them, we are growing them as a vegetative bacteria not as spore bacteria. They go into the spore form under conditions of stress and duress. That’s their way of protecting themselves.

What we found is that we’ve developed a way to be able to take this big 15,000 liter tank growing with trillions and trillions of spores in there, and then add a stress to that environment so we can get them all to go into the spore state, and then extract them in the spore state, and we were able to extract them 100% as in a spore state. What we see in other spore-based products is that about 50% of the strains in there are not in spore state, they’re in vegetative cells state. Now the problem with that is when spore forming bacteria is not in its spore state, it’s in its vegetative state. It’ll also die in the gastric system, like any other bacteria will. Only the spore state protects it. So some of these other products coming out, we’re seeing that they’re dying in the stomach, like any other probiotic product would and they’re not necessarily selecting spores that have shown the ability to colonize. Because there are spores that you can find out in the environment that will also move right through because they don’t express the right proteins in order to adhere to the mucosal layer and actually colonize.  Those are two very important things that one needs to look at when they’re trying to find and develop a spore for product for use as a probiotic.

Dr. Weitz:                            Interesting, interesting. How do you create stress in a spore-based probiotics? Do you show them clips of the News or something?

Kiran Krishnan:                  Exactly, yeah. That’s all you have to do, right? Just show them two or three News sources.

Dr. Weitz:                           Just show a loop of Rudy Giuliani.

Kiran Krishnan:                  Right. Let them go on Facebook for 10 minutes and they get stressed out. We do it through manipulation of the nutrients that are in there because the thing is you don’t want to stress them too much too fast or you will kill some of them. You want to create a really calculated stress where you give them a chance to go into their spore state and then you can extract them out into that spore state.

Dr. Weitz:                            A couple of other things I saw in some of the reading I did it that I thought was particularly interesting is bacillus subtilis helps to produce natto, which is one of the best sources of vitamin K2, particularly MK7 version, which is so important in reducing arterial calcification.

Kiran Krishnan:                  Yeah. In fact, one of the things that’s really interesting about the spores to me, which some of my earlier work, I was the first guy to bring nattokinase, if you remember that enzyme, to the US back in 2000. I was working with the Japanese company to make nattokinase from bacillus subtilis, actually, the natural fermenting bacteria and then develop ways to extract the nattokinase and then bring it into the US as a fibrinolytic enzyme.  One of the fascinating thing about the spores is that they are nutrient factories as well. When they get into the gut, they basically sit there, like the bacillus subtilis does, and when food comes in, they start fermenting and breaking down the food and converting them to things like vitamin K2-7 like you mentioned, but also methylated B vitamins. They produce ubiquinol. They produce CoQ10.  And one of our strains, which is a unique strain called bacillus indicus, produces 12 different carotenoid antioxidants in the gut for you, which is fascinating. It produces alpha carotene, beta carotene, astaxanthin, zeaxanthin, lutein, lycopene, all at RDA levels. Right at the site of absorption, right? They are the most bioavailable antioxidant, carotenoids that you can get into your diet, and they’re produced by bacteria sitting in your gut.  It’s a fascinating role that these bacteria play and the mutualistic relationship we have with them with this in this regard is really fascinating to me as a microbiologist because somehow we have created this communication with them that, “Hey, go into our gut. We’ll give you a home. Our immune system recognizes you as a normal part of the flora.” Our body is not trying to attack them, and so we give them a residency and in turn, of course, they kill the bad bacteria and get rid of them. They increase the growth of the good bacteria. They seem to be sealing up leaky gut, which is the study we published last year, and then at the same time, they produce the all of these nutrients for us that are directly absorbed into our intestinal lining, so it’s a really fascinating relationship we have with these bacteria.

Dr. Weitz:                            Wow, amazing.  Are you going to consider looking at the relationship between the indicus and macular degeneration because all those carotenoids have been well studied as helping to reduce the risk of chronic macular degeneration, which is one of the most common degenerative eye diseases.

Kiran Krishnan:                  Yeah. In fact, the rates of them are increasing the US and there is some talk that all of this blue light exposure that we get on a regular basis from screens and things like that are accelerating some of that and those are all theoretical, as I understand them right now, and not proven yet, but kind of makes sense when you think about it. But we are working with a neuro-ophthalmologist and we are looking at designing some studies around that. Because when you study carotenoids as a supplement, what you find is that the bio-availability of carotenoids as a supplement is less than 10%. It’s really hard to absorb carotenoids that are trying to pass through the gastric system, the small intestines, and actually gain exposure to the intestinal lining for absorption. Studies have been done on pure beta carotene, and they find that pure beta carotene by availability is a little less than 10%. When you compare beta carotene from the spores, it’s 100% bio available, because it’s produced right at the site absorption, past the gastric system.  I really believe that they are the most important sources of these carotenoids and antioxidants that we’re supposed to be getting in our diet.

Dr. Weitz:                            Wow, really amazing.

Kiran Krishnan:                  Yeah. Is that fascinating? And here’s what’s interesting. This indicus, that strain, one of the ways it was discovered was a huge European consortium study called The Color Spore Consortium. There was, I think, 14 different research institutes involved. They spent about five and a half million euros on funding this and what they were looking for are bacillus strains that produce carotenoids in the gut. And the reason they even thought of that is when you look at certain animals in the animal kingdom that express a lot of carotenoids on their skin, like flamingos are pink on their feathers because of a carotenoid. Salmon skin is pink because it’s of carotenoid stream, with the orange bands, those are carotenoids that they’re expressing.  The question is where do they get their carotenoids from, because they don’t eat colored fruits and vegetables, right? The investigation showed that these animals all have a probiotic bacteria in their gut that produces such high levels of carotenoids for them that it shows up on their skin. And then they said, “Okay, if those animals have those bacteria, there’s a good chance that humans have similar bacteria and are humans supposed to get our carotenoids from bacteria or we’re supposed to get it from the diet?” So they started looking at dietary carotenoids both from foods and supplements, and the bio availability of them had found that those were dramatically lower than we thought, and then they started looking, are there strains in the gut that produce carotenoids? And they found indicus in a couple of the strains that actually do.

Dr. Weitz:                            Fascinating. Really, really interesting information. Well, it’s been a great podcast, Kiran. Thank you so much for bringing us such great information. Anything you want to say about the products you’re working on and the availability?

Kiran Krishnan:                  Yeah, absolutely. And then again, thank you so much for having me. I love any opportunity to try to dispel myths and clarify rumors and things like that. I think accurate information in our world today is a rare thing as we know in every facet of our lives, and especially when it comes to your health and wellness, having the right information is really empowering.  The product that we work with healthcare practitioners and physicians with is called MegaSporeBiotic. You can find a lot of information about it and also about our research and webinars and all that stuff if you go to our website at microbiomelabs.com. That’s labs with an S at the end of it, and microbiomelabs.com. And of course people can get the mega spore product through their physician, through their practitioners such as yourself.  We believe you should always be working with a health professional with your supplements anyway. Because they have the capability of vetting the nonsense from the stuff that really makes sense, and so you’ll get your best bang for your buck. You will get your right nutritional therapy from your health practitioner.   We thank you for this opportunity and the ability to talk to you about this product.

Dr. Weitz:                            Awesome. This has been great. I’d love to catch up with you again sometime in the future.

Kiran Krishnan:                  Yeah, let’s do it again. I look forward to it.

Dr. Weitz:                            Sounds good. Keep up the good research. Talk to you soon.

Kiran Krishnan:                  Thank you.

Dr. Weitz:                            Okay.

 

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Improving Sleep with Dr. Jose Colon: Rational Wellness Podcast 70
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Dr. Jose Colon talks about how to improve your sleep with Dr. Ben Weitz. 

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast] 

 

Podcast Highlights

1:49  Sleep is very important.  We spend a third of our lives sleeping and there’s a lot of regenerative processes, and encoding of memories, and healing the body that occur with sleep. A 12 mth old should be getting about 11 hours plus a nap in the daytime. A 10 year old should be getting about 10 hours of sleep. A ninth grader should be getting about 9 hours of sleep. Adults should be shooting for 8 hours and the elderly should get at least 7 hours of sleep per night.

5:06  The consequences of poor sleep can include cognitive problems in thinking and thought processing. ADHD when the diagnosis is made as an adult and pseudodementia can both be related to sleep problems.

7:17  Sleep quality is as important as the amount of sleep. You need to have uninterrupted cycles of REM, when your brain is actually very active and we are encoding our memories with emotions and we have our testosterone secretion, etc. and non-REM sleep cycles, which is our deepest sleep where our brain wave is really slow and we have growth hormone and gastric acid secretion and myoprotein synthesis. 

9:03  One of the biggest disturbances of REM sleep is untreated sleep apnea. Antidepressants tend to decrease REM sleep, as does light exposure during sleep.

10:49  Some of the most important effects of sleep deprivation is poor memory, poor performance such as driving, increased inflammation (CRP, IL6, TNF), decreased testosterone production in men, alterations in the menstrual cycle in women, increased cardiovascular risk, and increased insulin resistance.

14:19  The most important factors that affect sleep include electronics and perhaps most important is stress and stressing out over the fact that you are not sleeping. Dr. Colon recommends instructing your patients that if they can’t fall asleep, to do some relaxation training like awareness of breath meditation, which will tend to slow down your respiratory rate, which will put you into that parasympathetic mode.

19:14  I asked Dr. Colon if everyone who gets a sleep study has sleep apnea and is prescribed a C-Pap machine? Dr. Colon explained that sleep apnea is when you stop breathing in your sleep and he answered that not everyone who goes through a sleep study comes out with a diagnosis of sleep apnea and for those who do have sleep apnea, not every treatment is with a CPAP machine.

22:59  Vitamin D deficiency can affect sleep and even induce sleep apnea.

25:15  Restless legs syndrome can affect sleep and this is often related to inadequate ferritin levels, which Dr. Colon recommends to get the ferritin levels above 50 by treating with iron.

26:58  Cognitive Behavioral Therapy is the gold standard for treating insomnia. Another emerging treatment for insomnia is mindfulness based treatment for insomnia, which was created by Jason Ong.

29:15  Circadian rhythm entrainment 

33:11  Some of the more effective supplements for sleep are zinc, magnesium, lavender, melatonin, but it is more effective to run a Micronutrient test or an adrenal profile or a melatonin test or a urine neurotransmitter profile and find out what your individual patient needs and treat that. 

 

               



Dr. Jose Colon is an MD who’s board-certified in Sleep Medicine and Neurology. He teaches for the Institute of Functional Medicine and he’s the author of books for women’s sleep (The Sleep Diet – A Novel Approach to Insomnia), sleep and mindfullness in children, and sleep for infants. He’s the founder of Paradise Sleep, on organization dedicated to the education of sleep and wellness. www.paradisesleep.com  

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.


 

Podcast Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition, from the latest scientific research and by interviewing the top experts in the field. Re-subscribe to the Rational Wellness Podcast on iTunes and YouTube, and sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.

Hello Rational Wellness Podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and leave us a ratings or review so more people can find out about the Rational Wellness Podcast. Today our topic is sleep. How important sleep is, how much sleep do we really need, what factors affect our sleep, and what we can do to improve our sleep. We’ll be interviewing Dr. Jose Colon, who’s an expert at sleep. He’s an MD who’s board certified in sleep medicine and neurology. He teaches for the Institute of Functional Medicine, and he’s the author of books for women’s sleep, sleep and mindfulness in children, and sleep for infants. He’s also the founder of Paradise Sleep, an organization dedicated to the education of sleep and wellness. Dr. Colon, thank you so much for joining us today.

Dr. Colon:            Hey, thank you. It’s wonderful to be here, and I appreciate your podcasting.

Dr. Weitz:            Great. So how much sleep do we really need? And I know it differs for kids versus adults.

Dr. Colon:            Yeah, so of course sleep is important. It’s a third of our lives and even more of that in kids. There’s a lot of regenerative processes, and encoding of memories, and healing the body that we’re having with sleep, so it is important. And when we ask how much sleep someone needs, I have to say it really is variable. There are things that we like to tell people. We want to tell everyone to get eight hours of sleep, to get seven to eight hours of sleep. And that’s true. That’s a good recommendation, but it really is variable. It’s also variable across the different ages. I like things that are easy to remember, so I’m gonna give you a couple of numbers that are easy to remember, but then we’re gonna talk a little bit more specifically about bright, okay? So easy to remember is that a 12 month old should get 11 plus one. 11 hours of sleep plus one nap in the daytime. A 10 year old should be getting about 10 hours of sleep. A ninth grader through high school, okay, your teenager, should be getting about nine hours of sleep. That’s a perfect storm of a lot of different problems because they’re asking them to wake up during non, you know, unphysiological times. When you have your eight to four job, okay, eight hour days into adulthood, you should be getting about eight hours of sleep. In your elderly, in your 70s, we try to shoot for about seven hours of sleep. And it’s not so much that the elderly need less sleep, it’s just that there are factors, medical factors, that occur that we get more sleep intrusions … sleep arousals, fragmented sleep, but seven hours is a number that’s easy to remember, plus it’s normal to reintroduce naps into the elderly period.

Now, all of these numbers that I gave you, you can plus or minus one of them. And many times it’s minus one of them. And even then, having said that, different people say different things. You know, Dr. Mark Hyman mentions that everyone should get about eight hours of sleep, and American Academy of Sleep Medicine and National Sleep Foundation reiterate that. Dr. Andrew Weil talks about how there are some people that can get less than six hours of sleep and have no ill effect, and he’s right, because international classification for sleep disorders also does have short sleep syndrome as a normal variant. There are some people that get less than six hours of sleep and have no adverse effects. Now, to classify for that diagnosis you need to have no adverse effects, of course.

Dr. Weitz:            I talk to people all the time who say, “I get five six hours that’s all I need”, but how do they really know if that’s really true? What are some of the things that they might not even be noticing that could be affecting them?

Dr. Colon:            Yeah, so let’s talk about consequences of poor sleep. And we all know consequences can be cognitive, they can be problems in thinking and problems in thought process. There’s a lot of diagnosis of adult ADHD that is made as an adult, where they haven’t had the symptoms before. And that’s someone that you really want to get a sleep study on and see how much sleep they’ve been having. Same thing with pseudodementia, I was taught that, in medical school, that if someone complains that they’re having dementia, the fact that they’re complaining means that they know it, so they may be depressed. Well, not so fast, you may want to make sure that they don’t have an untreated sleep apnea that’s causing that. Other factors-

Dr. Weitz:            What was that term you used, pseudodementia?

Dr. Colon:            Yes, pseudodementia. Pseudodementia. Yeah. And-

Dr. Weitz:            So these are people who don’t truly have dementia, they just have dementia because they’re not sleeping enough?

Dr. Colon:            Well, they complain of memory concerns, but then they do a … you know they do the cognitive testing and it turns out to be normal, so they diagnose them with pseudodementia, and they say that is from depression. And to put them on an antidepressant. But you know, I mean, it really could be an untreated sleep apnea. The other thing it could be, it could be mild cognitive impairment. Or subject cognitive impairment, as Dr. Bredison talks about in his book The End of Alzheimer’s.

Dr. Weitz:            And those are the beginning stages, before you get to full blown dementia, right?

Dr. Colon:            Yeah, correct, correct. Other consequences of disruptive sleep are insulin resistance. So if you’re seeing … any evidence of insulin resistance, unfortunately many times people will just check the hemoglobin A1C, but fasting insulin levels are higher before that. So these are all factors that you would look into, if they’re not sleeping well, take a look at their cognitive status, metabolic status, and that can tell you if it’s affected or not.

Dr. Weitz:            Interesting. So not only the amount of sleep, but there’s also the quality of sleep, and I know there’s the importance of getting the REM sleep, and can you explain what are some of the most important factors in the quality of sleep?

