Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Best Diet for IBS with Dr. Norm Robillard: Rational Wellness Podcast 80
Loading
/

Dr. Norm Robillard discusses what is the best diet for patients with Irritable Bowel Syndrome 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

6:47  When you look at studies on IBS, there is a wide range as to what percentage of patients are caused by Small Intestinal Bacterial Overgrowth (SIBO), in one meta-analysis from 4 up to 78%.  This has made some doctors and researchers to question what relationship SIBO has to IBS. Dr. Robillard explained that there are some issues with test methodology, including whether you use lactulose or glucose as the substrate and glucose is less sensitive since it will miss SIBO in the distal part of the small intestine, since it is absorbed in the proximal portion of the small intestine. Lactulose should be a preferred substrate, since it is not digested by humans. There are some potential issues with the 24 hour test preparation, which requires strictly following essentially an intervention diet and then an overnight fast and if these procedures are not strictly followed, it can affect the test results.  Also, this test is only one snapshot in time and there is a constantly changing situation in your gut where if you eat a lot of fermentable carbohydrates, the likelihood of SIBO will go up, while there are a number of mechanisms that work to prevent it from developing, including the Migrating Motor Complex, bile, hydrochloric acid from the stomach, digestive enzymes, and your Gastrointestinal Associated Lymphoid Tissue (GALT), the immune system clustered around your digestive tract. Dr. Robillard thinks the correct number is somewhere in the range of 45-65% of people with IBS who have SIBO. 

11:48  Dr. Robillard has coined the term LIBO for large intestinal bacterial overgrowth because he believes that some of the time the gastrointestinal symptoms are coming from an overgrowth of bacteria or archaea in the large intestine. When bacteria ferment carbohydrates they produce short-chain fatty acids, which are acidic. They did a study at John’s Hopkins that looked at 47 patients with IBS and they had them swallow a SmartPill that could detect pH changes.  They did not see any pH changes till they got to the large intestine, which they interpreted as bacteria in the large intestine, not the small intestine.  Dr. Robillard believes that when you have methane SIBO it is likely caused by archaea not in the small intestine but the large intestine, because the methane gas slows down motility, which causes constipation. This is why you get methane showing an elevated methane even in the zero time point in the breath test. He thinks that the archaea in the large intestine can overgrow and produces so much gas that if forces open the ileocecal valve leading to the gas getting into the small intestine. Evidence has shown that when researchers placed a pressure sensitive instrument in the ileocecal valve it was weaker, which could be because it is being forced open by back pressure from gas being produced in the colon.  Dr. Robillard also mentioned that he has written a book about reflux and his theory that reflux is caused by pressure from the gases being produced by the overgrown bacteria pushing up into the stomach pushing the acid up into the throat.  He found that a low carb diet made his reflux go away. 

25:37  If the archaea are really overgrown in the large intestine instead of the small intestine, this might explain why treating methane SIBO is more difficult and why Rifaximin is not as effective for the archaea, since it acts mainly in the small intestine.

27:18  The causes of SIBO can include the motility of the intestinal tract related to the migrating motor complex and the iliocecal valve. Hypochlorhydria or low stomach acid can also be a factor, since the acid helps to keep the bad bacteria out of the small intestine and from moving up to your throat, lungs and sinuses.  Low stomach acid can result from the use of Proton Pump Inhibitors (PPIs). It can also come from H. pylori infection, which is a corkscrew like spirochete bacteria that burrows through the mucosa into the lining of the stomach. If H. pylori grows in lower part of the stomach, the antrum, it can result in increased hydrochloric acid.  But if it grows in the upper part of the stomach, the fundus, where the parietal cells are, it can damage these parietal cells and results in decreased hydrochloric acid secretion. Low stomach acid both increases the risk of SIBO and also stomach cancer. Patients with liver problems like cirrhosis will produce less bile and are at increased risk for SIBO. Also patients with pancreatitis, since they may have decreased production of pancreatic enzymes. Kids with cystic fibrosis have a high instance of SIBO and GERD and have to be on digestive enzymes. Pain medications can slow motility and cause SIBO.  There’s an increased risk of SIBO with Celiac and Crohn’s disease. Diabetes can lead to nerve damage and predispose to SIBO.  Surgery and other adhesions in the intestines can lead to SIBO.  Scleroderma is also risk factor for SIBO.  Simply eating too many fermentable carbohydrates in your diet, esp. as we age since our digestion may not work quite as well as we get older.

33:18  Dr. Robillard has developed a special diet, the Fast Tract Diet, and the Fermentation Potential (FP) point system to easily keep track of how to eat less fermentable carbs. Dr. Robillard has also found that a super low carb diet like the ketogenic diet works well with GERD and SIBO. The Fast Tract diet limits lactose, fructose (and polymers of fructose), resistant starch fiber, and sugar alcohol.  The FP calculation uses the glycemic index, which measures how quickly carbohydrates are broken down and converted into blood sugar. For diabetes you want low glycemic foods, but for gut issues you want higher glycemic foods that digest more easily.  After you take the glycemic index you add in fiber and sugar alcohols to do the calculation and Dr. Robillard has developed an app for your phone that does this for you, the Fast Tract Diet Mobile App.

47:50  Wine and light beer are surprisingly low on FP points because foods that are fermented have less carbohydrate in them because the carbs are being converted into alcohol.

50:19  It is common in the Functional Medicine world that after the patient has been placed on a treatment protocol for SIBO that involves a restricted diet, such as a low FODMAP diet, along with herbal antimicrobials or other supplements for a number of months, once the patient feels better, that we try to broaden their diet as much as possible.  But Dr. Robillard does not really agree with this concept.  He does not feel it is helpful or necessary to add back in a lot of fermentable carbohydrates and fiber. He likes to see people diversify their diet by adding more low FP vegetables, fresh herbs, and small servings of fermentable foods, like pickles, kimchi, sauerkraut, and maybe a little bit of yogurt. If you have an animal-based diet with some fatty fish, plenty of green leafy vegetables, and some nuts, there is no reason to add grains and beans and other fermentable carbohydrates.  If you need some fiber, you can use psyllium or cellulose, or something like that’s not very fermentable.  Rather than supplement with prebiotics, Norm would rather have someone have an organic garden and compost pile, which will inhance your micobiota. Studies on compost piles show that they are similar to the microbes in your gut.  Dr. Robillard is also not a big fan of antibiotics for SIBO, given the harm they cause to our microbiota as well as other side effects.

 

 



Dr. Norm Robillard has a PhD in microbiology and he is the founder of the Digestive Health Institute and he is a gut health expert and author. He is the creator of the Fast Tract Diet and the Fermentation Potential (FP) System, the author of the Fast Tract Digestion book series and the publisher of the Fast Tract Diet mobile app. He also consults directly with patients.

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 expert 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. This is Dr. Ben Weitz. For those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review.

For those of you who’d like to see Dr. Robillard’s face, as well as listen to him, you can always go to our YouTube page and watch the video version of the Rational Wellness Podcast. Anyway, our topic for today is Irritable Bowel Disorder, or syndrome, and small intestinal bacterial overgrowth, and then how to treat it. Irritable Bowel Syndrome is a condition marked by gas in the intestines, bloating, abdominal discomfort, constipation, diarrhea, alternating one and the other, as well as a series of other symptoms. IBS, Irritable Bowel Syndrome, is the most common gastrointestinal disorder and occurs in up to 20% of the U.S. population.

For many years, IBS was considered a stress-related condition with no known cause, and this is partially because IBS was most common in women. Traditional medical treatment has been generally composed of medications for controlling symptoms, such as medication to reduce constipation, another medication to control diarrhea, et cetera, et cetera, but in functional medicine, we don’t wanna just treat symptoms, we’re trying to get to the underlying cause of our health conditions. Dr. Mark Pimentel, from Cedars-Sinai, was really the first one to discover that small intestinal bacterial overgrowth, or SIBO, is the cause of IBS in up to 84% of cases. SIBO consists of bacteria that normally grow in the large intestine or colon that then start to grow into the small intestine, which normally has relatively small amounts of bacteria.

When you eat certain types of carbohydrate foods that contain fermentable fiber, our gut bacteria eat the carbs and they produce various types of gases, like hydrogen and methane. When this occurs in the colon, this is not a problem, since the colon’s very expandable and there’s a valve, the ileocecal valve, to keep this gas from going back up into the rest of the digestive tract, but the small intestine is a relatively narrow tube and it’s not really expandable in a way that the large intestine is. If there are bacteria there that are eating fermentable carbs, they’ll produce gas, and this gas, likely, will cause discomfort, a feeling of gas and bloating, and many of the other symptoms of IBS or SIBO. The gold standard for diagnosing SIBO is finding more than a tiny amount of bacteria upon jejunal aspirate, which means that when putting a scope down into the intestines, you scoop a small amount of the liquid in the proximal jejunum, which is the lower part of the intestine, and then analyze it via culture, or PCR.

Unfortunately, this test is very invasive and it’s not typically done on a regular basis in clinical practice. What we have is a somewhat imperfect but fairly useful test, which is known as lactulose hydrogen-methane prep test to diagnose SIBO. Dr. Pimentel also found that SIBO often results from a bout of food poisoning, where the bacteria that causes food poisoning give off an endotoxin referred to as cytolethal distending toxin. The immune system reacts to this toxin and attacks this cytolethal distending toxin, but then, because the cytolethal distending toxin is similar to some of the structural proteins in the intestinal wall, the immune system cross-reacts and ends up attacking the intestinal wall. By this understanding, SIBO is really an autoimmune condition.  This can be diagnosed via a blood test that Dr. Pimentel developed called the IBS check test, and now Cyrex Labs has Array 22, that’s a more sophisticated way of trying to measure these antibodies produced by the immune system in this attack on these toxins, as well as the antibodies to the structural proteins in the intestinal wall, in order to be able to diagnose SIBO. This is all, obviously, a very complicated and confusing condition, and that’s why I’ve asked Dr. Norm Robillard to join us today. Dr. Robillard’s an expert at IBS and SIBO. He has a PhD in microbiology from the University of Massachusets where he studied Bacillus species of bacteria, which are the spore-based bacteria.  He’s the founder of the Digestive Health Institute, and he’s also a gut health expert, author, and microbiologist. He’s the creator of the Fast Tract Diet and the Fermentation Potential system. The author of the Fast Tract Digestion book series and the publisher of the Fast Tract Diet mobile app. Thank you for joining us, Dr. Robillard.

Dr. Robillard:                      Thanks for having me on, Ben.

Dr. Weitz:                            When you look at the studies on IBS, there’s a big range as to what percentage of patients with IBS are actually positive for SIBO, and so there’s one review paper that says it ranges from as little as 4% all the way up to 78%. This has led some practitioners and doctors and researchers to even wonder if there really is a relationship with SIBO and IBS and what percentage it is. On the other hand, Dr. Pimentel did a study in which he found that 84% of patients with IBS tested positive for SIBO.  Why do you think there’s such a wide variation in these results and what percentage of patients with IBS do you think are really caused by SIBO?

Dr. Robillard:                      Yeah, that’s a good question. Of course, there’s basic test methodologies. I used to run an analytics testing laboratory, and so there’ll always be precision, accuracy, intermediate precision, which is how closely different laboratories get the same result, so it requires a lot of training and a lot of calibration to get these labs on the same page. Of course, the test for SIBO, there are different techniques used.  Some people, you mentioned lactulose sugar, which is really, I would think, the preferred method, because lactulose is not digested by humans, so it passes through the intestines until it runs into bacteria that can break it down and produce hydrogen.  When you use lactulose, you can detect bacteria all the way through the small intestine.  But a lot of labs use glucose, which is quickly absorbed, and so if the bacteria are not up in the proximal or early part of the small intestine, you may not even see them with that test, so it’s less sensitive, however, it’s more specific.

There are some test methodology issues.  Before we went live, you and I were just talking about the test preparation, which I think is also important and, potentially, a flaw or an imperfection in this testing, because before people take the breath test, there’s a 24-hour preparation period where you’re, essentially, on an intervention diet, and so you’re avoiding legumes. You can still have some fish and chicken, no fruit juice, and you mentioned they can have some rice, and some rice is worse than others, as we’ll get to in a little bit, but nevertheless, they’re on an intervention diet for 24 hours and then they fast overnight before taking the test.

You, obviously, follow Dr. Pimentel’s work, and those folks down there have really worked a lot on this migrating motor complex, so SIBO is a snapshot in time. If these bacteria move their way up into the small intestine, your body, stomach acid, a lot of these mechanisms we’ll be talking about today, motility, it’s always trying to move these bacteria out, bile, antimicrobial factors, your immune system, and so the more chance you give it to not be either fed more with carbs, things like fasting, the more of a chance you have of being negative. On the other hand, if you feed everybody a lot of fermentable material, you’re going to see the number of people with SIBO go way up. Again, it’s a snapshot in time.

The last point I wanted to make is, and I hope we get a chance to talk about this a little bit today, I had coined the term LIBO in an article I wrote a few years ago on resistant starch, it’s to stand for Large Intestinal Bacterial Overgrowth. In your introduction, you mentioned, well, as long as all this fermentation happens in the large bowel, you can accommodate that all, bacterial growth and a lot of gas, but if you have too much, that could be problematic as well. People would come in with symptoms and test negative for SIBO, and they still have excess bacterial fermentation, that’s what I believe. The second part of your number was what’s a number, right? What should it be–87% or 4%?  Again, from being analytics testing all of these years, I do know that if you test something enough, the answer gets closer and closer to the accurate value. Dr. Pimentel had put together a meta-analysis of a whole variety of studies and really validated the finding of SIBO and connecting it to IBS, and I thought that was pretty powerful. When you look at enough data, you’re going to get a better answer. Is it 45% or 65%? I don’t know, but it’s probably somewhere in there, again, fluctuates.

Dr. Weitz:                            Right. Yeah, that’s interesting, you talk about LIBO, or bacterial overgrowth in the large intestine, I wonder if you could use the SIBO breath test to diagnose that if you just look at the rise in gases after 120 minutes or beyond.

Dr. Robillard:                      Probably not, because when you go from even somebody with SIBO, they have greater than 100,000 bacteria per mill in the small intestine, which anybody that works with bacteria will tell you, that’s such a tiny, tiny amount, and then you get to the large bowel, and the large intestine contains 100 trillion bacteria, so much more, so basically, this lactulose would be just rapidly consumed and produce a lot of gas, even if somebody didn’t have “LIBO”.

Dr. Weitz:                            Oh, okay.

Dr. Robillard:                      However, there was a study done, jumping into this LIBO thing a little bit, by a group that looked at, I think they were out of John’s Hopkins, looked at 47 patients with IBS, and some controlled, so it’s pretty good end for statistical analysis, and they had them swallow a wireless motility capsule, kind of a SmartPill, and this pill could detect pH differences, so it’s going through the stomach, small intestine, and into the large intestine, and it was measuring acidity. What they found was really interesting, they didn’t see any pH change, no increased acidity in the small intestine. Just to back up for a minute, when bacteria ferment carbohydrates, they produce short-chain fatty acids, right? They’re fats and they’re acids, and that’s where the acidity comes from, but they didn’t see any increased acidity in the small bowel of people with IBS, but when the SmartPill got to the large bowel, they did see an increase in acidity, and they indicated that they interpreted that as the bacteria in the large bowel.

For IBS patients who were very active, producing more of these short-chain fatty acids and more of the acid, they were questioning SIBO. While we’re on that topic of questioning SIBO, there was another lab up in Canada that used a radioactive tracer molecule when they gave people, and again, it was a pretty good sized study, I think it was about 40 people with IBS and some controls, when they gave them the lactulose breath test, at the same time, gave them the lactulose, they gave them this radioactive tracer probe. They could literally follow this probe on somebody’s body, and they had mapped out, here’s the end of the small intestine, the ileocecal valve should be right here, and they were literally following this radioactive probe through the small intestine. What they found was that by the time people were registering as hydrogen-positive within 90 minutes indicative of SIBO, that that dye had already reached the ileocecal valve and was entering at the large bowel.  Again, they were saying that they think that people that test positive with SIBO, perhaps, have faster motility, and that’s what they’re measuring, not the actual SIBO. I thought about both of these studies and I really think the answer is that both LIBO and SIBO exist. For instance, in this radioactive probe study, yes, as people were recording a positive breath test, some of this dye, for at least 5%, had reached the large bowel, but a lot of the dye was still back in the large intestine, small intestine, and a lot of the lactulose was still back in the small intestine, so I don’t think it debunks SIBO so much as it suggests, both of these studies, that we need to look at LIBO and SIBO. While we’re on that topic, again, with the SmartPill and the acidity, they found that they had no change in acidity in the small intestine, but they did in the large bowel, but again, getting back to the numbers, even if you have 100,000 or 500,000 bacteria in the small intestine, is that enough bacteria to meaningfully change the PH, especially when the small bowel adds bicarbonate and it neutralizes the acidity from the stomach, and all of that?  I think SIBO could exist, easily exist, and that it’s not debunked by these methods, but I do think it is a good reason for us to look at it in a different way and think maybe it’s a combination.

Dr. Weitz:                            Yeah. A thought I also have about that, and then I think maybe I should ask you to explain what the SIBO breath test is for those listeners who are not familiar with it, is some of the real acid-loving bacteria, like the lactobacillus, is they’re typically not part of the SIBO equation, whereas primitive archaea are, and I wonder, if they’re not really as acid producing as some of the bacteria, so that could be a factor as well.

Dr. Robillard:                      Well, in SIBO, so we’ve been talking about breath testing, but you also mentioned the gold standard, which is taking an endoscope that can sample the small intestine, aseptically as possible, pull these bacteria out and try to culture them. Some of those studies have been done and they’re not perfect studies because, first of all, 80 or 90% of the bacteria in your gut will not grow and culture. They haven’t figured out how to grow them, and that’s why they use the 16S rRNA gene sequencing to look at these strands molecularly. They have done some culture work and they find that SIBO is comprised of an overgrowth of some bacteria that are from the small intestine, so there’s your lactobacillus and some staph and strep, but also, bacteria that are more associated with the large bowel, some Firmicutes, some clostridium species, some bacteroides, like bacteroides fragilis and several other Gram-negative and Gram-positive strains, so bacteria in the large bowel and from the small bowel are overgrowing there, so that-

Dr. Weitz:                            Also the archaea, right?

Dr. Robillard:                      Well, okay, some people may have thought that early on, because in some of these breath tests, the people have high levels of methane and they’re like, “Wow, okay, must be the archaea,” they’re not bacteria. These other micros called archaea take the hydrogen and they use it to reduce carbon dioxide to methane. That’s the little molecular food chain there, and so where are these archaea? Because wow, even in the first sample, they have high methane and they just continually have high methane, but remember, with these breath tests, they have you blowing in these tubes, right, so that if any hydrogen’s being produced by bacteria in your gut gets absorbed into your bloodstream, exhaled through your breath and you capture it in this tube.

You blow in that first tube, it’s called times zero, put the cap on, put a label on it. That’s times zero, that’s before you drink the sugar solution, then you set that aside, then you drink the lactulose sugar solution, and then every 15 minutes, 20 minutes, depends on the test, usually about every 15 minutes, you blow in a new tube and put the cap on. With hydrogen, you can see a real kind of time course there if you plot it out. Zero sample is hardly any hydrogen in it, and then all of a sudden, starts to come up, and it may be 40 minutes, and 60 minutes comes up, then it starts to, maybe, go down a little bit, and then it hits the large bowel past 90 or 120 minutes and it goes through the ceiling.  You can get a profile like that with hydrogen, but with methane, you almost always just see that it’s high in the zero time point, so that’s telling us that it has no dependence on the lactulose sugar. It’s doing its thing, taking the hydrogen and CO2 and combining that to make methane. There has been some work on it, I’m not sure I can cite any particular studies at the moment, but that shows that these archaea are in the large bowel and that they’re just churning away. Some people may not know this, people with IBS-C, or constipation-predominant IBS, almost always have these really high levels of methane because methane, there’s been good work on this, you can inject methane into the intestines of animals and it slows down the transit.  There’s just such a tight corelation with people that are high methane having slow transit and constipation. There is a strong belief that these archaea organisms are doing that in the large bowel.

Dr. Weitz:                            I thought that they had grown into the small intestine, and that was one of the theories, I talked about Dr. Pimentel’s theory about the autoimmune component, but to follow up on that, what that meant is by damaging the structural proteins in the small intestine, it caused decreased motility, and he describes it as like a stream that stops running quickly and starts backing up and that allows the bacteria from the large intestine to grow into the small intestine, so I thought that’s where the archaea-

Dr. Robillard:                      Well, right. This whole story, and it’s a great story, by the way, they worked out with Cytolethal Distending Toxin and the autoimmune reaction with Vinculin, which slows down motility, hits the nerves and so forth, causes constipation. Slowing everything down, whether that causes archaea organisms to back up all the way into the small intestine, I’m not sure. I do have my own theory about connections between the LIBO and SIBO. Something we’re not talking about today, but it’s just relevant in this discussion, is when I first got into nutrition and dieting, it was only because I had chronic acid reflux myself, and I had found that a super low carbohydrate diet caused my symptoms to just go away, and so I was so amazed by this.  I was playing around with this idea, and I started following the food groups through the digestive process and came up with this new theory that, what was happening, I believed, was that I was consuming too many carbohydrates, too many were getting malabsorbed, feeding blooms of gas-producing bacteria, right? As a microbiologist who grew these bacteria, right? You mentioned I worked in a Bacillus lab for my graduate work, but I also worked as a post-doctorate fellow on bacteroides fragilis, that’s 10% of the gut bacteria, and E. coli. I was actually the first one to be able to move genes between E. coli and this strict anaerobe bacteroides through this conjugative process.

One thing I knew about these bacteria, they produced a lot of gas. They were saccharolytic, they loved carbohydrates, they produced a lot of gas, and I came up with a theory that all this gas produced too many carbs, was pressurizing my stomach, it was translating into my stomach, and they do know people with GERD, acid reflux, have much higher pressure in their stomach, and the theory was it was pushing reflux, opening this valve instead of the original theory that stood for 60 years. We’re saying that this valve was dysfunctional or it was weaker, or it was relaxing spontaneous, and so there’s a lot more evidence for this gas-producing bacteria driving reflux, and so I’ve written a couple of books on that. Now, to this new discussion on SIBO versus LIBO, these guys with the PH SmartPill, they found all this acidity past the ileocecal valve in the early part of the large bowel.

How could that relate? Suppose you had SIBO and LIBO, how’s the SIBO getting there? I have a theory that it might work the same way as my acid reflux theory, that these bacteria are producing a lot of gas in the early part, the ascending colon, just past the ileocecal valve, a lot of growth, a lot of gas, and maybe this same gas pressure is pushing back on the ileocecal valve. It’s interesting, it ties into another study done out of John’s Hopkins as well, I think, where they found that people with SIBO, was it a SIBO population or an IBS population? I think it was SIBO, but one or the other, but probably people with SIBO, they found their ileocecal valve pressure and they measured it like a colonoscopy tube going right up to the valve.  They put a pressured, sensitive, like a manometry instrument, position it right in the ileocecal valve, and it was weaker, there was less pressure, people that had SIBO. It could be the same thing, if you have gas pressure from bacteria pushing back on that valve and pushing it open, if you have a pressure-sensitive tube in there, it’s going to look like it’s weaker, but really, it’s being forced open by back pressure. Anyway, something to think about.

Dr. Weitz:                            That’s interesting. If the archaea are really in the large intestine, that could be one of the reasons why it’s difficult to correct methane SIBO and kill or cut back the archaea if Rifaximin, which is what gastroenterologists often use when they treat this, is basically acts in the small intestine, so it might not be acting in the large intestine where, under your theory, the archaea really are.

Dr. Robillard:                      Yeah. Well, it probably explains why Rifaximin alone is not efficacious for IBS-C.

Dr. Weitz:                            Right, that’s why they usually recommend Rifaximin plus Neomycin, or another antibiotic.

Dr. Robillard:                      Yes, and both are nonabsorbable. If you’ve seen my other work, you know I’m not a big fan of antibiotics, but at least these two are nonabsorbable. You can eliminate some of the systemic problems.

Dr. Weitz:                            Right.

Dr. Robillard:                      They use both. The Rifaximin is probably, by their own estimations, not very useful in the large bowel, right?  There’s a whole story about, well, it won’t upset your microbiome because it requires bile for its most efficient inhibition, and 95% or more of the bile is reabsorbed at the end of the small intestine, so the Rifaximin is probably not a big factor. It would be, really, what’s the Neomycin doing?

Dr. Weitz:                            Interesting. We’ve talked about a couple other things that could cause SIBO, we’ve talked about the damage to the motility of the intestinal tract, and you mentioned the migrating motor complex, and you also talked about the ileocecal valve. What are some of the other causes of SIBO?

Dr. Robillard:                      Yeah. Motility is big, and Pimentel thinks it’s really probably one of the biggest. Low acid is another one, people with hypochlorhydria, achlorhydria. The acid not only is it important for digestion, but it’s important for keeping the bad bacteria out of your gut, keeping the bacteria in your gut from moving up to your throat, lungs, and sinuses, so acid’s important. By the way, on the acid, there is an autoimmune disease that will lead to atrophic gastritis and hypochlorhydria, but it’s quite rare, actually, so unless somebody has a lot of other autoimmune conditions, you might not have to look at that one, but definitely PPIs, that’s what they do, they knock down your stomach acid.

Dr. Robillard:                      The other big one is a prolonged infection with Helicobacter pylori, bacteria that infects the stomach, it’s a corkscrew shape, like a spirochete, and it burrows down through the mucus and anchors on the stomach lining and it makes these colonies. Depending on where those colonies are in your stomach, that’s where the damage happens and that’s where the gastritis and atrophic gastritis happens. For some people, it effects the hormones that regulate stomach acid and they can have too much stomach acid, and they’re very susceptible to duodenal and stomach ulcers. People that have these bacterial colonies of H. pylori near the parietal cells that produce the acid, those are the ones you have to worry about having low stomach acid, so that’s a big one, too, I think, in a subset of people. Any kind of-

Dr. Weitz:                            That’s really interesting because most people think of H. pylori as automatically associated with increased acid production, but you’re saying if the H. pylori grows in a certain part of the stomach, it can be associated with decreased hydrochloric acid secretion?

Dr. Robillard:                      Absolutely. Right. The two doctors down in Australia, one of them gave himself an H. pylori infection and got gastritis.

Dr. Weitz:                            Yeah, Marshall, right.

Dr. Robillard:                      Wow, that was a great story, but they were focused on the ulcers, with the cause of ulcers, but they can also cause the opposite.

Dr. Weitz:                            Interesting.

