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Homeopathy with Ananda More: Rational Wellness Podcast 84
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Ananda More discusses Homeopathy 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

7:58  The majority of the scientific studies about homeopathy are either positive or inconclusive.  Only 5% are negative. There are over 1000 published studies and close to 200 randomized clinical trials.  On the other hand, quite a number of studies on drugs that were negative were never published and, in fact, the pharmaceutical industry had a history of doing a study over and over many times till they got three that were positive, that they would then pass on to the FDA for approval.  Ananda said that she has “heard many stories throughout my life with my friends and family who are doctors in research where they’ve been asked to change their results for specific studies, because the results didn’t quite line up with the expectations of the funders. I had a friend who was told that if she published her results, she wouldn’t be allowed to get her PhD, for example.” We also have to consider that these medical journals are being funded by advertising from big pharma.

12:47  Mainstream medical journals like the New England Journal of Medicine, rarely ever publish papers on homeopathy.  Ananda said that when the word homeopathy is in the abstract and the result is positive, the study isn’t even sent out for review. Also, there is very little funding for research on homeopathy.  Homeopathic medicines can’t be patented and they are easy to replicate.  So you don’t have the same possibility of profits that you do with other forms of medicine.

14:19  In the Magic Pills documentary there’s a section where there was an outbreak of leptospirosis in Cuba due to some severe hurricanes in 2007. They only had enough leptospirosis vaccine for 1% of the population and besides the vaccine requires two separate dosages to incur immunity. So they decided to do a homeopathic intervention, which they distributed to 2 and a half million people.  It completely stopped the epidemic and the levels of this disease dropped far below the historical averages for years afterward. But when these scientists (immunologists and epidemiologists) tried to publish their results, they were turned down by all the medical journals. They did eventually publish their results, but only in a homeopathic journal, Homeopathy. The paper is:  Large-scale application of highly-diluted bacteria for Leptospirosis epidemic control. The lead author, Dr. Bracho, started receiving death threats after publishing this paper. 

18:05  How can Homeopathy be effective when the active ingredient is is so diluted?  Homeopathy is an energy medicine and not only do you need to dilute the active ingredient, but there is this process of producing the formula that includes hitting the glass vials that the formula is in very hard against a surface, known as succussion. This creates high temperatures in the bottles and it creates nano particles of the active ingredient within the vial. It also sloughs off nano particles from the glass and silica is a conductor. 

22:38  Ananda was at a conference and Dr. Bracho from Cuba came and told this story about the homeopathic intervention that was so effective and long lasting and she wanted to get this story out there to help change people’s attitude about homeopathy, which is why she decided to make Magic Pills.

24:04  The Australian National Health and Medical Research Council released a report in 2015 that has been very influential and has led to a shift in public policy and opinion against homeopathy in a number of countries around the world, including in Australia. In both Australia and the United Kingdom homeopathy was covered by the national health system and now it is not due to the influence of this report.  This report was supposed to be a review of the research on homeopathy, but in the end they cherry picked the data and only included five studies, four of which were negative and one of which was positive, and they concluded that there is no evidence that homeopathy is effective for any condition. But this review had serious methodology problems, including using an arbitrary criteria that excluded any study with less than 150 subjects. NHMRC’s own guidelines are that a good study is over 20 subjects. Their methodology was so poor that they were refused for peer review publication. When the Australian Homeopathic Association did a freedom of information request they found out that there had been a previous study done by a well respected scientist, but they refused to release that first report. The speculation is that first report concluded that homeopathy was effective for certain conditions, so there is a global movement to release the first report, where you can sign a petition. 

28:28  Homeopathy has a long history in the United States and in fact, the senator who brought the bill that created the FDA, Royal S. Copeland, was an MD who practiced homeopathy.  There are homeopathic hospitals, which still exist today, including Hahnemann Hospital in Philadelphia, and there is a statue of Samuel Hahnemann and a memorial to homeopathy in Washington, DC, that was endorsed by President McKinley. But now the FDA has decided that they wanted to change the oversight on homeopathy and they have created a draft document that is creating some oversight over homeopathy but might be setting themselves up to make homeopathy illegal, since in order to go through a new drug application process, it requires a minimum of $300 million and homeopathy has thousands of medicines and which medicine is used is individualized for each person. The homeopathic industry isn’t big enough to be able to afford this process, so this could be setting the stage for removing homeopathy in the US.  And we know that in the US, the ability to lobby congress is what allows you to get favorable legislation, and homeopathy is a threat to the pharmaceutical industry, which spent $240 million to lobby congress in 2015 alone. 