Dr. Colon:            Yeah, so that’s something that people commonly ask me. They’ll be like, “Dr. Colon, tell me about REM sleep”, and all the cycles are important. People many times think that REM is your deep sleep, but it’s actually a very active brain time. Very active brain time. And we’re taking today’s information and we’re encoding memories, in particular memories with emotions. In our REM sleep we also have increased blood flow that’s going through our organs. In that first REM cycle you have testosterone that is secreted. But this is all in balance with your non-REM sleep as well. The non-REM sleep, just like a washing machine has a deep soak, our deepest sleep is at the beginning where our brain wave is really slow and we have growth hormone secretion, we have gastric acid secretion, so all of this is important. And you have this really rhythmic setting to where you have this gastric acid secretion in the beginning of the of the myoprotein synthesis, and then with our REM sleep we have increased blood flow, delivering it to our body for healing our body. So it’s all very important.

Dr. Weitz:            What are some of the, how does your REM sleep get disturbed? Like can you get a normal amount of sleep but it’s just not the quality of sleep? What happens there?

Dr. Colon:            One of the biggest disturbances of REM sleep is actually a untreated sleep apnea. And the reason for this is because in REM, our body has less muscle tone, so you don’t act out your dreams, it’s a protective mechanism. But when we decrease our muscle tone, our muscle tone in our airway also decreases as well. So some of the problems that can occur with REM sleep can be an untreated sleep apnea. Other things that can affect our REM sleep are antidepressants decrease REM sleep, and that’s one of the major factors there. Another thing that can affect your sleep in general, whether it’s your REM sleep or your non-REM sleep, is light exposure. If you’re sleeping with light exposure, some new studies have shown that that increases insulin resistance as well.

Dr. Weitz:            Yes, so your room should be very dark, maybe even wear a sleep mask or something like that if it’s not.

Dr. Colon:            Absolutely. A quiet, dark room is helpful. Sleep masks can be helpful if they’re tolerated, I was actually in Iceland where they had 24 hours of sunlight, and I could not keep that on my face.  And I’m like, I’m a sleep specialist, I need to get to sleep, you know, but I couldn’t keep it on my face.  But other people can, other people sleep very well with it.

Dr. Weitz:            Yeah, I’ve got one from Tempurpedic, and it sort of pushes gently on your eyelid, and if you push gently on your eyelid it actually stimulates that oculocardiac reflex that causes you to relax.

Dr. Colon:            That’s a good tip, that’s a great tip, I’m gonna use that in my clinic.

Dr. Weitz:            So let’s go through some of the negative effects of what happens when you don’t get enough sleep. I know I was, I listened to your lecture and I was looking at your Powerpoint and you talked about decrease in performance, you talked about memory problems, maybe we could go through some of the more important ones.

Dr. Colon:            Yeah, one of the things that you see really early on is memory. And it’s been shown that sleep deprivation, when people do different functional memory tests and cognitive tests, that they work as if they’re impaired, sometimes worse than someone who is intoxicated. And they’ve actually done these studies where they give one group of people alcohol and they sleep deprive another group, and they put them on driving simulators, and consistently the sleep deprived group does worse. So if you combine sleep deprivation with alcohol, then that’s even worse. Other things that can affect, that can be affected if you have poor sleep is-

Dr. Weitz:            By the way, when it comes to memory, is it more long-term, short- term, or both?

Dr. Colon:            Definitely clearly short-term, you see some problems, like okay, I went to the kitchen to get something, what did I go to get? You don’t forget your own name, but I guess … both can be affected. But immediately you see short-term memory issues.

Dr. Weitz:            Okay. And then go ahead, you were gonna say something else?

Dr. Colon:            Well, other things that poor sleep affects and decreased sleep is your inflammation status. Inflammation and sleep are really bi-directional, where inflammatory disorders are associated with more sleep concerns, but likewise if you have short sleep, you have higher markers of c-reactive protein, Interleukins, and measures of inflammation such as Tumor Necrosis Factor alpha. That affects cardiovascular status as well, so they’re … doing findings that when you treat your sleep apnea with CPAP, that that also improves your cardiac status, but beyond that, when you treat insomnia with cognitive behavior therapy for insomnia in cardiac patients, they have better cardiac outcomes as well.  I also can’t emphasize enough the insulin resistance. Poor sleep really affects insulin resistance as well.

Dr. Weitz:            So you can be working with somebody who is a type 2 diabetic or a pre-diabetic, and maybe controlling their, let’s say you’re a Functional Medicine practitioner and you’ve got them on a low carb diet and still they’re waking up with high fasting blood sugar, it could be their sleep that’s actually affecting that?

Dr. Colon:            Yeah, and same thing with Polycystic Ovarian Disease. You know, likewise, all of those things, you’re very correct.

Dr. Weitz:            So it, can it directly affect your hormone levels?

Dr. Colon:            Yeah, absolutely. You know, for men you have that first REM cycle where you’re secreting the testosterone, and untreated sleep apnea has been associated with testosterone that’s low. And then also with women, I mean women have what, a 28 day cycle, that’s the lunar calendar. So I mean, yes, sleep does affect it, yeah.

Dr. Weitz:            So in men, is it more likely to affect total or free testosterone, or both, or?

Dr. Colon:            Both.

Dr. Weitz:            Interesting. So what are some of the most important factors that affect sleep? You talked about light, what about electronics, EMFs, what are some of the other factors?

Dr. Colon:            So all of those are really important. The light, the electronics, EMF, every single study that I read about electronics and sleep, there’s nothing positive, I mean nothing is, everything comes back that electronics really disturb sleep. But you asked me another question, you asked me what are some of the most important factors that affect sleep? And I gotta tell you, in my experience, the most important factor that a stress … that causes problems with sleep, is stressing out about sleep pattern, is people, some people can’t sleep because something’s bothering them and what’s bothering them is that they’re not asleep. And sometimes we overemphasize, you can’t overemphasize sleep, yet sometimes we overemphasize it to the point that it causes sleeplessness. So it’s important for patients to know this, it’s important for them to know that yes, we’re gonna try, we’re shooting for our seven to eight hours of sleep per night. But if you have a night that you haven’t slept, you’re not gonna drop dead the next day. You’re gonna be okay.  You know, if you’ve gotten those first four hours, the core sleep is within your first four to five hours. If you’ve gotten that, this is gonna help you, at least for the next day. Do we want to do that chronically? No. But some people literally lose sleep over not sleeping.

Dr. Weitz:            Right. So maybe you should say to yourself, if you had a poor night of sleep, don’t worry about it, and even if you just … I usually like to tell the patients, look, even if you just lay there and rest, that’s beneficial to your body. And don’t worry about the fact that you didn’t sleep.

Dr. Colon:            You know, so let me add something to what you just said. Alright, this is gonna help your patients, okay? You’re correct. Even if you’re not asleep, if you’re resting, that’s helpful. Everyone has a heart rate, everyone has a brain, okay, and these are interconnected with our breathing.  So you can instruct them, if you’re not asleep, this is the time to do some relaxation training.  This is the time to do an awareness of breath meditation.  And when you do this, you’re naturally gonna start to notice your breathing.  When you notice your breathing, your respiratory rate slows down.  As your respiratory rate slows down, you’re hitting that parasympathetic response. And this is so clutch, because if you’re not asleep, you’re at this parallel where one of two things are gonna happen. You’re either gonna stress about it, and you’re gonna go up at the sympathetic stress, or you can elicit that relaxation response and then at least you’re getting the decrease in cortisol, you’re getting the decrease in heart rate, and you’re starting to relax.  So you’re right, if they’re not asleep, you can have them do some type of relaxation response and they’re still getting some R and R, some rest and restoration.

Dr. Weitz:            So I have heard about the importance of breathing through your nose as opposed to mouth breathing and some people even tape their mouth, what do you think about those techniques?

Dr. Colon:            That … you know, so sometimes we use chinstraps so your mouth doesn’t open if they have an untreated sleep apnea, because-

Dr. Weitz:            People actually put tape over their mouth.

Dr. Colon:            Yeah, I don’t recommend that.  I haven’t heard of tape over their mouth. You know, we prefer to breathe through our nose, it’s more natural to breathe through our nose. Some people have some congestion to where they need to breathe through their mouth. Recently when I was in Lima, I told you that I had some congestion from some of the pollution that was over there, well one of the nights I woke up in the middle of the night and I had a lot of congestion.  I had to breathe through my mouth.  Now chronically you don’t want to do that, you’re right.  Chronically you don’t want to do that. And if you have that congestion, ideally you want to figure out what’s causing that congestion.  Do we have too much gluten or dairy in our diet?  Do we have environmental exposures?  What can we do to reduce that?

Dr. Weitz:            Yeah, I’ve always been a mouth breather for a number of years, and I took some training on breathing with a Butyeko breathing coach, and it really helped.

Dr. Colon:            That’s great.  At the same time, I also have some people that are retired boxers that they’re not going to breathe through their nose.  So you have to work with the clients where they’re at.

Dr. Weitz:            Right. So can you talk about sleep apnea and what exactly happens when you get a sleep study, and does everybody who goes through a sleep study end up with a CPAP machine, and what are some of the other concerns people have with that?

Dr. Colon:            So not everyone who has a, who goes through a sleep study comes out with a diagnosis of sleep apnea.  And even people who have sleep apnea, not every treatment is with CPAP. But sleep apnea is where you stop breathing in your sleep.  Your airway collapses while you’re in your sleep, and it’s restrictive, and you have less oxygen. That can induce cortical arousal so it affects your brain.  And then the known method, the single best known method for treating it is the CPAP machine, which cushions your airway open.  But there’s other people that can wear a dental device, a dental device that advances your jaw forward and just to kind of give a demonstration, okay, if I’m asleep, my jaw comes back.  Okay you hear a snoring sound? Now if I move my jaw forward, now I’m not making that snoring sound there.  So these are very effective, and … yes, they’re very effective for mild to moderate sleep apnea.  So you need a sleep study to see where you’re at. But the compliance of those have been shown to be better than that of CPAP, actually.

There are some patients that the sleep apnea may be positional only. So I do have some patients that I’ve treated successfully with a positional sleeping to avoid sleeping on their back, now they sleep on their side, and there’s positional devices that have been studied and have some robust literature. I typically tell people to get a full body pillow. When you have a full body pillow, that’s gonna align your shoulders to your knees, so you know what that does for your back, preserves your back and make it so you can stay in that position throughout the night. So those are the main treatments. There are of course some sleep apnea surgeries that are not really highly recommended. There are-

Dr. Weitz:            I’v had some patients get those surgeries recently where they carved out part of the back of their throat, and you know, tried to make some more room there.

Dr. Colon:            They’re serious surgeries … that I have referred some patients for it, and I’ve yet to have a surgeon in my area want to do it. They’re like, “No, why don’t you go back to Dr. Colon and work on that CPAP a little bit more.” They don’t have very good track records.

Dr. Weitz:            I just had a patient see a sleep expert who gave them some sort of device that stretches out the upper palate.

Dr. Colon:            So rapid palatal expansion is something that is very well established in the pediatric age group that decreases the incidence of obstructive sleep apnea and the severity, and I do advocate for that. In the adults, that is, I feel is an emerging topic. It is not being talked about by sleep experts. It’s being talked about more within functional dentistry, and I think that it has a bright future, but the sleep experts don’t have the data on that at this time.

Dr. Weitz:            I also interviewed a functional dentist who told me that he thinks that a fairly decent percentage of patients with sleep apnea really just have vitamin D deficiency.

Dr. Colon:            I have … the answer is yes, vitamin D deficiency affects sleep. In particular, sleep apnea. It also causes inflammation to where you can get tonsillar hypertrophy, which further affects sleep apnea. I had a patient that I saw for multiple, well I saw him for sleep. The patient has multiple sclerosis. Now when I diagnosed him with sleep apnea, and it was a marginal sleep apnea, but it was definitely present. It was present. And knowing that he has multiple sclerosis, knowing the functional medicine background that I have, I know that vitamin D can affect multiple sclerosis. So I got a vitamin D level on him, I started treating him with vitamin D, and his multiple sclerosis doctor endorsed it. “Yes, yes, let’s go ahead and treat.” Now, interesting. Something happened with his insurance company that they stopped paying for the CPAP machine. What happened, I don’t know, you can’t make sense out of nonsense, so don’t try. Regardless, it got denied. So I had to repeat a sleep study on him, and when I repeated it, sleep apnea was no longer there. This was after several months treatment on that vitamin D.

Dr. Weitz:            How much vitamin D were you giving him?

Dr. Colon:            We were doing … it was, I think, conservative. I think we were doing like 5000 units.

Dr. Weitz:            Okay.

Dr. Colon:            And some people will say, “Oh, 2000’s conservative.” No, I think 5000 was conservative. But even then, you know, it was only that much, and it was after several months of treatment, we repeated it, and it was negative. So what was wrong? I mean, was my sleep study wrong? No, I mean I looked at it, I read it. Both of them were quality, and I went back and looked at both of them. And the measurements were there. But he just didn’t have the sleep apnea. And he didn’t lose weight either.

Dr. Weitz:            So one of the things that can interfere with sleep is restless leg syndrome. And I know there’s some controversy over exactly what the causes are, and I saw one article that found a correlation between IBS/SIBO and restless leg syndrome, which I thought was really interesting, because I end up treating a lot of cases of IBS and SIBO. Can you talk about restless leg syndrome for a minute?

Dr. Colon:            Restless legs are uncomfortable sensations in your legs that are worse at night, worse when you rest, and they’re relieved by movement or by mental activity. There are many causes, and even then there’s two kinds, familial or non-familial. And there’s many causes, one of the main causes that everyone with restless legs needs to be evaluated is ferritin is  deficient. And notice I didn’t say iron deficiencies, because you can not have anemia but still have less ferritin. And if you don’t have the … enough ferritin you can have-

Dr. Weitz:            What’s the distinction there?

Dr. Colon:            So what are the main treatments that, medical treatments that people give, is the dopaminergic medications, right? Well you know, the dopamine receptor has ferritin in there, and further, so low CNS ferritin has been shown to cause restless legs and treating that. So the ranges, when you look at ferritin, you know it says that the range may be to 10 to 20, or if you’re at 20 that’s normal, but if you have restless legs, 50 and below, you know below 50, that’s symptomatic, and you want to be treating with iron in those patients.

Dr. Weitz:            Interesting. So how, besides restless legs syndrome, let’s go over some of the … I know you mentioned a few of these, but let’s go over some of the therapies to restore better sleep. You mentioned cognitive behavioral therapy, what exactly is that, and how does that work?

Dr. Colon:            Yeah, so CBTI is the gold standard for treating insomnia. And CBTI is working with a psychologist that really kind of helps retool sleep. That’s what I explain to patients. But one of the things that these therapists is doing is that they’re addressing our attitudes, our concerns, about sleep. You know how I said that some people don’t sleep because they’re stressed about sleep? Well, yeah, that’s what the psychologist works with. They’re like, “Okay so what’s gonna happen if you don’t sleep?” They’re like, “Well, if I don’t sleep I’m not gonna function the next day.” “Okay, and then what’s gonna happen?” “Well, I’m gonna go to work and I won’t be able to function. And if I can’t function, I’m gonna be fired, and if I’m fired, I’m gonna be homeless.” And literally people with insomnia can have some degree of catastrophic thinking that occurs. And the CBTI helps out with that.

And another emerging treatment in insomnia is gonna be MBTI, or mindfulness based treatment for insomnia. This was created by Jason Ong. And there is a perception, yet misperception that we can meditate ourselves to sleep. I mean, yeah, you can induce a relaxation response or sleep, and relaxation therapy and relaxation training is good for sleep, and I teach my patients how to do that. But MBTI is different, because you’re actually doing a practice of mindfulness, an eight week practice of mindfulness. What are some of the core concepts of mindfulness? Non-judgment. So if you stop judging yourself, you know that you’re not asleep, you stop … you worry about the present moment, don’t think so much about the future, the MBTI has been shown to be very helpful for insomnia as well.

Dr. Weitz:            Great, great. What is circadian rhythm training?

Dr. Colon:            Circadian rhythm entrainment is that we all have a 24 hour cycle. Everyone lives in a 24 hour society. Believe it or not, actually, our internal clock has a tendency to go 25 hours. So if you put people in a cave and you take them away from light cues, you disrupt their light cues, they stay up later, and later, and later, an hour later the next day. And what resets our cycle is that morning light, and then the darkness at night. So I’ll use, and even then, you really do have some people who are night people, and some people who are morning. You know, people have different circadian clock genes that predispose their circadian cycles. So circadian entrainment is trying to work on a particular wake up time with light exposure and you can even add melatonin, based on where their melatonin secretion should be coming out. When should they secrete melatonin? There’s a very, very helpful tool called a morningness-eveningness questionnaire. It has a German name to it that I can’t pronounce, so I just call it the morningness-eveningness questionnaire. And you can go online and get it, it’s called the AutoMEQ, M-E-Q, Auto M-E-Q.