Dr. Robillard:                      The people that have low stomach acid, not only will it really mess with your digestion, can still have symptoms, but they also are at higher risk for stomach cancer with the low stomach acid, which caused me to wonder, if they studied PPIs, if they would see there was also a gastric cancer risk with PPIs. No one’s been reported so far, but it also really knocks down your stomach acid. Just to cover a couple more quick ones, any kind of liver issues, we talked about liver and it produces the bile and that’s antimicrobial, people with cirrhosis, any kind of liver problems, they can have SIBO, a lot of problems, anything with your pancreas, pancreatitis, the pancreas produces amylase, protease and lipase, right? If you have any kind of problem with your pancreas, you won’t be digesting food as well, especially if you’re deficient in the amylase.

Even kids with cystic fibrosis, while they don’t have a pancreas problem, per se, they do have a lot of mucus in the ducts where the enzymes are released from, so kids with CF have a very high instance of SIBO and GERD, for that matter, right? There’s another link there, and they have to be on digestive enzymes. Problems with drugs, we talked about PPIs, pain medicines, man, there’s a whole story about MSDS, it’s just unbelievable. Too many pain meds, especially narcotics on the motility front, Pimentel, in one of his interviews, was talking about anybody on morphine has SIBO. You don’t even have to ask, so they really do slow down the motility.  We talked about GI infections already, and not just bacterial. Gastroenteritis from food or water-born illnesses, bacteria, yes, but also protozoa, viruses, anything that causes gastroenteritis.

Dr. Weitz:                            You mean even fungal infections, and you can have what’s called a SIFO, or a Small Intestinal Fungal Overgrowth?

Dr. Robillard:                      Certainly, sure. We talked about the ileocecal, other genetic-based diseases, celiac and Crohn’s, it’s huge, diabetes, it might be a nerve damage issue going on, surgery and adhesion’s, I’ve heard Pimentel talk about that. I cover all of these in the Fast Tract Digestion books, by the way. I have a whole chapter on this. Speaking of scarring, scleroderma is a big problem for a lot of people with SIBO.

Here’s one that never gets any attention, and I’m not sure why, too many fermentable carbohydrates in your diet. Now, I learned that the hard way myself. When I was in my early 40s, I was having a terrible time eating all these carbs and having all these symptoms, took the carbs out of the equation and no problem, so I really think that some people, maybe as we get a little bit older, a lot of these functional GI issues start in our mid 30s and 40s, our digestion just may not work quite as well. You might not be able to put your finger on exactly what it is, but if you’re not digesting and processing carbohydrates well, digesting these things is a real finely tuned collaboration between our own digestive powers and the ability to use bacteria to help us out. If we overwhelm them and then throw in a couple of these other potential underlying causes, I mean, you’re in real trouble.  There’s a handful. I have a whole chapter on this if people want to read more.

Dr. Weitz:                            Yeah. It’s interesting, I think a lot of us in the functional medicine world, when we are putting patients on treatment protocols, I know myself, we usually use a diet that’s designed to have less fermentable carbohydrates. I typically use the Low-FODMAP Diet. Now, you’ve looked at some of these diets, like the Low-FODMAP Diet, specific carbohydrate diets, some of these other diets that are popular, and you found some problems with those diets and so you came up with your system. Maybe you could tell us about your Fast Tract Diet and your fermentation-potential figure for being able to analyze, quantitatively, which foods to include.

Dr. Robillard:                      Sure. This story goes back quite a few years, 15 years ago is when I really found that very low carbohydrate helped my GERD symptoms, started looking into this, and so that’s not on your list, right? You mentioned FODMAP and specific carb diet, but just a low carb, even a ketogenic diet, I use ketogenic diet in my own consultation practice as a troubleshooting tool. We’ll get into the Fast Tract Diet in a minute, but it allows some carbohydrates, kind of a flexible approach for people with different dietary preferences. Jasmine rice is better than basmati rice, for instance, for reasons we can talk about, but what happens if, well, even the jasmine rice I’m having IBS symptoms or heartburn symptoms”? Okay, well, there may be a problem for you even digesting the easier to digest starch.

For instance, jasmine rice has amylopectin, an easier to breakdown starch, some people have trouble even with that, so I’ll go to a ketogenic diet just as a troubleshooting method to say, well, let’s take all the starches out and see how you do. Why did I come up with this diet? Well, initially, I had just found low-carb diet works, but when I came up with this theory about the underlying cause of reflux, linking it to bacterial overgrowth, similar to what Pimentel was doing at the same time with IBS, I was doing with acid reflux, when you limit all of the carbs that seem to be okay, so I had written a book on just this mechanism. I just wanted to get out there, it’s a new theory, new way to look at acid reflux.

I was living not too far away from you at the time in Thousand Oaks California, and I was pretty close to Dr. Mike Eades who was living down in Santa Barbara, he and Mary Dan, his wife, also an M.D. who wrote Protein Power, their book was the first time I ever read about any kind of diet ever, and it was to go on this low-carb diet. I noticed, in his book, which he had written in the mid-90s, he said, “Oh, by the way, we have patients that their heartburn improves on a low-carb diet,” and I’m like, “Ah, that guy speaks my language,” so I sent him my book on the mechanism. Well, actually, I didn’t just send it to him, I was going to send it to him, but when I had him on the phone, I said, “Gee, I’m gonna be at the farmer’s market down in Santa Barbara,” we agreed to meet and I gave him a copy. We became friends, drank some wine together, and we’re talking about this stuff, and he was the one that really asked a key question, he said, “Well, low carbs is helping heartburn, we know that, and now we know there’s a mechanism for it,” and he bought in fully into my theory.

He thought it made sense, and there’s a lot of evidence for it, but he said, “You know, which types of carbohydrates are the most problematic?” That one question sent me on my way for another couple of years of research. I wasn’t really aware much of the FODMAP and the specific carb diet. I think I had, at some point, read Elaine Gotschall’s book Breaking the Vicious Cycle, I can’t remember exactly when, so I was aware of that, but I was just thinking about which of these carbs are hard to digest? I didn’t have any specific lenses on except just look at these, so I came up with lactose, fructose, and, of course, polymers of fructose, those are actually dietary fibers, resistant-starch fiber and sugar alcohol, so there’s five.

The next step was to come up with a way to quantitatively measure these in foods because you pick up a pear, how much of these five things are in that pear? Who knows. Give it to the best dietitian in the world, she might not know either, or he. I was thinking about this problem, and by the way, the specific carb diet, it limits disaccharides, it limits grains and starches but not honey. That didn’t cover these five that I was interested in, and the same with the FODMAP diet, which, right, Fermentable Oligo-, Di-, Mono-saccharides and Polyols, so some of the monosaccharides like fructose, polymers are fructose, sugar alcohols, polymers of galactose, for that matter, too, but not fiber or resistant starch.  I think the reason not all these diets cover it is because they either just don’t think some of these are very fermentable or they just think they’re so darn healthy for our gut that we need to include them. I came up with the five, I came up with the FP calculation to quantitatively measure them, but many years after I wrote the first Fast Tract Digestion book, I came across this textbook, can you see that?

Dr. Weitz:                            Yeah.

Dr. Robillard:                      Textbook of Primary and Acute Care Medicine, it’s fat.

Dr. Weitz:                            Wow.

Dr. Robillard:                      A lot of good stuff in there, but this book was published in 2004. It’s used to train doctors, but I think some doctors might have skipped the chapter on intestinal gases because when you go to page 1192 and open it up and read it, there’s those five carbohydrates that the Fast Tract Diet restricts, so it’s not that far out there. It’s aligned with this Textbook of Primary and Acute Care Medicine, that’s why I chose those five and why I developed my own diet that was low-carb keto is a great approach. The other ones, I think they’re missing a couple, and I think that can be challenging for some people if they’re having problems.  There’s so many different types of fibers and we know some of those are very fermentable, stachyose, ravinose, various other polymers of sugars. I think you need to limit all five, and then the other thing was I needed to find a way to do it quantitatively, so I could make the diet something people could use. In the books, in the mobile app, the Fast Tract Diet mobile app, there’s all these tables of all these foods with these FP values. The FP calculation, it took me a long time to figure it out because I didn’t know how I was gonna measure the five carbohydrates in a way that you could just look at any food and say is there a lot of fermentable material in this or not?

I struggled with that issue, and for a while, I started thinking about the glycemic index instead of thinking, well, that measures how quickly carbohydrates go into the bloodstream, must be some way to use that. I was just, I don’t know, kind of dense thinking about it at first, but as I thought about it more and more, eventually I realized that it wouldn’t be that hard to modify that equation, flip it around and modify it because instead of measuring carbohydrates going into the bloodstream, I wanted to measure how many carbohydrates were persisting in the small intestine and not being absorbed. I turned the equation around, but because the glycemic index equation does not measure fibers or sugar alcohols, I needed to add those back after, so I flipped the equation around. Then, after that first part of the calculation, you add dietary fiber and any added sugar-alcohols, and so all you need is the glycemic index and the nutritional facts for any food and you can do this calculation.  Of course, the app has a calculator for this, but also, it has tons of table sets. We’re releasing a new version in the next month, we’re about 10 months behind releasing this, but it’s going to have over 1,000 foods in it now. It’s got voice recognition on it, so if you just open it up, I have it opened up now, search. Whoops, I pushed on the happy face instead of the other thing.  Carrots.  You can bring up carrots raw, and you can cook them after, by the way, but it will just tell you what the fermentation points are for any given serving size.  And if the points are too high and you still like carrots, just use a few less. Use half the number of carrots, it will cut the servings, it will cut the points in half. That’s how it works, in a nutshell.

Dr. Weitz:                            Is there a quantitative amount of FP points somebody’s supposed to have in the course of a day or is that related to their total caloric intake, or how does that work?

Dr. Robillard:                      No, that’s a good question, it does matter a great deal.  In fact, we’re listening to our readers on this one.  We had initially set a flexible range between 25 and 35 points, and just to put that into perspective, 30 grams of undigested carbohydrates that are fermented by bacteria can allow bacteria to produce 10 liters of gas, so just an ounce of these carbs can drive a whole bunch of gas production, that’s why you do need to limit these.  Typical western diet may have 150 or more FP points a day, so that’s 50 liters of gas, that’s a lot. We wanna get that level down, and so we recommend somewhere between 25 and 45, depending on if you have a lot of severe symptoms, you want to go to the lower end, and as you get better and start improving, you can increase up to more than 45, but you’ll probably never really be eating 150 a day again if you’re somebody that suffers with these functional issues.

We have a Facebook group, Fast Tract Diet Official Facebook Group, people should join. There’s about 8500 members on there right now sharing recipes and talking about all this stuff. We have a lot of groups of people with these different conditions, not only IBS and SIBO, acid reflux, we have people with laryngo-pharyngeal reflux, real subtle irritation in the throat and vocal chords, it’s linked to reflux but it’s subtle, but it’s also persistent and it’s hard to get rid of. We’ve had people on the page, many of them, saying, “Well, this irritation’s persistent, subtle, but you know what?  If I really was diligent with my points, I had to go less than 20, down to 15, and I had to do it for weeks,” and some people months, and finally their throat symptoms would get better when nothing else worked.  They were driving this with us and they were saying, “You know what?  You’re not cutting the points enough, you have to cut more,” so we’re learning from them.  We’re involved in a clinical study where we’ve actually reduced the points based on what people on our Facebook group are telling us.

Dr. Weitz:                            Interesting.  I wonder if there’s an issue with pre-diabetic or diabetic patients, because your program is actually promoting consumption of foods that have a higher glycemic index, right?

Dr. Robillard:                      I never thought about it as promoting.  It is a flexible eating plan, right?

Dr. Weitz:                            Right.

Dr. Robillard:                      Yes, if you were going to have rice, rather than Uncle Ben’s or basmati white rice, because a small bowl of those is going to give you a whole lot of points, maybe 10, 20 points, depending on how big the serving size is.

Dr. Weitz:                            Partly because those foods are digested slowly, right?

Dr. Robillard:                      Yeah, yes.

Dr. Weitz:                            It makes them more preventable.

Dr. Robillard:                      So far, I’m making your point for you, yeah, versus a jasmine or sushi rice has a higher glycemic index, hence a lower FP.  They’re more easily digested, more will go into your bloodstream, less will stay behind, so you’ll have less GI symptoms.  Now, what happens, though, your blood sugar increases, and so in the book we’re cautious to warn people about prediabetes metabolic disorders and diabetes, and people have to be responsible for their own blood sugar levels.  Somebody that doesn’t have an issue, or they’re an athlete, or they’re carb loading, or they’re a construction worker, so this book, a lot of different people are going to use this book.  Other people may have to really watch their carbohydrates, so a low GI, low GI carbs is one way to do it, but it is going to feed the bacteria a lot, so that’s the downside.

If you’ve got functional GI issues, your solution, in the end, will probably be a lower carbohydrate diet. That way you’ll have less blood sugar, you’ll also feel less of the bad guys in your guts, the overgrowing bacteria. We’re not telling people to load up on sugars, even if you look at our tables and the serving sizes.  I mean, there’s different categories on this app, so let’s just go down to rices, right?  Well, here’s the one we just talked about.  I’m gonna click on jasmine rice.  Cooked jasmine rice, all right.  What’s the total serving size?  I don’t know if you can see it there, but it’s a half a cup.  People with blood sugar issues, chances are they’re wolfing down a lot more rice than that, so we purposely, even though it’s low in FP points, we purposely tell people that, really, small serving sizes are better, lower carb is better, and eat slowly and chew well, which will also help digest these starches and some of these carbs better.

Dr. Weitz:                            I was surprised to see wine and beer, or light beer, on your list because these are fermented, but I guess there’s a difference between foods that are fermented and are fermentable, is that the case?

Dr. Robillard:                      Okay. Yeah, you’re bringing up a couple of points there. Foods that are fermented, right, there’s less carbohydrate in those foods when you consume them because the fermentation happens in a vessel, in a vat or a tank or a mason jar, right? The lactic acid bacteria, in the case of pickles, the yeast in the case of beer and wine, they’re using the sugars and they’re producing alcohol, right? Well, not in the lacto-fermented, they’re producing short-chain fatty acids and so forth, but in the beer and wine, they’re producing alcohol and they’re consuming the carbohydrates, so when you consume those foods, there’s less carbohydrates than there otherwise would be in there.  However, when it comes to beer, a light beer has many fewer points. I think it’s somewhere around six or something for a bottle of light beer, four to six maybe. No, I’m sorry, maybe three or four, but when you have a heavier beer, like one of my favorites, IPA, it has a lot more points because there are a lot more carbohydrates in there. Regardless of the fermentation process, you still have to look at, anyway, it’s gonna take me too long to find the drinks and open up the beers, but-

Dr. Weitz:                            Yeah, I got it.

Dr. Robillard:                      Yeah. I purposely watch my points on days when I’m going out with my buddies because I want to have a couple of IPAs, but they have more points, and so if I’m also eating french fries, and something like that, and I have a couple of these beers, it’s kind of like death from a thousand cuts. These points add up and then they really get you, and then you need a couple of days, two or three days, to unwind it. You have to pick your poison. Distilled liquors are fine because they have no carbohydrates at all.  Dry wines, red or white, are pretty low in points, and light beer is pretty low on points. From there you just have to conserve your points and pick your poison.

Dr. Weitz:                            Now, it’s common in the Functional Medicine community to put a patient on one of these restricted diets along with using some other protocols to try to get rid of the SIBO, and yet, once we’re done with the treatment period, whether that be one month, two months, six months, whatever that period is, it’s usually recommended that we try to broaden the person’s diet as much as possible. This is to make sure that we are bringing back in some of the fibers that are necessary to have a healthy microbiome and also to make sure we’re getting all of the phytonutrients from having that diverse diet, but you have a little bit different take on using your Fast Tract Diet, don’t you?

Dr. Robillard:                      Well, I do. I’ve been doing this for 15 years myself, and my own, which was terrible, chronic acid reflux, it was horrible.  I was choking in the middle of the night, reflux entering my lungs and all-day heartburn, it was a terrible situation, so I’ve been doing this for 15 years. I don’t worry so much about encouraging people to add back fermentable material. I find that when people get better, and the more you do stay lower FP or you control these fermentable carbs or focus on identifying and addressing all of these underlying conditions, like a lot of people with H. Pylori, they will say, “Well, I’m just not gonna do anything about it. I heard it’s not that big of a deal,” maybe when you’re younger, but in time, gastritis, loss of stomach acid, and you might need some help.  We have a consultation program where we really work on this, what are these things and what are the risk factors and what are your symptoms?  How do we mostly throw things out, but the things that are remaining, the few things that are remaining, we have to confirm and address those.  Of course, I’m a microbiologist, I’m not a doctor, so I give them my notes.  I’m a consultant microbiologist to them, they take my notes to their doctor and we work through these things.  You have to identify and address potential underlying causes, that’s one thing.  

As you reduce the fermentable carbs, work on the underlying causes, you’re going to have less fermentation, less bacteria there that make proteases that damage the enzymes and the tips of your villi, toxins, you may actually damage the microvilli and villi themselves, kind of like a mini version of celiac disease where you get some blunting, does occur with SIBO. As you have less inflammation, control your diet, look at these causes, your digestion will improve.  I do like to encourage people I work with to broaden their diet, in terms of three food groups, low FP vegetables, and there’s a lot of those.  If you look at the vegetable lists and apps, there’s, I don’t know 180 vegetables, fresh herbs, but low FP, fresh herbs, low FP fresh vegetables with the idea of a diverse diet.  They do have some fiber and some fermentable material, just not as much, but diversifying it will diversify your gut microbiota.  Fresh vegetables, fresh herbs, and then also some small servings of some fermented foods, lacto-fermented pickles, kimchi, sauerkraut, that kind of thing, maybe a little bit of yogurt, just don’t go overboard.  That’s a nice mix, but this thing about immediately feeling like you have to come back with a ton of fiber, I think that’s misguided. I think I might be one of the only ones out there, at this point, arguing against too much fiber. Everybody just seems to think we’re starving our microbiota.  I just don’t believe it, especially if you have an animal-based diet with some fatty fish and you still have plenty of green leafy vegetables and you’re consuming some nuts, to me, that is an ancestral diet and a healthy one.

I feel like people, when they get better, they can be the best judge of what they can tolerate.  I feel like I don’t have to ram fiber down their throat.  On that topic, I was reading a review by, his name’s William Chad, I haven’t met him yet, a gastroenterologist up in Michigan who I hope to meet at this upcoming SIBO conference because he’s a GI guy doing work on diet, it’s just great to see.  He wrote a review, co-authored it with, I think, one of the Australian folks that works on these diets, on fiber, and they are on the same page with me.  They recognized there’s so many different types of fiber and their fermentability is so different, and so they worked, well, what’s the fermentability of all of these diets?  I have a chapter on that in the Fast Tract Digestion books where I do the same thing, and they reach the same conclusion, psyllium, cellulose, something like that’s less fermentable, and if you’re gonna play around with anything, maybe start there, that’s the less invasive of all of these other ones because some of the other ones are very fermentable. There’s papers on using these.  People that had GERD, they gave them fructooligosaccharide, right?  A polymer fructose, but it’s a mini dietary fiber, and their reflux, they were measuring it with probes.  The reflux occurred much more frequently, it was much more severe, and they had terrible symptoms, so that’s a prebiotic.  They gave people with GERD a prebiotic and they really almost killed them.  I mean, it was terrible symptoms and terrible reflux.

Dr. Weitz:                            That’s very common in the Functional Medicine world right now, is prebiotic supplements.  You even see doctors saying, rather than use probiotics, it’s much more important to use prebiotics, and it’s definitely very popular right now.

Dr. Robillard:                      Yeah, it is.  I’m not against prebiotics in very small amounts or a little bit of experimentation.  Some people are worried about taking a probiotic because some of these probiotic contain a prebiotic with the idea that it’ll help get these bacteria going once you swallow them and they get into your intestines, but if you look at the label closely on those, they typically add about 50 milligrams of one of these prebiotics, which is really a tiny amount.  It’s less than a 10th of an FP point because an FP point is a gram.  One FP is one gram of fermentable material.

Dr. Weitz:                            Yeah. I think part of this putting the prebiotics in afterwards, also, after your treatment period is part of the 4-R or 5-R program that’s been so prominent in the functional medicine world and pretty much accepted as one of the few biblical versus in the functional medicine world, which is that first you get rid of the bad bacteria and then you replace and repopulate with bacteria and prebiotics with probiotics and prebiotics.

Dr. Robillard:                      Yeah. I mean, my favorite way to repopulate is just to have an organic garden and a compost pile. That’s what I’ve been doing my entire adult life, flipping the compost and growing my own garden so I get away from the chemicals for a lot of the year. We’re harvesting some squash right now, we’ll put them in a basement, they’ll still be good next spring. If you make some pickles, those will last you another winter. There are ways to eat less chemicals.  Also, when you eat some of your vegetables raw, I mean not all of them, cooked vegetables are little bit easier to digest, but at least some of them raw, some grains. We grow a lot of dill and parsley and basil, then you are repopulating your gut with bacteria from your environment. By the way, they’ve done studies on compost piles. There’s a lot of similarities between the microbes in our gut and what’s in a compost pile. A lot of the same groupings of bacteria.  That would be my preference, yeah.  I’m not a real nut for the prebiotics unless they’re in limited amounts.

Dr. Weitz:                            Right. I’d like to ask you one more question because I know we need to wrap up soon. From reading some of your articles, you’re generally not recommending a lot of nutritional supplements. You do recommend digestive enzymes and ox bile and probiotics, but you don’t particularly like herbal antimicrobials, and I think these are a common part of many functional medicine protocols for SIBO. I know myself, we typically put the patients on one of these restricted diets and include these antimicrobials, and the thought is first we’re gonna starve the bacteria and then we’re gonna try to kill them using natural agents like berberine and oregano oil, et cetera, et cetera, but you’re not a big fan of these?

Dr. Robillard:                      Yeah. I mean, I could see why there’s a temptation to do that. I’m not totally against it. I spent 10 years working on and developing antibiotics. I worked on the development of Cipro, I’ve studied a mechanism of action of antibiotics, I’ve studied mechanisms resistance and the genetics of antibiotics, so I’ve worked on them for along time, they can be lifesavers.  I mean, they’re very important. I’m against the loose use, I guess, of antibiotics because of resistance and a lot of problems. I really want to see diets continue to be improved and refined, and a lot of people have eating disorders or preferences and it’s hard for them to change their diet, I understand that. “I’m a foody,” I hear that a lot, “I wanna eat what I wanna eat.” I get it, but I have more of an ancestral health perspective and I’ve been reading more and more about this over the years and it just makes so much sense, that the more we can eat like our ancient ancestors, that’s really the way we evolved, but of course, it’s not exactly the same today. The foods not the same.

The Western diet is just not only terrible but also the availability of all of these snack foods, it’s just too easy to eat these things, and so it’s harder to change your diet. Also, our microbiota is changing, especially since the invention of antibiotics and the clinical development of antibiotics in the 40s, that’s only been, what, 60 years, it’s having a huge impact on our gut. Also chemicals and preservatives, so our gut bacteria are not the same, they’re not nearly as diverse. If you go back and look, and Jeff Leech has done some great work living with and eating like and sampling the guts of the Hadza in South Africa. Their guts are much more diverse and much more in touch with the biosphere than we are.

We’ve got this gut microbiome that’s gotten used to eating more processed foods, more easy to digest food, and then, all of a sudden, we’re getting all this advice, well, if you wanna be like the Hadza, you better throw some of this fiber at it, but your gut microbiota and your digestive tract is not handling it well. You can keep fighting it or you can just say, “Well, I have to go with it a little bit, but I still wanna eat healthy, green-leafy veggies,” occasionally maybe a half of a sweet potato or a half a cup of rice, for some people. You also have to consider, you mentioned diabetes, but also, how about cardiovascular risk? It’s huge. I don’t know if you follow the work of Ivor Cummins and Jeffery Gerber, but they just came out with a new book that’s super, and follow their lectures.

Dr. Weitz:                            What’s the name of the book?

Dr. Robillard:                      Eat Rich, Live Long, I believe. Yeah. I just started reading it myself, but yeah, you can also google Ivor Cummins lectures, just phenomenal stuff.

Dr. Weitz:                            Okay.

Dr. Robillard:                      Really looking at things, starting out from the basics and saying, “What’s important? Is LDL really that important?” Turns out, actually, it correlates very poorly with cardiovascular risk, but you know what all correlates really well? Insulin. It’s just fascinating lectures, I can’t say enough for their work.

Dr. Weitz:                            I’m not sure if you’re distinguishing between antibiotics, which are prescription medicines, and oregano oil. I totally agree that antibiotics, especially broad spectrum antibiotics, have a negative effect on the microbiota and can have harmful effects, but generally speaking, my understanding and my reading of the research is that these herbal antimicrobials don’t have a negative effect on the microbiota.

Dr. Robillard:                      Yeah. Okay, so I didn’t cover that, let’s cover that. First of all, when you look at the history of antibiotics, most of them came from other living things, back in the day, anyway, from bacteria, from fungi, and then the Germans started to figure out how to use chemistry and sulfur drug, came up with sulfur drugs and so forth, and then it grew from there. A lot of regular commercial antibiotics come from other organisms, so do these herbal antibiotics, and while I would say you could put them, maybe, on a less invasive scale than some of these more powerful pharmaceutical antibiotics, every antibiotic is going to kill or inhibit, right? Some are cidal, some are bacteria static, are going to kill or inhibit a certain variety of bacterial types, and they’re also going to have a certain potency, right?

What is the concentration of antibiotics you need to get to to kill those particular microorganisms? With herbals, and there is that one study, is that also, I think that was John’s Hopkins as well. It’s funny, all these study’s from John’s Hopkins, talking about using berberine, some other herbals, and they were as good as Rifaximin, so I think that’s interesting and it’s good to look at. Maybe they’re not as bad, but we don’t really know that much about it.

A lot of the work for those has been done on the side, outside of the mainstream, and I do think we need to learn more. By the way, when you say something as good as Rifaximin for treating SIBO, you’re basically saying, if you look at the target studies, that’s 10% better than placebo. I think diet, behaviors, and identifying and addressing underlying issues, those three things should be front and center. If you don’t do that, I think you’re dead in the water. After that, then you can start to look at supplements, digestive enzymes, absolutely.  If there could be a stomach acidity issue, betaine, right, some vinegar, work your way down. Somewhere, herbals are in there as something to try, but for me, at least, and for people that I work with, I just don’t know enough about it to really be too gung-ho.

Dr. Weitz:                            Have you used motility agents like ginger and 5-HTP, things like that?