35:16  The other problem with this draft document is that it is removing the FDA guidelines for manufacturing a homeopathic product, the CPG Sec. 400.400, which outlines proper manufacturing guidelines. By getting rid of these guidelines, it will be more difficult to assess if a homeopathic product is being properly manufactured.  Based on what has happened in other countries, this has created a worry that this document is part of a process that will limit or make homeopathy illegal in the US. 

36:24  There’s a group of mothers that depend upon homeopathy that have created this organization, Americans for Homeopathy Choice, to lobby for homeopathy and they have already delayed the passing of this draft document. You can go to Homeopathychoice.org and learn more, sign up, and write letters.  According to Ananda, “Even if you don’t believe in homeopathy, I think this is about protecting our rights to freedom of choice. It’s a basic human right to decide how you want to treat your body and how you want to medicate yourself. If you want to try other options first in a safe manner, I think that’s absolutely a human right.” 

39:48  Ananda has made this documentary about homeopathy, Magic Pills, which she if inviting people to screen with groups of people in their homes, coffee shops, churches, theaters, etc. which you can learn about by going to the website, magicpillsmovie.com or by going to the Magic Pills Movie Facebook page.

 



Ananda More is a Homeopath in Toronto, Canada at Riverdale Homeopathy, where she sees patients and teaches educational programs for homeopathy and she made an incredible documentary on homeopathy called Magic Pills that has not been released in the US yet but you can screen with groups of people in your home or in other public places.  She is dedicated to spreading the word about homeopathy. 

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. For those of you who enjoy 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. Today, our topic is homeopathy, and we’ll be joined by homeopath Ananda More.

For those of you who are not familiar, what exactly is homeopathy? Well, according to Wikipedia, the source of all knowledge, skepticism, sarcasm there, homeopathy is a system of alternative medicine created in 1796 by Samuel Hahnemann based on his doctrine of like cures like, a claim that a substance that causes the symptoms of a disease in a healthy person would cure similar symptoms in a sick person.  

There are quite a number of studies that show the effectiveness of homeopathy, while quite a number of other studies show no benefit. Scientists and mainstream doctors tend to be skeptical, because some of the theories behind homeopathy don’t line up with the general accepted principals of chemistry and physics. For example, the concept that by diluting a homeopathic formulation more, it gets stronger. Goes against the principle that you need a minimum of the active ingredient to create an effect in the body, and having less than this amount will tend to be less effective or have no therapeutic effect.  This skepticism, combined with a report produced in 2015 in Australia by the National Health and Medical Research Council that declared that there are no health conditions for which there is reliable evidence that homeopathy is effective. Homeopathy, in other words, according to them, is no better than placebo. They stated that homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.

Yet over 5 million adults and over a million children in the US and many more million around the world use homeopathy on a yearly basis. Many get positive results with very few side effects. We have asked Ananda More, a homeopathic practitioner from Toronto, Canada, and a filmmaker to help sort out the truth about homeopathy. Ananda wrote, directed, and produced an incredible documentary on homeopathy called Magic Pills that includes some amazing footage on how homeopathy is saving lives in Africa, India, South America, and Cuba, among other countries. Homeopathy can be delivered at a fraction of the cost of traditional medicine and medical care, which some of these people don’t have access to in these developing countries because of their poverty levels.  Ananda, thank you so much for joining us today.

Ananda More:                   Hi, Ben. Thanks so much for inviting me on.

Dr. Weitz:                         That’s great.

Ananda More:                   Wow, you started with a challenge there.

Dr. Weitz:                         Ananda, can you tell us how you came to become a homeopath?

Ananda More:                   Sure. So I was very, very skeptical of homeopathy. I did this course in university on witchcraft and the occult.  One of the things we studied under witchcraft and the occult was homeopathy. Were were taught that the idea is that they’re giving you highly diluted substances-

Dr. Weitz:                         Is that a broom in the back? Oh no, I’m kidding.

Ananda More:                   Probably.  So we were taught that it’s a medicine that believes that there’s these highly diluted substances, and they dilute them and dilute them and dilute them until there’s nothing there. Then we’d give this to people to treat whatever is ailing them. We’ve decided that this is medicine. To me, it just sounded preposterous. The way it was taught as well with that perspective also made it sound preposterous. I was very skeptical.  I was willing to open my mind up to traditional Chinese medicine, herbology, even Reiki, like the idea of energy medicine appealed to me, but this, I just couldn’t wrap my head around.