Dr. Weitz:            Cool. And you talk about sleep restriction, restricting your time in bed, I guess this is for somebody whose sleep cycle’s all messed up, and if they’re having trouble sleeping at night and then they end up sleeping during the day, how does that work?

Dr. Colon:            So let’s, before we talk about how it works, let’s talk about what does not work, okay? So there are some people that spend extra time in bed, because they want to sleep more. And that sounds logical, okay if I’m not getting to sleep til … I’m throwing numbers out. If I’m not getting to sleep til midnight, let me go to bed earlier, so I can eventually get to sleep. The problem with that is that you’re spending more time in that bed learning not to sleep. And training your brain to not be asleep. So the key is to … the time. Restrict the time that you’re in bed until the times that we are going to be asleep. So that’s what we mean by sleep restriction, as well as also having a very strict wake up time, because that helps with the circadian entrainment as well.

So another thing that people say is, well if I didn’t sleep until this time, I need to sleep in longer. That sounds logical, but it’s causing a cascade of problems that’s disrupting your circadian system, which we have a natural tendency to run at 25 hour cycles, so if you didn’t get to sleep til whatever time, it doesn’t matter, wake up at the same time. And if you do that on a regular basis, that’s going to help your sleep drive, get to sleep a little bit earlier. So sleep restriction isn’t so much sleep depriving people, although you do go through a period of time where they might get a little bit less sleep, but you do that in a way that they end up getting to sleep on a regular time, a little bit early on a regular basis.

Now that is something that I would do either with a board certified physician in sleep medicine, or that would be a great period to find someone who, through the Society for Behavioral Sleep Medicine, a sleep psychologist.

Dr. Weitz:            Cool. What are some of your most effective herbal or nutritional supplements for sleep?

Dr. Colon:            You know, so whenever someone asks me what is the best supplement for sleep, I always say what are you deficient in? So I will commonly run some micronutrient analysis to see. I can show you evidence that zinc has been helpful for sleep, that magnesium has been helpful for sleep, lavender is helpful for sleep, melatonin is helpful. Everything that’s out there I can show you evidence. But what is it in your patient? So you run a micronutrient analysis and you look for a specific deficiency. Or you may run an adrenal profile, and you can find that they’re epinephrine or norepinephrines are high, or their cortisols are high, you know, some ashwaganda is gonna be good for them, or some rhodiola. If their cortisol is high, lavender has been shown to decrease the cortisol. Run a melatonin profile, and if their melatonin is normal, then giving them more melatonin is not gonna help out. If you see that their melatonin is low, okay then that’s someone that we may want to supplement with melatonin, or have them eat more foods that have both tryptophan to make your own melatonin, as well as also natural melatonin such as tomatoes, cherry juice, walnuts.

Dr. Weitz:            You do do urine neurotransmitter testing to see if their serotonin or GABA is low?

Dr. Colon:            I have, and the context that I do that is I’m saying, “Look, I’ve been seeing you, you’ve done the sleep hygiene, we’ve done the sleep studies, we’ve done the standard of care, and you’re still having some issues, do you want to do a little bit more?” And some people say, “Yeah, yeah, okay let’s do more.” And I’ve had a patient that their glycine was low. Alright, well let’s supplement glycine. Other patients that their serotonin could be off. I had one patient with excessive sleepiness that had high, really high GABA levels, well GABA is inhibitory. So they were complaining of insomnia, but in essence they were sleeping during the evening, it’s just that they were tired during the daytime. And we ran it, the GABA was high, well DHA can attenuate that response. So we targeted individualized treatment.

Dr. Weitz:            Interesting. GABA can also help with sleep, and some people use it in sleep formulas.

Dr. Colon:            Correct. GABA can help with sleep, but also if you have chronically high GABA levels, which many patients with idiopathic hypersomnia can have defective, overactive kind of GABA receptors.

Dr. Weitz:            So just like many things, not too much, not too little, gotta get it in that sweet range.

Dr. Colon:            Yeah, that and what are we treating?  So I get the question a lot, “Dr. Colon, what’s the one big thing that we can do with sleep?”  And number one is not worry about it, but number two is what are we treating?  Are we treating … do we have an unknown sleep apnea, if we have restless legs, do we have SIBO as you mentioned, do we have magnesium deficiencies, keratin deficiencies, and even sometimes throwing in micronutrient analysis and also the neurotransmitter profiles.

Dr. Weitz:            Right.  So basically try to get at the root cause, do a careful history-

Dr. Colon:            Yes, sir.

Dr. Weitz:            Do a certain amount of, you know, a reasonable amount of testing, and then let’s try to have some real target for what … you know, that we can really try to intervene and get to those root causes, which is really what functional medicine’s all about.

Dr. Colon:            You hit the nail on the head, doc.

Dr. Weitz:            Okay, Jose. So for those listening or watching this podcast, how can they get a hold of you? And how can they get a hold of your books and your training programs?

Dr. Colon:            Yeah, so all of my books are on Amazon. They’re also from my publisher, Halo Publishing, and yeah, I wrote a book for women for insomnia called The Sleep Diet a Novel Approach to Insomnia, which I wrote it at a time when I had no idea about nutrition, so it’s not so much about diet but about different lifestyle aspects. And I have, as you mentioned, children’s sleep book and a book for infant sleep. And I also put information on my website on sleep tips for free on paradisesleep.com.

Dr. Weitz:            And are you available for consultations in person and over the phone, or via Skype, or?

Dr. Colon:            I do work for a health system, so all of my consultations are within my clinic, actually.

Dr. Weitz:            Oh, okay. Great, excellent. And what’s your website?

Dr. Colon:            Www.paradisesleep.com

Dr. Weitz:            Excellent, thank you Dr. Colon, thanks for spending the time with us.

Dr. Colon:            My pleasure, you have a great one.

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Detoxification with Dr. Bob Rakowski: Rational Wellness Podcast 69
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Dr. Bob Rakowski talks about how to detoxify your body with Dr. Ben Weitz. 

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast] 

 

Podcast Highlights

3:35  Environmental toxins are so insidious, that we just can’t avoid them.  Dr. Federica Ferrara is a researcher from Columbia University, who’s been studying this for over a decade and she literally took air samples from very sophisticated mechanisms that she had pregnant women wear all over the country and every single woman, every single day, was exposed to these neurotoxins that were known to cause harm to the developing fetus.

4:44  We can start by detoxing our kitchens and don’t buy any unhealthy, processed foods that you shouldn’t be eating, so you remove temptations.  We also need to be concerned about all our exposure to wifi and electromagnetic forces, so unplug your wifi, have a digital sunset, have a day without any electronics, to give our brains a rest.

7:32  In order to detox our bodies, Dr. Bob has been talking about the magnificent seven–You gotta eat right, drink right, think right, move right, sleep right, poop right, talk right, every single day.  So, when we’re gonna eat right, we want to avoid the toxins and yet we want to get the nutrients that help our body to cleanse, so detox is a very nutrient dependent, and believe it or not, protein dependent process. We also want to make sure you are pooping right, since this is how we get rid of toxins. Dr. Rakowski also mentioned one of his favorite quotes, from Jack Lalanne, who happened to be a chiropractor, he said, “If God made it, it’s okay; if man made it, don’t touch it.”  “Move right actually helps to detoxify. There’s no doubt about it that movement, we’re gonna exhale, we’re gonna blow off carbon dioxide, we’re gonna sweat, that’s a pathway.”

12:10  Poop right means that you should go at least once a day and preferably multiple times.  You should have enough fiber so it goes through easy.  What controls bowel function is fiber, water and neurologic tone.

13:20  Talk right–every cell’s in communication with every other, so we gotta make those cells right and flexible and responsive and have the right acid alkaline balance. Acid is the top toxin that we make.

13:30  Sleep right, since we detoxify our brain and body when we sleep, and we go through a liver detoxification in the middle of the night. 

14:12  If we don’t have good digestive function and we are not pooping regularly, then estrogen and toxins that need to be eliminated will get reabsorbed. And if we have leaky gut, as one in two people have, these toxins will pass through the gut wall directly into the blood stream.  Dr. Rakowski says “You are what you eat, and that’s pretty true. You are what you absorb, that’s more true. You are what you don’t eliminate. That’s most true!”

17:58  In order to facilitate liver detoxification, Dr. Bob likes to have his patients do a seven day detox with Medical Foods, like the Ultraclear Renew from Metagenics, and organic, non-starchy vegetables only. If you try detoxing by fasting, within 24 hours of the fast, since the liver is protein and nutrient dependent, liver detoxification will slow down by 50% before you start breaking down your own tissue. Some people try to do liver detox with food and he quotes a study from the Journal of Advances in Therapy that found that food is too weak to replete the depleted cells and bodies, therefore supplementation is advisable for everybody.  Dr. Rakowski has treated hundreds of high level celebrities, professional athletes, and Olympians with his 7 day Medical Food detox and he has found that many of the Olympians set a season or personal best within a week of completing the detox.  He recommends doing this one week intense detox twice per year.

26:58  Too many in our society don’t get enough sleep and Dr. Bob likes to use calming adaptogens and theanine from green tea, which is a GABA facilitator and is very calming. People need a sleep routine and a dark, cool room without wifi.  The best of the best need 8.6 hours of sleep per night.  Dr. Rakowski personally takes 50 mg of timed release melatonin at bed. He mentioned an NIH study in which they administered 50 mg of melatonin and vitamin D and they found that it prolongs survivability and prevented lean tissue breakdown in inoperable cancer patients. Melatonin does not cross the blood brain barrier.  Dr. Rakowski notes that in the last decade his biological aging has been very slight.

 

                        



Dr. Bob Rakowski is a Doctor of Chiropractic, Certified Clinical Nutritionist, and the director of the Natural Medicine Center in Houston Texas. Dr. Rakowski is available for consultations in person or remote via Skype or Zoom and he can be reached through his website, http://thedrbob.com

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.


 

Podcast Transcripts

Dr. Weitz:                            This is Dr. Ben Weitz with the Rational Wellness podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field. Please subscribe to Rational Wellness podcast on iTunes and YouTube, and sign up for my free ebook on my website, by going to drweitz.com. Let’s get started on your road to better help.  Hey Rational Wellness podcasters, thank you so much for joining me again today. For those of you who enjoy the Rational Wellness podcast, please leave us your ratings and your review on iTunes so more people can find out about the Rational Wellness podcast.

Our topic for today is toxins and how to remove them by conducting a proper detoxification program. Our modern world has many toxic substances in the air, food, water, as well in products … as well as in products that we cook with, clean our homes, apply to our skin, hair, teeth and various other personal care products, products that we use on our lawns, and products that we use in construction and painting our homes.  We often find fluoride, chlorine, and sometimes ammonia that are purposely added to our public drinking water as well as small amounts of prescription medicines. We’ve all heard about the lead in the water in Flint, Michigan, but other … But a recent scientific American report found thousands of cities across America with toxic levels of lead in your drinking water. A recent report from the Environmental Working Group demonstrated that there are toxic levels of PFCs, a certain type of chemical, in the drinking water of 15 million Americans in 27 different states.  These PFCs are chemicals that come from nonstick cookware, such as Teflon coated pans, stain resistant coatings on carpets, upholstery, and clothing such as scotch guard, lining fast food containers, pizza boxes, candy wrappers, and microwave popcorn bags. These are also in paints, sealants, anyway, I could go on and on about toxic chemicals in our modern environment, and these chemicals make our way into our bodies and often, are stored there.  The Environmental Working Group conducted a study in 2009 that found measurable levels of BPA in umbilical cords of nine out of ten infants, as many as 232 chemicals were found in the umbilical cord blood of infants before they even stepped foot in the world. I’m glad that we have Dr. Bob Rakowski with us today to give us some information on how we can start to get some of these toxins out of our bodies.

 Dr. Bob Rakowski is a chiropractor, kinesiologist, certified clinical nutritionist, certified biological terrain instructor, and the clinic director of the Natural Medicine Center in Houston, Texas. In addition to running a busy chiropractic and functional medicine practice, Dr. Rakowski has lectured internationally for over 25 years on various topics in natural and lifestyle medicine. Dr. Bob, thank you so much for joining me today.

Dr. Rakowski:                     You’re welcome. I tend to like to smile whenever I’m on camera, but I probably couldn’t help but have a scowl as you were sharing the grim reality of these toxins that, literally, it’s been said, environmental toxins are on the attack, because they’re so insidious. We just can’t avoid them, and in fact, if you don’t mind me throwing out a little research, there’s a researcher from Columbia University, Dr. Federica Ferrara, who’s been studying this for over a decade and she literally took air samples from very sophisticated mechanisms that she had pregnant women wear all over the country and every single woman, every single day, was exposed to these neurotoxins that were known to cause harm to the developing fetus.  And so, we’ve gotten to the point where, you know what, they’re everywhere, so what do we do about it? I guess that’s the topic for our beautiful conversation today.

Dr. Weitz:                            Exactly, exactly. So, what can we do to … Before we go into detox, what kinds of … What do you think are some of the most important things we can do to try to avoid being exposed to these toxins?

Dr. Rakowski:                     Well, you said a lot of things right there, so the number one rule in toxicology is to separate yourself from the toxic source. So, maybe the first thing you want to detox is your kitchen.  There’s a great mentor out there, his name is Bryan Tracy, he asks a couple of simple questions. What’s the one thing that you can start doing that you haven’t been doing that’ll improve your life the most? And what’s the one thing that you can stop doing?

Well, we can do the same thing with nutrition. Most of us are going to make faster progress by stopping putting garbage in our body and if you’re like me, I can resist almost anything but temptation, so if it’s in my kitchen, there’s a little bit of a challenge. I’m more likely to take it then. So, get your, buy your willpower by either shopping online, sending someone else to the store, stay in the periphery, don’t go down the center aisles with all that packaged garbage.

So detox your kitchen and have strategies there, but we’re taking advantage of this beautiful communication medium and this may be beyond the level of what we’re talking about in terms of chlorine from our body, but we’re exposed to wifi and electromagnetics and things at a level that people have just never been exposed to before, and the data shows that there’s problems. In fact, I’m a little older than you, but Henry Kissinger was Nixon’s Secretary of State-

Dr. Weitz:                            Oh, no. I remember Henry Kissinger.

Dr. Rakowski:                     Yeah, brilliant guy, but basically this guy says, “You know what, the disease of the modern century with all the exposure is actually gonna be insanity because our brain never unplugs from the input and that overstimulated brain is in a very unhealthy state.” So mental illness is happening earlier and faster. So, unplug your wifi, have a digital sunset, have a day without any electronics, clean out your kitchen, and then a lot of times when people think about detoxification, they think, “Well, okay, I’ll do something to enhance my bowel function.”  But you’ve got the liver, the kidneys, the bowel, the skin, and the lungs, all such critical part of detoxification. There’s things we can do for all of them.

Dr. Weitz:                            Oh, absolutely. Everybody should unplug their wifi at night if possible, just hard wire everything, get rid of wifi as much as you can, don’t have your phone in your room. Don’t have your alarm clock next to your bed. There’s a million things we can do. In fact, just consider the fact that if you’re laying there at night on a mattress with metal coils and you’ve got your wifi on, you’re concentrating all those radio waves-

Dr. Rakowski:                     Tell them no thank you. No.

Dr. Weitz:                            So, let’s start talking about what we can do to detox our bodies. How can we really get rid of these toxins?

Dr. Rakowski:                     All right. So for years, I’ve talked about the magnificent seven. You gotta eat right, drink right, think right, move right, sleep right, poop right, talk right, every single day.  And that poop right is kind of the elimination process, but all seven have something to do with it. So, when we’re gonna eat right, we want to avoid the toxins and yet we want to get the nutrients that help our body to cleanse, so detox is a very nutrient dependent, and believe it or not, protein dependent process.