Dr. Robillard:                      Yeah. I think, again, there’s a whole thought that motility is slow because something’s wrong, right? That could be, and yes, with the vinculin and then the gastroenteritis, absolutely. There may also be an adaptation too, depending on what you’re consuming, right, because bacteria want to help us get all of those calories out of the food. Our bodies are collaborating with the bacteria, so depending on what you’re eating, your motility could speed up or slow down for a whole variety of reasons, it doesn’t really mean something’s absolutely wrong.  Also, you do have to look at the extremes of diet, as well. I was reading a study the other day that, in anorexics, they found that they had a spike or an increase in these archaea organisms, Methanobrevibacter smithiii, that produces the methane, so it makes me wonder, under extreme caloric deprivation, is this a mechanism to make sure you ring every last calorie out of any kind of vegetative matter you consume by these archaea going up and motility slowing down? I first try to look at everything in terms of what could the natural mechanisms be here. Am I smarter than 50 million years of evolution? No.  I just have a little more of a cautious approach. I try to really understand before I just jump to try this and try that.

Dr. Weitz:                            Awesome. Thank you Dr. Robillard. This has been an amazing podcast, gives us a lot to think about. How can listeners get a hold of you and get your books and your programs?

Dr. Robillard:                      Sure. Well, you can find us at DigestiveHealthInstitute.org, and I would also encourage people to join the Fast Tract Diet Official Facebook Group. I’m on there most days, poking in here and there and answering a few questions, but there’s a lot of people that have become real experts on the diet, and they’re very helpful as well. I think those are the two main places to find us. If you wanna specifically look at the mobile app, you can go to FastTract, T-R-A-C-T, Diet.com. You can find those on iTunes and Android store, as well.

Dr. Weitz:                            That’s great.

Dr. Robillard:                      Thanks for having me, Ben. It’s great talking.

Dr. Weitz:                            Thank you Norm. Yeah, I really enjoyed the conversation.

Dr. Robillard:                      Me too.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Toxic Mold with Dr. Jessica Tran: Rational Wellness Podcast 79
Loading
/

Dr. Jessica Tran discusses how to avoid and correct Mold Toxicity 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

6:05  The diagnosis of mold toxicity is difficulty to make, since the symptoms like fatigue, joint pain, skin rashes, respiratory problems, cognitive and neurological issues, fatigue, and headaches could be indicative of many other conditions.  Mold may be a diagnosis of exclusion, after other causes have been ruled out.  Patients with dementia or Alzheimer’s may have mold toxicity as a trigger.  In fact, Dr. Tran said that she has seen a handful of patients with triple negative breast cancer who have all had tremendous mold exposure.  Patients who have multiple chronic illnesses, say somebody who has hypothyroidism, Lyme infection, allergies, etc. will often have a mold allergy or mold sensitivity or a mycotoxin issue.  We can get mycotoxins from our food, which most people will eliminate on their own.  But these patients may have a compromised ability to eliminate mycotoxins.  The key is to take a good, detailed history.

14:12  Dr. Tran likes to screen patients who she suspects of having mold toxicity with a urine test through either RealTime Labs or Great Plains but she likes to have them take either liposomal oral glutathione 500 mg three times per day the day before or an IV Glutathione drip or push the day before collecting the urine.  This will increase mold excretion.  Without doing the glutathione challenge, you can have someone who has been exposed to mold and is reacting to it, but they may be a poor excreter.  It may be stored or stuck in their body and not coming out.  It’s the same concept when you test for heavy metals and do an oral chelator challenge and then test the urine. Dr. Tran talked about the Autism study when they looked at the baby’s first haircuts looking for mercury to see if mercury was related to autism. But they found the opposite–those with autism had lower levels of mercury. But what this study really showed was that the autistic kids were poor mercury excreters.

20:25  The best ways to test your home for mold is to contact a mold expert to come and impect your home or office.  If you want to test it yourself, the ERMI kit is better than the HERTSMI, since the ERMI looks at more forms of mold and is more extensive than the HERTSMI.  If your budget is very limited, you can get a petri dish from Home Depot or Amazon and just leave it in your home for a couple of days and then mail it in and they send you a report.

21:57  A Functional Medicine approach to treating mold problems should include looking at the whole person and also look at food allergies and other environmental allergies. For the mold component, treatment should start with glutathione, either liposomal or intravenous. You should also add phosphatidylcholine, which helps improve the lipid membrane. Dr. Tran says she may also use binders like psyllium, bentonite clay, and/or activated charcoal.  She finds that cholestyramine is fairly harsh, so she does not use it.  Dr. Tran will also look at the gut, esp. since mold has a relationship with candida overgrowth. 

 



Dr. Jessica Tran is a board-certified Naturopathic Doctor who is practicing Functional Medicine at the Wellness Integrative Naturopathic Center in Irvine, California, where she practices with Dr. Darin Ingels. The website is WellnessIntegrative.com and she can also be found at DrJessicaTran.com   Dr. Tran’s office phone is 949-551-8751 where she sees patients in office or remotely. 

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. Dr. Ben Weitz here. 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 and review. That way, more people can find out about the Rational Wellness Podcast.

Our topic for today is toxic mold, its effect on our bodies, and how to get rid of it, with Dr. Jessica Tran. Exposure to mold and mold toxins, known as mycotoxins, affects many people and often is an undiagnosed underlying trigger for many other symptoms and conditions.  Many people are unwittingly living or working in water-damaged buildings, and this exposure may be causing many negative effects on their health including skin rashes, respiratory problems, cognitive, neurological issues, fatigue, headaches, joint pain, even increased urinary frequency, and a list of other symptoms. When looking at a patient from a functional medicine perspective, we usually focus on likely underlying triggers and root causes of their health condition, and mold may be one that is sometimes overlooked.  Research indicates that mycotoxins can bind to DNA and RNA and cause damage, alter protein synthesis, increase oxidative stress, deplete antioxidants, alter cell membrane function, act as potent mitochondrial toxins, and alter apoptosis, which is important for killing off cancer and other cells that we don’t want in the body. Molds and mycotoxins can negatively affect our hormones including our sex hormones, thyroid, and adrenal function. In some cases, POTS, postural orthostatic tachycardia syndrome, fibromyalgia, chronic fatigue, and a bunch of other conditions can be caused by mold exposure.  Other conditions that may have a mycotoxin component include various cancers, diabetes, atherosclerosis, heart disease, hypertension, autism, rheumatoid arthritis, lipid problems, Crohn’s disease, Sjögren’s syndrome, MS, Alzheimer’s disease, et cetera. 

This is why we’ve asked Dr. Jessica Tran to join us today. Dr. Tran is a board-certified naturopathic doctor having completed her naturopathic degree from Bastyr University. She also completed a three-year specialty environmental medicine fellowship, and she also recently completed an MBA in health care from UC Irvine.  Dr. Tran is extremely knowledgeable about mold and mycotoxins and environmental conditions, and this is why we’ve asked her to join us to share some pearls of wisdom with us today. Dr. Tran, thank you so much for joining us.

Dr. Tran:              Thank you so much for having me. I’m excited to be here.

Dr. Weitz:            Excellent. How did you become interested in environmental medicine and studying mold and patients suffering with mold toxicity?

Dr. Tran:              It was through my fellowship program at Southwest that I became more familiar with mold. It was never on my radar. It wasn’t anything I ever learned in undergrad or even living in Seattle where it’s very moldy and damp. I rarely had encountered anyone or any patients that came in for us with symptoms that remotely resembles mold, toxicity or mold allergy. I was probably seeing them, but it wasn’t anything that was exposed to me at that time.

Dr. Tran:              In my fellowship program, because I was at the Center of Environmental Excellence there, we saw patients from around the globe, and it was there that I had patients come in, and it was through my mentor and faculty director who through our history uncovered that patients who were living in water-damaged homes or had exposure to mold had chronic illnesses that after seeing 40 or many, many different doctors, their symptoms and condition wasn’t resolved.

One of the things that really fascinated me was that you can have mold exposure and not even see it in your home because it could be behind the drywall of the home, and patients would usually have a history of, “Yeah, we had water damage. We cleaned it up,” or, “The toilet overflowed,” but we then … Part of the fellowship program, you learn about building practices and how to ask certain questions. We have our patients or a home inspector go in, take a look, and lo and behold, sometimes people would have black mold behind their shower wall or in their bathroom or even in their home or kitchen sink, roof leak, and that was really where I learned a ton about patients who were exposed to mold and having mycotoxin issues.

Dr. Weitz:            Cool. So, what would make you suspect that a patient that you’re dealing with may have an underlying mold problem that’s part of their health struggles, especially when symptoms of mold toxicity could also be caused by a number of other things?

Dr. Tran:              That’s the hardest aspect. It’s usually for most … As a general practitioner, it’s really hard to know because patients are coming with fatigue, joint pain, and all these other things that are so many different things that you can have value … they have … For me, sometimes, I’m one of the last people that patients see, and it’s a diagnosis of exclusion. If it’s something that a doctor hasn’t looked at, it’s something that I usually ask. One of the things that are strange, rare, peculiar, or that patients will come and being overlooked is patients with dementia or Alzheimer’s.  To this date, I’ve had a handful of patients who have triple negative breast cancer, and hands down, every single person has had a tremendous mold exposure. So there’s certain cancers that I believe-

Dr. Weitz:            Wow.

Dr. Tran:              Wait. We don’t know if it’s the culprit, but it’s definitely an association that we see. It’s definitely something that’s, for me, just my bias is strongly correlated that I see in my practice. We take an environmental perspective, environmental history, and part of the history, somebody who has many chronic illnesses, I would say three or four conditions, like hypothyroidism, Lyme infection or other allergies. Most of them will struggle with a mold intolerance, and that could be mold allergy or a mycotoxin issue.  The mycotoxin issue, we get mycotoxins from our food, right? So we’re all exposed to mycotoxins to some degree. Our body naturally will eliminate mycotoxins on its own. But as you know, people who struggle with metal issues, their ability to eliminate may be slowed based on their genetics. So they may have a compromised ability to eliminate. Even though, naturally, we all have the ability to eliminate it, some people eliminate slower than others, and because it’s slower there’s a buildup that occurs, and we develop this toxic burden, and it’s not just with mold, it’s with other things like metals in the environment, glyphosate, like different herbicides. You know, pesticides we’re exposed to also.  So it’s the totality of everything that we have to look at. But definitely, the mold mycotoxin issue is huge, and it’s hard to really know if it’s how big a factor it is.  I’m always asking a patient about whether they have water damage in their home, and most patients who are mold-sensitive will know because through their history, with their itchy eyes, runny nose. When they walk into a damp room, they’ll know. Others may not. So it’s a good history, is what I’d say.

Dr. Weitz:            So what percentage of patients that have symptoms of mold toxicity or that do have mold toxicity know that their home or office has mold that they’re getting exposed to?

Dr. Tran:              Surprisingly, I believe, and maybe my patients are more educated. They will say to me, “I think my home … ” Maybe I’m mold-sensitive because I’ve read about it online. But for most patients, I don’t think … They don’t suspect because it’s never anything that they’re clued into.

Dr. Weitz:            Right.

Dr. Tran:              So I actually believe it may be more diagnosed than we ever realized it to be because it’s something, but it’s not really talked about or taught in conventional medicine. Most conventional practitioners will send a patient to an allergist. The allergist will do a skin scratch test. It may not even show up because the mold, allergy is not IgE-mediated–it may be a delayed response. So we may-

Dr. Weitz:            An IgE or IgM reaction.

Dr. Tran:              Yeah, so there are patients who are immune-compromised that are more susceptible to getting certain mold infections, especially in their lungs. When patients are immune compromised, that’s recognizing how much medicine. But for people who have a low-level toxin exposure with mold accumulation, it may be overlooked.

Dr. Weitz:            You mentioned triple negative breast cancer, and we’ve had a few patients with that over the years, and that’s really a grim prognosis, very hard cancer to treat. Do you find that treating the mold increases their prognosis?

Dr. Tran:               It’s hard to say. But in my experience caring for these patients, with triple negative, their prognosis is better, and I think it’s because we’re doing everything else, right? We’re changing their diet. We’re helping them change … decrease stress. I think it’s everything together. But I say that with the triple negative breast cancer because there isn’t anything … The prognosis is terrible. Some patients go around different chemotherapy agents, which usually have no evidence, which blows my mind because it’s supposed to be a research … science-based.

Dr. Tran:               But I know they’re doing their best. They’re trying to find the best regiment for patients.  I find a lot of my patients with the triple negative breast cancer and comparing to people who decide to go conventional versus integrating Functional Medicine, alternative medicine aspect, they do better because of everything they’re doing, the diet, lifestyle, supplements and hormonal balance. Even though estrogen/progesterone isn’t playing a role, there’s cortisol, the adrenal glands, right? So that plays a role too. We have to address that.

Dr. Weitz:            Yeah, and I’m not convinced. Even though they’re estrogen-receptor negative that estrogen metabolism still isn’t important in these women.

Dr. Tran:              Oh, and it’s gut, right? Gut function?

Dr. Weitz:            Right, yep.

Dr. Tran:              Gut function’s essential, right?

Dr. Weitz:            Right.

Dr. Tran:             Our microbiome is very important. How our gut … You know, B vitamins are important. If the patient has dysbiosis, they’re most likely to have an altered level of beads. I mean, we know that there’s so many different co-factors in our body that we need for metabolism, essential detoxification. I really believe for triple negative and certain types of cancer, it’s the depletion of essential nutrients that leads to altered or uncontrolled growth of cells, right?  So that’s why when we see patients with certain cancers, we’re always looking at nutrient levels. How can we support them from that?  And food is medicine.  We start there first and look at how will they absorb.  We can see that we go through higher levels of intervention.  We may need like IV nutrient therapy.

Dr. Weitz:             Right. Do you find any tests useful for screening patients for mold toxicity? Such as, say, some of the urine tests?

Dr. Tran:              They can be useful, yes. So the caveat for that is that when you do these urine tests, it doesn’t tell you what your burden is. It tells you your level of exposure, and it tells you you’re able to excrete. Similar to toxic metals, so we … There are some people who are non-excreters. They don’t excrete well. What I do find in the patients who are poor excreters, they’re not going to have a high level of mycotoxins in their urine. It’s going to actually show a low level. It’s counterintuitive, but then what I learned, and I learned this through Dr. Tim Guilford that glutathione binds to mycotoxins.

So what I’ve done in patients where I know they’re living in a water-damaged home. I know they’re … They have every classic symptom that the urine test shows that it’s negative. I do a glutathione challenge. So the day before, I will either dose with liposomal glutathione throughout the day, with 500 milligrams three times a day. Or I’ll do an IV bolus of glutathione drip or push and then collect the next morning first urine void. Then you’ll see it.

Dr. Weitz:             Cool.

Dr. Tran:              I do have a case. I can show you with the lab results at the presentation. So whole family has exposure living in the moldy home, and there’s one … The mom has very high levels of leukotoxin, and of fragilis in the home, from air samples in the home. Her urine test shows that she’s exposed. Her friend who has developmental delays and issues, his levels showed very little, like nothing. Nothing excreted out. The interesting thing is that the son saw my colleague in the office, Dr. Ingle. I recommended the tests. He saw the results. He’s like, “Oh, okay. No exposure.”

Dr. Tran:              But when you look at … because they’re exposed. The kid has to have some excretion.  But what it tells me is that this kid is a poor excreter.  He’s probably very, very burdened but he’s not excreting well.

Dr. Weitz:            Did you do the glutathione and retest with him?

Dr. Tran:              Yeah, and so you will see when you do the glutathione and then you retest. You see a greater level of excretion, maybe not a ton. I have a handful of cases where that’s the case, where toxic mold exposure. Their practitioners will do … I see them. They will see other practitioners around town. They have a test. It’s negative, and I’m like, “Let’s try this. Let’s try a glutathione challenge test,” and then lo and behold you see a greater expression of mycotoxins, and I believe it’s because it’s stuck, stored or what not in the body, and not excreted well. We see that with metals. So it’s my experience in metal toxicology with the chelaters. I drew from that to apply in this situation.

Dr. Weitz:            Meaning when somebody comes in, you suspect might have heavy metal toxicity. Instead of just measuring their urine, you give them a oral chelater, and then you measure their urine the next day with the idea that the chelater is pulling the metals out that then will get excreted?

Dr. Tran:               Exactly. That’s the exact concept because we don’t really … When we’re doing a first morning urine challenge test either for mold or heavy metals, just first … No chelater. First morning void just shows us what the patient is exposed to and how well they’re able to eliminate. It doesn’t tell us what’s bound … For metals, we know this from metals really well, is that certain metals will bind very strong to proteins and make certain enzymes non-functional. It’s the affinity of these metals that bind it so strongly when you have a chelating agent on board, it pulls it off and then freeze it up, and then you excrete it out through the urine.

Dr. Tran:               So, same concept. I don’t know if you’re … Are you familiar with the autism study When they looked at the baby’s first haircuts and looking at mercury?

Dr. Weitz:            No.

Dr. Tran:               There’s a study looking … because we had believed that mercury was implicated in developing autism. So there’s a study that looked at babies’ first haircuts, and we expected to see a higher level of mercury excretion in kids on the spectrum. But the opposite was what the studies showed. It was in fact the neurotypical kids. The control’s had high levels of mercury versus the autistic kids, and that study demonstrates and illustrates the fact that the autistic kids are poor excreters since their genetics doesn’t allow them to excrete. That’s the takeaway from that study.

Dr. Weitz:            I see.

Dr. Tran:               We have a study similar, which I’ll talk about. Same thing with children on the spectrum do not excrete ochratoxin very well either. So you’ll see the control group will excrete really well, but the children on the autistic spectrum will not excrete ochratoxin very well. The study doesn’t take the leap to do a glutathione challenge test or anything. They hopefully one day will get there. But the research does show that there are people who just do not excrete very well.

Dr. Weitz:            Cool. So what’s the best way to test your home for a mold or mycotoxins?

Dr. Tran:               There’s different ways to test. So you can do a spore trap analysis. You have somebody come to the home, measure the spores in the home. You could do … The inexpensive way to do it is … I tell some of my patients. You can get a petri dish. You go to Home Depot or buy on Amazon online a petri dish mold, you know, test. Just put it in the home, and if you just leave it in there, in the home for a couple days, then you send it back and you get a report. It’s not very expensive.

Dr. Tran:               I usually recommend patients to get it evaluated by a mold expert or somebody who comes in the home. They can do the moisture test testing, looking at indoor mold samples and outdoor mold quality. There’s some people who will talk about the ERMI and the HERTSMI. So we’ll go over that at the presentation, the pros and cons. But in a nutshell, the ERMI is a more extensive evaluation. The HERTSMI is looking at the five molds, mycotoxins, like producing molds that Shoemaker believes are most … has the most adverse effects on our health. So those are the differences in a nutshell.

Dr. Weitz:            Okay, so let’s get into treating. So how do you treat a patient that we believe strongly or is confirmed from testing are sick from mold or mycotoxin exposure?

Dr. Tran:               For treating a patient, you also have to not only look at the molds. You look at the whole entire person. You have to look at the food allergies and there are other environmental allergies to get the best resolution. There’s some people who will just treat in isolation, like feel like we will do a disservice if you just do that. But there’s some people who just want just the mold component. If you look at just the mold component, what the evidence shows is that liposomal glutathione, IV glutathione does bind into the mycotoxins.  If we’re talking about mycotoxins alone, you know, glutathione, in conjunction with phosphatidylcholine, because it helps improve the lipid membrane, is essential because we know it impairs cellular … a lipid bilayer. So phosphatidylcholine is another oral or IV. It’s something that can be used. Looking at the gut microbiome is really important.

Dr. Weitz:            So it’s interesting. You talk about liposomal glutathione is something that binds to the mold. I’ve been hear people talking about liposomal glutathione or the forms of glutathione as a way to push the mold out and then using clay and charcoal and pectins and things like that to bind it.

Dr. Tran:              Yes.

Dr. Weitz:            One of the experts calls it the push-catch strategy.

Dr. Tran:              In my experience, if we had to pick one, glutathione’s my favorite.

Dr. Weitz:            Okay.

Dr. Tran:              The binders, yes. Some people like to use cholestyramine. I find that it’s really harsh. So there are other binders that are good like psyllium, bentonite clay, that’s good. It’s hard to find a good source of it too. It’s fairly inexpensive. Some people will take activated charcoal at nights.

Dr. Weitz:            Right.

Dr. Tran:              I think it’s essential for us to know how to schedule it so patients don’t deplete their nutrients more than they are depleting their nutrients.

Dr. Weitz:            Right, because those binders if they’re consumed at the same time with foods that have a lot of nutrients or nutritional supplements, they’ll bind with those two and take them out.

Dr. Tran:              Yes, yeah, absolutely. We’ll do a lot of gut work too when patients are exposed to mold. Some patients are like, “Why do I have to look … Why are you making me do a stool test?” I’m like, “It’s part of the evaluation,” because it’s not just … because mold has a relationship with patients with candida too.  Some people who have an overgrowth of candida will just experience symptoms of mold, allergy, and toxicity to a greater degree.  So we want to make sure we evaluate it, and we treat it appropriately.  That’s why I like the sensitivity testing, our functional comprehensive stool analysis, because we can actually treat with the correct nutraceutical.

Dr. Weitz:            Cool. Of all those binders, I’ve seen clay, charcoal, cholestyramine, chlorella, zeolite, modified citrus pectin, beta-sitosterol, glucomannan, diatomaceous earth. Can you sort those out? Or what are your two favorites? Or do you like to use some in certain cases?

Dr. Tran:              I would say my favorite would probably be the bentonite clay and activated charcoal.

Dr. Weitz:            Okay.

Dr. Tran:              And there are super soluble fiber products that I like to use too. I think fiber’s important because it also helps, and it really depends on the patient’s budget too. So, activated charcoal is relatively really expensive, and it is something that’s put on board for just to help. If they can do with different fibers, and we rotate the fibers, that’s something that I like. Some people can’t tolerate one fiber over the others. That’s why you have to understand what theIr intolerances are too.

Dr. Weitz:            Okay, interesting. Hey, have you noticed that we seem to be in this charcoal phase of consumer products? I mean, in fact, in my household, my wife had brought home a toothpaste with charcoal, a facial mask with charcoal. Occasionally, we have a treat of ice cream made from coconut, and they have a flavor that is charcoal ice cream.

Dr. Tran:             I think that’s a new trend and fad.

Dr. Weitz:           I mean, it’s … Everywhere is charcoal.

Dr. Tran:             I was with a friend this weekend, and I ordered a lemonade charcoal, and she was like, “What is this?” I’m like, “It’s lemonade charcoal. It’s a trendsetter.” We went and had an amazing bowl in Los Angeles, and it had charcoal, and she was like, “I can’t … Why is there charcoal in everything?” I’m like, “Just wait. In a couple of months, six months from now, it’s going to … support everyone there. But it’s trending here in LA. Yeah, it’s every … lemonade, yeah.

Dr. Weitz:           Yeah, I guess we haven’t had a new fruit that only grows in the Amazon that’s the new super antioxidants. So we got charcoal now.

Dr. Tran:             I could tell you about other exotic fruits that hasn’t been well talked about.

Dr. Weitz:           Oh okay. Maybe we could start a trend right here on the Rational Wellness Podcast.

Dr. Tran:             I’ll bring that to you next time, other botanicals and nutrients that aren’t trending yet that that we can tell about, yeah.

Dr. Weitz:           Okay. We’ll be the trendsetters. So when you’re treating a patient for mold or mycotoxin toxicity, do you have them avoid foods that may contain mold or … And do you have them avoid eating mushrooms, by the way, which is another trend is foods that have dried mushrooms in them, like reishi and chaga and whatever the latest trendy medicinal mushroom is-

Dr. Tran:             Cordycep.

Dr. Weitz:           … that’s put in coffee and tea and everything else?

Dr. Tran:             Yeah, so, it really depends on the patient’s tolerance, and that’s of the other thing is making sure we understand the patient’s food intolerances. In general, most providers who are treating patients with molds, they avoid all of it. Even avoid the mushrooms. Avoid cheese, everything. I find that some patients will be able to tolerate taking cordyceps or reishi for adrenal support when they’re mold sensitive, but there are other patients who cannot tolerate it. So it’s patient specific. You really have to identify their needs, yeah.

So as a blanket statement, I think, in general, sure, you can avoid. But I think mushrooms have such beneficial uses, and I also there are good uses of mold. Not all molds are bad.

Dr. Weitz:           But we could very easily say since these are common foods that have mushrooms, and they’re also very common allergen, say, avoid wheat, corn, cheese. There’s a few other common foods that also are probably irritating to the gut. You could easily take those out as part of your program and improve their overall health. Take out alcoholic beverages.

Dr. Tran:             Yes, yeah, you can.

Dr. Weitz:           Should we be using an air filter?

Dr. Tran:             Well, in Orange County, LA area, I think we should … air filter.

Dr. Weitz:           What’s the best kind of air filter to get?

Dr. Tran:             It depends on what you’re trying to eliminate. So what I tell patients-

Dr. Weitz:           Mycotoxins.

Dr. Tran:             So if you’re looking to get rid of mycotoxins and mold spores, you want to look for an air filter that has a MERV 8 rating at least. Each filter will have a different rating. I’ll show that to you in the presentation. There’s different types of air filters and qualities, and the issues of the air filter is … You can have charcoal, carbon filter, air filter, or you can have one with ozone. Then people will say that certain air filters will emit too much EMF. So you have to look at the EMF excretion. You know, the emission of EMF.

Dr. Weitz:           Yeah, I just did a podcast with Oram Miller, and he’s the EMF guy. He spoke in our last Functional Medicine meeting as well.

Dr. Tran:             One of my favorites air filter, which is the IQAir Air … You know, he and other people will say, “It emits too much EMF for certain patients.” So I like the IQAir, Blueair or the Austin Air are the three top air filters that … It was just passed down from me … I’m just regurgitating that information … and in our industry is what we recommend to patients. There are other ones like-

Dr. Weitz:           So what are those three again real quick?

Dr. Tran:             The IQAir.

Dr. Weitz:           IQAir.

Dr. Tran:            IQAir is big and bulky, but it’s beautiful. It’s quite expensive. The Blueair is nice and sleek.

Dr. Weitz:          So we can turn our home into a blue zone with the Blueair filter.

Dr. Tran:            Yeah. The Molekule, which is newer. I have one in my office. It’s-

Dr. Weitz:          Could you repeat that last one because you broke up a little bit.

Dr. Tran:            Oh, I apologize. My internet. I am hardwired, though. Is the Molekule. The Molekule is the last one that a lot of you were … or a lot of people have been talking about. I actually have three in my office. I love it.

Dr. Weitz:            Oh, wow.

Dr. Tran:               I have every single one in my office. I have the Blueair, Austin Air, just so that I can show patients the different types of air filters they can pick for their home. I think honestly, like anything at Costco is good too. If they want to go Target, most products at Target are sufficient too.

Dr. Weitz:             Yeah, but don’t buy your fish oil at Costco.

Dr. Tran:               I know. I don’t get that. But yeah, it’s interesting. But yeah, but quality of Costco fish oil is just …

Dr. Weitz:             Oh my God.