Then I found myself in India very sick. I was in this place called Pune, and I was traveling with a friend of mine, who’s German, which is where homeopathy originates. Her mom was a homeopath, and she had her nice little first aid homeopathic kit with her. I was, to be graphic, throwing up and everything going out both ends. It was really bad.  She comes along and goes, “Hey, want to try one of my little sugar pills?” I was delirious. I was like, “Whatever. I’ll make you happy. I’ll take your little placebo pill.”  When 15 minutes I felt absolutely fine, I was kind of floored.  In a way, there was a control, because other people in the place where we were staying had the same illness and were sick for days.  Not very scientific, but I had a nice way to compare what had happened.  I was kind of surprised.

At that point, I decided to go see a homeopath in India. That homeopath gave me some remedies. I’d been dealing with and struggling with depression most of my life. I think it’s genetic. It runs in my family. The depression that I had been dealing with, but that’s how I knew the world, that’s how my filters worked, that’s how I perceived everything around me, suddenly changed and my perception of life changed. It wasn’t sudden. It was gradual over a couple of months, but it really changed my life. At this point, I was heading to law school. I was all gung ho about doing human rights work. I realized that I thought I could help a lot of people with homeopathy, if it really did work for others the way it worked for me.  That’s when I decided to go study homeopathy, and my aspirations of being a lawyer went down the drain. Sometimes when I see what I pay my lawyers, I’m a little disappointed in my choices, but not really. It’s been an incredible journey really.

Dr. Weitz:                         That’s great. Let’s talk about homeopathy. Is there a science that proves that homeopathy is effective?

Ananda More:                   The majority of the science either shows that it’s effective or the study couldn’t tell. In a very equivalent manner to what you see in conventional medicine, you get about 40, 45% of studies have positive results for homeopathy. You get around 40% that are inconclusive, and around 5% that are negative. If you really look at the scientific literature, you’re getting more of a positive overview rather than a negative one.  We have over 1,000 clinical trials. We have almost 200 randomized controlled clinical trials that have been published. In terms of basic science, there’s thousands of studies that have been done as well. By basic, I mean working in vitro with cell lines, with plants, sometimes with animals. Many of those studies have been replicated. Again, they often more often than not show a positive result for homeopathy.  There’s something there definitely. This idea that homeopathy is unscientific I don’t think is true. Science is a way of studying things. We can set up appropriate ways of studying the effects of homeopathic medicine. Now as more and more science, particularly in physics, and our technology improves and we have more ways of looking at water molecules, at what’s going on in these solutions, we have a better understanding that what may be the basis for how homeopathy works.

Dr. Weitz:                         I’d like to point out a lot of people don’t realize this, but quite a number of studies on drugs that end up with negative results end up never getting published, whereas they tend to only cherry pick the studies that are positive and publish those.

Ananda More:                   Right. So there was this history in the pharmaceutical industry of doing a study over and over again until they were able to get enough positive studies to pass onto the FDA. I think they need three studies for the FDA. So they could do 900 studies and only three of them are positive, cherry pick those three studies and use those to defend their case. There’s more controls put in place against that now, but I know it’s still happening. But technically what’s supposed to happen is the study is supposed to register before it’s done in a way to kind of control that aspect of things.

Dr. Weitz:                         Do you think that’s actually being done?

Ananda More:                   I think it’s improving. Is it being done 100% of the time? I doubt it. I’m not one of the keepers of that process, so I can’t speak to that, quite honestly, in a good way. But the honesty is too that a lot of studies, they’re manipulating the data set. They’re finding ways to get the results they want. We see a lot of research is being funded by the pharmaceutical industry, and they have ulterior motives. I’ve heard many stories throughout my life with my friends and family who are doctors in research where they’ve been asked to change their results for specific studies, because the results didn’t quite line up with the expectations of the funders. I had a friend who was told that if she published her results, she wouldn’t be allowed to get her PhD, for example.

Dr. Weitz:                         Wow.