So, if we talk about this wonderful organ called the liver, there is phase one of liver detoxification, which by the way, I like to make the analogy of that’s like burning garbage in your fireplace. So maybe let me take a step back on that. So, partly what I like to tell people is, imagine you have an old time home and you had two ways of getting rid of garbage. You could flush it down the toilet or you could burn it in the fireplace. Well, the toilet, we’re gonna call that the plumbing system, that’d be the bowel and the kidney’s and if that backs ups, guess what? We want to do something about that right away.

But if you burn garbage in the fireplace, now you gotta get the smoke out of the chimney. And so, phase one is actually burning the fire, that is an enzyme dependent process. So the liver has a series of enzymes called cytochrome P450s and there’s more than 75 that are known now, but these are all protein dependent. So sometimes people say, “I’m gonna go on a fast or a juice fast, I’m gonna detox.” Well, if the body doesn’t have the protein from your diet to detox, it’s gonna take the protein from your stores.

It’s gonna breakdown the lean tissue or possibly liver proteins, like albumen and globulin, in extreme cases, even hemoglobin, that can break down. But you don’t want your body breaking down the detox, you want to have it present with the amount of proteins that are needed, and then phase two has a lot of micronutrients. So, as you and I know and have discussed in the past, there’s literally detox formulations by really sophisticated companies where they’ve actually put it to the test. They put it through human clinical trials, exposed people to certain levels of toxins and found out, “Wow, they neutralized them and pass them through when we support them with these nutrients.”

So those are different types of medical foods or functional foods that we can do it, but when we go back to eating right, I have a couple favorite quotes. One is from Jack LaLanne, who happened to be a chiropractor, he said, “If God made it, it’s okay; if man made it, don’t touch it.” Michael Pollan, listed by people as one of the top 100 most influential people on planet Earth said, “Eat food …” Go for it.

Dr. Weitz:                            No, I was gonna say, the guy who wrote Omnivore’s Dilemma and … Yeah.

Dr. Rakowski:                     In Defense of Food, the subtitle is, “Eat food, not too much, mostly plants.” And so we break that down, I wish he’d said, “Eat natural organic food grown in nutritious nutrient dense soil, multiple colors every day, mostly plants.” So why mostly … Why not too much food? Well, we’re overeating as a general rule.  We have more people dying from overeating than starvation now and that’s the first time in the history of the planet that that’s happening. Why mostly plants? Simple enough, data from Bruce Ames Geneticist from the University of California Berkeley, people that eat the most fruits and vegetables get the least cancer. Those that eat the least, get the most cancer. So we want to get all those good plant nutrients in our system.  When it comes to drinking right, we can detoxify with drinking. I’ve got a nice detox tea here in front of me, but there’s plenty of great herbal teas. I have a big propensity towards drinking organic coffee has actually been shown in massive studies to actually increase longevity, and there’s people talking about bullet proof coffee and I actually have a way I believe of making coffee bomb proof instead of bullet proof. That could be another topic-

Dr. Weitz:                            Bomb proof coffee.

Dr. Rakowski:                     Bomb proof coffee, baby. That’s the way to go. We don’t want liquid calories, we want to detox with it, and then think right, guess what? You detoxify your mind through meditation. That’s been described as like a shower for your mind. I was sharing that this weekend at a conference. I had about 70 doctors in attendance, but I said, “Just imagine that the doctor next to you hadn’t showered today. Or maybe, how about they haven’t showered this week? Or maybe this month or maybe this year, or maybe ever?” I said, “That’s our mind. We have to shower our mind with good meditation.”

Move right actually helps the detoxify. There’s no doubt about it that movement, we’re gonna exhale, we’re gonna blow off carbon dioxide, we’re gonna sweat, that’s a pathway. Poop right, guess what, that’s certainly gonna be the bowel function and I was actually lecturing at NASA, and believe it or not, a rocket scientist asked me, he says, “Well, Dr. Bob, how exactly does one poop right?” And believe it or not, people don’t know. You gotta go at least once a day, preferably multiple times. You should have enough fiber that it goes through easy. Bowel function is fiber, water and neurologic tone, and it should have a certain color and consistency. Talk right, every cell in our body is potentially-

Dr. Weitz:            When it comes to poop, I think that digestive problems are so endemic, they’re so common in our society that I think people have forgotten what proper bowel function is. There’s, I mean, you start questioning how many people have either constipation or diarrhea or gas or bloating, abdominal discomfort, reflux, etc., it’s unbelievable.

Dr. Rakowski:                     Well, I’ll give you a stat. This is the American College of Gastroenterology. They say one in two, one in two, that could be me or you on this podcast, thank God it’s neither of us, have chronic digestive disturbance. It’s really a crime against humanity.

Dr. Weitz:                            Yeah.

Dr. Rakowski:                     Talk right, guess what, every cell’s in communication with every other, so we gotta make those cells right and flexible and responsive and have the right acid alkaline balance. Acid is the top toxin that we make and then finally sleep right, and believe it or not, we detoxify our brain and body when we sleep, and actually studies show, and Chinese medicine is known for thousands of years, how they knew I’m not sure, we go through a liver detoxification in the middle of the night.  And so we want to be asleep at that time. So, body’s have good systems. By the way, just on sleep, ’cause I’m kind of a sleep nerd, Anders Erickson, who is probably the world’s leading authority on peak performance wrote a book called Peak, and he said the best of the best of the best in any endeavor, sleep 8.6 hours a night. They nourish, rest, and recover the brain and body, and what a beautiful stat that is. So I’m a big sleep man.

Dr. Weitz:                            Yeah, some of the important things about digestion are that when we do get rid of toxins through our liver, most of those toxins are excreted through our stool and so if you’re constipated, a lot of those toxins are gonna get reabsorbed. So, something like estrogen is just gonna get resorbed and reabsorbed and we’re gonna have problems with all these toxins. So, you gotta be eliminating, so you gotta have good digestive function and then if you have a leaky gut, a lot of these toxins are just gonna cross directly into your blood stream.

Dr. Rakowski:                     And at least one in two people walking around are dealing with that challenge. Just ’cause I like words and little phrases that are memorable, most of us have heard, “You are what you eat,” and that’s pretty true. You are what you absorb, that’s more true. You are what you don’t eliminate. That’s most true. And that probably needs to raise the level of concern in some people. We want to keep those bowels moving, every single day, and preferably multiple times a day.

Dr. Weitz:                            So what are some of your keys to making sure people have a good digestive system?

Dr. Rakowski:                     Well, I’m gonna tell. It’s fiber, water and neurologic tone. And it’s also habit. So we know that bodies have routines and reality is, if people need to use the restroom, they need to know that they need to honor that reflex. So there’s a reflex that’s existent in all of us, but especially in infants, it’s called the gastrocolic reflex, and so when they eat, they poop, when they eat, they poop, when they eat, they poop. So you put something in, something comes out the back end. That seems to work pretty well.  But somehow, someway, we begin to start to suppress that reflex and then it becomes suppressed to the point where it becomes nonfunctional and we see too many people. So if they’re gonna retrain the bowel, they want to increase their fiber, they want to increase their water, and then when it comes to neurologic tone, that’s an interesting term, really muscle balance, but by stretching the colon, the colon has a stretch reflex to eliminate.  So there’s fibers and I like people to rotate their fibers and get most of them from organic fruits and vegetables, but they can certainly supplement. There’s a form of magnesium that I like a lot called magnesium citrate and it’s a very poorly absorbable form of magnesium, so it pulls water into the gut and it helps that bowel function, but people need to honor their bowels.

 I’ll tell a funny story. My kids are now 24, 21, and 20, but when my son was six years old, he already knew the importance of bowel function. So he was shopping at the mall with my wife and he always kept saying, “Mom, I have to go to the bathroom. Mom, I have to go to the bathroom.” He probably likes to shop as much as I did. But Kelly said, “Jacob, you don’t have to go to the bathroom.” He looked at her and said, “Mom, actually I do. I have to poop. Think about all those toxins I’m absorbing.” What a great point, right?  And so Kelly did just what you did, she laughed and she took him to the restroom and said, “Okay, you win. Go. Honor your body.”

Dr. Weitz:                            Did your son become a chiropractor or nutritionist?

Dr. Rakowski:                     You know what, he has a nutrition company that he owns, and actually, super proud of him, proud of all my kids, but he’s basically retired, financially free by the time he was 22 years old.

Dr. Weitz:                            Wow.

Dr. Rakowski:                     But his mother taught him well. But yeah. The picture of health as my kids are, all of them are, solid individuals that honor what they put in their body and honor the functions of their body.

Dr. Weitz:                            That’s great. So, how do we facilitate liver detoxification?

Dr. Rakowski:                     We gotta do it with nutrients. And by the way, that’s my top way of doing it, ’cause it’s nutrient dependent and it’s energy dependent, so we’re gonna start with proteins. We gotta have enough protein and it’s known within 24 hours of fast, that phase one of liver detoxification is gonna slow down by about 50% before you start breaking down your own tissue.

So some people try to do it with food and I’ll quote a study from the Journal of Advances in Therapy, they literally took people that were aged matched, health matched, gave one group an organic diet, the other group organic and supplements, they did tissue biopsies of the nutrient level at the start of the study and end of the study, people that got the best organic diet did not improve their nutrition status one bit. But people that supplemented did, so here was the conclusion. They said food is too weak to replete the depleted cells and bodies, therefore supplementation is advisable for everybody.

So, you could play it simple and go with a multivitamin, Omega 3s and plant nutrients and super foods and vitamin D and things everybody needs, but I’m a big fan of Medical Foods and functional foods. So I consume them myself, let’s say conservatively, 300 days a year. And I recommend that to my patient base as well. My rule of thumb in clinical practice, and I see some pretty amazing patients, high level celebrities and athletes and Olympians, when in doubt, detox.

So we’re gonna put people on an intense seven day detox where they’re only gonna do detox support nutrients and Medical Foods and organic diet, and then a pretty big dose. For a big guy, I might do six or seven servings of the Medical Foods a day. I’ve treated some NFL players that have done really well with that, and then at the end of the week, we see how they’re doing and … I’ve got a, literally, an interview I did with an Olympic coach and he said, “You know what, some people might think this is not a good idea in the hard part of training,” he says, “But all my athletes, and I’ve treated over 50 Olympians,” he said, “set a personal best or season best within a week of doing it.”

I like the idea of nothing but Medical Food shakes and organic vegetables, non starchy for that matter, low glycemic index, ’cause you don’t want to spike blood sugar, and get people to get the right fiber, the right water, the right elimination to help their body through. As I tell people, it’s been published now for well over 20 years in the clinical literature, symptoms of chronic poisoning include fatigue, sleep disturbance, intestinal distress, allergy symptoms, headaches, confusion and anxiety, and guess what? Those things can actually temporarily get worse on a detox, and so people will call me and say, “This ain’t working. I’m sick as a dog.” I say, “No, it’s working. The reason you’re sick as a dog is it is working.”

So we can either, one, tough it out, which believe it or not, a lot of people decide to, ’cause after a few days, this too shall pass; we can buffer it with other nutrients, things that support glutathione or bowel function or kidney function, or they can slow down the process. Stop, slow down, support it, or tough it out.

Dr. Weitz:                            Yeah, a lot of people talk about glutathione, NAC, lipoic acid are really important nutrients for facilitating detoxification. Do you use glutathione in your practice?

Dr. Rakowski:                     Yes, and no. Not to a high level, but certainly I’m going to support it in every different way. It’s a tripeptide, glutamine, glycine and cysteine and so for most people, cysteine, which is a sulfur containing amino acid, is a rate-limiting step, but cysteine, most of it’s derived from something called methionine, I don’t know if we want to get too deep about chemistry, but that requires B vitamins, activated B vitamins and more Bs then to actually help the body convert that all the way down to glutathione.

Another factor is in that pathway, the body can deplete a lot of its cysteine in making something in the body called metallothionein proteins, which by the way is another detox protein, but it clears out heavy metals. You mentioned the lead in the drinking water, but the data shows the modern skeleton contains 500 to 1,000 times the lead of preindustrial humans, so heavy metal detox, guess what, that’s a different thing altogether, and there’s different nutrients that drive that process, as well.

Dr. Weitz:                            Yeah. We do a NutraEval on a lot of our new patients and that includes a heavy metal panel and we see a lot of mercury, a lot of people with elevated metals, very common.

Dr. Rakowski:                     And certainly that’s gonna deplete glutathione along the same path. So pretty tough game. A good comprehensive doc like yourself that knows what to look for and knows how to guide people through. Guess what, people are struggling and they need what they offer, what we offer.

Dr. Weitz:                            Yeah, a lot of people are shocked to see how high their mercury levels are, and a lot of it’s coming from fish.

Dr. Rakowski:                     Yeah, I’ve been in clinical practice 26 years and there was a clinic, basically in the same center as mine, called the Detoxification Centers of Texas, and they would actually infuse substances that were known to pull out heavy metal and capture a 24 hour urine, and they did this for the purpose of documentation, really to get insurance reimbursement. But I asked the clinic director, I said, “Look, how long you been doing this?” And she said, “Well, 12 years.” I said, how many negatives have you seen? In other words, nobody had an excess of heavy metals.” She said, “Bob, zero. Zero. It’s just ubiquitous. We’ve got these metals in our system.” Now, are they harmful to everybody? Probably not. We have different sensitivities, but are they harmful to all people? Yeah, and they don’t know it. So it’s a good thing to find out.

Dr. Weitz:                            Yeah, a lot of times, they have unusual reactions. Some people will have elevated LDL cholesterol levels, some people will have … It’ll affect their digestion. Some people, it’ll affect their concentration and memory and so it really can affect your metabolism a lot of different ways and you don’t know it unless you really just test for it.

Dr. Rakowski:                     Yeah. I think it may be the best kept secret in all of medicine that we can pull these poisons out of the system and like we said, fatigue, sleep disturbance, intestinal distress, allergy symptoms, headaches, confusion, anxiety and other things can all get better with a good detox.

Dr. Weitz:                            So, after doing a one week detox, what can people do on an ongoing basis to continue to detox and so that they’re continuing to remove metals or remove toxins and reduce their burden as they go through their life?

Dr. Rakowski:                     If you don’t mind, I’m gonna answer that just a slightly different way. So I recommend the intense week twice a year, but I’ll often be asked at my seminars, “How long should we detox?” And the way I teach that is by saying, “Let’s do a little experiment. I’ll set my watch and let’s all stop detoxing right now.” Which, by the way, the basic element of detox is to exhale. So the room is dead in five minutes.  We know that we constantly need to support that, and we know with every breath, believe it or not, we’re taking in these toxins, and as our body makes energy, we create toxins, so we need ongoing daily support, and that’s why I said I’m gonna consume these functional food shakes myself, at least 300 days a year and many of those 300 days, I’m gonna take two or more per day. And so, I actually lectured in Orlando, Florida when Barry Sears, who wrote the book The Zone, released it. And he had the USDA food pyramid, which now they have their plate, which is not much better, but they had their pyramid back then with 9 to 11 servings of processed carbohydrates at the base of the pyramid.

And Barry Sears said this, he said, “If ever there was a terrorist like plot designed to take the health of the world down, this would be it.” But so I created a life pyramid where I have love at the base and purpose and discipline, but I also have a food pyramid. And so the base is gonna be food, organic food, not too much, mostly plants. The next one is gonna be super foods, so there’s tons of those. My favorite is ganoderma, which is also known as reishi. There’s aloe and there’s spirulina and there’s goji berries and acai berries.  Lots of berries are actually super foods in and of themselves. And then we move up and I think everybody should take a nice bioabsorbable multivitamin and then they should take omega 3s and probiotics and now we know instead of D, there should be a D3 K2 combo, and those are actually if you’re counting seven. So I like sevens, the magnificent seven. And the seven things we need in our nutrition pyramid.  Accompany that with seven good nights of sleep a week and at least seven good bowel movements, and we’re gonna be in pretty good shape.

Dr. Weitz:                            There you go. As far as sleep goes, there are many in our society that don’t get adequate amounts of sleep.