Dr. Tran:               We’ll talk about … I don’t know. Do you talk about that on your podcast because I don’t think the consumer, the public knows about the quality of their own fish oils.

Dr. Weitz:             I haven’t done a podcast just on that, but it’s definitely something I’m passionate about, but I definitely should.

Dr. Tran:               I have lab results for patients who take my supplement, and then they want to go to Costco to get it for less expensive, and their numbers change, and I’m like, “Well … ” I just don’t pay attention because my staff deals with the dispensary side. I mean, dispensing supplements, and I’m like, “Well, what supplement are you taking?” They show me this Costco bottle. I’m like I cringe.

Dr. Weitz:             Oh, I know, and it’s the size of a garbage can, and it costs $20, and you go, “What do you think?” You think you’re going to get caught?

Dr. Tran:              They’re like titanium dioxide. I mean, which is more than a lot of supplements and more patients can be safe. But there’s a lot of coloring and fillers, and I haven’t even … Yeah, you read the label, and you’re like, “Wow.”

Dr. Weitz:            I know.

Dr. Tran:              But it is something, and if it’s what they can afford, something is better than … But I don’t know. It depends on the situation.

Dr. Weitz:            Okay, Jessica. So thank you for providing us with some very interesting, useful information about mold. How can listeners and viewers get ahold of you? How can they contact you?

Dr. Tran:              At my office or through Gmail?

Dr. Weitz:            Yeah, yeah. Well, I mean, what’s your website? And you can give out your office phone number, and you do consultations in person, and do you also do them remotely?

Dr. Tran:              I do for certain situations, yes. So my website is wellnessintegrative.com. My office number is 949-551-8751, and I’m on drjessicatran.com. Instagram is Dr. Jessica Tran. I also have a Facebook page, I guess. People message me through that, my Facebook.

Dr. Weitz:            Okay, good.

Dr. Tran:              That’s Dr. Jessica Tran-Naturopathic Doctor.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Reversing Diabetes with Dr. Mona Morstein: Rational Wellness Podcast 78
Loading
/

Dr. Mona Morstein discusses how to overcome Diabetes with Dr. Ben Weitz.

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

 

Podcast Highlights

2:57  There are four or five main types of Diabetes:

  1. Type I is an autoimmune disease where a person’s own immune system attacks their pancreatic beta cells, and destroys it enough so that they cannot produce the insulin that the person needs to live. 
  2. Type II is the most common type and it is due to insulin resistance.
  3. Type 1.5 is Latent Autoimmune Diabetes of the Adult (LADA), which is type I that happens in people over 35, say generally 35 to 60 is where we see people getting a less intense type of type I, but can lead to the need for insulin.
  4. Gestational Diabetes, which is when a nondiabetic woman enters pregnancy, and then becomes a type II diabetic, generally due to gaining too much weight during the pregnancy
  5. MODY, mature onset diabetes of youth, which is diabetes because of gene defects, like when the beta cell produces insulin, but lacks a good gene to secrete it, or a cell doesn’t genetically have a good receptor.

5:34  Type II diabetics if poorly controlled or poorly managed, the high blood sugars cause oxidative damage that can destroy their pancreatic beta cells and these patients end up needing insulin, like type I diabetics.  And most diabetics are not properly controlled. 75% of type II diabetics do not get their HgA1c below 7 as recommended by the American Diabetic Association. And type I diabetics, if they end up injecting too much insulin in order to try to control their blood sugar–say 100 to 200 units a day–can develop insulin resistance like type II diabetics. Normally our bodies secrete between 30 and 40 units of insulin per day, so 100 units is a lot. The reason so many diabetics are poorly controlled is that we are only using a big pharma approach based around medications.  We need to use diet, exercise and lifestyle approaches to control blood sugar.  And most of the drugs do not directly affect insulin resistance, except for Metformin, which deals a little with insulin resistance. But Metformin’s main job is to decrease the liver’s production of glucose. The TZDs like Actos and Avandia were directly affecting insulin resistance, but they are not in broad usage because of all their side effects. The 2nd most common category of drugs for diabetes are the sulfonylureas, like Glyburide and Glipizide, which can cause weight gain, hypoglycemia, and they can aggravate insulin resistance. They also don’t significantly reduce the HgA1c. The DPP4s like Januvia lower the HgA1c at the highest dose say 0.5%, but a low carb diet can take someone who’s at 10 and lower them down to 6 in 3 months. There is no drug that can do what diet, exercise and lifestyle changes can do, what a Functional Medicine approach can do.

13:30  With type I Diabetes you have a gene that can turn on and give you type I Diabetes and then we have to look at what factors might turn this gene on.  These could include gluten, dairy, vaccine, environmental toxins, family stress and nutrient deficiencies.  Finland has the highest rate of type I Diabetes and they have done studies showing that giving newborns vitamin D and fish oils reduces the onset of type I.  Celiac disease can lead to type I diabetes.  Leaky gut seems to precede type I diabetes in many kids, so the gut is an important factor. 

26:16  When it comes to type II Diabetes, eating refined sugar, refined grains, junk food, and fast food and lack of exercise are important causative factors.  But Dr. Morstein also believes that saturated fat intake can play a role in worsening insulin resistance. If you are getting too much saturated fat without omega 3 fats to offset it, this will make diabetes worse. Here is a reference: Dietary fat, insulin sensitivity and the metabolic syndrome.

30:06  The lab testing that Dr. Morstein recommends for patients with diabetes include the following:  

  1. CBC
  2. Chem screen (liver, kidneys, etc.)
  3. Ferritin, which is the best early sign of fatty liver.
  4. Fasting glucose, HgA1c C-Peptide, which tells us how much insulin your pancreas can secrete, insulin (as long as they haven’t injected insulin)
  5. GlycoMark is a test that gives you a better idea of blood sugar control than HgA1c because it picks up blood glucose excursions better.
  6. HsCRP for inflammation
  7. Testosterone in guys.
  8. Red Blood Cell magnesium and zinc.
  9. Fibrinogen to see how clotty they are.
  10. Random Microalbuminurea through urine to pick up early, early liver damage

 

35:05  The best diet for Diabetes is the low carb diet and two of the most well known advocates for this are Dr. Richard Bernstein and Dr. Richard Feinman and here is a paper that they were among the authors of: Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base.   There is another approach that has evidence to show that it is also effective for diabetes, the Macrobiotic diet, which was demonstrated in the Ma-Pi2 study: The Macrobiotic Diet for Diabetes. Dr. Mornstein feels that for most patients, the low carb program will work better. She does think the low carb diet can include nuts and 30-40 grams per day of carbs, but no grains or legumes. She does not think you have to do keto, which is very, very low carb and harder to follow. Dr. Morstein thinks you can include some muffins or bread or pancakes made from almond flour. and she advocates including at least 5-10 grams of fiber powder to make up for the lack of fiber in a low carb diet.

40:34  Dr. Mornstein recommends not snacking between meals in contrast to some nutrition programs that advocate having a small meal or snack every 3 hours to maintain a stable blood sugar. The human organism easily has the capacity to not eat for 5 hours and that way you let your body rest from having to process foods. And this lets the liver and the digestive system rest.

46:00  Dr. Morstein recommends certain supplements for patients with diabetes, including a good multivitamin and mineral, like one that might require taking 6 capsules per day.  Taking a one a day multi may be a waste if the nutrients are not found in therapeutic dosages.  Dr. Morstein mentioned that she is big fan of fish oil and she is not a big fan of krill oil because each capsule contains fairly small levels of EPA and DHA, the active ingredients, such as a total of only 50 mg of EPA and DHA combined in a capsule. To get a therapeutic dosage of say 2000 mg of EPA and DHA would require taking 40 capsules per day. It’s a joke!  Dr. Morstein designed a proprietary formula made by Priority One called Diamend that includes therapeutic levels of nutrients that can benefit diabetics, including Zinc, Chromium, Berberine, R-Apha Lipoic Acid, Gymnema extract, Benfotiamine, Bilberry, NAC, Green Tea Extract, Turmeric, and Vanadium (4 capsules taken after breakfast and 3 capsules taken after dinner). With respect to Lipoic acid, if you take R Lipoic acid you get twice the amount of the active ingredient than if you take just Lipoic acid, which is a combination of the R and the S isomers, but the S form is not active in the body. An elevated HgA1c is causing oxidative damage to the body, so taking the proper anti-oxidants can prevent some of this damage, such as R Lipoic acid and NAC that can provide antioxidant protection, reduce insulin resistance, and also support the liver.  Berberine is a great herb that is comparable to Metformin and also supports the liver. Benfotiamine is the fat soluble form of thiamine (B1) which can prevent damage to the nerves, the kidneys, and the eyes, at a dosage of 450 mg per day. The Burmannii or Indonesian type of cinnamon is a helpful supplement that if taken in capsules at bedtime can help to lower their morning glucose at a dosage of 1000 mg per day. Fat cells in the stomach region can make tumor necrosis factor alpha that causes insulin resistance and curcumin can help to decrease the inflammation and help with insulin resistance. Curcumin can also help rpotect the brain and reduce the risk of developing Alzheimer’s.  Gymnema sylvestre is Dr. Morstein’s favorite botanical and it has been shown to help the pancreas produce insulin again, and it also reduces cravings for sugar. If you are going to a holiday party, bring some gymnema sylvestre and swish some around in your mouth and it will reduce your craving for sweets.

 

 



Dr. Mona Morstein is a board-certified Naturopathic Doctor who is practicing Functional Medicine at the Arizona Integrative Medical Solutions with a focus on treating patients with obesity, diabetes, thyroid, hormonal imbalances, and gastrointestinal disorders like SIBO and IBS. She is the author of the best-selling book, Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type I and Type II Diabetes. She is the founder and executive director of the Low Carb Diabetes Association. Her website is Arizona Integrative Medical Solutions and Dr. Morstein is available for telemedicine.

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 Doctor 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 doctorweitz.com. Let’s get started on your road to better health.

Hello Rational Wellness podcasters thank you so much for joining me again today, Doctor Ben Weitz, here, and for those of you who enjoy listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and review, so more people can find our Rational Wellness Podcast. Our topic for today is diabetes and prediabetes, which are epidemic and increasing in the United States and around the world. 9.4% of adults in the US are diabetic, and in some states as many as 15%. This equates to about 30 million Americans with diabetes, and somewhere around 90 million with prediabetes, and these rates are climbing among children and teens.

One out of three Americans have diabetes or prediabetes, and 90% to 95% of these are type two diabetes, which are caused by diet and lifestyle. Rates are even higher among certain populations among American Indians, blacks, Hispanics, and Asians, and among whites. This paralleled by an increasing shocking rates of obesity and being overweight with about 70% of the US population being overweight or obese. Of course, these numbers are pretty much paralleled by the rest of the world especially as we spread our American lifestyle around the globe.

I’m happy to have Dr. Mona Morstein to join us today to give us some information. She’s a naturopathic doctor from Tempe, Arizona, who’s practicing functional medicine at Arizona Integrated Medical Solutions with a focus on treating patients with obesity, diabetes, hormonal imbalances, and gastrointestinal disorders like SIBO and IBS. She’s the author of the bestselling book, Master Your Diabetes: A Comprehensive Integrative Approach for Both Type I and Type II Diabetes. She’s also the founder and executive director of the Low Carb Diabetes Association. Mona, thank you so much for joining us today.

Dr. Morstein:                    Thanks very much. Ben, I really appreciate it.

Dr. Weitz:                         I’d like to begin the discussion by talking about the different types of diabetes, and the distinctions between these.

Dr. Morstein:                    Yeah. There’s kind of four or five main types, there is type II diabetes, which is the most common type is due to insulin resistance where usually early on at least for sure people can make insulin but their cells are no longer responding to the signals to take glucose in, and like you said there are a number of reasons the cells don’t respond. Obesity being one of them, but there are other factors involved, as well. Type I diabetes is an autoimmune disease where a person’s own immune system attacks their pancreatic beta cells, and destroys it enough so that they cannot produce the insulin that the person needs to live.  There’s gestational diabetes, which a nondiabetic woman enters pregnancy, and then becomes a type II diabetic, generally due to gaining too much weight during the pregnancy. There’s MODY, a mature onset diabetes of youth, which is diabetes because of gene defects, like the beta cell produces insulin, but lacks a good gene to secrete it, or a cell doesn’t genetically have a good receptor. Then the last is type 1.5, Latent Autoimmune Diabetes of the Adult (LADA), which is type I that happens in people over 35, say generally 35 to 60 is where we see people getting a less intense type of type one, but they can still for sure lead to full need of insulin.

Dr. Weitz:                         Yeah. Type 1.5, right? I never heard of that, before.

Dr. Morstein:                    Yeah. Type 1.5. Yeah.

Dr. Weitz:                         Interesting. I think there’s some confusion among the general public, I’ve heard people discuss diabetes and say that type twos become type one-

Dr. Morstein:                    Yeah. Right. Yeah. We have a couple things. One, we have a lot of patients who are adults getting type two, very commonly misdiagnosed as type two, and there’s a very simple blood test that can be done. We do have some lean type two patients. You will see lean, so we have to make sure is it really type two, or do they have LADA. Now, the type two becoming type one, so if you are under poor care and/or are not making changes you need to reverse your type II, if you have bad control of your type II, the damage that these high blood sugars can cause over the years can affect the pancreas as well as eyes, kidneys, nerves, and heart, you know the blood vessels, and so people can kind of destroy their pancreatic beta cells and this oxidative damage from poorly controlled diabetes, and then as a type II need to be on insulin, like a type I.

Dr. Weitz:                         Right. Then type Is can also have concurrent type II, if they’re poorly controlled?

Dr. Morstein:                    Yes. I’ve seen type I’s coming into my office that are injecting a 100 or 200 units a day, so for a nondiabetic, say for not a lean, but a normal weight nondiabetic, so we make maybe around 30 to 40 units of insulin a day, for whatever we eat, or drink, or whatever. If you have someone walking in the door, and they’re injecting a 100 units a day to control their blood sugar, that’s going to cause insulin resistance.  That’s way above the physiological norm of what the body is designed to have in it all the time, so you can get type Is that have insulin resistance. Now, a type I is going to develop insulin resistance when their blood sugars go over about 170 anyway, just high blood sugar can make them insulin resistant, so that is a part of it, but it’s not the core nature of their condition, which is the autoimmunity.

Dr. Weitz:                         Right. It’s amazing, though, the patients that I’ve seen how many are poorly controlled, the kids they really don’t want to prick their finger, they don’t want to test their blood sugar, it’s a pain, and the type II a lot of them are in denial, or just think everything’s okay, and they don’t want to test regularly, so I don’t know what the percentages are, but it seems like a lot are uncontrolled, or poorly controlled.

Dr. Morstein:                    I know the last statistics we really have in that regard, you know, from 2002 to 2006 where almost 75% or so of people couldn’t get below seven-

Dr. Weitz:                         Wow.

Dr. Morstein:                    Which is the ADA guide. 

Dr. Weitz:                         On the hemoglobin A1C. Yeah.

Dr. Morstein:                    There’s a significant generally 50 to 60, to sometimes 70 depending upon the study do not obtain at least what they consider the three ADA goals, which is an A1C less than seven. LDL’s less than a 100, and blood pressure less than 130 over 70, so we have very bad goal reaching in our country, and a lot of it is of course due to the obvious, that it’s a big pharma based treatment, that it’s drugs, and those with type II there’s only one drug really that was designed to deal with insulin resistance, and that was the TZD’s, which because of a lot of problems with them have essentially gone off the market. I mean, you can use them, but-

Dr. Weitz:                         What drugs would those?

Dr. Morstein:                    Those were the Actos and Avandia type drugs.

Dr. Weitz:                         Okay.

Dr. Morstein:                    Right? Now, Metformin deals a little bit with insulin resistance, but it’s not it’s main job, which is to decrease livers production of glucose, so you have a disease of insulin resistance, and essentially no medications out of the huge list of medications that they give patients that actually deals with insulin resistance, they’re all just about clear the glucose out of the bloodstream, and the way they do that can actually cause quite a number of problems in patients.

Dr. Weitz:                         Why is that? I guess they’ve just been unable to develop a drug that controls insulin resistance.

Dr. Morstein:                    Yes, or that controls insulin resistance, but again you’ve got it also might cause this or that damage. Right?

Dr. Weitz:                         Right.

Dr. Morstein:                    Drugs have side effects, many of them, we’re lucky with Metformin that it’s just some gastrointestinal distress, and doesn’t really cause anything else.  But some of these other drugs, the second most common one, the sulfonylurea’s, they cause weight gain, they can aggravate insulin resistance. They can cause hypoglycemia, significantly. They’re all just designed to clear the glucose-

Dr. Weitz:                         By the way, what drugs are included in the sulfonylurea?

Dr. Morstein:                    Sulfonyurea’s are like glyburide, which is the worst for causing hypoglycemia. Glyburide, Glipizide, so those kind of drugs, but they’re cheap. They’re going to be by conventional care, another drug to use, but they have problems. Right? Also, many of them don’t really significantly reduce the A1C’s very much, like the drugs like Januvia, the DPP fours, they may lower the blood, the A1C in three months at the highest dose of maybe 0.5% where a low carb diet could take someone who’s at 10 and lower them down to six in three months. The diet, and the lifestyle there’s no drug that equals the amount of improvement that just what we’re trying to do on this naturopathic, or functional level can do. Right?

Dr. Weitz:                         Right. But that word doesn’t seem to have gotten out.

Dr. Morstein:                    Yeah. Well, you know the ADA acknowledges there is a low carb diet, it’s not like they’re saying, everybody should be on it, and then now they’re approving bariatric surgery for people who can’t get their A1C’s under control, but they can’t just come out and say, hey, everybody, you guys, everybody, really just do the low carb diet.

Dr. Weitz:                         Right. Yeah. They’re still recommending whole grains, and a low fat diet.

Dr. Morstein:                    Well, you know, I went to the ADA site, and you know I will say there’s a lot of good things about the American Diabetes Association.  For one thing, they devote a lot of money to research, and they have also, if you’re a fireman, and you’re a diabetic, or you’re in school, and you’re a diabetic patient they’ve paved the way for the rights, the civil rights, and the working rights that people with diabetes in our country.  However, to become a sponsor in the ADA you have to drop at least a $100,000.00, that’s the lowest level.

Dr. Weitz:                         Wow.

Dr. Morstein:                    You know, who aside from drug companies can be supportive of the ADA?  That’s their funding.

Dr. Weitz:                         Yeah. Let’s talk a little bit about type I diabetes.

Dr. Morstein:                    Yeah.

Dr. Weitz:                         What are some of the most common triggers?  A lot of people have talked about milk products–dairy sensitivity–as being one of the triggers. Can you talk about that?

Dr. Morstein:                    Well, here’s the deal, obviously the number one cause of type I diabetes is you have a gene that can turn on and give you type I diabetes.

Dr. Weitz:                         Right.

Dr. Morstein:                    It starts from you just randomly got this gene. Then what might be factors turning on the gene?  Well, you know I go through things with every patient, and there’re questions on vaccinations on gluten, on dairy, on environmental chemicals, on stress in the families, on nutrient deficiencies. The Fins, Finland, had the highest per capita onset of type I diabetes, and they’ve done studies where giving new born vitamin D and fish oils reduced the onset of type I in those populations compared to the kids that didn’t get those supplements.  What is it individually that affects each child, who knows? We have a lot of kids drinking milk, and they’re not getting type I, so we can’t say, oh, my goodness. I will say this, I read a good article, a study saying that with, you know, for me, as I note in my book, if we could identify kids with celiac disease early on, right away, and we got them off of gluten their risk of developing type I would go down about to zero.

Dr. Weitz:                         Wow.

Dr. Morstein:                    We’ve got all these pediatricians giving them antibiotics of their ears, or vaccinations whatever, but we need to get them to screen every child who’s now eating gluten, because you have to be eating gluten, so toddlers, a two year old, right, test them for celiac disease before potentially it’s unknown and then we get kids developing type I diabetes since those two are so connected, but-

Dr. Weitz:                         By the way, what’s the proper test for celiac?

Dr. Morstein:                    The proper test with celiac in a child is you can do a stool sample for toddlers. Right? There’s also a blood test, a pediatric blood test, but people, you know, you have to be eating gluten every day, like equivalent of about a piece of bread for at least three to four weeks before the test, otherwise we can’t see if there’s celiac disease. 

Dr. Weitz:                         Unless you do an intestinal biopsy.

Dr. Morstein:                    Well, they’re going to do that after the blood work.

Dr. Weitz:                         Right.

Dr. Morstein:                    Yeah. We’ve got a lot of kids, I see kids, they never had a vaccine, parents, they’re a very loving family, there was no stress, like a pet dying, or grandma, God forbid, they don’t spray environmental, they don’t have an exterminator come into their house, or outside, and you’re just like, why did this happen? We just don’t know. We can’t identify it on each individual.

Dr. Weitz:                         Right. I notice in your book you mention the A1 milk being more problematic than A2 milk?

Dr. Morstein:                    Yeah. I think most people understand, or not most people, but milk in America, that A1 milk is from cows that have a different amino acid basis to the protein molecule of milk, and that is more allergic in humans versus many other countries in the world use cows that make what’s called the A2 milk that has a different amino acid, it’s very less reactive. Our milk is why we certainly see many people have at least a cows milk sensitivity, which can be a lot of mucus, and sinus, and asthma, or it’s the number one food that causes GERD, reflux, even without mucus, it just goes right to the stomach. Those are from the allergy to the milk protein.

Lactose intolerance, you just can’t you just can’t digest the lactose, that would be A1 or A2, but in terms of allergic to milk, and there are some connections if you have that allergic to milk, there are some similar proteins on the pancreatic cells, so if the immune system is kind of attacking the milk, and it could get confused and maybe attack the similar proteins on the pancreas.

I do want to mention one thing, though, when we talk about food sensitivities, or just in general we’re talking about often times leaky gut, and what’s interesting with leaky gut is that when kids have diabetic antibodies, but are not yet showing the disease they pick up an upregulated Zonulin, they show leaky gut in these kids. Another reason people might get type I is a virus getting through the gut wall, and then attacking the pancreatic beta cells, and causing damage to them, so we look at the gut quite a lot, and if you’re getting into food sensitivities, we’re going to think your gut is unhealthy, as well, since it all comes from the gut, but leaky gut seems to precede type I diabetes in many kids.

Dr. Weitz:                         That’s interesting, because we heard about the research from Alessio Fasano, who talks about this triad of autoimmune disease where you have a leaky gut, and then you have gluten, and then you create this upregulated immune system and that sets up the potential for autoimmune disease.

Dr. Morstein:                    Yeah. Although, I will differ in one regard, I know there’s a very big anti-gluten, anti-dairy, but for those of us like myself who does a lot of food sensitivity testing, you know some people are sensitive to corn, and some to soy, and some to eggs, and some to almonds, and I think before we just pull everybody, and not everybody actually reacts to gluten. I really think that we should always strive to do very individual care with the food sensitivities and really see what does this patient, what does their body reacting to?

Dr. Weitz:                         One of the problems is these food sensitivity testing is so problematic.  Sometimes you do a test, you seem to get reasonable results, and then you do a test and nothing comes up except clams, and some other bizarre food, which they’ve never eaten, and now you spent all this money for this test, and nothing comes up, or-

Dr. Morstein:                    I would say there are-

Dr. Weitz:                         Or you do a test and everything comes up.

Dr. Morstein:                    Everything coming up, obviously, is a-

Dr. Weitz:                         Leaky gut.

Dr. Morstein:                    Sign of leaky gut, but I think there’s a lot of labs doing food sensitivity, but I know the lab I use, I’ve flown out there, I visited their lab. I can verify the one I use for the last 16 years, which is Alletess Labs at foodallergy.com, they must have got that right at the beginning. I mean, I can verify their consistency with truly finding what people seem to be reactive to, and if people have a lot of foods, you know, the idea with food sensitivities you take them all out the first month, start healing their gut with the supplements, and then they come back in a month, then they should be significantly better, and then you can start adding the foods back in. Nobody has to be off all of these foods for a year, or two, or whatever. It’s an indication of something needs to be healed, but guts heal from leaky gut enormously quickly when the irritant is removed, because they’re so vascularized.

Dr. Weitz:                          Yeah.

Dr. Morstein:                     Yeah.

Dr. Weitz:                          I just want to point out, I just had a discussion with Cyrex where I had one of these tests come back where there was nothing tested, and they said, from now on we can include a total IGG with the test at no additional cost, and that way you can tell if the person’s immune system just isn’t working well, and they’re total IGG is suppressed then they can factor that in, and recalculate the results, and-

Dr. Morstein:                     I guess there’s also cheaper tests than Cyrex.

Dr. Weitz:                          You mentioned vaccines as triggers.

Dr. Morstein:                     Yeah.

Dr. Weitz:                          As possible triggers for type I diabetes

Dr. Morstein:                     Possible.

Dr. Weitz:                          And I noticed in your book you mentioned giving the kids some supplements to help with their immune system like you mentioned vitamin D, and echinacea, and milk thistle.

Dr. Morstein:                     Yeah. When I was in medical school we had a pediatrician come in and say, “Hey, when I have to give vaccinations I’m boosting their immune system a couple days before, during, a couple days after.” Then obviously it made great sense to us, because we don’t usually get exposed to viruses by injection, we breathe them in, and then it takes days for the process to happen, so it’s a little bit of a shock to the immune system. I think giving NAC, you know, there are kids that maybe can’t make glutathione, that might get, as well, they might get some nerve damage.

I do a product called Immugen from a company called Progena, because it’s glycerine, kids love it, it’s a great immune system booster, and D, and maybe some Liposomal, now, I give glutathione, because kids can’t really take, obviously, an NAC capsule, and it’s nasty flavor wise, so by giving some ways to support antioxidant status, immune status, it can really, I hope, seem to boost things in the kids, so they don’t have a really serious reaction against not only just against the vaccination, but the liver as just part of the excipients, but I have a good website where the CDC lists all the excipients in all of the vaccinations, and so-

Dr. Weitz:                          Yeah.

Dr. Morstein:                     That’s what we’re trying to have the liver clear better-

Dr. Weitz:                          Right.

Dr. Morstein:                     It’s that junk that it comes with, you know the virus that they’re injecting.

Dr. Weitz:                          Yeah. The World Health Organization actually recommends giving 200,000 IU’s of vitamin A prior to the MMR vaccine.

Dr. Morstein:                     Yeah. They came out 25 years ago saying they’re very much into 2,000 units of vitamin A, also for treatments, if someone has measles they said, “Hey, give them a 100,000 vitamin A,” as this huge immune booster. I’ve used that in many conditions in toddlers that were pretty sick. Of course, I do it maybe for three days, or four days, but vitamin A is cheap and the World Health Organization can use it in rural villages, it’s easy. It’s a huge immune booster. I would just give a clinical pearl, don’t give it all at one time, if it overwhelms the kid, they can have a really nasty headache, so you want to break it up into several doses throughout the day, and that should stave off the headache that can last for a few hours with acute elevated vitamin A.