Dr. Rakowski:                     Too many, too many, and so there’s a lot of calming adaptogens for the central nervous system. Green tea has an amino acid in it called theanine, and theanine’s very calming, so it buffers the caffeine in green tea. I like straight theanine, which is a known, if your listeners are familiar with the term GABA facilitator, very, very calming.

Melatonin, we now know that melatonin is, believe it or not, even in single cell organisms, it’s a mitochondrial specific antioxidant, enhances human energy production. The gut makes 400 times the amount of melatonin as the brain and melatonin puts the brakes on our stress drive in our body. So since the gut has so much, it likely doesn’t cross the blood brain barrier, but by calming our stress response, that’s often calming enough to put people to sleep. But people need a routine, they need a dark, quiet, calm, cool, peaceful room without wifi, and whatever their routine is, wind down an hour before bed, don’t get hyped up watching sports, ’cause that’ll keep you up for hours, or something that rivals you in any other way.

Have a wind down routine on your body, honor that routine, and figure out what you need for your sweet spot. The best of the best need 8.6 hours a night. Sleep is a little bit like a shoe size, but our military actually did a study and they found out if they gave soldiers less than six hours of sleep for six straight days, they actually functioned as if they were legally drunk.

Dr. Weitz:                            Wow.

Dr. Rakowski:                     So imagine those guys walking around with high powered weapons. Sleep deprivation is the norm. So, a good sleep routine and enough hours to have you wake up refreshed.

Dr. Weitz:                            How much melatonin do you like?

Dr. Rakowski:                     Well, now you’re asking me. I’m a big melatonin guy, so I actually like to use 50 milligrams of time release … 10 milligrams time released capsules, I take five at bedtime, but the NIH did a study, by the way I’m-healthy, right-

Dr. Weitz:                            That’s a very high dosage, 50 milligrams.

Dr. Rakowski:                     It is. They did 50 milligrams at bedtime, not even timed release, just straight up 50 milligrams with a dose of D3 and they found out that it prolongs survivability and prevented lean tissue breakdown of non-operable cancer patients. And remember, it’s not gonna cross the blood brain barrier, and it’s pretty fascinating. I do it myself. I can’t say I do it all the time, and there’s plenty of times when I’m on the road, “Oh, I forgot my melatonin.”  Guess what?  I still sleep.  But someone posted something on the internet how everybody and their brother these days wants to be a bio hacker, doing different things to try to increase longevity, but it’s a mitochondrial specific antioxidant that’s present in single cell organisms that it buffers the stress response and now I’ve been doing that for about a decade, since I saw that study in the NIH.   I can tell you that in the last decade, my biologic aging has been very slight. So, I think it’s a complete program, but that’s one factor there.

Dr. Weitz:                            Wow. Very interesting. Yeah, we usually use 20 milligrams for patients with cancer. Some of the studies seem to indicate, and I’ve had some patients who get nightmares when they go up to 20 milligrams.

Dr. Rakowski:                     There is another further downstream metabolite of melatonin, which is profoundly hallucinogenic and what’s fascinating about that is there’s a plant in South American, and shaman they use something called Ayahuasca-

Dr. Weitz:                            Oh, yeah.

Dr. Rakowski:                     … it’s a downstream metabolite of melatonin-

Dr. Weitz:                            Interesting.

Dr. Rakowski:                     Yeah, the shaman actually believe that it increases a higher level of consciousness, and for many it does, but for others, it can cause these profound responses. So I’ll share with you, I was teaching a seminar like I do, many, many times a year, literally taught over 10,000 hours to help professionals around the globe, and I had a 30-year pharmacist in one of my classes that said, “You know what, I love melatonin, I’ve been experimenting with it for a long time,” and here’s what they said, they said they believe the people that have the really most profound responses, in their experience, actually need more and it’s something that they can get through over time.  Now, I’m of the mindset that there’s gotta be, possibly, a pathway that needs to be supported in another way, nutritionally, to make it happen. And so, that might be activated B vitamins, it might be some of the minerals, and we know our general population, well, here’s the stats, 99% are deficient of one or more of those things. So when we do a comprehensive program, I think we can help a lot of people with that.

Dr. Weitz:                            Cool. Cool. Very interesting. Yeah, they use Ayahuasca for patients with PTSD. Apparently, it’s one of the more effective treatments for that.

Dr. Rakowski:                     Since I’m in a community of such naturally minded people with a lot of means, I literally know dozens, including myself, that have gone with shamans with organic product and realized, “There’s something to this plant.” But part of what I like to say is, “Don’t try this at home. Let’s go with people that have dedicated their lifetime to studying the plants and the rain forest and helping people to understand their body and work through the process.”

Dr. Weitz:                            What about using high dose melatonin with patients with PTSD? That would be a kind of interesting study.

Dr. Rakowski:                     I haven’t seen that study. I’m a big fan of thiamine as the GABA facilitator. I don’t know that I want to take the chance on those folks and nightmares, but if we know they handle it right, that might be a titrated up dose.  God bless those people. They’ve had more challenges than I wish on any person.

Dr. Weitz:                            Yeah. Great. So, thanks for providing us some great information, Dr. Rakowski. This has been a fun podcast. For listeners who want to get a hold of you, what’s the best way for them to contact you?

Dr. Rakowski:                     I’ve got a website called thedoctorbob.com, and that’s a good way. There’s a “contact us” tab, and that’s a great way to do it. if you did contact me because of this podcast, let me know, and I certainly want to send our friend Dr. Ben a thank-you note, and one of my favorite things is to share information and I appreciate the opportunity to do it with you and your incredible group.

Dr. Weitz:                            That’s great, and you’re available for consultations via phone or Skype?

Dr. Rakowski:                     All the above, yeah. We kind of shifted now away from Skype to Zoom-

Dr. Weitz:                            Zoom, okay.

Dr. Rakowski:                     … for whatever reason, but it’s probably been a couple years since I’ve done Skype, but I’ve Zoomed halfway around the world and most of the things I’m going to recommend, I do have connections halfway around the world, ’cause I’ve taught halfway around the world, and we can make recommendations and connect you with a great source for nutrition, poor nutrition, to help you with whatever you’re challenged with.

Dr. Weitz:                            That’s great. Thank you so much, Bob.

Dr. Rakowski:                     You’re welcome.

 

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Optimum Hydration with Dr. Dana Cohen: Rational Wellness Podcast 68
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Dr. Dana Cohen explains how to optimize hydration by eating foods with water in the gel state with Dr. Ben Weitz. 

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast] 

 

Podcast Highlights

2:48  Dr. Cohen explains that being in a state of sub-clinical, low grade dehydration can lead to fatigue, brain fog, dry skin, constipation, but them, even more important things, it puts you at risk for certain cancers like bladder cancer and colon cancer. It also can put you at risk for Type II diabetes and Alzheimer’s disease.

5:25  Dr. Cohen explains that we know that water exists as liquid, ice, and vapor. We now know that there’s another phase of water called gel water or structured water, which is the type of water that’s in our cells and this exists in plants, in fruits and vegetables.  So by eating more fruits and vegetables we can get better hydrated than by just drinking water, which she talks about in her new book, Quench: Beat Fatigue, Drop Weight, and Heal Your Body Through the New Science of Optimum Hydration. Now we have science to back up why we should have a green smoothie and eat more hydrated foods.

7:15  Dr. Cohen recommends drinking 16 oz of water with some sea salt and a squeeze of lemon to start your day and then drink 8 oz of water before every meal. They’ll feel better and they’ll also lose a few pounds.

9:35  Dr. Cohen said that common table salt is just sodium and is dehydrating, while natural sea salt or Himalyan pink salt have other minerals besides sodium, so they are hydrating for the body. 

11:48  Dr. Cohen wrote that we should eat fruits and vegetables that are in season because research shows that the microbiome changes seasonally.

13:53  Dana noted that chia seeds are one of the more hydrating foods and she highlighted the gel that forms when you wet them.

16:19  Lychee fruit is great for skin, has antioxidants, helps with blood sugar and protects against sun damage and is a very hydrating food. Since it has a short growing season, she will often use a nutritional supplement, Oligonol, and she will open two capsules into a smoothie. 

18:35  Prickly pear from cactus is another very hydrating plant food.

19:33  Aloe vera has water in the gel state, so it is also very hydrating.

 

                            



Dr. Dana Cohen is a nationally renowned internal and integrative medicine specialist, based in New York City. Her new book is Quench: Beat Fatigue, Drop Weight, and Heal Your Body Through the New Science of Optimum Hydration. Her website is www.drdanacohen.com and her coathor’s website if HydrationFoundation.org.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.


 

Podcast Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with, The Rational Wellness Podcast, bringing you the cutting edge information on health and nutrition from the latest scientific research and by interviewing the top experts in the field.  Please subscribe to The Rational Wellness Podcast on iTunes and YouTube and sign up for my free eBook on my website by going to drweitz.com. Let’s get started on your road to better health.  Hello Rational Wellness Podcasters. Thank you so much for joining me again today and, for those of you who enjoy The Rational Wellness Podcast, please go to iTunes and give us a ratings and review.

So our topic for today is water and what is the best way to get hydrated. It’s often stated that Americans do not drink enough water, and many doctors believe that as many as 75% of Americans are under-hydrated. I personally test all of my patients with bioimpedance analysis for their body composition, and we find very few who are optimally hydrated.  I often encourage my patients to drink more water and so do many functional medicine doctors, nutritionists and health coaches. Its typically recommended that patients drink eight to 12 glasses of water per day or at least half of their body weight in ounces of water. However, new research has discovered that water, which has been thought to exist in one of three states, liquid, gas or, solid actually exists in a fourth gel like state that has the potential to hydrate the body more effectively and efficiently than just plain water.

This new state of structured water is also more organized, making it more effective for healing at the cellular level. Dr. Dana Cohen is our special guest today and, she’s a nationally renowned internal and integrative medicine specialist based in New York City. She trained under the late Dr. Robert Atkins and also under Donald Ronald Hoffman, two of the pioneers of functional medicine.

Dr. Cohen says that new research shows that hydration may not be as simple as drinking more water, it’s a premise of her new book, Quench: Beat Fatigue, Drop Weight, and Heal Your Body Through the New Science of Optimum Hydration. And in fact, she says, drinking too much water can actually cause harm to your body by flushing out vital nutrients and electrolytes from your cells.  Dr. Cohen, thank you so much for taking time out of your schedule to join us today.

Dr. Cohen:          Thank you for having me.

Dr. Weitz:            So, how dangerous is it to be under-hydrated and what concerns can arise from not being properly hydrated?

Dr. Cohen:          Okay so, I want to clarify first that we’re not talking about overt dehydration where you’re in the hospital needing IV fluids and you have heatstroke, and those are, can be life threatening. We’re talking about this sort of sub-clinical, low grade dehydration which we give evidence that shows basic things, fatigue, brain fog, dry skin, constipation, but then, even more important things, it puts you at risk for certain cancers like bladder cancer or colon cancer. It also can put you at risk for Type II diabetes and even Alzheimer’s disease. So it is, I think, a very real problem.

Dr. Weitz:            How do you know if you’re under-hydrated?

Dr. Cohen:          So, okay, good question. Everybody, the first thing people think about is thirst. The truth is, thirst is not a great measure because we’ve learned to override our thirst or ignore our thirst so, some ways that you can know, once again, fatigue. We actually, I really believe that fatigue is your first sign of dehydration and instead of maybe going for some coffee or sugar in the afternoon, think about hydrating better when you get that slump.  So fatigue, brain fog. Other things that we can think about. So, we’re meant to urinate every two or three hours and, if you’re not doing that, you may be dehydrated. A good rule of thumb and at home test that we can do is, look at the color of your urine, we want it to be pale yellow. If it’s dark orange or darker, you’re dehydrated, with one caveat that us as integrative practitioners know, if you’re taking B vitamins, that rule doesn’t hold because it turns your urine bright yellow.

Dr. Weitz:            Yeah, my urine is very dark, I take so many supplements.

Dr. Cohen:          Yeah so, that’s not the best thing for you to do.  Another good at home thing is, you could pinch the top of your hand, the skin on the top of your hand, if it stays up there, if it tents up for longer than a millisecond, you’re dehydrated or, can be dehydrated.  So, that’s a little at home test you can do as well.

Dr. Weitz:            So, what’s the best way to get properly hydrated?

Dr. Cohen:          Great question.

Dr. Weitz:           We kind of teased that in the intro.

Dr. Cohen:          So, what we talk about well, lets just get right into it. Let’s talk about the new, the new discovery that we’re all, that you sort of alluded to earlier.  We know that water exists as liquid, ice and vapor. Now we know that there’s another phase of water and, this phase of water we call gel water or structured water in the book is, it’s different, it has different properties than regular bulk water.  What we’ve discovered is that this is the type of water that’s in our cells and also happens to be the type of water that’s in plants.  And so, by eating your water, by having more plants and vegetables and that can kind of thing, it’s a much more effective way of getting better hydrated.  So, that’s what we tell you.  A lot of it is instinctual but now we have real science to back up why we should have a smoothie every day and why we should eat our greens in concentrated forms and eat more hydrating foods.

Dr. Weitz:            Are there products on the market now, structured water? And, if they’re not, I’m sure there will be.

Dr. Cohen:          They do exist. There are machines that can structure your water. We don’t talk, I don’t know any of them, I don’t, what’s the word? Recommend any of them because I haven’t done the research on them, I don’t know about them. The book is for the masses, this is for every person how you can get this water by eating better, eating more fresh fruits and vegetables, eating your water and following some simple rules.  We lay out a very easy five day plan in the book where you just follow them. So, I’ll give you a couple of them right now. A first rule is, we want to wake up and front load your water so, 16 ounces of a big glass of water with a little bit of sea salt to get some good electrolytes in there and a squeeze of lemon, start your day that way, that’s one rule.

Another rule I can give you is, you want to drink eight ounces before every meal. So that’s a way of getting water in right before your meal and there’s some research behind that that it also can help lose a few pounds if you just do that and do nothing else.

Dr. Weitz:            Now, now, you know, I like to have some of my clients do that but I know a number of people in the nutritional world who feel that drinking water prior to your meal is going to dilute your enzymes.

Dr. Cohen:          Yeah, I’ve had no problems with it and I’ve been researching this book for three and a half years, I’ve been giving the program to patients and, in fact, their digestion is improving, they do lose a little bit of weight, their brain fog goes away, their fatigue, if you’re hydrating better.

Dr. Weitz:            It doesn’t matter if the water is cold or room water, does it matter if it’s carbonated?

Dr. Cohen:          It’s a good question, I don’t know, I really don’t know. I know in Chinese medicine there’s something to, depending on what type of whether you’re damp or a hot person, I don’t know, and there’s something to that. I’m not a Chinese medicine practitioner so I don’t know. I definitely think there’s something to it but, I honestly don’t know. As far as carbonation, I don’t have a problem with carbonation, I actually drink a lot of Pellegrino, a natural carbonated spring water but I think the jury is out on that one, I don’t think there’s evidence either way.

Dr. Weitz:            Yeah, even acupuncturists in my office, we kind of still having a battle. I’ll put ice on a patient and she’ll say, “No, don’t put ice, we have to use heat.”

Dr. Cohen:          I know and I think the truth is, whatever gets you to drink better, I think is important.

Dr. Weitz:            So I was reading your book, Quench, this morning while walking on the treadmill and drinking some water.

Dr. Cohen:          Love it. Excellent.

Dr. Weitz:            I want to ask a couple of questions that are a little bit off track and then we’ll get back to the foods is, you talked about how some foods like pizza have the wrong kind of salt that’s dehydrating while natural salt is hydrating. Can you explain that?

Dr. Cohen:          Yeah so, like the store bought table salt, I don’t think I should mention any names but, the one with the girl with the umbrella on it and the galoshes, I mean its sodium, it’s just sodium, there’s no minerals, there’s no other minerals in there.

Dr. Weitz:            Yeah, there is iodine in it. Sodium iodine.

Dr. Cohen:          Sodium is iodized salt, yes, yeah, if it’s iodized but, you can get sea salt iodized as well and that’s a whole conversation on its own and I do think almost everybody is deficient in iodine as well. Unfortunately, we don’t have great ways of measuring that but yes, the iodine is a separate issue.  But, the table salt is just sodium, real salt has an abundance of other minerals and electrolytes that we need that is and, there’s a lot of research behind it too that’s been shown, it’s not going to affect your blood pressure in a way that we at least thought salt was such a bad thing for us.  So that’s the difference.

Dr. Weitz:            Yeah so, in fact, you say that having sea salt and natural forms of salt like Himalayan Pink Salt actually helps with blood pressure.

Dr. Cohen:          Well, I think there’s something to that, I’m not sure if it actually helps with blood pressure but, I don’t think it harms.

Dr. Weitz:            Yeah.

Dr. Cohen:          You know so, I think and, there may be a select few that have very salt sensitive hypertension that they do need to worry about it so, its hard for me to say, I still want people to be careful, who have high blood pressure and even using real salt, you just need to monitor and look at it but, I don’t think it’s the foe that we’ve made it to be at all.

Dr. Weitz:            Yeah, no, I read that book by James DiNicolantonio about salt (The Salt Fix) and it was really sort of a shock that, everything we thought about salt, kind of like, everything we thought about saturated fat isn’t quite true.

Dr. Cohen:          Right. Exactly.

Dr. Weitz:            One more thing that I was reading about in your book was, you talk about eating seasonally, eating fruits and vegetables that are in season and you also mention that our microbiome, which is the bacteria in our colon, actually changes according to the season and I thought that was really fascinating and I don’t think that’s information that people commonly talk about.

Dr. Cohen:          Yeah, we touch upon it lightly in the book and, we’ve looked at the research, I think his name is Julliard, John Julliard, I think his name is. There’s some very interesting research that how the microbiome does change seasonally and that’s one of the reasons that we should eat what’s available to us. I have a feeling that that’s probably the key of why eating seasonally is really good and important for us. And there’s some research to back that up as well.

Dr. Weitz:            Yeah, interesting.  So, can you tell us about why it’s so important to eat certain fruits and vegetables and seeds that can help to hydrate us?

Dr. Cohen:          Suer so, I would love to, I picked out four things today to specifically talk about so, they’re a little bit unusual but they’re sort of fun to talk about.

Dr. Weitz:            By the way, these are examples, right? And, most, my understanding from reading your book is, most fruits and vegetables and also nuts and seeds in general are very hydrating?

Dr. Cohen:          Exactly, exactly and we lay out many, many examples in the book. We have over 50 recipes. I love to just bring up the example of even iceberg lettuce. Iceberg lettuce, you know, we always thought has no nutritional value. As it turns out, it’s probably one of the most hydrating vegetables you can eat because it’s just loaded with that structured water and that alone makes it worth it’s weight in gold.  So iceberg lettuce, there’s a reason for. So, let’s talk about chia seeds first.

Dr. Weitz:            Okay.

Dr. Cohen:          Chia seeds …

Dr. Weitz:            And by the way, I wouldn’t normally think of dried seeds as being moisturizing.

Dr. Cohen:          Yes. So, if you’ve ever seen or made a recipe for chia pudding, you know that when you add liquid to chia it forms that gel, it makes a very gelatinous, a mucilaginous surrounding the seed so that is that gel water, it’s going to hold onto and absorb water better than regular water.   And, there’s actually this Mexican tribe of people, the Tarahumara tribe who, anthropologically would run 50 mile marathons on water and chia seeds. So chia has, they are really the star of the show, they are a super food, they’re loaded with Omega 3 fatty acids, they’re really good for endurance, they’re great for blood sugar and, I just think, I love to throw them in my smoothies, make chia pudding, throw them on your salads. They’re a very hydrating food.

Dr. Weitz:            Okay.

Dr. Cohen:          Second one I want to talk about, another sort of fun and unusual one …

Dr. Weitz:            Now, do you just eat the chia seeds raw or do you grind them up first?

Dr. Cohen:          I love to grind them because you’re creating more surface area when you grind them. I’ll do both but, I think grinding them, you’re probably getting more gel water because you’re creating more surface area. So I think ground chia seeds are a better way to do it.  In fact we tell a story in the book from my co-author. She is an anthropologist, her mother was in a nursing home with Alzheimer’s and she was suffering from dehydration, like literally overt dehydration and, her mother would never ask for more water or, you know, she was very proper and she decided to tell the nurses to put some chia in her water every morning and that cured the problem, she never had another UTI after that, urinary tract infection. So, yeah, chia seeds are really important and great for us and inexpensive. Anybody can find them everywhere, it’s a great thing to do and to start putting in your water.

So let’s talk about the second one, speaking of seasonal fruits and vegetables, I want to talk about Lychee (aka, litchi) fruit. Lychee, have you ever had a litchi? Do you know what it is?

Dr. Weitz:            Not really. I was at some wedding that had like every exotic fruit known to mankind and I’m sure I ate it but I don’t remember which one it was.

Dr. Cohen:          I think lychee, you’re going to start to hear about lychee’s like, I think it’s going to be the next super food.

Dr. Weitz:            Next super food?

Dr. Cohen:          Yeah.  They are delicious, they’re from South-East Asia in fact, you know, I love anthropological information, these ancient Chinese princesses used to have their servants get them litchi fruit to keep their skin youthful so, lychee is great for skin, youthful skin, it’s a very powerful antioxidant, it helps with blood sugar, it helps protect against UV radiation, ultraviolet radiation from sun damage, that kind of thing.  Couple of problems with litchi is, they, and by the way, they taste incredible, they’re delicious. I’ll often just sort of throw them in water and it’s a tiny little fruit, I actually have some here, I’m going to show you. Can you see that?

Dr. Weitz:            Okay.

Dr. Cohen:          So they look like little eyeballs, these are seeded, there’s a pit in the middle and, so when you pop open a litchi you can see the gel just sort of coming out very, very gel like. The one problem is, they’re seasonal so they’re hard to get, only short period of season we can get them and, they’re high in sugar.  So, what I’ll often do is recommend a supplement because I do recommend a lot of supplements. There’s a supplement called Oligonol, there’s over 30 human clinical trials, it’s made from lychee fruit. I’ll pop open the capsules in the winter and throw it in my smoothie, two capsules a day and that supplement has been shown to help with decreased belly fat, decreased brown spots from skin aging, really great supplement made from lychee.  And, other than that, a couple one or two lychee in a glass of water will help structure that water a little bit better than without it.

The third thing I want to talk about is, and you may have played a little bit more with this is, prickly pear which is a cactus fruit. I do have one here. I love prickly pear. Basically what I’ll do is I’ll cut off both ends, peel it off, it’s bright red. This is water infused with prickly pear. Can you see how red it is?

Dr. Weitz:            Okay, yeah.

Dr. Cohen:          Also, really delicious but, it does have seeds in it so you have to put it through a strainer before you do anything with it.  Prickly pear is great for blood sugar also, helps with cholesterol, what else is it good for? Known as a hangover remedy. So, if you’ve imbibed too much, have some prickly pear. Prickly pear and lime is a really wonderful water infuser. There’s jam’s and jellies you can make with that but, maybe a little too much sugar also.

And then last I want to talk about is, aloe. All these cactus fruits. Aloe, I grew up in South Florida, originally from Long Island but, we moved to South Florida when I was little and, we always had aloe plants outside. So, everybody knows if you get a burn, you go outside, cut an aloe leaf and put it on top of your burn, it really helps your skin. But taken internally, aloe can help with digestion, it can help with constipation, also maybe help with blood sugar so, basically just open an aloe leaf, take that gel inside of it, throw it in your smoothie, or just eat it. There’s aloe juice you can buy now, great for all of those things, for digestion, heart burn, constipation.  So a couple of fruits, sort of fun and unusual, easy, play around with them and, they’re ally delicious.

Dr. Weitz:            Sounds good, yeah. We use aloe a lot for all sorts of issues, it seems to be really good for the skin and it’s good for the gut as well so, we use some supplements that have aloe in it as one of the ingredients.

Dr. Cohen:          Yeah, the one thing I’d be a little careful about is too much, even natural aloe can lead to diarrhea so you just got to find your perfect sort of dose.

Dr. Weitz:            Yep, yep.  Great. So, how can listeners or viewers get hold of you and get a hold of your book? I’m assuming its available from Amazon, Barnes and Noble.

Dr. Cohen:          Everywhere books are sold. My website is, www. drdanacohen.com and my coauthors website, there’s a lot of information, it’s the hydrationfoundation.org. Tons of information up there about water and all the new research that’s coming out with new water.  And by the way, water is way more complicated than I ever thought before I embarked on this journey and every day there’s something new coming out about it so, yeah.

Dr. Weitz:            Yeah. Good, good, good and, I’m assuming you still see patients in your office and remote. Do you do consultations?

Dr. Cohen:          I don’t see people remotely unless, you have to see me one time in person because I still am an old timely doctor, I like to put my hands on patients but I do see people in New York City, my office is called completewellnessnyc.com.

Dr. Weitz:            Great. Thank you so much for joining us.

Dr. Cohen:          Thank you Ben.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Endometriosis with Dr. Felice Gersh: Rational Wellness Podcast 067
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Dr. Felice Gersh talks about how to manage Endometriosis with diet and lifestyle changes with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Itunes, so more people will find The Rational Wellness Podcast] 

 

Podcast Highlights

3:15  Endometriosis, the growth of uterine tissue outside of the uterus, begins with retrograde menstruation, the movement of cells from the uterine lining up the fallopian tubes. Each month when women shed the endometrial lining of their uterus, some of the cells are still living and go through the fallopian tubes into the pelvis and then the body’s immune system gets activated. During this period, estrogen levels are lower, which is inflammatory, and this activates the immune system to do it’s job an remove these endometrial cells.  Because women today get pregnant later in life and have fewer pregnancies, women today have so many more menstrual cycles than women used to, which increases their risk for endometriosis and also breast cancer.

6:52  It turns out that estrogen is a potent modulator of inflammation and while low levels of estrogen are pro-inflammatory, high levels of estrogen are anti-inflammatory.  These inflammatory cells secrete enzymes called matrix metalloproteinases that dissolve these endometrial cells in the pelvis, along with the other immune cells. As women go through the monthly cycle to prepare the body for possible childbirth, estrogen levels slowly rise, peak and then drop in this beautiful ebb and flow cycle. But in women with endometriosis, this whole system is not working properly and it creates really a disaster for these women because this very elaborate, very well-programmed system is not working properly in them.

9:48  One of the things that disrupts this cycle of estrogen rising and falling and the immune system being primed at the right time are endocrine disrupting chemicals like pesticides, pthalates that are in scents and plastics and BPA and BPS in cash register receipts. We put them in children’s mouths in dental sealants and many other plastic products. These endocrine disrupting substances disrupt our normal hormonal flows and balance and they change our genetic expression (epigenetics) and actually have effects for generations. And so it’s really creating a tremendous challenge for reproductive functions when the hormones that are so intricately involved in all these functions are not going to work properly. And endometriosis is like the perfect storm of all of this coming together to create really a massive negative impact on these women’s lives.

16:29  Since estrogen receptor beta as being a key factor in endometriosis, should we avoid an estrogen receptor beta agonist like soy be avoided?  Dr. Gersh feels that because soy contains weak estrogenic substances, it serves as a blocker for estrogen receptors for stronger estrogens, so organic soy can be protective for women.  She also recommends consuming antioxidants, polyphenols, and quercetin, all of which can help with reprogramming hormone receptors. In endometriosis we have total body immune dysfunction, so it is really an autoimmune disease. Women with endometriosis have significantly higher rates of certain cancer. But we can use food as medicine. Foods like apples and onions that have a lot of quercetin can have an impact because quercetin is a mast cell stabilizer and mast cells are the first responders of the immune system and they are filled with inflammation, containing preformed tumor necrosis alpha. Mast cells also stimulate substance P, which stimulates nerve production, which results in more pain in the pelvis and bodies of patients with endometriosis. Quercetin, green tea extract, resveratrol, and vitamin C can all help to calm down the immune system. Studies also show that women with endometriosis have an altered gut microbiome, so improving the gut is also beneficial. And the interaction between estrogen, the immune system, the gut, and the brain is incredibly complex. And this new pill that has been approved to help with endometriosis that shuts down the brain stimulus to the pituitary to shut down estrogen production is not likely to be effective for modulating the condition, because it’s not just about having only high or low estrogen but the rhythm of the highs and low of the estrogen/progesterone cycle. 

28:52  Dr. Gersh likes to have her patients go through a 4 week liver/estrogen detoxification program to improve estrogen metabolism using DIM and broccoli sprouts to encourage estrogen to be metabolized in the healthiest way and produce the right estrogen metabolites. 

36:24 The body and our hormones need to be in balance and when you place women on hormone replacement and give them the same amount of estrogen daily for years, these women are not getting the fluctuations of estrogen from low to high that are so important for modulating the immune system and the other hormones. For example, when you get the spike of estrogen that is right before ovulation in a normal cycle, that spike upregulates progesterone receptors, and testosterone, and thyroid so that they actually work better. Women with endometriosis, their progesterone receptors are malfunctioning so they don’t receive the progesterone. It is clear that what we are doing with hormone replacement therapy is not physiological, though we need more research to tell us how to do it better.

 

                              



Dr. Felice Gersh is a board certified OBGYN and she is also fellowship-trained in Integrative Medicine. Dr. Gersh is the Director of the Integrative Medical Group of Irvine and she specializes in hormonal management. Her website is http://www.felicelgershmd.com/ and she is available to see patients at 949-753-7475, she lectures around the world, and she will be releasing her first book on PCOS in the Fall of 2018.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111.


 

Podcast Transcripts

Dr. Weitz:            This is Dr. Ben Weitz with the Rational Wellness Podcast. Bringing you the cutting edge information on health and nutrition. From the latest scientific research and by interviewing the top experts in the field. Please subscribe to the Rational Wellness Podcast on iTunes and YouTube. And sign up for my free ebook on my website by going to drweitz.com. Let’s get started on your road to better health.

Hello, Rational Wellness Podcasters. Thank you so much for joining me again today. I’m very excited that we’re gonna be talking about a very important topic related to women’s health. A condition known as endometriosis. Now, I’m sure a lot of you are not quite aware of what this is unless you suffer from it, but this is a condition that actually affects 10% of women in the United States. And this is when endometrial tissue … That’s the tissue that lines the uterus, ends up growing outside of the uterus. Most commonly on the ovaries, the fallopian tubes, or the intestines. Though it could occur anywhere in the body. The most common symptoms are pelvic or other pain, menstrual irregularities, and infertility. There can also be pain during sex or during urination. The conventional medical treatment typically consists of hormones, surgery to remove the tissue, and various types of pain medications. And then I just read an article that was sent to me by our guest, Dr. Gersh, about it. A new medication that is a hormone blocking agent that seems to have some effect as well.

And so I’m very excited that I’m going to get to interview and share some information with you from Dr. Felice Gersh. I just want to say I’m really excited about the fact that I get to interview these really super smart people on this podcast. And apart from being able to serve you, my audience, it’s also great for me to be able to interview these really smart people and do a little mini symposium every week about a new topic. Oh, by the way, those of you who enjoy the Rational Wellness Podcast, if you can go to iTunes and give us a ratings and review, that will help more people to find out about it.

So Dr. Gersh is a board certified obstetrician and gynecologist. And she’s also fellowship trained in integrative medicine. Dr. Gersh is a director of the Integrative Medical Group of Irvine where she sees patients. She also lectures around the world and writes on various topics relevant to women. And her first book on polycystic ovarian syndrome will be released this fall. Dr. Gersh, thank you so much for joining me today.

Dr. Gersh:           Oh, it’s my pleasure. And I definitely am thrilled to be able to discuss endometriosis with you and for all of your listeners to learn about it.

Dr. Weitz:            Yeah, it’s great because it’s really a very difficult condition for the women who deal with it, painful, and the treatments so far are not really that helpful. So I’m happy that we can bring a Functional Medicine approach to understanding it. So when we try to understand endometriosis, it’s hard to understand how tissue from the uterus ends up in another part of the body. And I was trying to put my head around it until I read that retrograde menstruation, which occurs in up to 90% of women, is believed to be the mechanism by which it occurs.  Can you explain what that is and how that happens?