Dr. Weitz:                          Yeah. I never liked the idea of giving one huge bolus, the same thing with the 20,000, or 50,000 injectable vitamin D, it seems to make so much more sense to give 5,000 or 10,000 a day over the course of a week than give them a 50,000 unit shot.

Dr. Morstein:                     Yeah. Shots are a little rough, anyway.

Dr. Weitz:                          Yeah.

Dr. Morstein:                     With vitamin D, it’s oily. 

Dr. Weitz:                          Moving on to type II diabetes, and-

Dr. Morstein:                     Yeah.

Dr. Weitz:                          Mechanism for type two. Most of us are aware of the fact that eating sugar, and lack of exercise are some of the main factors, because we got this rising blood sugar, and insulin resistance, but I read in your book that you also said that increased saturated fat intake can play a role.

Dr. Morstein:                     Yeah. I mean, I know there’s a lot of ketogenic, and et cetera, Paleo people out there, but the science is pretty clear that if you are getting too many saturated fats and I believe it’s too many saturated fats unopposed by a good amount of omega three fats, so omega three fats lower insulin resistance. Saturated fat, if you’re getting too many they can absolutely worsen insulin resistance.  The idea is not that you can’t eat saturated fats, but that we have got to make sure people are getting into their diet a balance of omega three oils, for sure. If you get even with meat, if you get grass fed, grass finished organic meat, half of that is essential fatty acids, but if you’re getting it, you know, you’re just lazy, or you’re going out to eat a lot, that’s feed rot meat, that has no omega threes, after 90 days of being fed grains, that meat has no omega threes left in it, so this can be throwing people off with their oil balance.

Dr. Weitz:                            Interesting. Yeah. It’s true with the Paleo movement, and the ketogenic movement there’s a big push for saying that saturated fat is perfectly fine, and a lot of people are sort of like, can it really be fine? Should we really have as much butter as you can consume? Then of course, there’s the fat with sugar problem. You know? That I think Mark Hyman calls sweet fat, which is that’s really a bad combination is when they’re eating junk food, and they’re getting the saturated fat with the high glycemic carb, sugar combination.

Dr. Morstein:                     Yeah. I mean, it’s certainly refined sugar, refined grains, junk food, fast food, but if you just want to overeat anything, gluttony, unfortunately is whatever you’re overeating to gain that abdominal fat is going to be a problem, and of course the problem with insulin resistance is once it sets in insulin is one of the hormones that tells your brain I’m full, I’m done, that’s enough, you know, that’s it, I don’t need to eat more, and you can get that insulin resistance in the brain can tell people I’m still hungry, I still want food.

It’s not lack of willpower, it’s literally our appetite is driven by chemicals and hormones, and when they’re thrown off we’re just not going to get signals that I’m done, that’s enough, walk away from the table. Once people get on a low carb diet in a week, they’re like, “Oh, my God, it’s easy. I can just eat a piece of fish, and this, I’m full,” because that can settle down in their brains very quickly through food when we get that under control. Whatever you’re overeating to become overweight, or drinking, of course, soda pop, you know, energy drinks, these sugary, sugary things they’re just really some of the worst. Right?

Dr. Weitz:                          Yeah. Even Gatorade-

Dr. Morstein:                     Yeah.

Dr. Weitz:                          And some of the things people think are healthy. When it comes to lab testing, what labs do you like to run for patients with either prediabetes, or diabetes?

Dr. Morstein:                     Obviously, people need to have their yearly with the liver, and kidney, and glucose, and the lipids, and their CBC. I always include ferritin, which is not standard on labs, not just ferritin, has three different roles in the body. One is storage of iron. Two, we store it when there’s a bacterial infection, a serious bacterial infection, and three is acute phase inflammatory marker, and if we have a type two who’s got elevated ferritin while you do maybe have to rule out a condition called, hemochromatosis, which is a genetic hyper absorption of iron from your food, mostly these people have fatty liver, and so we need to do an ultrasound of their liver, and we can pick up fatty liver. That really drives insulin resistance, and fatty liver is the number one chronic disease of the liver in our country, today, and can cause the same kind of fibrosis and cirrhosis that alcoholism does.

Dr. Weitz:                          And truly caused by sugar and high glycemic carb intake. Right?

Dr. Morstein:                     It’s just caused by too much fat, really, whatever caused the fat. It’s the abdominal fat will then go and get to the liver, and cause the liver to have now too much fat in its cells. Of course, an A1C, a C-peptide, so you can draw insulin to see how much insulin they make as long as they’ve never injected insulin. As soon as someone’s injected insulin, that you can’t measure it anymore, it’s an inaccurate reading, because as soon as you inject insulin you’ll make insulin antibodies, so C-peptide is the part of the insulin molecule that breaks away from it for it to actually form insulin, so they’re equal.  There’s one C-peptide for one insulin, but we never make antibodies to C-peptide.  That tells us what is your pancreas able to produce in terms of insulin.  There’s another test called GlycoMark, which is a 1,5-AG substance that helps us look at excursions, and sometimes interpret the A1C better, because you can have an A1C at six, because you’re having lows all the time-

Dr. Weitz:                          By the way for those who don’t hemoglobin A1C is believed to be a three month indicator of blood glucose levels.

Dr. Morstein:                     Yes.

Dr. Weitz:                            Right?

Dr. Morstein:                     A1C is our monitor, how you’re doing longterm. It could the same number of A1C can be there if you’re under good control, or if you’re just going up and down all the time, so the GlycoMark can help us interpret that. I do vitamin D, we might need to check thyroid, we might need for guys, we might want to check their testosterone levels, there’s just maybe some red blood cell magnesium, red blood cell zinc, these can be low in people with diabetes. I would want to do an HsCRP, which is a monitor of inflammation that’s related to cardiac disease, and a fibrinogen to see how clotty they are, just because people with diabetes type II, well, if it’s not well controlled have a very high increased risk of dying of cardiovascular disease, which is basically what they usually die from. These are broad base labs that we’ll want to do.

Dr. Weitz:                          Cool. Do you include adiponectin and leptin in your labs?

Dr. Morstein:                     I don’t. I don’t do either of those.

Dr. Weitz:                          Okay.

Dr. Morstein:                     For one thing, leptin, you know there is a leptin resistance, or adiponectin, those are going to be fixed when fix their weight, so to measure them we don’t really have any specific ways, I feel, that’s really effective in that, and those will readjust once the insulin resistance is settled down.

Dr. Weitz:                          Cool.

Dr. Morstein:                     One other lab, the Random Microalbuminurea that’s a good urine test to pick up early, early liver damage, before it shows up in the lab work. No, I don’t measure those hormones.

Dr. Weitz:                          Okay. Cool. Let’s talk about treatment.

Dr. Morstein:                     Yeah.

Dr. Weitz:                          What type of diet is best for diabetics, and prediabetes?

Dr. Morstein:                     Doctor Richard Feynman and Doctor Bernstein, Richard Bernstein and 25 other physicians, or researchers came out with an article that was printed in Elsevier Journal on that a low carb diet is the premiere treatment for people with type two diabetes.  https://www.sciencedirect.com/science/article/pii/S0899900714003323 Actually, other researchers just came out showing that type one diabetes pediatric patients were improved on a low carb diet, plus a thousand other studies. Now, you’ve got two, you do have the MaPi2 study, which show that people on a macrobiotic diet, that was higher carbs, but no animal fat at all, no real oils at all, actually was very significant in uncontrolled type two diabetic men at really reducing everything we wanted to have reduced. The Macrobiotic Diet for diabetes study. You get some people that are saying, you know, a plant based diet, higher carb, but for most people it’s got to be low carb.

In our society, honestly, people are going to thrive much better in our society, and be able to socialize and eat out, and on a low carb diet then they will on some macrobiotic diet. Now, the low carb can be what I call the omnivore low carb, where you eat some meat, and fish, and some organic soy, and you make things out of nut flours, and coconut, and eggs, just all around variety, you eat nuts, or there’s the keto aspect, which is very, very low carb, or there’s actually a vegan type of low carb, and then there’s an ovo-lacto vegetarian type of low carb.

Dr. Morstein:                     For my patients, in reality, most of them don’t want to do keto, and I don’t make them, and I don’t think you need to, but they do that 30 to 40 grams a day of carbs, which will work very well for almost everybody, but it gives them a little more food to eat, you know, almond muffins, or pancakes, and things that make life more enjoyable for most people eating low carb.

Dr. Weitz:                          Do you let them include any whole grains, or legumes?

Dr. Morstein:                     No. I don’t. No, the grains, you can’t, no, you can’t do any grains.

Dr. Weitz:                          What about legumes?

Dr. Morstein:                     Yeah. Legumes, no, you can’t, now, every now, and then I have a couple patients who are in really great control, and if they have a couple tablespoons of hummus, because there’s got oil in it, and it’s got the garlic in it, they say that a little hummus doesn’t bother them. Okay. No, beans and grains, and potatoes, and sweet [crosstalk 00:38:29]-

Dr. Weitz:                          Beans are so high in fiber. Right?

Dr. Morstein:                     Yeah.

Dr. Weitz:                          And their glycemic index is in the 20s.

Dr. Morstein:                     You would think with the beans it would work, but for my patients eating beans, you know, they’re going to go up now, they might come down just after an hour or two, say, but it’s tough. The beans are incredibly high in fiber, in fact that’s for a nondiabetic patient, I’m not an advocate of keto, or Paleo at all, and there are studies where these changes in the microbiome by not eating grains, or not eating beans in nondiabetic patients just as a general diet are devastating to the microbiome, because the microbiome, the beneficial bacteria eats fiber.  When we take out these great sources of fiber, we change the bacteria, we start making less short chained fatty acids, and that’s not a good thing for colon cells, or even systemically. On a low carb diet I’m very adamant that my patients have to add fiber powder back in. If you’re on low carb, you’ve got to be getting at least five to 10 grams of fiber powder in a day to make up what we’re taking out, because vegetables just really won’t do it enough.

Dr. Weitz:                          Yeah. Of course, whole grains are also high in fiber, too, which that makes it harder to get the fiber.

Dr. Morstein:                     Yeah. I mean, for people that are nondiabetic to eat whole grains, and to eat beans I am an advocate of that, as well, for sure, but once you become a patient with diabetes they just can’t do it anymore, so at least with supplements we’ve got to replace both water soluble, and water insoluble that balance of fiber at least into the diet while having to eat healthy diet, or otherwise.

Dr. Weitz:                          I notice you recommend no snacking, and for years we’ve always recommended snacking, you don’t want to go to long, or your blood sugar will dip, so every two to three hours you have to have some food in your system to keep an even blood sugar, and that theory seems to be gone.

Dr. Morstein:                     I have from day one in medicine, which is about 30 years ago, I’ve always been an anti grazer, even for hypoglycemia you have to eat many meals throughout the day, that’s called enabling the condition-

Dr. Weitz:                          Yeah, but grazing is different than snacking, like say, here I’m going to have 12 almonds as a snack, or something at 3:00.

Dr. Morstein:                     I mean, if you just want a snack, but the question is that the human organism easily has the capacity to not eat for five hours. I eat a breakfast, and I go hike 10 miles without eating, that’s what the human organism can do. Right? This idea we cannot go from breakfast to lunch, and lunch to supper, and then from supper to breakfast, we can’t do that physiologically, this as just wrong, and so we want to at least in terms of intermittent fasting, at least from dinner to breakfast, at least 12 hours. Right?

Now, you want to go 16, whatever, there’re other ways to do intermittent fasting, but we have got to teach people that have trust in your body, eat a decent meal, and then don’t eat for five or six hours, and you’re going to be fine, and not only that, now you don’t have to think about eating, and now your adrenals aren’t stressed, and your liver isn’t stressed. You know what, I tell patients, when we’re measuring your heart rate, or excuse me when we’re measuring your blood pressure, the first number is when it’s feeding and the second number is when it’s at rest, and the second number is really the number we are really interested in. Right? Because that heart needs to rest, and you know what, your gut needs to rest, as well, it does not want to be digesting food all the time.  You don’t want to be active all the time, you need your sleep, you need to rest. Think of your gut as any other part of your system that needs rest. Right?  That means it doesn’t have to digest all the time. In fact, fasting is the healthiest a human can do to get over an illness, a chronic illness, that’s not eating at all, is putting your gut totally at rest. We just have to retrain people, and especially people who are injecting insulin, snacking, well, how are you going to, that’s going to screw up your insulin totally, so yeah, I’m a very big anti grazer, for everybody.

Dr. Weitz:                            You know, when it comes to intermittent fasting I just think it’s so ironic, because I’ve been involved with healthcare, and nutrition for 30 years, and I know when we got started the biggest thing was you have to eat breakfast, you have to eat within a certain period of time, everybody skipping breakfast, and they’re running out of the house, and that’s why they’re fat, because they eat too much at dinner, because they didn’t eat breakfast, and you have to eat breakfast, because that gets your metabolism going, so that was so important, and now the big trend is if you want to be healthy you got to skip breakfast.

Dr. Morstein:                     Well, not me-

Dr. Weitz:                          Okay.

Dr. Morstein:                     But that is for some. I eat breakfast. I’m breakfast, lunch, and supper. We have to learn, everybody

Dr. Weitz:                          A lot of people do the intermittent fasting

Dr. Morstein:                     Yeah, they do. I do fast from supper to breakfast, but I like breakfast.

Dr. Weitz:                          I’m with you on that. I prefer to skip dinner if I’m going to skip a meal. Right?

Dr. Morstein:                     I know. Here’s the deal, we have unfortunately, right now on planet earth we extremism all over the place with politics, and whatever, this, and that, and it’s certainly

Dr. Weitz:                          Planet Trump, now.

Dr. Morstein:                     Yeah. You know, it certainly entered into nutrition, too, and I think what we have to realize is that there isn’t one way that everybody is going to thrive eating, and so our jobs with Functional, Naturopathic medicine is what does this person need for their health? Me, I like breakfast, and I work better with it, but other people, especially if you have weight to lose, and so forth, doing a longer fast is great, and working out, where you don’t have food in you can burn more fat.  If it works for them, and they can do it, I mean, these are good ways to consider, but we just have to not make rules that everybody has to eat this way, and unfortunately we get too many docs that say, “I eat this way, so now everybody has to eat this way,” and that’s the exact opposite of the beauty of say Functional Medicine where we’re supposed to be looking at each individual.

Dr. Weitz:                       Right. And individualizing the program 

Dr. Morstein:                  Right.

Dr. Weitz:                       To their specific physiology, and their needs, and the way their body works.

Dr. Morstein:                  Exactly.

Dr. Weitz:                       For the final section, here, I’d like to talk about supplements that can be a benefit for patients with diabetes, or prediabetes.

Dr. Morstein:                  Yeah. Now, just to get out of the way, I have a proprietary formula called Diamend

Dr. Weitz:                       Yeah.

Dr. Morstein:                  From Priority One, which I think is a really good product. It’s in one bottle, you get everything you need at therapeutic doses, but when we’re taking supplements, yeah, I mean, people with diabetes say everybody needs to me on a good multiple vitamin, and a good one, like maybe you’re taking six a day that gets in all of the basic nutrients, so we know that you’re getting in everything you need to have your body work well, and antioxidants, and nutrients that help your organs, your liver, your adrenals work better, and help you become less insulin resistant, which is zinc, and chromium, and vanadium, and so forth, and it’s just easy to get them in one good package. 

Dr. Weitz:                       I know you mentioned therapeutic levels, and-

Dr. Morstein:                  Yeah.

Dr. Weitz:                       You talked in your book about how you can take some multi one a day vitamin-

Dr. Morstein:                  Oh, yeah.

Dr. Weitz:                       It has these ingredients that people are reading about in the latest news story, but they’re in trace levels that are going to be insignificant if you’re going to take a specific nutrient like chromium, or like cholic acid, or some of these others, it’s got to be a therapeutic level, or you’re kidding yourself.

Dr. Morstein:                  That’s an excellent point, and that’s why I think docs like us, because we can have patients bring their supplements in, we know how to read the label, see if it is a valid supplement, a good dose for what they need, or not, and like with fish oil, I’m not an advocate of krill oil. Right? Because when you see the amount of EPA and DHA 

Dr. Weitz:                       Oh, it’s a joke.

Dr. Morstein:                  It’s a joke.

Dr. Weitz:                       I know.

Dr. Morstein:                  It’s a total joke. 

Dr. Weitz:                       24 milligrams of EPA, and 30 of DHA-

Dr. Morstein:                  Exactly. People have heard that it’s krill oil, so you’re paying twice as much for a useless therapeutic EPA/DHA product, so 

Dr. Weitz:                       I know you’d have to take 20 of those capsules to get-

Dr. Morstein:                  Right.

Dr. Weitz:                       Two grams of EPA and DHA.

Dr. Morstein:                  Exactly. Thank you. Yeah. I am a big advocate of quality fish oils just like you said, and then there are supplements, you know diabetes damages oxidative damage. There’s several different pathways that happens through, but it’s oxidative damage, so we need supplements that help reduce insulin resistance, and that help protect the body, so that even if their A1C isn’t at 5.1, because an A1C over 5.5, and certainly over 6.0 is indicating by science it’s causing damage to the human body. That damage is oxidative. You’ve got some supplements like alpha lipoic acid, or NAC. they’re not just antioxidants, but they reduce insulin resistance. Right? They both help the liver, and most patients who are type two diabetic, and overweight have fatty liver. You can get some nutrients that really have a really big crossover benefit in several ways to the body. Right?

Dr. Weitz:                       By the way, in your book when you talked about lipoic acid, you mentioned something that I think most people are not aware of, which is that there’s a difference between lipoic acid, which is commonly seen on the market, and R-Alpha Lipoic acid. Can you talk about what the R four means and the difference?

Dr. Morstein:                  Right. There’s two different isomers, or chemical ways it presents Alpha Lipoic acid.

Dr. Weitz:                       We usually think of D and L forms, but-

Dr. Morstein:                  That’s with vitamin E-

Dr. Weitz:                       Oh, okay.

Dr. Morstein:                  Of course, certainly-

Dr. Weitz:                       Right.

Dr. Morstein:                  Yes, exactly D and L, and that’s with phenylalanine as well as a DL-

Dr. Weitz:                       Right.

Dr. Morstein:                  But in alpha lipoic acid there’s the R and the S isomer.  The S isomer is not active in the body.  In fact they say it may interfere a little bit with the R. Only the R isomer is active in the body, and if your bottle just says alpha lipoic acid, half of it is R, and half of it is S. About 20 years ago, companies figured out a way to make just R, and have it be stable, and so if you’ve got alpha lipoic acid, 600, only 300 of it is the R, if it says R alpha lipoic acid 600, you know, you’ve got a double effect, so we prefer just the R’s when we’re working with our patients.  Of course, Berberine, right when 

Dr. Weitz:                        By the way, what’s a therapeutic dosage for R, lipoic acid?

Dr. Morstein:                   I would say orally if you’re getting around 600 milligrams a day, there’s a very, very rare side effect I’ve only seen in two patients in 30 years, which is it can burn the stomach, but I mean for literally the hundreds, and hundreds of thousands of people that I’ve put on Alpha Lipoic acid it’s very rare. But you certainly can’t open the molecule and drink it down, it’s an acid, so it does have to be swallowed in a capsule. Little kids can’t take it until they can swallow a capsule.

Dr. Weitz:                        Okay. I’m sorry, keep going.

Dr. Morstein:                   No, I’m just saying we mentioned Berberine-

Dr. Weitz:                        Yeah.

Dr. Morstein:                   Had that great study comparing it to Metformin.

Dr. Weitz:                        Right.

Dr. Morstein:                   We like Berberine, it can upset some stomachs, but if you give a 1,000 or 1500 most people can handle that. Also, a very good liver herb as well. That’s another good product to consider.

Dr. Weitz:                         Okay.

Dr. Morstein:                    We’ve got the blueberry, bilberries for the eyes. Green tea extract was shown to help the pancreas. There’s little 

Dr. Weitz:                         You got benfotiamine which is the fat soluble form of B1

Dr. Morstein:                    Yes. Benfotiamine, very excellent, shown in studies for nerve damage, kidney damage, eye damage, and of course that, and the endothelial lining are the four areas where diabetes has its most effects, because those cells cannot prevent glucose from entering them. Insulin resistance does not affect those cells, so if your blood sugar is 300 your eyeballs are 300, and your kidney is 300, and your nerves are 300, and your endothelial lining, your blood vessels, so this is why those degenerate so commonly in people with diabetes, but benfotiamine around the max doses around 450 milligrams a day, very good safe, safe product. Ironically, we usually think fat solubles are harder to absorb than water solubles, but with benfotiamine it’s actually better absorbed than water soluble thiamine.

Dr. Weitz:                         Cool. In your book, you also talk about L-carnosine.

Dr. Morstein:                    Yeah.

Dr. Weitz:                         Which can reduce glycosylation.

Dr. Morstein:                    Yeah, I actually don’t use it too much.

Dr. Weitz:                         Okay.

Dr. Morstein:                    Yes. I learned about that from another physician years ago, and there are some studies supporting that, but to me also vitamin E might be able to do that, I just think if we’re getting the person under better control then that should lower, and it does, the glycosylation throughout their body. We think of it as the A1C, but it can also, fat and protein, it’s a fat and protein reaction, the maillard reaction, and that can happen in joints, and tendons, people with diabetes can get more into injuries of frozen shoulders when their blood sugars and A1C’s are higher, because that’s happening throughout their body, not just on their red blood cells where we can measure the A1C.

Dr. Weitz:                         How about cinnamon?

Dr. Morstein:                    Yes. Cinnamon. There’s a type of cinnamon that was shown in studies to help lower blood sugars. Some people 

Dr. Weitz:                         Which type of cinnamon is that?

Dr. Morstein:                    The Burmannii type of cinnamon. It tastes good, and it’s good in the fall when it’s getting cold. Cinnamon is another. Some patients take cinnamon, like some capsules at bedtime, and they say it can help lower their morning glucose, so it’s a pretty benign substance, it’s a 1,000 milligrams, they did studies on a 1,000, 3,000, 6,000, but even the 1,000 might be beneficial, or just using it as a spice on your food. Curcumin of course, as an anti-inflammatory, we do know that the tummy fat makes tumor necrosis factor alpha, it makes Interleukins, these can go to cells that cause insulin resistance, and so decreasing inflammation via fish oils, and curcumin can all be helpful to patients. Also, we do know the association with Alzheimer’s in people who have had poorly controlled diabetes, and curcumin has been shown to help reduce the risk of Alzheimer’s, so there was a good study in India that people eating more curcumin have less risk of developing Alzheimer’s, so again, and it’s also a good herb for the liver, so these things, again, have really good crossover for our patients.

Dr. Weitz:                            You talk about fiber and the need for fiber. What do you think about some of the resistant starch supplements on the market, and they have medical foods with resistant starches?

Dr. Morstein:                     Yeah. I mean, you know I’ve tried those and never really saw they did too much, and historically there were bars that were given to kids at night time to prevent them from having lows during the night, but kids on insulin don’t have to have lows during the night if they’re on a low carb diet. I mean it’s not like, I mean in conventional care eating whatever you want and covering it with insulin is the axium of treatment, and that’s going to cause all kind of highs and lows, but in terms of did I see real clinical benefits to resistant starch, I honestly didn’t, and if people are just eating correctly, that’s going to work for so many people. I mention it in the book as people think about it, I haven’t seen it clinically that helpful addition.

Dr. Weitz:                          You also mentioned the herb gymnema sylvestre.

Dr. Morstein:                     Yeah. I should have mentioned that earlier.

Dr. Weitz:                          Yeah.

Dr. Morstein:                     Gymnema sylvestre is my favorite botanical. There’s that and bitter melon as kind of two, but I love gymnema sylvestre, the studies have used 400 milligrams, but with some patients I’ve gone up to 2,000 or 2400. Gymnema sylvestre has been shown to help the pancreas produce insulin again, and it also reduces cravings for sugar. In a tincture form, it’s pretty amazing, that if you put a tincture of gymnema sylvestre in your mouth, and swish it around for a minute and then swallow it you can’t taste anything sweet, it’s disgusting. You can’t eat it. For some patients that are still working, you know, the holiday times, and going to parties I’ll give them a little one ounce bottle and say, “Just take this before you go to the party, then try to eat that cookie,” you’re not going to spit it out, because-

Dr. Weitz:                          Wow.

Dr. Morstein:                     It’s just going to be nothing in your mouth, and it’s really an amazing way to go, it just numbs the sweet taste for about an hour, or hour and a half.

Dr. Weitz:                            That’s great.

Dr. Morstein:                     Yeah.

Dr. Weitz:                          That’s a great hint. I know we both have patients, and we got to go, so let’s make this a wrap here. For listeners who want to get a hold of you, what’s the best way for them to contact you, and to get a hold of your book?

Dr. Morstein:                     Yeah. My book, the short name is Master Your Diabetes, it’s up on Amazon, Doctor Morstein, M-O-R-S-T-E-I-N, Master Your Diabetes, and my website is drmonamorstein, M-O-R-S-T-E-I-N, and from there I’m in Tempe, Arizona. I do telemedicine, as well. Check out my website, and give a call if you are interested.

Dr. Weitz:                          That’s great. Doctor Morstein, thank you so much for this interview.

Dr. Morstein:                     Thank you very much, Doctor Weitz …

 

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Detoxification with Dr. Bryan Walsh: Rational Wellness Podcast 77
Loading
/

Dr. Bryan Walsh discusses proper detoxification 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. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

3:04  Dr. Walsh had the typical health care provider’s view that we are all toxic and we should detoxify when we can. But then he heard a detox guru talking about phase three detoxification and it didn’t accord with his understanding of it.  Secondly, he learned that there was a phase zero detoxification. Thirdly, he had read that there was a biphasic response to toxins in that certain nutrients at a low dosage increased detoxification enzyme activity, while at a higher dosage it inhibited the same enzyme for detoxification.  This meant that the amount of some of these nutrients found in food would stimulate detoxification, while the concentrated, isolated forms and the amounts found in supplements such as in detox formulas and powders might actually be inhibiting detoxification.  This led Dr. Walsh into doing a deep dive into the scientific literature and to formulate a detox program that does not include a lot of supplements.

8:24  Which toxins each person gets exposed to has to do with your socioeconomic status, your occupation, where you live, your lifestyle, what kind of cosmetics and cleaning products you use, your water, and your air.  When you look at the data from National Health and Nutrition Examination Survey data from the CDC, we’re excreting all kinds of toxins, including heavy metals like mercury and arsenic, organophosphates, organochlorines, and aflatoxins from mold.  Some toxins exert oxidative stress and others are endocrine disruptors and may disrupt the thyroid, sex hormones or adrenal function.  Toxins may also have a direct cytotoxic effect on our cells.  Some toxins affect the endocrine system, while some have more of an effect on the neurological system and the brain.