Dr. Gersh:           Sure, that’s step number one. Because you have to have a root for the lining tissue from in the uterus to end up in the pelvic cavity. So every time a woman has a cycle … And that’s another issue is that women in this day and age have about 400 or more cycles per lifetime for their reproductive years. Whereas in more ancient times, women started having babies at a very young age and then they would nurse, which would delay the resumption of their menstrual cycles. So they spent a lot of their reproductive years either pregnant or nursing. They had fewer often than 100 cycles for their entire reproductive life. So that is another problem is that we’re cycling so often and having so few pregnancies and at a much later age. So what happens-

Dr. Weitz:            And by the way, that’s also a risk factor for breast cancer and a lot of other things too, right?

Dr. Gersh:           Well, there are apparently some amazing things that happen when women have their first pregnancy.  And actually the risk for breast cancer … A whole separate issue we can talk about another day, is actually dramatically reduced in women who have their first pregnancy before the age of 20.  But nowadays, that’s hardly something that we encourage women to do is to get pregnant, and have babies, and then nurse for three years before they’re 20 years of age. But there are all these interesting things that actually happen in the breast and with receptors, like the way the receptors work in the different parts of the body when the body does what it was originally programmed to do, which is to start reproducing.  And I say this over and over in all of my lectures is that whether we like it or not, we are what we are.  We’re animals of the animal kingdom.  And the prime directive of life is reproduction and survival to raise the young.  And that’s how the female body is designed.  And we have beautiful mechanisms, but nowadays with the world we’re living, we’ll touch on the role of endocrine disruptors. Which I know you’re aware of and how that relates to endometriosis and what that’s doing to women’s reproductive health. And of course, reproductive health is linked to all of health for a woman. They’re completely intertwined.

So what happens, if we go back to retrograde menstruation. So every time a woman has a period, the vast bulk of the lining which is shed goes out, of course, out through the vaginal canal and out of the body. And it’s like a renewal. And it allows the body to try again and to try to get a pregnancy going on the next cycle. And then a significant but certainly a small fraction of the uterine lining tissue actually goes backwards through the tube. So they call it retrograde menstruation. And some of these cells, they’re actually living. And a lot of the tissue is actually half alive, half dead. It’s filled with a lot of inflammatory cells.  And as it goes into the pelvis, the body’s immune system is activated.  So it turns out that estrogen in a normal woman and when things are working properly, low levels of estrogen are actually pro-inflammatory.  It actually calls the inflammatory cells to come and then do their jobs.

So you can think of estrogen as sort of a modulator of inflammation. High levels of estrogen are actually a very anti-inflammatory, while low levels are actually pro-inflammatory. And that’s why a woman has this beautiful cycle with highs and lows. It actually regulates how the immune system works. So during a menstruation cycle, the estrogen level is very low. And the inflammation is going to be higher. And so the lining is … The elimination of the uterine lining is actually an inflammatory process and the uterine lining is infiltrated with these inflammatory cells.  And the same thing happens in the pelvis. But these inflammatory cells at that time are there for a purpose. They do what they’re supposed to do in a healthy woman. They secrete these enzymes called matrix metalloproteinases. And these enzymes are specifically designed to dissolve these aberrant cells because they’re not supposed to be in that place for long. These cells that come up from the uterine lining, they’re supposed to be dissolved. And then the macrophages, those inflammatory cells that arrive, and the neutrophils, they are designed to gobble up these now dead pieces of tissue from the uterus. And they gobble it up and all’s well with the world.

And then the estrogen level starts to rise. And mid-cycle when you have that really high level of estrogen. And then for the next little while when the progesterone level starts to really rise, then at that time, the inflammation is the lowest. The actual level of time in a woman’s menstrual cycle when inflammation is lowest is when her estrogen peaks. That spike of estrogen because that’s when you wanna prepare for ovulation and then you prepare for implantation. And then at the very end, then of course the inflammation starts up again if there’s not a pregnancy.  So it’s this beautiful ebb and flow between the ups and downs of the immune system. But in women with endometriosis, this whole system is not working properly and it creates really a disaster for these women because this very elaborate, very well-programmed system is not working properly in them.

Dr. Weitz:            That’s great. Because that’s one of the thoughts I had. When I read that 90% of women have this retrograde menstruation, the next thought was why don’t all women have endometriosis?  So the explanation is that the immune system normally knocks out those cells. And so in some women that immune system doesn’t function quite as well as it should.  What are some of the most important factors that allow this endometrial tissue to survive and grow outside of the uterus?

Dr. Gersh:           Well, it’s complex. But more and more what we’re finding is it’s those ubiquitous endocrine disruptors. That’s what’s happening in women with endometriosis is that they’re malprogramed in terms of the way the receptors are working. And it involves at least estrogen and progesterone and probably others like melatonin. It gets very complex. So these hormones are very involved in multi-tasking. Like I mentioned, estrogen is very involved in immune system regulation, but so is progesterone. And they work with many signaling agents and growth factors. So it’s incredibly complex the way this whole thing works. But it all relies on the proper programing of the receptors so that when the hormones arrive in the receptor, the right thing happens. So hormones are signaling agents. They tell the cell what to do. Depending on how it reacts, it can make a protein, it can make a certain kind of enzyme. And so it all correlates and it’s very finely tuned.

So if you have endocrine disruptors that are in the mother and it gets into the fetus during the developmental time, when these receptors for estrogen and progesterone are actually developing, then you can have malprograming from the get go. And then it’s also been shown-

Dr. Weitz:            Can you mention a few of these endocrine disrupting substances?

Dr. Gersh:           They’re everywhere. So there’s been a lot of research on the organophosphates that are in pesticides and the phthalates that are in scents and plastics like vinyl and such. And then the bisphenol A’s and the bisphenol S’s that are in cash register receipts. And we would put them in children’s mouths for dental sealants and they’re in a lot of different plastics. That’s why you don’t want to heat things in the microwave in these hard plastics because it gets released. And water bottles-

Dr. Weitz:            By the way, even if it says BPA free, still don’t trust it. Because what they do is they take the BPA out and they put BPS in which just isn’t on the radar yet and probably soon will be as an endocrine disruptor.

Dr. Gersh:           Oh, it is. Right. And then there are these other things that are banned but they’re still out there. And in some countries they’re not banned and they’re like the aromatic hydrocarbons like dioxin. And these have enormously long half lives. They’ll live for at least a dozen years before the body can excrete them. And they are concentrated in fat tissue. And these things stay in the body for huge amounts of time. So we are inundated and it turns out that depending on the dose and the timing in pregnancy and also in the infant after birth and even around the time of puberty, all of these can combine to alter in every which way the way that these hormones work. So there’s been a lot of focus on the receptors, but it also … It’s more complex than that. It all involves the production, the dissemination, the excretion, so basically every facet that can be involved with these hormones is impacted by these endocrine disruptors.

So they are chemicals that work in the body to mimic hormones, but they’re not hormones.  But they interfere with the development in the embryo, in the fetus. And it changes what are called the genetic expression. What we call epigenetics. I’m sure you probably talked about that. And this thing that is so frightening is that it can last for generations. That it alters the way that genes work and then it gets passed down. So even if, say, a future mother then has a very careful lifestyle and somehow avoids as many of these endocrine disruptors as possible, she may be genetically programmed to actually have a baby who has malfunctioning of the receptors. And she didn’t … It wasn’t even from her. It was from her grandmother. So these things are now getting passed on and the human evolution maybe really being altered by these chemical endocrine disruptors.

And the thing that is so disturbing is how little press this is getting. That’s why I’m so excited that you are allowing me to talk about it. I’m sure you talk about it all the time. I hate to use these words. It sounds so ominous. But I kinda say we live in poison world because we do. Because we’re just eating things and we have all these pesticides, and herbicides, and chemicals, and plastics, and we now know that things can off gas from the rooms that you have. The indoor air pollution and the outdoor air pollution. And all of these things impact. And so it’s really creating a tremendous challenge for reproductive functions when the hormones that are so intricately involved in all these functions are not going to work properly. And endometriosis is like the perfect storm of all of this coming together to create really a massive negative impact on these women’s lives. It just breaks my heart that there’s so many women now that are having to live with this condition.

Dr. Weitz:            Yeah, I think it’s so important we talk about the importance of these endocrine disrupting substances. For one thing, a lot of these substances, they’re not even listed on the ingredients. So if you’re using any personal care product and it has the word perfume or fragrance, it most likely has phthalates in it and they’re not required to list that because it’s an inert ingredient. So this is something as consumers I think we need to speak out and maybe not now, but maybe some time in the future, we can demand that these substances at least be listed on the ingredients so we can avoid them. But-

Dr. Gersh:           Something I was gonna say exciting is that in California, the state senator Dianne Feinstein, has introduced a bill that hopefully will get passed. And it’s like … Step number one is just labeling and acknowledging what you’re actually putting into your products.  And so hopefully that will get passed.  It actually has bipartisan support. So at least step one may actually come to pass in the near future.

Dr. Weitz:            Good, good, good, good. Nice to hear that. Yeah. Because we need to … As a consumer if you’re trying to avoid these things, you at least need to know if they’re even there. In the meantime, I encourage people to go to the Environmental Working Group, ewg.org,  which is a great resource for listing toxins in various personal care and cleaning products.

I read an article about estrogen receptor beta as being a key factor in fueling endometriosis. Should women avoid estrogen receptor beta agonist like soy and are there any natural estrogen receptor antagonists that we can include to help counter some of this?

Dr. Gersh:           Well, those are great questions. And it is true that as part of this whole endocrine dysfunction and the way that the body is now being sort of redesigned, is that it turns out that there … Well there’s … As a background, there are three types of estrogen receptors. Alpha, and beta, and what are sometimes called GPERs (G protein-coupled receptors) or membrane receptors. And it turns out that different areas of the body may have a propensity of one type or another type. There are estrogen receptors on every type of immune cell. So the T cells, the B cells, and the mast cells, and all the different … Every single immune cell has these receptors. And in the uterus and in the pelvis, there is a lot of the beta receptor. The gut, by the way, is predominantly beta receptor.  And so it turns out that you have this imbalance of having too many receptors. And so you have this inappropriate estrogen sort of stimulation that occurs. That’s right. And they’re actually looking at what can you do. And it turns out that it may actually turn out … That soy, if it’s organic … It has to be organic, may actually be somewhat of a benefit because it’s very weak. And it can actually create these phytoestrogens that can circulate. And actually also work in the gut which we can talk about how all the microbiomes are disrupted including the gut and women with PCO … And with endometriosis, not PCOS. They actually also have that too. And it seems like that’s involved in everything now, right? The gut microbiome.

Dr. Weitz:            Absolutely.

Dr. Gersh:           And everything.

Dr. Weitz:            There’s no conversation in Functional Medicine that shouldn’t involve the gut at some point.

Dr. Gersh:           It is. It gets into endometriosis as well. So it may be that if you can fill these enormous numbers of extra beta receptors with something that’s really weak … So it’s filled with a weak estrogen instead of a more powerful estrogen, it would actually work something as a blocker. So you’re filling it with something weaker. So we need to have more data. The problem is that Big Pharma of course … And you mentioned that there’s a new drug that’s in the pipeline that may come out and may have some benefit as far as pain. But they’re not looking at things like eating soy. They’re not looking at eating flaxseeds. They’re not looking at the phytoestrogen. There’s no money in that.

Dr. Weitz:            No there’s no billion dollar drug coming out of flaxseeds.

Dr. Gersh:           Right. And funding for these kinds of little studies. And they’re so complex too because it’s very hard to have controls. But when you look at it at least theoretically and what we do know from other studies is that if you fill … And even like breast cancer. If you fill a receptor with something that’s weak, you’re going to block the effect of something strong coming along. So I do think … And we have to be careful because there’s so many crappy soy products. I’m sure you talk about that. Soy pretending to be chicken is not what we’re talking about. It has to be organic because so much of the soy is GMO. So it has to be organic soy, it has to be unprocessed, it can’t be fermented.  But I think there will be some definite benefit with that.  And in fact, as a functional medicine doctor, and I’m sure all of your listeners are into that world as well, we use food as medicine.

So there’s definitely a role for giving antioxidant containing foods. The polyphenols that work … In fact, one of the things that I really push of foods that have a lot of quercetin because we can’t … We don’t have the power yet to know how to reprogram hormone receptors. I wish I had that power to … We can’t go back. We talk about this with the brain a lot. You get one chance to make a good brain for a child. You don’t get, oh, let’s do a redo. And the same thing with hormone receptors. When these things happen and they get altered, we don’t know how to undo it. So we have to create what I call workarounds. We find other ways. Because the body has many different back roads to try to stabilize things. So if we have an out of control immune system because their receptors, remember, also are not functioning either because it’s not just in the pelvis, it’s the pelvis in the female with endometriosis becomes the focus because their everything is so totally out of whack because of the menstruation cycle and all that inflammatory tissue with the endometrial cells coming into the pelvis that’s creating all this havoc. This chaos.

But these same processes are occurring elsewhere in the body in the woman with PCO … I keep saying PCOS. In the women with endometriosis. So they have dysfunction in more sites. That’s where the focus is. And it’s really now a whole total body immune dysfunction. And it’s actually linked with autoimmunity as well because we know the immune system is one. So you can call it autoimmunity. But the new term that’s often used is autoinflammatory which actually makes more sense because it can manifest with allergies, with this type of crazy reaction in women with endometriosis and autoimmunity, they’re all linked. And of course, unfortunately, it also links with cancer. And women with endometriosis have significantly higher rates of certain types of cancers as well because you have to think of it as total body immune system dysfunction.

And we can do what we can do. But we can do a lot. We can use food as medicine like using organic types of whole soy and the polyphenols and the foods like apples and onions and such that have a lot of quercetin because quercetin is a mast cell stabilizer. And it turns out that the first responder of the immune system which is so heavily involved in this process in women with endometriosis are the mast cells. So they’re like the first responders. And if you can stabilize them so they are not so crazy and they’re doing … Because they put out all their inflammatory products. They’re the only cell in the body that has preformed tumor necrosis factor alpha. They’re just filled with all the inflammation to try to destroy an invading bacteria. But now they’re just exploding in the woman’s pelvis and they’re creating high levels of protein P, Substance P that is now producing more pain fibers.

So I’m sure that you’re aware because we were looking at the articles together that women with endometriosis have a different nerve innervation that they … And this all stimulates from the mast cells that explode and that creates more of the substance P which then stimulates more nerve production. It’s like the worst of all worlds. So you have all this inflammation and then you’re actually creating more nerve innervation to these endometrial implants so that you create more pain, so you’re getting this hyperesthesia. You’re getting more pain and more nerve fibers that are coming in that are all sensory. All about pain. So if we can just calm down those most cells, we can really have a big impact.

 So I use lots of antioxidants and these … All those different tools that we have to calm down the immune system. So I give quercetin and I’ll give green tea, and resveratrol and vitamin C.  All of these can really help to stabilize the immune system in women with endometriosis and as well when you help to get the gut healthier and you work on the gut health and the microbiome because they do have … We have studies now that show that women with endometriosis do have an altered gut microbiome. And also vaginal microbiome. It’s just sort of the uncharted territory that is going to be the next really area of explosive research is the role of the vaginal microbiome in women with all these different disorders including endometriosis which is altered.

Dr. Weitz:            The vaginome.

Dr. Gersh:           It’s everywhere. Yeah. And so we can do so much to improve the gut barrier health. So if we can reduce impairment of the gut barrier we call leaky gut, we can … Which also then creates more inflammation right because then you have these endotoxins or lipopolysaccharides that come out and then cause this immune system which is already in an up regulated state because of the way that the estrogen receptors are working on them. The mast cells are filled with estrogen receptor alpha. And it turns out when you have a lot of beta, it actually down regulates alpha. The whole thing is so complex, we’re just barely scratching the surface and understanding all that’s going on, but we do know that if you can improve gut health, if you can help restore the microbiome, if you can help to maintain gut barrier structure and reduce leaky gut, and reduce systemic inflammation, and calm down the response that’s so overwhelmingly inflammatory in the pelvis every time a woman has a menstrual cycle, then we can have so much benefit for these women.

And really, the whole mind body can make a lot of difference. We know that emotions and that our brain function can actually alter immune function. It’s so amazing. You can do … My personal favorite is guided imagery and you can envision in your mind how your brain can control and calm down these immune responses. And so the role for mind body and energy medicine in women with endometriosis is really huge. And happily, the mainstream medicine, which is usually entrenched in pharmaceuticals and surgical procedures … Which they still are by the way. But there is a group that have come out officially and said we need to rethink what we’re doing for women with endometriosis because it isn’t working. The conventional world of giving birth control pills is not stopping the progression. It usually has very minimal impact on the pain as well. Taking away women’s hormone is a horrible solution. Because hormones are not just about reproduction, hormones in women are about every function. It’s about cardiovascular health, and immune health, and brain health. So just taking away women’s hormones is a terrible solution and isn’t really solving the problem.

And this new pill that’s coming down the pipeline is sort of a variant of drugs that have been out for a while, which basically is to completely shut down the production of hormones so that you have no estrogen. And it starts at the level of the brain. So it just shuts down the brain stimulus to the pituitary. So it’s all shut down. So you don’t make any estrogen. And this drug, instead of being a shot, like the former drugs, like the depo lupron. Instead it’s a pill and it can apparently be more titrated so that instead of it being a total shut off of hormones, it’s gonna be a partial shut off. But as we mentioned, it’s not just about having estrogen, it’s about having this beautiful rhythm because you need to have the lows and you need to have the highs. You need to have that spike of estrogen in order to have that whole antiinflammatory effect. And if you simply have a low but static level, you’re gonna have chronic inflammation if you have chronic low levels of estrogen. Or even if you have chronic moderate levels, you’re not gonna have the right effect. You need to have the right cycle but it’s a problem if you have too many cycles.

It’s definitely complex, but I welcome even pharmaceuticals that can help with symptoms because these women have so much suffering that even if we can help reduce their pain and we’re not really solving underlying problem, for some women, short-term, that could still be helpful. We have to think about the suffering too, as well as the underlying cause sometimes.

Dr. Weitz:            Great. I only have about 100 questions after this discussion.

Dr. Gersh:           It’s so complex. Yeah.

Dr. Weitz:            I just want to mention quickly, I don’t know if you ever use detox programs. But since we’re talking about toxins-

Dr. Gersh:           Oh, yes.

Dr. Weitz:            Yeah. Is there a benefit to doing a liver detox, or an estrogen detox, or some sort of a detox program to decrease some of that burden in our body of some of these stored endocrine disrupting substances?

Dr. Gersh:           Well, we definitely … I always include that. Of course like so many things that we do, we don’t have hardcore published data on a lot of these things. But in practical use, what we really need to do is have proper metabolism of estrogen as well. It turns out that estrogen metabolites are so key to actually a lot of functions. So the estrogen metabolites production begins in the liver. So estrogen has to be detoxified, it starts off by going through the liver where it goes through the first phases, phase one, phase two, until you have glucuronidation and all these different processes. Sulfations, all these different things … Methylation that can then create the first step of metabolites. And then it goes into the gut and the gut has its own set of bacteria. The estrabolome that actually work to further detoxify and create other metabolites. And these metabolites actually have action. They even have some of their own receptors that are separate from estrogen receptors. And they’re actually very key to function.

 And you can’t have any of this work properly if you don’t have a healthy liver. So absolutely, I start every one of my patients for just about everything with a four week detox. And I would, for a patient like this, I would definitely use something like DIM or indole 3-carbinol absolutely and use sulforaphane. We definitely want to have broccoli sprouts and all of that because we definitely need to have the estrogen that’s in the woman’s body to get properly detoxified, and eliminated, and have the right metabolites produce. Not the wrong metabolites. 

Dr. Weitz:            For those of us who don’t know about the metabolites, if you’ve gone to your doctor or you’re a doctor and you’re just measuring hormones through serum, you won’t know anything about these metabolites so you have to look at your hormones in urine to see how the estrogen is getting metabolized, what pathway. Do you use urine testing for hormones?

Dr. Gersh:           I’m looking at it more and more now because like you said, the first step may not be that, but that is part of the process in Functional Medicine is to understand these pathways which are totally ignored. We know that what’s going on with the metabolites really does matter. There’s … One of the metabolites which is 2-methoxyestradiol has been shown to be very, very critical for liver health. So it’s one of those feedback things that you make … The liver is involved in detoxifying. And one of the detoxification products which is a metabolite, which is 2-methoxyestradiol is a back key to keeping the liver healthy. And it also works to … They found … We don’t even know too much about it. But we know it helps to maintain liver health, it also maintains myocardial health.

Dr. Weitz:            Wow.

Dr. Gersh:           So it helps to maintain the actual muscle fibers of the heart to be healthy. But you need to have the liver working properly to make that one metabolite. And that’s just one of other metabolites that … And then of course like you mentioned, you can also make the wrong metabolites that can then be carcinogenic even. So it’s very very complex, but you can’t have anything work properly in the body if you don’t have that incredible organ, the liver, doing its job right.

Dr. Weitz:            Isn’t it amazing how the body works when it’s in balance and can function properly?

Dr. Gersh:           It is. And it’s so … The thing that Big Pharma has done and it has been such a big disservice is what I call the dumbing down of medicine. Telling doctors, “Here, they have these … You have this patient with these symptoms. Just give this drug and don’t even worry about how it works because somebody at the big pharmaceutical company took care of that for you.” When in reality, of course, the drugs are going to have tremendous amounts of collateral damage because you can’t alter one area and think you’re not altering others because it’s this incredible interrelationship of enzymes, and pathways, and hormones, and neurotransmitters, and everything. And how they interrelate. And we are not smart enough to go in there and alter one pathway and think you’re not gonna then imbalance all kinds of other pathways.

So we have to go back to basics and start with having a healthy gut, and healthy food, and healthy liver, and healthy environment in utero. And as an OBGYN, I talk over and over that you have to be healthy before you get pregnant. Because you’re impacting your child’s life and future generations because of the epigenetic modification. So we have a system where women have a lot of infertility now. It’s just such a high problem. A big problem, high percentage. 

Dr. Weitz:            By the way, men also.

Dr. Gersh:           Men. Oh yeah. Sperm counts are plummeting. It’s a huge problem. A lot of it is coming from things like phthalates. So you end up going to these fertility centers where they put everyone on fertility drugs and then they do in vitro fertilization. And they don’t even think is this really a problem because nature is saying, “This is an unhealthy couple.” This woman or this man, they shouldn’t really be making a baby because they’re not healthy. It’s like a clue. Fertility is a vital sign of health. If you’re infertile, it means something is wrong with you. Unless you just had your tubes tied, but other than that, there’s something really wrong and you need to go figure out what that is before you then trick a body into getting pregnant and then of course have lots of pregnancy complications and then have children who then have significant problems because we now know the children are very much the product of the environment that they are growing in, in every which way.

So we have to change the whole paradigm of how we consider fertility. We have to look at the health issues before we try to get people pregnant and not just trick the body into getting pregnant and then having all these repercussions down the line. So we just have to change the way we think about everything. And endometriosis is the perfect example of a medical condition that is so prevalent that is really the result of all these things that we have done wrong.

Dr. Weitz:            Yeah. You talk about the gut and one of the important things about the gut is that estrogen, after it’s metabolized, needs to get excreted. And if you’re constipated and you have gut problems, gut dysbiosis, that estrogen may not get excreted so it’ll just keep recirculating and causing more havoc.

Dr. Gersh:           That’s right. You want the perfect balance when people talk about the different enzymes that detoxify estrogen. They’re not good, they’re not bad. You just need the right amount like everything. They’re not evil enzymes. Beta-glucuronidase is not evil. You need it. Because it actually can help recycle estrogen and get more, especially in women in the menopause. But you don’t want it at the wrong amount. Everything is supposed to be in the right balance. And we live in a world that has become very imbalanced. So we’re struggling. All of us health care providers, we’re just struggling to try to help our patients get back in balance. And it is a challenge, but we can do so much good with all these different things that you’ve mentioned.

Dr. Weitz:            When you talk about the hormones and the importance for estrogen and progesterone, and all this and how all that serves a purpose, I think sometimes about hormone replacement therapy and the way sometimes it’s done is to give women an exact same level of estrogen every day for the rest of their life. And if all these fluctuations are so important, I wonder how beneficial that way of approaching it is.

Dr. Gersh:           You are so brilliant and you hit it right on the head. That is exactly what we’re doing and it is absolutely wrong. The reality is that there’s never a time in a woman’s existence when she has a static amount of estrogen. And of course, this also goes back to birth control pills which we can talk about another day which are … Actually, they are what they are. They’re endocrine disruptors and they create a static situation and that’s why they’re involved with a lot of metabolic problems including higher rates of breast cancer. And women in the menopause are not getting treated in a physiologic way. Estrogen, as I mentioned … Low levels have one effect. High levels have a different effect. And the body made this beautiful balance. And in fact, there’s now some data that the way that the estrogen ebbs and flows impacts dramatically the hormone receptors of other hormones and itself as well. So when you get the spike of estrogen that is right before ovulation in a normal cycle, that spike upregulates progesterone receptors, and testosterone, and thyroid so that they actually work better.

So if you live in a world where you have a static amount of estrogen and you’re never gonna have that upregulation of those hormone receptors, so those hormones may not work properly. And in fact, in women in menopause, for example, they may have physiologic or so called normal levels of thyroid circulating. But they have all the symptoms of being hypothyroid. And of course the doctor says, “Oh, another crazy woman. She says she has low thyroid and all the symptoms and I measured her thyroid and it’s perfect.” Well it doesn’t matter what you have if it doesn’t get in the receptor and work. And if you have static low levels of estrogen … Either if you’re taking a little bit or you’re not having any, then those thyroid receptors are not gonna be working properly. And neither will the testosterone, neither will the progesterone receptors. And none of them are gonna be working properly.

And as … And unfortunately like in women with endometriosis, their progesterone receptors are completely malfunctioning. They don’t receive … They have them, but they don’t receive the progesterone, so you don’t get the desired effect. The same thing can happen if you don’t have progesterone or you have little bits or if the receptors don’t work. So it’s not just about how much is in your body. It’s how the receptors are actually working with it. And you need to have that beautiful up and down of the estrogen with the menstrual cycle in order for all these hormone receptors to do their job properly.

And it gets even more complex because there are tumor suppressor genes that are actually activated when you get that estrogen spike. And then that actually sets the tone for what happens as far as program cell suicide. To kill off … Our body’s ability to kill off the incipient or growing cancer cells. And there’s actually some data that when the menstrual cycle happens, which is sort of a purging of these cells from the uterine lining, that a similar thing happens in a normal menstrual cycle in the breast. And that crappy pre-cancerous cells of the breast are actually creating programed cell suicide or apoptosis and they’re killing themselves off. So nature actually has it’s own tools to actually eliminate breast cancer cells in a normal cycling woman.

But of course, none of that is going to come into play if you have a static situation. So I really think we need … And I’m actually supporting a new nonprofit that’s actually trying to create … To raise funds to do research on doing hormone research on women in menopause where you actually try to do a more physiologic replacement to mimic the ups and downs because we need data. We absolutely need data. Because all I can say is what we’re doing is not physiologic and it can’t be the best. It cannot be the best. Is it better than nothing? I think it’s definitely better than nothing. But I know it’s not best.

Dr. Weitz:            Right. One more quick question because I know you have to get to your practice. Is … You touched on some natural substances that can be helpful for women with endometriosis and you talked about antioxidants, and phytonutrients. And a couple that I saw in some articles, one was pycnogenol which is for pine bark extract at 30 milligrams twice a day. I saw melatonin and any inflammatory substances like quercumin, boswellia, fish oil, and there was also discussion about NAC which seems to be one of the most amazing nutritional supplements for almost anything.

Dr. Gersh:           Yeah, actually pretty much all those are wonderful antioxidants and antiinflammatory agents. Quercumin is actually very important. I’m glad you mentioned that. Specifically quercumin for women with endometriosis. Because it seems to act as a blocker of the enzyme aromatase. So you actually can have some blockage of this really excessive amount of estrogen that’s produced locally. And because of all this … What’s going on in the pelvis of women with endometriosis, they actually can produce high amounts of estrogen. So remember, high amounts of estrogen in a normal woman, what did I tell you? They’re antiinflammatory, right? So high levels of estrogen actually is antiinflammatory. So what happens in the pelvis, there’s so much inflammation in the woman with endometriosis, that her body locally produces more estrogen. There’s a lot of areas of the body that have the enzyme aromatase and can produce their own local estrogen. We call that a paracrine effect as opposed to an endocrine where you make the hormone where it circulates through the body. In these cases, it’s made and used locally. So the pelvis is one of those places that it can make its own estrogen.

So the body is making humongous amounts of estrogen trying to put out this fire. All this … To reduce the inflammation. But it doesn’t work. Because the hormone receptors aren’t working properly and you’re actually creating more havoc because the alpha, the beta, none of this is working properly. So you have this explosion of inflammation and estrogen production. Quercumin can actually help block the enzyme aromatase. So you’ll make less of this estrogen that you don’t want in this case. You want to drop the estrogen. And that’s the same thing with breast cancer. Where the breast can also make it’s own estrogen, it has … And that’s why dense breasts are a warning sign because it means the breast is inflamed and it’s making a lot of estrogen. And estrogen is all about healing. It’s about proliferation, it’s about growth. But when you have an abnormal environment whether it’s cancer or endometriosis, you’re taking what is a good thing and you’re sort of turning it on it’s head and it’s actually creating havoc instead of healing which is what its original plan and goal is. So quercumin is an absolute must in women with endometriosis. Or boswellia, wonderful- I’m sorry.

Dr. Weitz:            Do you have a recommended dosage for quercumin for the average woman?

Dr. Gersh:           Well, why don’t you … I would say start with 500 milligrams three times a day. And you definitely want one that’s absorbed. So quercumin or turmeric. If you take it in one format, it’s very good for the gut. Which is I’m totally in favor of. But if you wanna make it a systemic treatment, you have to make sure that it’s on the absorbable form. So that you get it in systemically. So that is a very important thing. And NAC, like you mentioned, it’s a precursor to glutathione, the master antioxidant, detoxifier of the body. But it has amazing functions in its own right. So NAC is part of many detoxification protocols. So I use it all the time.

And melatonin is essentially an estrogen related hormone. And people don’t realize that estrogen is actually in control of the production of serotonin. There are actually serotonin neurons and they’re actually controlled by estrogen. So when you don’t have enough estrogen or it’s not properly received, you will not make serotonin properly. Which is one of the reasons why women in menopause have more depression and sleep problems. And serotonin goes on to make melatonin. So you’ll have this problem as I mentioned in the beginning. Melatonin has many functions in the body and it’s one of the most potent nonrecyclable antioxidants. So melatonin is another very wonderful tool for women with endometriosis to use.

Dr. Weitz:            Awesome. Awesome. Thank you so much, Dr. Gersh. You’ve given us so much important information and some great tools to help with women with endometriosis, both for patients and also for practitioners to use. For patients and practitioners who’d like to get a hold of you, what’s the best way for them to contact you?

Dr. Gersh:           Well, we see patients in the office. So you can certainly give us a call. I have an office website-

Dr. Weitz:            What’s your phone number by the way?

Dr. Gersh:           Oh. Our phone number is 949-753-7475.

Dr. Weitz:            Great. And that’s in Irvine, California?

Dr. Gersh:           And we’re in Irvine. Right, right. Central Orange County. In Irvine. And our website is www.integrativemgi.com. That’s for … The name of the group is the Integrative Medical Group of Irvine. So it’s integrativemgi.com.

Dr. Weitz:            Great. Excellent. Thank you so much for spending this time with us, Dr. Gersh. It was very [crosstalk 00:46:38]

Dr. Gersh:           Oh, it’s my pleasure. And if people … If you live far away, you can’t come, if you go to the website, you can also sign up and we’ll send you our regular newsletters as well.

Dr. Weitz:            Okay. That’s great. Excellent. Talk to you soon.

Dr. Gersh:           Oh, bye. Have a wonderful day.