13:52  Dr. Walsh doesn’t like most of the serum or urine tests for toxins and prefers using questionaires.  Here are two of the questionaires that he finds helpful to screen for toxic exposure:  http://www.eha-ab.ca/acfp/docs/taking-an-exposure-history.pdf  and  Qeesi.org

19:22  To properly detox you have to do three things: 1. Mobilize, 2. Optimize the detoxification pathways, and 3. Promote excretion. To mobilize, you want to go on a hypocaloric diet so that you start breaking down fat stores, which will mobilize toxins stored there. You should also use a 6-8 hour time restricted eating period, which means that you should have your two or three meals within an eight hour period of time and have no food the rest of the time. To optimize the detox pathways, this is heavily nutrient dependent, requiring certain vitamins, minerals, amino acids, and other nutrients.  You need methyl groups, you need sulfur groups, you need glutathione, you need certain amino acids, like glycine. To promote excretion, you have to sweat, so Dr. Walsh recommends using a sauna.  You want to drink a lot of water, so that you urinate.  You want to consume enough fiber so that you poop and include some binding agents to insure that the toxins leave the body.

28:18  Detoxification does occur in the liver, but also in the kidneys, the enterocytes, and even in the testes.  The four phases of detoxification include phase zero, which is the entry of these environmental pollutants into the cells. Phase one makes the fat soluble compound water soluble by adding a hydroxyl group. But it also produces a toxic intermediate, so it is important that phase two be sufficiently upregulated so that these toxic intermediates go through conjugation or sulfation or methylation or glucuronidation or glutathione or acetylation.  Then phase three takes that water soluble detox product out of the cell to be excreted through stool, urine or sweat.  You need to be careful to avoid nutritional supplements like curcumin, piperine, and milk thistle, which inhibit phase three of detoxification. For excretion, it is important to include fiber and binding agents, like bentonite clay, charcoal, and chitosan.  And it’s also crucial to sweat, such as by using a sauna, though Dr. Walsh does not like steam rooms, unless you are using purified water.  But overall, Dr. Walsh is not a believer in taking a bunch of nutritional supplements for conducting a detoxification program.  For example, when you take curcumin via food, it enhances phase III detoxification, while curcumin as supplement decreases it: https://www.ncbi.nlm.nih.gov/pubmed/18439772

43:17  Dr. Walsh also recommends as part of his 10 day detox program, 4 days of a modified Fasting Mimicking diet.  He cites the work of Dr. Valter Longo from USC who has published research on the anti-aging benefits of it, though he is not worried about the issue of a low calorie diet mobilizing toxins, which Dr. Walsh is concerned with.  So Dr. Walsh uses the same macronutrient ratio recommended by Dr. Longo, which is basically a low protein, ketogenic program, though Dr. Walsh recommends including foods that facilitate detox.  While Dr. Longo recommends the same amount of low calories to everyone, Dr. Walsh recommends low calories, but with the exact amount of calories based on your weight.

 

 



Dr. Bryan Walsh is a board-certified Naturopathic Doctor who sees patients and teaches at the University of the Western States and is an expert at detoxification. Dr. Walsch’s web site is drwalsh.com and he offers a course on detox for patients https://www.metabolicfitnesspro.com/walshdetox/  and also a course on detox for other doctors and practitioners: https://www.metabolicfitnesspro.com/everything-you-wanted-to-know-about-detoxification-2/

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, Dr. Ben Weitz here. For those of you who enjoy the Rational Wellness Podcast, please go to iTunes and leave us a ratings and review. That way, more people can find out about the Rational Wellness Podcast. Today we’re here. We’re going to speak about detoxification, getting rid of toxins from our bodies. We all are probably aware of the fact that we live in an environment in which there are toxins in the air, in the food, pesticides, chemicals in products that we put on our skin, use in our house. We have tons of information that we been exposed to about all these different toxic substances that get into our bodies and, potentially, have negative health affects.

Today we have Dr. Bryan Walsh, who’s a board certified naturopathic doctor, who sees patients, teaches courses in biochemistry and physiology at the University of Western States. He’s also scientific advisor at Lifetime Fitness. He’s devoted a considerable amount of time researching and writing about the concept of detoxification to help us to get rid of some of these toxins. That’s what we’ll be discussing today, his particular approach to detox. Dr. Walsh, thank you for joining me today.

Dr. Walsh:           Thanks for having me. It’s a pleasure to be here.

Dr. Weitz:            How did you get interested in detox as a particular topic?

Dr. Walsh:           Well, that’s a great question. I’ve been steeped in the health world for a long time, well before I became a naturopathic physician. I started out as a fitness professional a long time ago, read up on nutrition as much as I could. I was a massage therapist. I was really into that world and it doesn’t take long being in that world to come across this concept that we’re all toxic and we’re going to die if we don’t detoxify. You’re introduced to all these different ways of supposedly detoxifying your body from foot baths, to colonics, to you can see people online saying, “Drink a little bit of lemon juice in the water. It’s a great way to detoxify the body,” and all these different claims.

My initial, I guess, exposure to this whole concept was that of what everybody else’s is. We’re super toxic. It’s killing us slowly and if we care about out health, we should probably detoxify. And that was it for a really long time. Then, I forget the specific time, but there was a time, recently, I’d say maybe this year or last year. I heard a particular detox guru talking about phase three detoxification. Which most people in this industry have heard of, it’s been around for a little while. I think phase three might have been discovered in the early ’90s. The way that he was describing phase three didn’t entirely jive with what my understanding was. This guy is a guru, I’m not. At least, I don’t consider myself to be. I thought, “That doesn’t really … that’s not right. I don’t think.”

I decided to go into the scientific literature and say, “What is phase three really?” I’ve heard a lot of people say a lot of things about phase three. What it is, what it’s not. I decided, I was like, “I’m not going to listen to anybody else, I’m going to do this myself.” You know how PubMed works. Where you go in and you read a paper. Then it’s cited in other papers and then you go down, the next thing you know, you have 50 tabs open in Firefox or Chrome and you’re reading all these papers. This little mini dive to just trying to figure out what phase three was three things happened.

One was I realized that this guru, who’s teaching people about phase three to sell his supplements, wasn’t entirely accurate. I have a problem with that, as we were just talking about that prior to this interview. In this space, whatever you want to call it, Functional Medicine, nutritional medicine, alternative complimentary medicine. We need to be 100% accurate with what we’re talking about, because we’re so intensely scrutinized by conventional medicine. First of all, the way he was describing phase three to practitioners wasn’t entirely correct.

The second thing that I saw was that there’s a phase zero detoxification. Which, I’ve been in this business for a long time, and I have never heard anybody ever, at any time, utter phase zero. I thought, “Wait a minute, what is this phase zero, that I’ve never heard about?” If we’re talking about detoxifying people, it should be a part of this conversation that we’re having. So, that blew my mind.

Then the third thing, and this may have been one of the things that really sealed the deal for me, was I started reading about what’s called a biphasic response when it comes to certain compounds, or nutrients, or herbs, or minerals, whatever. This biphasic response, specifically in these papers, was talking about how, at a low dose, increases certain detoxification enzyme activity, but, at a high dose, inhibits the very same enzyme for detoxification.  I thought, “Well, wait a minute.”  A low dose would be the kind that you find in food.  So if you were to eat the herb, itself, or to take turmeric, for example, for its curcumin content that, that might stimulate detoxification.  But these papers didn’t explicitly say this, but in a high dose, which I read as, isolated, concentrated, supplement form.  Trying to get as much of the herb, or nutrient, or compound in your body, as possible, might inhibit detoxification.

When those three things happened … All it was, was this guy was talking about phase three. I thought it was wrong. I decided to look it up myself. A, he was a little bit wrong about phase three. B, there was a phase zero that I never heard about. And, C, I really wondered if what we’re doing, as an industry, if we were actually detoxifying people, or not, by giving people these powders, and potions, and supplements in concentrated, isolated forms when the studies were pretty clear that many of the things that we’re using in detoxification formulas might actually be inhibiting detoxification. Then I though, “Oh my gosh, I need to completely get any bias out of my head. Everything that I though I knew about detoxification.” Wiped my brain clean. Wiped my desk clean. And I started from the very top. I said, “All right, what have I heard? That we’re toxic. All right. What does the literature really say? Are we, in fact, toxic or not?”  Two was, are these things stored inside of us? We hear that they are. Is there a synergistic effect of multiple low-dose toxin exposure all at the same time? We hear that, but what does the scientific literature say? Does the dose matter? We hear that the dose makes the poison. And, at the doses that we’re probably exposed to, that it’s not going to cause a problem, so I wanted to look into that.

 Then after answering all these, I guess, basic questions that you and I have heard about for a really long time in this industry. If those are true, if we do have exposure, if it does get stored, if it is causing damage, if there is a synergistic effect, if the dose doesn’t matter, and if a low dose can cause just as much damage as a high dose, what can we do about it? What does the scientific literature say or suggest is the most efficient and safe, I will add, safe, efficient, effective ways of actually detoxifying the body, and assessment. That was a big … How do we test this? You know the labs. There’s labs out there that are supposedly these toxin panels and will … What does the literature suggest about those, as well?  That was the dive. I ended up reading over 300 papers on this topic over the course of months.  That’s my story with this.  So I have come up, now, for air again with a brand new view of what detoxification is.  With really solid answers to those questions that I feel very confident talking about, in fact.

Dr. Weitz:            Okay, maybe we could start by just talking about what are some of the most common toxins that we get exposed to in our environment, and get stored in our bodies. What are some of the health consequences of some of these?

Dr. Walsh:           That’s actually … That’s interesting. That’s a difficult question to answer, because … Well, I just give you an example. There was one specific paper that I found that said that based on one’s socioeconomic status, we are exposed to different toxins.  For example, somebody might have a garden in their backyard, and they’re, therefore, spraying pesticides.  But somebody with a lower socioeconomic status might eat more fast food and, therefore, are more exposed to certain other toxins.  A certain class might use more, what’s it called, sunscreen on themselves, or their kids, or certain cosmetics.  They’re all common.  When you look at the NHANES data, in terms of what people are excreting. We’re excreting everything. We’re excreting everything from elements, so things like arsenic, and the heavy metals, mercury, aluminum. We are exposed to a lot of organo-phosphates and organo-chlorines that persist of organic pollutants. We’re exposed to … Some people might be exposed more to aflatoxins, because they have mold exposure, which other people don’t.

I actually think that’s a really difficult question to answer, because it depends on, well, according to studies, your socioeconomic status, the job that you have, where you live. We’re out in well-water country. I can tell you that we don’t use any pesticides in our yard garden, but I drive down the road, and these farmers around us are spraying who knows what. That’s absolutely getting into our water.

Dr. Weitz:            Absolutely.

Dr. Walsh:           But, on the other hand, and somebody that lives in an urban society and is drinking city water. They’re going to have different exposures. So it depends on your lifestyle. What kind of cosmetics and cleaning products do you use? What kind of food you eat? The water, the air, all these things. I think it’s difficult to say what are the most common ones, because that really will be specific to one’s diet, lifestyle, job, where they live, for example.

The second part of your question is the damage. That was another question I had. We hear these things are so bad. Well, why? Why do they cause problems? And it turns out that depending on the specific, I’ll call it a toxin, they’re really xenobiotics or environmental pollutants. Or the class that they’re in, they really do exert different effects. One of the most common ones, though, that across the board is oxidative stress, surprisingly. I didn’t know that, that was going to be the case, but in many individuals that have multiple chemical sensitivity, they exhibit a tremendous amount of oxidative stress. Other ones, you hear them as endocrine disruptors, but what does that really mean?

It turns out the stuff is so compelling, though, when you look at it. Depending on the environmental pollutant, let’s just talk about thyroid. Just about every single aspect of thyroid hormone physiology can be negatively impacted by an environmental pollutant. So, starting up at the top, the hypothalamus, the pituitary, TCH, thyroid’s ability to bind onto … thyroid binding globulin on the receptor, itself, and conversion on the thyroid’s production of this, every single step. We often think of the sex hormone, that these are all estrogenic. That’s not entirely true. There are some that have been shown to suppress adrenal function, and suppress cortisol, for example.

Then there’s other ones that have direct, what I call cytotoxic effects, on a cell. For example, certain ones might mess up the membrane of the mitochondria. Other ones might negatively impact some of the enzymes involved in the citric acid cycle, or the electron transport chain. Other ones have more indirect effects, like with the immune system, and then that will have system-wide effects. It’s really … There’s so many of these things out there. There’s so many classes of these and they all exert different effects. That it’s hard to say. Some of them exert more neurological symptoms, whereas other ones might impact the endocrine system more. It really depends on the environmental pollutant and what specific effects it causes. But …

Well, here’s another quick one. In the scientific literature, so many chronic conditions have been linked back to xenobiotic or environmental pollutant. Things that you don’t … I mean, of course, the neuro developmental things, like ADD, ADHD, and autism, as well as, things like Alzheimer’s and Parkinson’s. But then there’s things, like obesity, things we never think of, but the studies are really clear, cardiovascular disease, atherosclerosis, hypertension, and even diabetes. Some of these papers say the correlation is so strong that, perhaps, xenobiotic exposure is, not only associated with diabetes, but maybe a significant contributor.  Anyhow, that just speaks to the fact that it depends on what it is, but it can impact virtually any part of a cell, the mitochondria, the pliable membrane, the endoplasmic reticulum, enzymes, transporters, hormones, neurons. You name it, they can cause damage in some way.

Dr. Weitz:            What’s the best way to screen to see what kinds of toxins that we have in our body?

Dr. Walsh:           That was disappointing to me. When I looked into the literature to see what really was the … That’s the big question, of course, because … So, right now, what have we talked about?  Yes, we’re exposed. There’s absolute proof that they’re stored. They do cause damage. Then the next rational question is, all right, well, how toxic am I? When people are talking about how toxic they are, what they’re actually asking is, what’s my total toxic load or total body burden? Which is really to say, “How much do I have stored in my body?” That’s really the question. And the problem is, there’s no way to assess that. There’s no way to evaluate that. I know that people, “Well, what about the hair tissue mineral analysis test?” No. What about the urinary test to show excretion? No. I can go into some of the reasons why too.

One of the gold standards in toxicology, when evaluating this, is a fat biopsy. That’s really what we’re looking at … How much is stored in fat? Well, it turns out that for a variety of reasons, and there’s papers on this too, that suggest that you have different amounts of stored xenobiotics in subcutaneous fat, than you do visceral fat, than you do in different fat depots in different areas of the body. And these papers say that, that doesn’t correlate to serum levels, so you can’t do a blood test and say that, that reflects you and what your storage is, because it may differ.  Then there was one, and this is a rodent study, so you have to take that into consideration. Well, here’s a good example. Let’s say you and I, right now, let’s say we practice in the same area. We live the exact same lifestyle, exact same exposure. You’re following a hypocaloric diet, right now. Intermittent fasting, time restricted feeding, hypocaloric diet. I’m stuffing my face, standard American diet. I’m eating more than my basal metabolic rate. We both go to do a test. Now, because you’re in a hypocaloric state, you’re probably mobilizing more of your stored xenobiotics, and every mammal study says that. That when there’s a hypocaloric, or fasted, state, serum levels of xenobiotics go up every single time, every single mammal, including humans.

Now, I’m in an anabolic state. I’m storing things. When we go to do this toxic panel, you come out sky-high in all these toxins. And you see your practitioner and they’re like, “Oh my gosh, you are so toxic. You must do a detoxification program.” Then, me, because I’m in an anabolic stuffed fed, overfed state. That mine are probably stored. And my levels, on my test, might come back as normal or low. And the practitioner says, “Wow, you’re not toxic, at all.” When, in fact, I might be far more toxic, in terms of my storage, than you are, but you’re in a hypocaloric state. Right there, that totally negates … It’s a severe confounding variable when considering assessments.

Then the last one, that rodent study I was going to say, they showed that when these … They put these rats on a yo-yo diet, poor rats. They would go hypocaloric and their xenobiotic levels would go up in their blood. Then they’d make these rats hypercaloric and guess what happened? These xenobiotics went into different tissues. You might have a certain amount in a certain fat depot in your body that does get mobilized, but then it’s going to go somewhere else depending on your caloric state. In terms of screening, all of this is my opinion. It’s based on the scientific literature, but people can use it how they want. Is there is some pretty good questionnaires that are out there, that are in the … They’re validated questionnaires in the scientific literature that, I personally, think are amongst the best ways of screening if we have toxic exposure or not.

Dr. Weitz:            Can you mention which ones those are?

Dr. Walsh:           There’s a whole bunch of them. One of them is abbreviated and I forget the actual … It’s the Qeesi questionaire. If you do links to this in your show notes, we can-

Dr. Weitz:            Yeah, I will. Yeah, maybe you can email me.

Dr. Walsh:           That one’s the most elegant. It’s fairly long. I’ll give you a couple of them that I like for two reasons. One is this one is very comprehensive. It’s not quick, 10 questions, are you toxic or not. It looks at a variety of things from your actual physical exposures and your lifestyle, as well as symptoms across a variety of systems in the body. And I think is really very comprehensive. The benefit of some of these, though, is it forces you, when you ask these, or answer, these questions to jog your memory to see what your exposures might be that you are totally unaware of. Right now, you can say, “What are my exposures? I drink reverse osmosis filter water. I eat organic food. I use coconut oil for my lotion. Apple cider vinegar for my deodorant. I don’t have any exposures.”  But when you go through some of these questionnaires that have these questions, you say, “Oh my gosh, I work in a building that whatever.” They’re really good at helping, not only see if you might have a certain amount of toxicity, if you will, but also what the sources might be.

Dr. Weitz:            Okay. In your concept of detoxification … Actually, you were talking about the phases of detoxification. I’m not sure everybody even knows what phase one and phase two are, and you were talking about phase zero and phase three. Well, actually, your concept of detoxification, you have three basic principles, and then you list the phases in a second one. Maybe we could go through your three main important principles of detoxification that you outline in your program.

Dr. Walsh:           Yeah. And, again, I humbly will say that I think my … I’m a teacher, not by choice, I think I was born into it. When I look past throughout my entire life, everything has been teaching. I say that because when I go through what these three principles are, there’s a feeling you know that being empowered just feels amazing. That you feel like that you know enough information that nobody can pull the wool over your eyes. That you’re an informed individual. So by teaching these three things, these are just … These are principles that must be in place for anything to call itself a detoxification program. I say this so that when people are evaluating, “Well, what about this detoxification?” They can run it past this list of three things.  The first thing that for something to call itself a detoxification, that it absolutely must include is mobilization. You have to get these things out of storage.

Dr. Weitz:            I thought you were going to say it has to come in a box, just kidding.

Dr. Walsh:           No. It can, if it’s a well developed one, it absolutely can, UPS, no.

Dr. Weitz:            Okay.

Dr. Walsh:           You have to mobilize in the first place. The best ways to mobilize, that I’ve seen, and also makes physiological sense, is to go on a hypocaloric diet. Now, i think a calorie restricted diet, I also believe a time-restricted feeding in a window of about six to eight hours, is probably the best. And all that calorie restriction means is less than, essentially, your basal metabolic rate. Exercise. So the technical word is, lipolysis, which is the breakdown of the lipids, or fat cells, but that’s where the majority of these things are stored. When you are in a state, a catabolic state of lipolysis, you do get mobilization of toxics, period. This is not conjecture.

Dr. Weitz:            Right.

Dr. Walsh:           Every mammal study that I’ve looked at, including humans, when people, or mice, or monkeys go hypocaloric, their levels in the blood go up every single time.

Dr. Weitz:            You’ll have to admit that virtually every detox program out there involves some sort of modified fast or fast. They pretty much all involve eating less foods.

Dr. Walsh:           Right.

Dr. Weitz:            So this concept, I think, is incorporated in most of the commercial detoxification-

Dr. Walsh:           Whether they knew it, or not, right. It absolutely involves that.

Dr. Weitz:            Right.

Dr. Walsh:           The second thing, then is, and this speaks to those phases of detoxification. You have to optimize detoxification. Step one is to get them out swimming in your body. All these things, now, are mobilized. They’re going through your blood. You are not going to get rid of them. These are the fat soluble ones that you do not, you cannot … The normal routes of excretion are any water forms of excretion. You can sweat it out. You can urinate it out. There’s a little bit of water in stool, so you can poop it out. You can, technically, salivate it out, or if you cry a lot, you watch a lot of This is Us reruns, then you can cry it out, technically, through tears.

Those are all … I mean, in theory, you could measure any one of those as a form of toxin … Those are all measurable things. We have to take these things that are fat, they like fat, and turn them into things that like water, so we can get rid of them. Those are those four phases of detoxification; phase zero, phase one, phase two, phase three. You have to optimize those. If you’re not, then these things just go in the body and you can’t excrete them, because they’re still fat soluble. Then the third, and last one is, you have to focus on excretion. I’ll just take a step back and say, “Let’s talk about different detox programs to see if they fit those things.”

Mobilization, improved detoxification pathways, and then to really, really facilitate excretion in some ways. Let’s say that somebody were to do a juice fast, some popular juice fast where the juice comes in a box, or maybe they’re just juicing things on their own. Are they in a hypocaloric state? Probably, if all they’re doing is just drinking juices, they’re probably in a hypocaloric state. So they’re probably mobilizing, and that’s fine. Step two is, are they improving detoxification pathways? Now, it depends on what they’re consuming. There are studies that suggest that things commonly juiced, things like carrots and celery-

Dr. Weitz:            We’ve had a technical difficulty, so we’re going to continue this podcast. We’re not exactly sure where we left off, but hopefully we won’t have any lost train of thought. So, go ahead Dr. Walsh tell us more about detox.

Dr. Walsh:           Yeah, no problem. You can tell me if I’m going too far backwards. I was saying the three things that are required in order for somebody to do a detoxification program; mobilization, optimizing detoxification, and then optimizing excretion. Those three things are critical. Then what I said was if you go back, and you start evaluating things that are supposed to be detoxification programs, where they detoxify the body, they have to have those three things. So, just a juice fast, is really common. You mentioned that most juice fasts are hypocaloric, so they probably are increasing mobilization. But then, I think this is the part that we got a little bit glitchy, is depending on what somebody’s consuming, you may, or may not, be either stimulating or inhibiting detoxification pathways. The things that have been shown in the literature to stimulate detoxification pathways, people typically aren’t juicing things like, broccoli, for example, or cabbage, or possibly things like mung beans, which aren’t really juiceable.

Dr. Weitz:            But it is the case that detox is a nutrient dependent process, right?

Dr. Walsh:           Absolutely. Well, yes. I mean, if you want to really get into the biochemistry of it, there are a number of different micro-nutrients, vitamins, and minerals that are even required for these pathways to be taken place in the first place.

Dr. Weitz:            Right.

Dr. Walsh:           In phase two, which I’ll get to, but just really quickly. You need methyl groups, you need sulfur groups, you need glutathione, for example, you need certain amino acids, like glycine. It’s heavily nutrient dependent.

Dr. Weitz:            Hence, the concept of trying to put together a program that has concentrations of these nutrients has some basis in the science, right?

Dr. Walsh:           Totally. Here’s the point. Is a juice fast a detoxification program? From the mobilization standpoint, yes, it probably is. You will be mobilizing. But from optimizing detoxification, I think that, that’s highly skeptical. And it depends on what somebody’s juicing. There’s some evidence in the literature that things that people usually juice, like apples, carrots, and celery may actually inhibit certain detoxification pathways, so then, that’s questionable. Then for excretion, if somebody is just doing a juice fast, they are not doing anything to enhance excretion. In fact, if they’re only consuming juice and, therefore, not fiber, and we can go into great detail on this, or not, but they’re probably urinating, and that’s fine. If they’re not sweating, that’s a huge problem. It’s a huge problem when it comes to detoxification.  Certain things are preferentially excreted via sweat, other ones are preferentially excreted via biliary, in the bile and the gastrointestinal tract. If you’re not sweating, or your not binding things up severely in your gastrointestinal tract, and in the juice fast, you’re not, then you’re not excreting. I, myself, would say that a juice fast is not a detoxification program. Yes, it mobilizes whether, or not, it increases detoxification pathways depends on what you’re consuming. Then the third one, excretion, I’d say a big, no, to that.

Does a colonic, is that a detoxification? Well, if you’re not mobilizing, then, no, all you’re doing is your moving things through your bowels faster. Which is great, that’s excretion, that does nothing for the second step detoxification of the first step, mobilization. That’s what I really want people to do is to be able to look at a detox … something that is allegedly a detoxification program, and say, “Does this increase mobilization?” Check, yes. “Does this increase detoxification pathways?” That’s a big one. That’s questionable with a lot these nutrients that people are using in powders, and supplements, and capsules. And excretion, is just saunaing detoxification? You maybe excreting things that you had swimming around in your interstitial fluid, technically, but not out of your cells, because you might not be in that mobilized state.

Dr. Walsh:           So those three things are critical for something to be called, to truly, truly be called a detoxification.

Dr. Weitz:            Can we go through those detox pathways? People typically talk about phase one and phase two of detoxification. It’s phase zero and phase three that are the newer ones. Typically, people talk about phase one and phase two as related to the liver, correct?

Dr. Walsh:           Yeah, well, and that’s not true, at all. When people talk about these … I’ll tell you what the phases are, then we’ll talk about why it’s not just a liver. The liver happens to be a huge organ and, yes, it does this, but the kidneys do this very well. The enterocytes of the intestines do this very well. In men, it turns out the testes, actually, do this very well also. Which isn’t surprising, given the role of the testes in terms of, essentially, passing along somebody’s DNA in that xenobiotics. If one couldn’t detoxify well down there, then that could really disrupt somebody’s …

Very simply, if you’re to picture, like a box. I’m trying to look for a prop real quick, but I don’t have one. If a box is a cell or, you’re in a room there. I would say, if somebody’s in a room it’s pretty easy to picture. If this room has two separate doors, this is as simple as it is. Phase zero is quite simply the entry door into your room, which is the cell. Your cell has a nucleus and mitochondria. It has a computer. It has lights and electricity and ATP. That first door is phase zero. That’s the entry of one of these environmental pollutants inside of a cell. You can say a liver cell, but it’s not the only organ that does this. It comes in, now, it’s inside the liver cell. We’ll say it’s a person came through that door.

Then phase one is biochemically not too challenging, but I’ll say what it does biochemically and then I’ll change it back to this metaphor or analogy. Phase one makes that fat soluble compound, first of all, makes it water soluble. It does so, not exclusively, but either by adding what’s called a hydroxyl group or exposing one that was already there. Now, this has this hydroxyl group on it. It’s water soluble. The way that I use this as an analogy. If somebody walked through the door, phase zero. They’re now inside the cell and you, put a sticky note on their forehead, just right on their forehead, or you start berating them, “You suck as a human being. You’re a horrible, miserable, ugly, smelly human being.”

Now, and that’s phase one. Now, this person is really angry. Who wouldn’t be if you start to berate … and they have a sticky note?  So they start trashing your room. They throw your computer across the desk. They start knocking lights over. They start doing all these things.

Dr. Weitz:            Fake news.

Dr. Walsh:           But in a cell, after phase one, and this isn’t across the board, all the time, but it’s actually considered to be more damaging to the body than, in some cases, the original environmental pollutant was, after phase one. You just berated this person, “You’re fat, ugly and your breath stinks.” Now, they’re really, really mad, but that’s phase one. But phase two is collectively called conjugation, and conjugation means, to add something.  Now, in phase two, you’re like, “I’m so sorry. Here’s $100 bill.” Well, the person may have had hurt feelings about what you said, but now you gave them $100 and they’re not angry anymore. After phase two, it’s still water soluble, but it just got $100 bill. It’s not going to damage anything inside of your cell anymore. It’s not going to damage your room. Now it’s a happy person. You made fun of it, it was angry, it started messing things up after phase one. Phase two, you handed it something, now, he’s happy.

Dr. Walsh:           Now-

Dr. Weitz:            Now, let me just stop you for one second. So the story that’s often told about detox, especially from some of the companies that provide these detox programs is, phase one produces a toxic intermediate that’s why if you just do a juice fast you get all these toxic reactions, and headaches, and all these negative things. You have to have the right nutrients that help support phase two, so you take that toxic intermediate, put it into a water soluble form so it can get excreted. Therefore, you support phase one and phase two, and that’s the end of the story.

Dr. Walsh:           Yeah. That’s a good story, but if the intermediate metabolite, after phase one. With that hydroxyl group, it’s technically a free radical. Now, I haven’t seen too many people that get sick from free radicals, if that makes sense?

Dr. Weitz:            But doesn’t that explain when somebody does a juice fast and they have toxic reactions-

Dr. Walsh:           I think that part of it-

Dr. Weitz:            – and the amino acids and the other nutrients for phase two.

Dr. Walsh:           I don’t know. I’m not convinced that, that … It might be because of mobilization, and they’re not excreting things. I don’t know if it’s only because it goes through phase one. Technically, I mean, they’re water soluble, but technically it’s still inside the cell. It hasn’t gone out of the cell yet, so that’s a good story, and it might be true, but I don’t think there’s any proof as to that’s what’s causing this.

Phase two is the conjugation. You hand them $100 bill, or in the case of actual biochemical pathways, sulfation hands to the sulfur group, methylation hands to the methyl group, glucuronidation hands to the glucuronic acid, glutathione gets glutathione glycine, acetylation gets in the acetyl group. That’s the $100 bill. Now, it’s water soluble and happy. Now, it has to get out of the cell to go back into the interstitial fluid, which is water, to be excreted. That’s the other door and that’s phase three. Now, here’s the problem. There’s certain things that can block phase zero, like diesel exhaust has been shown to block food. It’s fairly new. It’s only been discovered in the early 2000s. But phase three, curcumin blocks phase three, piperine from black pepper, which is usually used with curcumin to make it more available, blocks phase three. Milk thistle, honestly, is a mild phase three inhibitor, as well.

And here’s the thing, so now you have this happy person that could leave that third door. Then you’re done with them. You’ll never see them again, because they get excreted. But here’s the problem, you know, beta glucuronidase, which undoes glucuronidation. There are other enzymes that can undo conjugation, which to put it back into the metaphor is, there are things that can take that $100 bill away from that person, whether it was sulfation or methylation. Can take that $100 bill and, now, they’re the intermediate metabolite again. If you block phase three, and that person, metabolite, after phase two stick around inside that cell, now, the conjugation reaction can be undone. Now, it’s back in the intermediate metabolite. That’s why making sure that … This becomes my opinion, at some point here, but I don’t know that we should be taking a lot of supplements when it comes to a detoxification program. Because the reality is, and I can go head-to-head with a lot of people on some of these things, it’s really hard to say whether something actually improves detoxification or not.

Not from enzyme activity, or MRNA expression, for these proteins. There are all these things, but if it actually … What I’ve looked at, which is biphasic response, is that food, and the doses that are found in food, will generally stimulate detox … There was one great paper, by the way, that looked at food-based curcumin and isolated curcumin. Food based stimulated detoxification pathways and isolated absolutely inhibited. In fact, conventional medicine … Think about cancer, think about chemotherapy. What they really want is to keep that chemotherapeutic agent inside of the cell, so that it can fight cancer, correct?

Based on what we’re saying is that best way to do that is to block phase three. If you close that second door, you keep inside that cell whatever is inside that cell. If it’s a chemotherapeutic agent, that’s what you want to be able to exert more of an effect on cancer. What is conventional medicine using as a potential phase three inhibitor to help augment, or improve, chemotherapy? Is curcumin, so should curcumin be in a detoxification program? If it’s truly detox, you want to open up phase zero, have phase one and phase two working very well, and keep that second set of doors wide open, phase three, so that stuff can actually get out. Then, for the third part of the detox, is to be excreted via sweat, via bile and poop, via urine, or, like I said, technically, salivate, saliva, or tears.  I don’t know if that answers the question. But that’s phase zero. Phase zero is entry into the cell. Phase one redox, oxidation, the hydroxyl group is added or exposed, intermediate metabolites, sometimes more toxic, not always. Phase two conjugation gets handed something. Phase three exits the cell and then is excreted, as long as the body is excreting.

Dr. Weitz:            Interesting.  In order to promote excretion, you talk about using particular fibers and binding agents to help get rid of some of these toxins?

Dr. Walsh:           Yeah. What I did, again … Bentonite clay, I’ve been familiar with bentonite clay, as a fitness professional, and different types of fibers, and all these things. But what I wanted to do was look to the literature and say, “Well, what actually shows an improvement in the excretion and, not necessarily, of xenobiotics, but of bile.” So like a bio-acid sequester, like cholestryramine, the old cholesterol lowering drug, bound up bile to excrete it. If we can bind up bile, because so many xenobiotics are found in bile, and is their primary form of excretion, we need to bind up bile. We need to bind up all the stuff in the gastrointestinal tract for a variety of reasons, but I tried to find things that had some scientific basis behind it, so things like charcoal, for example, fiber, soluble, insoluble fiber.  An interesting one is chitosan or ketosan, which is typically used for fat loss, not very well. But there is papers showing that it is, actually, effective at increasing xenobiotic excretion via bowel habits. The other big one is sweat. You have to sweat. In fact, I recently came across a paper that, the short version was and, again, if I come back in a future life as a lab rat doesn’t sound very good. They had two groups of mice or rats and they gave one group a pretty significant burn on their skin, which is unfortunate. They injected both sets of mice with a certain xenobiotic and, not surprisingly, the ones that had a burn had higher levels of this environmental pollutant, because skin is such a major route of excretion. And, in fact, is the preferred route of excretion of some xenobiotics, not all, but some.

So if somebody is not actively sweating, during this hypocaloric phase, then I don’t think we’re getting rid of as much as we need to. To the point then, this is a bold statement. But I have some more papers that I’ll be adding as some bonus content coming down the pike. This stuff just blows your mind, blows your mind. I would not, myself, my family, or any patients, or clients put them on a fat loss program without supporting detoxification pathways, period. If they couldn’t sweat, I would say, “You probably don’t want to do a detoxification program.” If it’s really … I’ll just give you a tip on some of these things. There’s evidence that weight loss actually increases one’s risk for dementia, cardiovascular disease, diabetes and cancer, very strong, and the author cite this as a reason. Weight loss induces mobilization of xenobiotics. They go up and if you’re not getting rid of them, cause damage to cells way down the level.

Now, you look good in sexy jeans, or skinny jeans, but in 20 years might have cancer, or dementia, because of the weight loss. And, in fact, a steady increasing BMI, as one ages, seems to be protective over some of these thing, which is counter to what we want to look like, ourselves, but it’s very compelling stuff. Yeah, this is real, man. I would not do a fat loss program without making sure I was sweating and excreting and supporting detox. I would not. I would not put a patient on one, because I think that the detriments are too strong.

Dr. Weitz:            Sounds good. I know you’re a fan of infrared saunas, or a particular type of infrared sauna, right?

Dr. Walsh:           Well, you know, no, actually. I don’t like steam rooms, because of the water that they’re potentially using. I think that you can have a lot of model organic compounds found in steam. Again, unless it was purified water. But, no, here’s the thing. Again, I try not to have much of an opinion, but base it off of what I’ve read in the literature. Interestingly, in the literature, when they collect the sweat they’ll have a cohort of people to collect their sweat to look at xenobiotic levels. But they don’t tell them how to sweat. So, whether it’s via exercise or in a sauna, it didn’t matter. That when you sweat, you excrete. There’s people out there that might split hairs about a far infrared sauna and a near infrared sauna or the old ones, which are called the radiate heat saunas.  Listen, from what I’ve read, I tend not to like to split hairs over things, just sweat, man. If all you have is an old coal one, and you pour your water on it, and that’s all you have. That’s fantastic, do it. I love near infrared, personally. I think far infrared are interesting. There’s some questions about the electromagnetic frequencies, and stuff, and some of those things. But the goal is to sweat. I don’t care how somebody … In fact, I have people contacting me about my program. They’ll say, “I don’t have access to a sauna, but what if I went up into my attic?” I’m like, “As long as it’s not filled with asbestos or all this toxic stuff up there, then fine. Listen, sweat. It doesn’t matter.”  I like how the near infrared saunas feel and the bright red lights. But, no, I think to say one’s superior is myopic, personally. I think just sweating, according to science, is the most important aspect.

Dr. Weitz:            Interesting. I got that from an interview you did with Mercola. Maybe it was Mercola who liked the near infrared.

Dr. Walsh:           Yeah, he likes near infrared more than far.

Dr. Weitz:            Okay.

Dr. Walsh:           But that’s splitting hairs. To me-

Dr. Weitz:            He didn’t like the EMF thing about it.

Dr. Walsh:           No, just to sweat is the most important aspect.

Dr. Weitz:            Let’s go-

Dr. Walsh:           I would say this … Sorry to interrupt. What’s nice about the sauna, though, is it’s controlled. You can control the temperature and the time, so that, in terms of knowing the quantity that you’re sweating. That’s why I suggest the sauna, but if someone doesn’t have access to it, just sweating is what’s important.

Dr. Weitz:            Let’s go over one more thing. This will be the final question. Is part of your program involves … I know you have a 10-day detox program and part of it includes a four-day version of the Fasting Mimicking Diet that’s been popularized by Dr. Valter Longo, who sells you this box, or his company, and people who are part of this program called, ProLon, sell you this box of pre-packaged foods that you open up and make soup and things like that. You basically have put together a program that involves using real food, but to create the same effects.

Dr. Walsh:           Yeah. The short version is, if someone’s never done a detoxification, just an average person, that maybe has never done one. I recommend doing what I put together, just my view on this, is a 10-day program. The first six days, because of what you talked about, is the very high nutrient … It’s low calorie. It’s hypocaloric, you have to mobilize, but it’s fairly high protein. It’s high protein to ensure that, whoever this average person is, that maybe wasn’t eating perfectly, isn’t particularly healthy, might be protein deficient, or I should say, amino acid deficient. That they have the sulfur groups, and they have the methyl groups, and they have the glycine and all the precursors, the glutathione, in order to really support those phase two detoxification pathways.

That’s why I recommend the 10-day program for somebody who hasn’t done it before. That’s the first six days. Then the last four days, or someone could do five, if they wanted. It is what I refer to as a modified fasting mimicking diet.  Now, I think the work that Longo did is … the papers are brilliant. I think they’re fantastic. The findings of these things are so interesting.  My concern, however, is that every paper that I’ve looked at, where any mammal goes hypocaloric, their xenobiotic levels go up, period. He’s looking at this from diabetes reversal, and autophagy, and mitophagy, and all these health promoting effects, and that’s great.  However, instead of … So the macro-nutrient ratios that he’s come up with are brilliant. The calorie levels, which I won’t get into, but I think that should be based on one’s weight, rather than just having set calorie levels.  So a very hypocaloric diet with very specific macro-nutrient ratios.

Dr. Weitz:            By the way, what are those macro-nutrient ratios?

Dr. Walsh:           It depends if it’s … According to the one paper that I use, that have the specific ratios. Honestly, it’s basically ketogenic.  It’s very low calorie, first of all, but it’s moderate carbohydrates, very, very low protein.  In fact, you can, in what I put together, you can reach your protein levels just by eating vegetables for that are required.  It’s very low protein, which there’s no additional protein that’s actually consumed.  The amount of protein found in the vegetables that I consume, you hit your mark.  Then a little bit of fat.  It’s like carbs, protein, and fat, so that somebody can be in a ketogenic state and not push themselves out. My concern with his work, however, is while really compelling stuff that he’s produced is what about this xenobiotic thing? What about these papers that I’ve seen that show that, if you lose weight, or if you mobilize, and that can cause some other chronic conditions or situations much later in life? Instead of just saying, “Here’s some soup or here’s some avocados and some tofu, or whatever it is to reach the macro-nutrient ratio level that he recommends.” I recommend specific food that, according to the literature, have been shown to support detoxification pathways.

I mean, again, what he’s put together is brilliant. I think it’s genius. I think it’s fantastic. I have no problems with it, other than, if you just eat rice and avocados to meet those macro-nutrient ratios, you’re basically doing nothing to help support detoxification pathways. And these people will have increased environmental pollute levels in their blood, period. I say, instead of eating foods to meet the macro-nutrient ratios, eat specific foods that, according to the literature, have been shown to support detoxification impact. That’s the 10-day.

Now, what I do recommend for someone, like yourself, however, if you’d really wanted to do a good detoxification program over the course of a few months, is not to do … You’re a healthy guy. You eat a healthy diet. You live a lifestyle. I think that you could do two four to five day fasting mimicking diets a month. In week one, you might do four or five of those days. Then, again, in week three do another four or five days. And the next month, do the same thing. So you don’t need to do the full 10 days, because arguably those last four or five days, where it’s really hypocaloric, that’s where you’re going to get the maximum, and it’s time restricted eating, you’re going to get the maximum mobilization. And if you’re eating the right foods … I have some evidence that this absolutely lowers xenobiotic levels.  For someone, like you, that’s already healthy, I don’t think you need to do the 10 days. I think four to five day, modified fasting mimicking diet, a couple times a month would be the most effective way.

Dr. Weitz:            Awesome. It’s been a great interview Dr. Walsh. How can we find out about your fasting programs and the other programs you offer?

Dr. Walsh:           Remember, I don’t agree just with fasting. I think we’re too sick to-

Dr. Weitz:            I’m sorry. I’m meant your detox programs.

Dr. Walsh:           I know.

Dr. Weitz:            How can listeners and viewers-

Dr. Walsh:           Yeah. If you go to drwalsh.com, D-R-W-A-L-S-H dot com, backslash detox, that’s all you have to do. Then there’s a funny little picture of me with two buttons. One says, “Practitioner,” and one, basically, says, “Non-practitioners,” because I created two programs. The practitioner version of this goes into great detail. They both go into the science. I show the studies on the screen. I walk people through the pathways on the whiteboard. Again, I don’t want to tell people what to do without having the reason why the recommendations are there. So that they’re knowledgeable and empowered and understand why they’re doing these things. Why everything is in the program that’s in there. I don’t just say, “Take these potions and detox.” I want them to know. The difference in the programs is the practitioner program is about nine hours. The non-practitioner is about four hours of video. The practitioner program goes in way more detail in the biochemical pathways of phase zero, phase one, phase two, phase three. I go heavier into the science. It’s more technically detailed, but they both have the same output, where it’s, here’s the program, here’s how to do it.

Dr. Walsh:           When I add on some of these additional, bonus, content features, both programs … And the practitioner program, if a practitioner gets the practitioner program, they also get the non-practitioner program for free.

Dr. Weitz:            Great. Any other points of contact you want to give out for people who would like to get hold of you?

Dr. Walsh:           No, that website is the hub.

Dr. Weitz:            Good. Good. Excellent. Well, thank you, Dr. Walsh.

Dr. Walsh:           It was my pleasure. Thanks so much.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
How to Fix Your Fatigue with Dr. Evan Hirsch: Rational Wellness Podcast 076
Loading
/

Dr. Evan Hirsch discusses how to fix your fatigue 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

2:51  What distinguishes fatigue from chronic fatigue is that fatigue is generally relieved by a good night of sleep and chronic fatigue goes no for an extended period of time, usually longer than 6 months. Dr. Hirsch has found 15 different causes of fatigue: 1. not drinking enough water, 2. not getting enough good sleep, 3. deficiency in adrenals, 4. deficiency in thyroid, 5. deficiencies in sex hormones, 6. nutrient deficiencies like B12, vitamin D, magnesium, 7. heavy metals, 8. chemicals, 9. molds, 10. infections, 11. allergies, 12. negative emotions, 13. EMFs, 14. hidden dental infections, 15. parasites.  One of the founders of Functional Medicine, Dr. David Jones once said that the key to health is finding what we don’t have enough of and providing it and finding what we have too much of getting rid of that.

8:45  Adrenal fatigue or dysfunction can be a common cause of fatigue.  While testing for adrenals can be helpful, you can tell from symptoms if there are adrenal problems. Dr. Hirsch likes to start by using Adrenal Px from Restorative Formulations, which he’ll have patients take every 3 hours until 4 pm and if they need to he will recommend up to 3 capsules per dose.  In addition, make sure they are sleeping well, eating healthy, drinking water, etc. Dr. Hirsch mentioned that one doctor analysed all the studies on cortisol levels and fatigue and there was no correlation at all. If his patients need more support, he’ll recommend Adrenal Px syrup and he may add in some licorice root.  If that hasn’t taken care of the problem, he’ll use a product called Adrenal Para-NS from Byron White formulas. And finally, that hasn’t helped enough, then he will recommend hydrocortisone. 

16:40  Thyroid is another important gland that affects energy levels. Low thyroid is really two conditions: 1. low thyroid prodicution by the thyroid gland and 2. an autoimmune condition in which the immune system is attacking the thyroid. And this is usually because of either heavy metals, chemicals, molds, infections, allergies, emotions, or EMFs. One infection that Dr. Hirsch sometimes finds is involved is Bartonella and getting rid of Bartonella with the Byron White formulas can sometimes completely reverse low thyroid.  To support the thyroid Dr. Hirsch may start with some thyroid glandulars or iodine or kelp, but he generally finds that prescription thyroid is the most effective.  He does not like using Armour or Nature-throid because some patients may bneed more T4 and some may need T3 and we have to figure out the right dose for that individual. You also need to support the thyroid by supporting the adrenals and there’s this beautiful dance between thyroid, adrenals, and the sex hormones.                                               

19:45  Gluten, dairy, soy, and genetically modified corn can all play a role in the causation of thyroid autoimmunity.

24:04  Dr. Hirsch will sometimes use 20,000 IU vitamin D if a patient’s levels are below optimal, since vitamin D will stimulate T regulatory cells, which can help autoimmunity.  Most of his clients take 10,000 IU for maintenance.

27:42  Balancing sex hormones can help with fatigue. He finds that a lot of times when he finds younger men with mold, which results in low testosterone levels and low libido and once we get rid of the mold, their testosterone and libido comes back.  He will test for mold with urine testing from Great Plains or Real Time Labs after taking 500 mg of liposomal glutathione twice per day for seven days. For heavy metals he will use the Doctor’s Data provoked urine test using DMSA and test before provocation for baseline and then test after DMSA provocation.  To screen for other chemicals besides heavy metals he will use the Great Plains Lab GPL-TOX urine test also with glutathione provocation. To get rid of metals and other toxins he will recommend saunas, coffee enemas and cilantro and chlorella and modified citrus pectin. Dr. Hirsch likes to use a combination of products by Byron White that open up the liver and kidney pathways and helps to open the lymph and the neurolymph. He finds that most of his patients require at least 6 months to a year of treatment and sometimes as long as 36 months.

39:45  To support mitochondria, which are the organelles in the cells that produce energy, and they produce 70-80% of our energy.  Our mitochondria can get damaged by heavy metals, chemicals, molds, infections, allergies, emotions, and EMFs.  Not only do we have to remove that crap off of the mitochondria but we also have to inject the mitochondria with some good love in the form of like Acetyl-L-carnitine, L-carnitine and D-Ribose, CoQ10.  Dr. Hirsch likes to recommend a product from Research Nutritionals called ATP Fuel for supporting the mitochondria and he sees a boost in energy from using it.  Dr. Hirsch is on a mission to help a million people resolve their chronic fatigue!

        

 



Dr. Evan Hirsch is an MD who is practicing Functional Medicine with a focus on treating patients with chronic fatigue.  His website Fix Your Fatigue  offers a free download of his best selling book, Fix Your Fatigue.

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 e-book on my website by going to drweitz.com. Let’s get started on your road to better health.  Hey Rational Wellness Podcasters. Thank you so much for joining me again today, Dr. Ben Weitz here. For those of you who are enjoying the Rational Wellness Podcast, please go to iTunes and give us a ratings and review, that way more people will find out about the Rational Wellness Podcast. Our topic for today is fatigue and what do we do about fatigue. Today we have Dr. Evan Hirsch, who’s a medical doctor who practices in Olympia, Washington, using a Functional Medicine approach and his practice is really focused on treating patients with various forms of chronic fatigue. He’s written a best-selling book, Fix Your Fatigue. Dr. Hirsch, thank you so much for joining us today.

Dr. Hirsch:           Thank you so much for having me on Dr. Ben.

Dr. Weitz:            So since you’re a conventionally trained MD, how did you veer off the path into functional medicine?

Dr. Hirsch:           So, when I grew up, my mom was really into natural stuff. So, I think I was about 10 when she first started down her path, and she had very high cholesterol genetically, and she was able to reverse it using oat bran. We went on this six months of oat bran muffins, oat bran this, oat bran that. I remember just being really disgusted by oat bran at the end of it, but she brought her cholesterol down significantly and I thought that was very interesting, and then when I went through medical school, I just am very curious, I ask a lot of questions, and I wasn’t happy with the answers that I was getting from all of my professors and doctors-

Dr. Weitz:            Just put people on statins, right?

Dr. Hirsch:           Exactly, and so I was saying, “Well what’s the cause of the cholesterol issue? What’s the cause of the high blood pressure?” And getting to the root, and I didn’t like the answers I was getting so I went off into holistic medicine. I got board-certified in holistic medicine, went into integrative medicine, functional medicine, environmental medicine and that kind of led me down that path and then my wife got chronic fatigue and then a couple of years later I got chronic fatigue, and so it was working through all that that I really became so in tune with what the causes were for fatigue and how to resolve them.

Dr. Weitz:            Great, so what are some of the most common causes of chronic fatigue? And by the way, what distinguishes chronic fatigue from other forms of fatigue?

Dr. Hirsch:           It’s a great question. So fatigue in general just means that you’re tired and it’s not resolved with rest, because theoretically you should be able to work out hard and then you sleep well and then the next day if you’re not well rested you sleep well the next night and then you’re fine, so it may take a couple days to recover depending on whether you ran a marathon or not but you should recover. Fatigue is when you don’t recover and then chronic fatigue is when it’s been going on for a extended period of time. Conventionally it’s usually longer than six months or so but usually if somebody is having an issue after just a couple of weeks I say don’t wait because there’s things that are happening that your body should be recovering and at that point you need to start going after it.

So that’s the answer to your second question there, and then the first one and around the causes, so I have found that there’s 15 different causes of fatigue but to be brief on it, and we can definitely get into those, generally I put them into two categories, one is things that need to be replaced or deficiencies, and so that’s things like not drinking enough water, not getting enough good sleep, deficiencies in hormones, adrenal, thyroids, sex hormones, deficiencies in nutrients like B12, vitamin D, magnesium. And then the second part is excesses, so we’re talking about things that need to be removed, the crap that’s in the body that needs to be removed out that’s causing problems, so we’re talking about heavy metals, chemicals, molds infections, allergies, negative emotions, electromagnetic frequencies, hidden dental infections, parasites, so a bunch of that crap that’s not supposed to be in the body that’s just draining the body and causing all these deficiencies.

Dr. Weitz:            Yeah, a famous Functional Medicine doctor basically said, “It’s pretty simple, what do I not have enough of and add that and what do I have too much of and get rid of some of that.” I think that was Dr. David Jones.

Dr. Hirsch:           Yeah, that’s exactly right. What I find with a lot of docs, they have that theory but they’re not looking enough at molds. They don’t have enough knowledge around mold illness, how to diagnose it in a person, how to diagnose it in a home to make sure they’re not living in a home, what that process looks like and then infections. You really have to dive in there in order to get that knowledge beyond just what Dr. Jones said.

Dr. Weitz:            Yeah, absolutely, and the tricky part is that you could spend a lifetime just studying mold, you could spend a lifetime just studying heavy metals, and so each time you get into one of these specific topics as a functional medicine practitioner it’s like jumping down a new hole of a whole new set of things to learn about, and that’s the tricky part. You tend to find what you’re familiar with, so if you’re really comfortable dealing with heavy metals it’s easy to find heavy metals, and most people have heavy metals so you fix those and you’re gonna get some improvement.

Dr. Hirsch:           Right, exactly, and that is a problem with being a clinician is we always have to catch ourselves and make sure that we’re just not leaning on what we enjoy treating or what some of these old patterns are and really trying to be as expansive as possible. And so for me what I have people do when they first come to see me is I have them run a whole bunch of labs because I know my clinical suspicion and I can diagnose some things clinically but neuropathy, fatigue, I mean a lot of these things it could be multiple things. And in fact, with everybody that I see I tell them, “There are 15 potential causes, you have multiple causes of fatigue and the causes that you have are different than the person in the next room.”  So we all have different multiple causes and they’re all different from each other which makes it so hard to treat, so it’s really important to get all of those things assessed, the heavy metals, chemicals, molds and infections, looking inside the body, making sure and seeing whether or not they’re there, putting them together with the symptoms and then coming up with a plan and having the right tools in order to treat them effectively.

Dr. Weitz:            And one of the things that I find challenging in Functional Medicine is when patients come in with the conventional mold, they’re realizing, “Well of course I realize it’s gonna be a little bit different,” but basically they want to take the test, they want to be told it’s this, they want to take those pills and that’s it, I’ll see you, and the problem is these are a lot of times complex cases and there are levels of dysfunction. So if the person has mold but they also have a leaky gut and they also have nutritional deficiencies, and you can’t address all these at one time so you sort of have to prioritize, deal with some of the most significant ones first and it’s a different model than you’re used to going to their medical doctor.

Dr. Hirsch:           Absolutely. I tell people this is a marathon, it’s not a sprint. This is a long-term proposition and it’s gonna require a lot of information or a lot of buy-in from them, and the people who come to see me have already seen 20, 30 doctors and so they’re probably different maybe than the people who come to see you but they’re usually a lot more bought in than when I was just practicing functional medicine now that I’ve ditched myself in this way and people are coming to me for chronic fatigue.

Dr. Weitz:            I see, interesting. I was reading your book which is an excellent read, lots of good information, easy to read and you talk a lot about adrenals in one of the first chapters, can you talk about how important adrenals are to fatigue? And how do we assess adrenals? And what do we do about adrenals if they’re burned out or not functioning optimally?

Dr. Hirsch:           Absolutely, and this is one of the things that I do at the first visit. Generally even without labs I can tell whether or not someone has the symptoms of adrenal dysfunction, and to answer your question-

Dr. Weitz:            Do you ever have patients do a series of labs before they even come in?

Dr. Hirsch:           I don’t.

Dr. Weitz:            Okay.

Dr. Hirsch:           Yeah, they could. A lot of people come with their own labs but I don’t because I want to make the assessment and I want to make sure that I’m ordering the correct labs for them, but the adrenals are really a universal problem. The adrenal gland produces lots and lots of hormones, cortisol is the big one that we talk about a lot that manages stress, it manages the immune system, it manages inflammation, everybody’s heard of prednisolone and cortisone, well guess what? They come from cortisol and that’s our body’s natural anti-inflammatory. So whenever there’s inflammation in the body like from eating gluten or eating dairy or having an infection or having mold, cortisol goes and some of the other adrenal hormones go and try to put out that fire, and as a consequence those hormones coming from the adrenal gland end up going down and people will have low blood pressure, they will crave salty and sweet things.  Generally they’ll say, “I can’t walk past a bag of potato chips without having to stop to eat it.” And then with the low blood pressure they’ll kind of have dizziness when they go from a sitting to a standing position too quickly. They will have low energy throughout the day, but typically they’ll crash usually at around eleven o’clock or at around three o’clock. Three o’clock is the big one where people are like, “Man, between 2:00 and 4:00 I have to take a nap. I have to get some chocolate, pick me up, caffeine, 5-hour energy.” Whatever it is, that’s really when they’re crashing, or they exercise and they have exercise intolerance where they exercise and then they’re crashed out for two days and they’re like, “I thought exercise was supposed to be good for me.” It’s like, “Yeah, but if your adrenals aren’t working well your body can’t manage the stress of that exercise.”

For those of you who don’t know, the adrenal gland is a little triangular gland, sits on top of the kidneys, produces cortisol and some of these other hormones which regulate so many parts of the body, so important and really the sentinel gland. As the adrenal gland goes, so goes the thyroid, so goes the sex hormones, so its really so pivotal, so important. So that’s the anatomy of the adrenal gland, the symptoms that you’ll get with it, and then in terms of testing like I said, I can tell really based off of their symptoms but sometimes you’re looking at a morning cortisol level which is what I do in blood but you can also look at saliva to look at four times a day, but those are kind of the big ones.

Urine can be helpful looking at urine metabolites from the adrenals, so all of those can kind of give you a glance. I do believe that looking at the symptoms are most important. And then in terms of treatment, I’ve tried lots of things over the last 10 years and I’ve dumped all of my protocols into the book, you can read more about this but I found that there’s this one product called Adrenal Px by Restorative Formulations that’s Eleuthero root, Hawthorn root, but mainly the Eleuthero root that’s super smooth and super strong that I have people take every three hours until 4:00 PM and it makes a world of difference in their overall function. It’s really the first thing that I do when you talked about the common causes, one of the most common causes is adrenal dysfunction, maybe it’s cortisol, maybe it’s some other components of the adrenal gland.  But starting to work on that adrenal gland, starting to work on sleep, behavior, food, those are kind of a lot of the big things that I do initially that can make a huge difference in people’s lives.

Dr. Weitz:            Cool, there’s a lot of discussion these days about checking the cortisol within like the first 30 minutes of waking up, it’s called the cortisol wakening response, and so now some saliva tests. You actually spit into a tube before you even get out of bed and apparently you get the most accurate assessment of cortisol apparently using that test now.

Dr. Hirsch:           Interesting. I’ve got a free Facebook group with almost 1,000 people in it and I just did a Facebook live review of some of the work that Ari Whitten did at the Energy Blueprint. He basically looked at all of the research on cortisol and its association with fatigue, and I think most of the research was on blood and on salivary, probably wasn’t on this new technology, but what he found, and time and time again, I mean he went over like, I don’t know, almost 100 different papers and meta analyses and there’s really no correlation between low cortisol levels and fatigue.

Dr. Weitz:            Interesting.

Dr. Hirsch:           Yeah, and so what I really think is happening is that there’s a number of these different components, these different hormones that are being produced by the adrenal gland, epinephrine and norepinephrine which are like the adrenaline hormones, maybe they’re playing a bigger role but utilizing just cortisol to determine someone’s adrenal function really hasn’t been proved and has been disproved in the research to be effective and functional. So we need some better tools but in the meantime I do use it and I combine it with symptoms, making sure that … Because those symptoms can be very specific for the adrenals.

Dr. Weitz:            How often do you actually prescribe cortisol itself?

Dr. Hirsch:           Great question, so like hydrocortisone, Cortef , some of those prescriptive agents?

Dr. Weitz:            Yes.

Dr. Hirsch:           So I have a tiered approach where I’ll start off with giving people Adrenal Px and then if they need I’ll ramp up to three capsules per dose, four capsules per dose. If they need more support I will put them on the Adrenal Px syrup which is a little bit stronger, and then if they need more support beyond that oftentimes and they have low blood pressure I’ll add in a little bit of licorice root and then I’ll move into a product called Adrenal Para-NS by Byron White Formulas, and then I’ll get into hydrocortisone. So there are problems with hydrocortisone, it is a steroid. I mean cortisol is also a steroid, we’re making our natural steroids but it can cause people to put on weight.  They get a little bit of this chipmunk appearance with the jowls and often times they may get a bit of a hump on the back and they do put on the weight and they do start craving a lot more food which causes them put on the weight. So it’s not perfect, there is a book called Safe Uses of Cortisol by William Jeffries where he did use it long term, and I have used it long term with some people but the goal is that it really is just a band-aid, because when we figure out what’s causing stress on the body and that could be a mental, emotional stress or it could be physical stressors like all that crap that’s in the body that I talked about before, once we remove those it allows the adrenal gland to relax. It doesn’t have to produce all these hormones and you shouldn’t need as much of the adrenal support.

Dr. Weitz:            Cool, now another important gland that affects energy levels is thyroid, can you talk about that a little bit? And how often is that playing a role?

Dr. Hirsch:           Absolutely. Thyroid dysfunction is huge and part of that has to do with the fact that low thyroid is really two conditions, it’s low thyroid production by the thyroid gland and then it’s also an autoimmune condition. So the immune system is attacking the thyroid, and usually it’s because one of those crap things, what I call the usual suspects, heavy metals, chemicals, molds, infections, allergies, emotions, EMFs, they’re all in the thyroid and so the immune system is trying to get rid of the stuff in the body that’s not supposed to be there. So it goes on over to the thyroid, calls its friend, starts attacking the thyroid to get at what’s in the thyroid, usually it’s mercury, maybe it’s Bartonella which is this particular kind of infection.

It grabs at it, tries to pull it out, oftentimes not successful because they’re so sinister but that’s kind of the process and in that process you’re destroying the thyroid and you get lower levels of thyroid.  So in order to fix it you have to remove the crap that’s in the thyroid, that’ll slow down the destruction of the thyroid or stop it.  Immune system is no longer gonna react to it and consequently you’re not decreasing your thyroid levels. Now, I do like to use prescription grade thyroid when I am replacing the thyroid.  I’ll start off with some natural things, some thyroid glandular or some iodine or kelp or some of these other things, but generally I find that I get the biggest shifts when I dive into using the prescription agents.

Sometimes people need more T4, sometimes people need more T3.  People who just use Armour or Nature-Throid or Westhroid, they’re missing the boat, that’s basically like a combination of T4 and T3 but everyone’s an individual and most of the time those people who come to me on Nature-Throid or Armour, they need more T4 or they need more T3. We have to figure out the right dose for that individual, and this combination product is not a one-size-fits-all, but thyroid plays a huge role. You also support the thyroid with the adrenals, and there’s this beautiful dance that happens between thyroid, adrenals and sex hormones, and they really all have to be present and accounted for in order for the whole system to work.  So somebody steps out of the dance like when you have stress with the adrenal gland and that’s gonna tax the thyroid and the sex hormones or you get above 50 and all of a sudden the gonads start to shut down and sex hormones start to go down. If the adrenals aren’t robust enough, they’re supposed to take over production of the sex hormones, but if they’re not robust enough, then both the adrenals and the thyroid will start to decrease their function as well, as they try to scramble and compensate for each other.

Dr. Weitz:            Do you find that gluten is sometimes playing a role where the body immune system attacks the gluten and then you get this cross reactivity with the thyroid?

Dr. Hirsch:           Yes, gluten definitely plays a huge role, gluten-

Dr. Weitz:            Soy.

Dr. Hirsch:           … dairy, soy, corn, genetically modified corn, those are kind of the big ones that I see but the only time I’ve ever been able to really reverse thyroid and to get people off of their thyroid medication has been going after infections and heavy metals. There’s one particular infection called Bartonella, this is a funny, serendipitous story where I had a patient who I had just put on a treatment for Bartonella. Now Bartonella is this infection that causes a combination of symptoms usually a combination of headaches, neck pain, problem sleeping, anxiety, depression, pain on the bottom of the feet, muscle cramps in the calves, stretch marks sort of rash on the body and thyroid issues, and so you don’t have to have all those you just have to have some of those. The big ones are like pain on the bottom of the feet usually misdiagnosed as plantar fasciitis and the muscle cramps.

But I put somebody on treatment for Bartonella and she comes back in like the next day and she’s in a thyroid storm. So she was on thyroid medication, I started her on this path and now she’s got too much thyroid, she’s like hyper thyroid. Her heart is beating out of her chest, she’s got tremors, she can’t sleep, she’s anxious, agitated, I said, “I don’t know what’s going on but we got to decrease your thyroid because you’re hyperthyroid.” So we decreased her thyroid and over time as we ramped up on treating her Bartonella we were able to wean her completely off of her thyroid medicine, which I’d never been able to do before.  I never heard of anybody being able to do this before, so it was very exciting.  And so I find that about 50% of people who have thyroid issues who also have Bartonella, I’m able to get them off or wean down off of their thyroid medication, maybe not all the way but a significant way down off of their meds.

Dr. Weitz:            Very cool. What kind of treatment did you use for the Bartonella?

Dr. Hirsch:           So I’m a big fan of Byron White Formulas. He’s just done an amazing job with his herbal complexes, and so A-BART is really one of my favorite formulas which has neem in it and poke root and a number of other things to break up biofilm, to kill the infection, to push it out of its hiding form.  It’s incredibly potent, so even just one drop can send people into a die-off or a Herxheimer reaction where you’re killing the bug and you feel worse, and so sometimes I even start people off topically, just rubbing it into their hands can make a huge difference for folks, but his formulas are really genius and I love to use them.

Dr. Weitz:            Interesting, yeah. I interviewed Darin Ingels who’s an expert on Lyme disease and he mentioned the Byron White Formulas as one of the formulas that he’ll use, and I guess Bartonella is often talked about as a Lyme co-infection.

Dr. Hirsch:           Exactly, yeah. Acutely it’s cat scratch fever, where people get big lymph nodes and they get fevers but chronically, yes it can exist in ticks and fleas and mosquitoes and all these things that transfer Lyme.  And I find that I don’t have to treat Lyme or Borellia as much when I’m going after these co-infections, whether it’s Bartonella, whether it’s Babesia that will cause people spontaneous sweating, shortness of breath, cough, awful panic and anxiety as well as depression and suicidal thoughts. I go after those guys and I don’t have to really go after the Lyme, Borellia as much because then the immune system will come back on board.  I get rid of the molds and the heavy metals that brings the immune system back even more, because you really can’t treat these infections until you get rid of the heavy metals, chemicals and molds that have distracted the immune system. So you got to bring that immune system back in order to bring these bugs back into check.

Dr. Weitz:            Cool, I noticed you were talking about using 20,000 units of vitamin D sometimes for patients with thyroid problems, that’s pretty high dosage, do you find that to be necessary to go that high?

Dr. Hirsch:           Yes, and it really depends on what we’re doing, but when we’re looking at the thyroid and we talked about it being an autoimmune disorder, one of the ways in order to modify the immune system and what’s called the Th1/Th2 balance. One of the aspects of the immune system is causing this autoimmune component, and you can adjust that by dealing with the T regulatory helper cells and you can do that with high dose vitamin D, you can do that with glutathione, you can do that with low dose Naltrexone.  So there’s a number of different strategies that we can use to bring that seesaw back into balance and decrease the amount of autoimmunity that’s happening to the thyroid.  And there’s been lots of studies on vitamin D and I know doctors who try to get people’s levels up to 100 or 150 units on the blood and I’m really looking for more 60 to 100 but people are so deficient that you can give them 20,000 and oftentimes it’s not gonna put them into excess of 100. Most people live at around 10,000 but yeah, 20,000 is also really great for colds, boosting that immune system so that it’s able to function at a higher level.

Dr. Weitz:            Yeah, you probably noticed patients who’ve been to their medical doctor who tested their vitamin D and they said, “Oh yeah, I’m taking plenty of vitamin D. I’m taking 1,000 units a day.

Dr. Hirsch:           Right, yeah it’s almost comical. And the levels when we’re looking at those labs, normal range is not a normal range. It’s not an optimal range, it’s a population-based range, so I’m always telling people … Because a lot of those labs say yeah, less than 20 is low for vitamin D and I’m saying less than 60.

Dr. Weitz:            Yeah, exactly. There was just a study that showed that women who got their vitamin D above 60 had the lowest risk for breast cancer. I noticed you mentioned PEMF which is a kind of electrical machine, right?  And you sometimes use that for patients with thyroid issues.

Dr. Hirsch:           I did. I was experimenting it for a while, probably around that time that I was writing the book. I don’t use it a lot, in part, because some of the ones that I’ve used have just been too strong for a lot of my patients. It opens up the capillaries where you’re able to absorb things a lot better and you’re able to detoxify and I really need more control over detoxification because a lot of my patients were feeling worse. It was also very dehydrating for them and when you have adrenal issues you don’t maintain your salt balance well and so consequently you’re chronically dehydrated, and so it was just a little bit too much. I was using the BEMER technology and some of those and it was just too strong on people.

Dr. Weitz:            You might look into using cold laser. There’s a research group out of Brazil that’s published several studies using cold laser directly over the thyroid, there’s a certain protocol and they’ve actually been able to show changes in the cells and actually reverse Hashimoto’s in some cases.

Dr. Hirsch:           Wow, I’m writing that down right now.

Dr. Weitz:            Yeah, I’ll send you a copy of one of the papers afterwards.

Dr. Hirsch:           Great, thank you.

Dr. Weitz:            So you also talk about trying to balance the sex hormones as something to look at when patients are suffering with chronic fatigue, maybe you could talk about that.

Dr. Hirsch:           Sure, so sex hormones, generally I’m looking at that for people who are over the age of 50, but when mold is introduced it’s incredibly common in any age, especially scratched my head for a while, I’ve had all these men that had low testosterone levels, low libido, stuff like that, turns out that most of those had mold and once we got rid of the mold then the libido came back, the testosterone levels came back up. So it really is about where’s the stress on the organism? How are the adrenal thyroid sex hormones playing a role? Can we do it with herbs? Sometimes I’ll use maca and different forms of maca to boost estrogen, progesterone, testosterone, but sometimes I’ll need to go …

I had a patient today in my office who I needed to give bioidentical hormones. So she’s 47 years old, she’s moving into menopause, she’s got hot flashes and sometimes in the interest of time and in the interest of helping somebody resolve their symptoms I’m like, “Okay, we’re gonna boost your adrenals and while we’re boosting those I’m also going to give you this symptom relief because this is gonna make everything work better as we remove these toxins out of your body.”

Dr. Weitz:            Cool, yeah. One of the problems I think is all these endocrine disrupting substances in the environment.

Dr. Hirsch:           Yeah, we tested her for toxins and we found that there were a bunch of organophosphates, so pesticides that were found in her urine in addition to some mycotoxins or mold toxins that were there too.

Dr. Weitz:            Yeah, I’ve tested hormones on about 20 men in the last several months and like 17 of them were low, especially in their free testosterone, even called up the lab and said, “Is there something wrong?” But I think it’s getting to be really common that these endocrine disrupting substances and potentially mold and heavy metals as well are interfering with testosterone production.

Dr. Hirsch:           You got it right there. Yeah, and they’re all stressing out the hormone system which is really … When it comes to options in the body, I tell people, “Does your body want to survive or does it want to procreate?” And right now it just wants to survive. It’s dealing with all that crap coming at it, it’s stressed out of its gourd and it’s gonna send as many of its resources as possible over to the adrenals, to the thyroid, and it’s not going to worry about the production of testosterone. You can actually see that also when you’re looking at the steroid hormone pathway, that half of it is kind of like adrenals and the other half is sex hormones and you can see how it would be diverted.

Dr. Weitz:            So let’s say you have a patient with chronic fatigue and you’ve looked at the thyroid and adrenal and maybe even addressed the sex hormones, and now you’re starting to think, “Okay, could there be an infection or maybe heavy metals or mold,” and there’s nothing really clear in their history, how do you decide which way to go?

Dr. Hirsch:           So that’s where the labs come into play, because I’ve definitely been proven wrong. And actually another person I had today, I was like, “Well there is no history of known mold exposure.” Now most people don’t ever think that they’ve had mold exposure unless it’s been on the wall, and so I have to ask them, “Okay, have you ever lived in a place that had a leak in the roof or had a flood in the basement or had a broken pipe?” And then people say no and then inevitably they’ll come back the next time and say, “You know what? I think I did.” But it’s so nebulous and it could be that it was a place that they were growing up when they were five and they don’t remember. And so it’s all about the testing, it’s all about having good tests in the urine mycotoxin which is looking at the mold toxins is really the best test out there.  Now you have to propagate it with glutathione so you have to make sure that somebody’s taking glutathione so that they can push all of the micro toxins out and make sure you get a good test.

Dr. Weitz:            Oh, interesting. How much and how long do they have to take the glutathione for before you do the urine test?

Dr. Hirsch:           So seven days, 500 milligrams of liposomal glutathione twice a day, so that’s like a teaspoon twice a day of the ReadiSorb glutathione or the Tri-Fortify liposomal glutathione by Research Nutritionals, and so either one of those should work but seven days or however long. If they can’t take it for seven days because they start to feel like crap because they’re mobilizing all this crap that’s in their body, then just have them take it on that day so that they don’t have to suffer, but generally seven days, twice a day, 500 milligrams and then they do that test but that’s the urine test for the mycotoxins, the urine provocated test for heavy metals utilizing DMSA, really the best ways to get these things out of the body so that you can test them and determine what’s going on.  The PCR tests are basically a DNA test for a lot of these Lyme type infections in the urine through DNA connections is the best test out there. So there are a number of different tests but you got to make sure you’re looking at the right one.

Dr. Weitz:            Which test do you use for the mold? Do you use the Great Plains mycotoxin test?

Dr. Hirsch:           I’ll use both of them, the Great Plains or the RealTime Labs but Great Plains, less expensive, does a great job, I really like what they’re doing. RealTime Labs is covered by Medicare, they also do a great job and they’re expanding their panel a little bit more but I’ll use either one but the Great Plains is less expensive.

Dr. Weitz:            Cool, and then how do you assess for heavy metals?

Dr. Hirsch:           So I’ll use Doctor’s Data, looking at the DMSA provocation test where people take 10 milligrams per pound of body weight, so if they’re 200 pounds or over they’ll take 2,000 milligrams. But I do a pre and a post, so you wake up in the morning and you check your urine and that’s the pretest and that tells you what’s floating around in the bloodstream, and then you take 2,000 milligrams or whatever your weight is of the DMSA and then that’s gonna start pulling out the heavy metals from the tissues, from the organs, because that’s where the heavy metals live. They don’t live in the bloodstream, that’s why when you do a blood test for lead it’s really worthless, blood test for mercury, worthless.

You have to pull it out from the tissues and then you check it in the urine, you collect the urine for the next six hours and then you compare the two and that can give you some really good information as to whether or not someone has a heavy metal. And then there’s a lot of nuances to it because if they’re detoxification pathways are really clogged up with molds or chemicals then they’re not going to have a very positive results or if you detoxify them for a period of time then all of a sudden they’re gonna be releasing a lot more mercury, so they’re going to be like, “Why is my mercury getting worse?” Well it’s not getting worse it’s just that when you were detoxifying initially you could only get rid of up to this amount of mercury, but now that your detoxification pathways are so much open now you’re able to get rid of so much more mercury out of your body. So there’s a lot of nuances to that and I do talk about some of that in my book.

Dr. Weitz:            Interesting. Is there a way to screen for some of the other chemicals besides heavy metals, like the endocrine disrupting substances.

Dr. Hirsch:           So I use the Great Plains Lab, they’re GPL-TOX tests which looks at kind of a hundred different chemicals and that’s a really great test as well, and also should be provocated with the glutathione.

Dr. Weitz:            Okay, great. And then how do you get rid of heavy metals?

Dr. Hirsch:           So that is a great question too, so there are some more aggressive techniques or some more gentle ones. You can use things like saunas and coffee enemas and cilantro and chlorella and modified citrus pectin. I use a combination of products by Byron White. A combination that opens up the liver and kidney pathways, helps open up lymph neurolymph so basically lymph that’s in the brain, and our lymph system is really our garbage can or trash system that really helps to move things through, and then a product that he’s got called Envi-Rad which helps to get the metals out as well as the chemicals.  And in a study that Byron White did on his patients, he found that over a 10-day period when he combined all of these products he saw a 300% increase in excretion of metals in the urine which is pretty darn equivalent to doing it with DMSA which has a lot more side effects and consequences, and you have to make sure that you’re replacing a lot of the minerals and a number of other things. You have to protect the liver and the kidneys while you’re doing that so it has a lot more nuances to it, and so I’ve been very pleased with using this Byron White protocol.

Dr. Weitz:            Cool, how long does that protocol typically take?

Dr. Hirsch:           So it depends on the person, generally the people who are coming to see me need to do it for sometimes six months, sometimes 36 months, so it really depends. I tell people, I say, “I’d like to get you better in a year but depending on the number of causes you have and your ability to tolerate these supplements that I recommend will determine on whether it’s a year or whether it’s three years.”

Dr. Weitz:            Now, do you look at the guy to make sure that they are not constipated, so they’re actually excreting these toxins to make sure they don’t have a leaky gut so they don’t get reabsorbed.

Dr. Hirsch:           That’s a very important point. Nobody should ever be doing any sort of detoxification unless they can get things out of the body, and that means that you’re peeing regularly, you’re pooping regularly, that you’re sweating regularly, that you’re able to exhale. Those are the ways that we detoxify our bodies and so you have to be able to be stooling on a regular basis, once or twice a day. And so I’ll use magnesium to bowel tolerance, but a lot of times when … Constipation has a cause, it could be thyroid and I kind of have a chapter, I’ll dedicate it to this in the book. It could be thyroid, it could be parasites, it could be yeast, it could be a number of these infections that I test.  I really like that GI-Map stool test, really works well.

Dr. Weitz:            Yeah, we’ve been using that a lot too.

Dr. Hirsch:           Yeah, and it gives you a lot of good data and then you can determine whether or not you need to fix it, but everybody that I see has got a leaky gut because they have all these causes of fatigue which also all damage the gut, so there has to be some leaky gut repair. But I found that I’m just wasting time and money to try to heal leaky gut when someone’s got heavy metals, chemicals and molds. I can heal the gut at the same time as going after the fatigue by going after parasites or yeast, but it just doesn’t make a lot of sense for me when I’m treating these really sick people to go after that leaky gut and spending a lot of time there.

Dr. Weitz:            Yeah, especially if their primary symptom is not gut related so you have to prioritize.

Dr. Hirsch:           Exactly.

Dr. Weitz:            Yeah, so the final topic I want to touch on is mitochondria which is that part of the cell that’s truly responsible for producing energy, can you talk about how we think about the mitochondria with respect to fatigue?

Dr. Hirsch:           Absolutely, so the mitochondria like you said is the energy center of every cell in the body except for red blood cells, they don’t have them, but it produces about 70 to 80% of our energy, our ATP as it is. And so the mitochondria comes from a bacterial ancestor, it has this very important mitochondrial membrane which can get damaged by heavy metals, chemicals, molds, infections, allergies, emotions, EMFs, like all these things are going to damage that mitochondria, and so not only do we have to remove that crap off of the mitochondria but we also have to inject the mitochondria with some good love in the form of like Acetyl-L-carnitine, L-carnitine and D-Ribose, CoQ10.

There’s a number of things that I really like to use but the most important thing I think is also to heal that mitochondrial membrane, because what people forget sometimes is that around that cell, that membrane, is the communication tool for other cells, so there’s these ion channels, there’s these messengers that need to be working, and so one of my favorite products is ATP Fuel by Research Nutritionals which does wonderful things for healing the mitochondria and then repairing that mitochondrial membrane. And they did a study on 58 people, and after the saturation you’ve got to boost it up, taking it twice a day for the first two months but after the first two months they saw a 30% average increase in energy.  So just a really nice bump of one or two points of someone’s energy just from doing that, now imagine if you’re also boosting the adrenals, boosting the thyroid, B12, vitamin D, magnesium and then also removing the crap out of the body, you’re gonna get a lot better energy and a lot better function.

Dr. Weitz:            Cool, I feel more energetic already doc. So thanks for the interview Evan, this is really good. How can listeners get a hold of you?

Dr. Hirsch:           So you can find me at fixyourfatigue.org, F-I-X-Y-O-U-R-F-A-T-I-G-U-E.org. You can also check out my free Facebook group which is Fix Your Fatigue With Dr. Evan, you can find that from my website as well. I do have a free download on my website of my book, so if you want to get it on Kindle or on Amazon as Kindle or paperback you’re more than welcome, but you can also download the PDF for free, and I’ve really dumped all of my protocols into there so you can figure out how to solve your fatigue. And I do have about 10 spots available for one-on-one and group coaching right now, so if people are interested I’ll be filling that up in the next month or so. But otherwise, I’m on a mission to help a million people resolve their chronic fatigue so thanks so much for having me on and helping me with my mission.

Dr. Weitz:            Cool, that’s great, that’s a great mission doc. Talk to you soon.

Dr. Hirsch:           Thanks so much.