Ananda More:                   There’s a lot of research going on where people have created false studies and delivered them, submitted them to journals, only to have them accepted and published. This has been a matter of exposing the weaknesses of the peer review system. There’s also a lot of publishing bias, because who is it that’s actually funding these medical journals? It’s advertising dollars from the pharmaceutical industry. That really affects what we see as our evidence base. We’re talking so much about evidence based medicine, and yet how do we know we can trust that evidence base? We don’t. That’s very problematic.

Dr. Weitz:                         Yeah, that’s really important to point out. Have you found that mainstream medical journals, like the New England Journal of Medicine, you don’t see many papers on homeopathy in those journals.

Ananda More:                   I think there’s two issues going on there. One is that publishing bias that we discussed. A lot of the people I interviewed for my film, top scientists in their fields, said that as soon as the word homeopathy is in the abstract and the result is positive, the study isn’t even sent out for peer review. It’s rejected at the editorial stage. Another issue is that we don’t really have a ton of funding for homeopathic research, because there isn’t a lot of money in homeopathy. You can’t patent our medicines. They’re very easy to replicate. They’re very cheap to make. So you don’t have the same possibility of profits that you do with other forms of medicine.  Who funds most of the medical research? It’s the pharmaceutical and the medical industry. They’re not going to be funding homeopathic research. We depend on very few grants. A friend of mine, Dr. Alex Tournier, who’s a physicist in Heidelberg, he’s been struggling to raise enough money to maintain his lab, which is dedicated to homeopathic research. You’ve got both of those things, a profound publishing bias, along with a lack of funding for research.

Dr. Weitz:                         In your Magic Pills documentary, there’s a section where some doctors submitted a paper about their experience in Cuba after the hurricanes where they didn’t have enough money for medication or vaccines for leptospirosis, which commonly occurs after flooding and other types of water damage. Homeopathy was incredibly effective at reducing the rates of leptospirosis, but they were turned down for publication.

Ananda More:                   Yeah. So I just want to, just to get a few listeners up to date, what they did was there’s this disease, leptospirosis, which in North America is relatively unknown, but in tropical countries, it’s a pretty significant problem. It’s hard to diagnose, because it looks a lot like dengue and has some very generalized symptoms that are hard to specifically assign to a disease. It’s fatal up to 10% of the time, and it’s spread through water.  In Cuba in 2007, they had severe hurricanes that left the eastern coast of Cuba quite decimated. Homes were destroyed. There was no clean water, and flooding was everywhere. The Finlay Institute, which is a pharmaceutical company in Cuba that actually makes vaccines and is the only company on the planet that makes vaccines for leptospirosis, the issue wasn’t that they didn’t have the money. The issue was that they didn’t have enough vaccine on hand to take to those areas. They only had enough vaccine for 1% of the population.

The other issue is that that vaccine takes two doses and months to incur immunity. It’s not an instant fix. It takes a long time. In order to get it out there, it’s an injection. You’re dealing with cold chain, you need to be able to get to that area and maintain the vaccines cold. There’s a lot of issues with trying to get something like that to people in a fast manner.

They decided to attempt a homeopathic intervention instead, which they got out to 2 and a half million people. In the course of two weeks, they completely stopped the epidemic. Not only that, but the levels of the disease were far below their historical averages for years afterwards. Yeah, when these guys, who are immunologists, epidemiologists, they were scientists, they were not homeopaths, they have never had issues getting their work published, they got their work published all the time, and they even have their own vaccine journal that they’re the editors of. Suddenly they send it out for publication, and they were shocked, because in Cuba, they’re more isolated, they didn’t realize that there was this bias against homeopathy, and everyone refused to publish these results. They would get excuses like, “Well, we need a signature from all two and a half million people involved.” That sort of thing they’d never been asked for before. It was ridiculous.  So it was quite evident to them the level of bias that existed. They did eventually publish their results in a homeopathic journal called Homeopathy. When they did, Dr. Bracho told me he stopped reading his email because of the death threats that he was receiving.

Dr. Weitz:                         Wow.

Ananda More:                   He didn’t leave the country for over two years of fear of being attacked.

Dr. Weitz:                         Wow. Can you explain to the skeptics out there how can it be that by diluting the active ingredient that … Well, to begin with, everything we’ve learned about other forms of medicine is you need to find the right amount of the active ingredient and give that in an effective dosage. In some cases, if it’s not effective, then you give it more frequently or you give an additional dosage. That’s how we use herbs. That’s how medications are typically used. How can it be in homeopathy that by first of all diluting it so much that you’re going to have any effect at all, and then how can it be that by diluting it more, it makes it stronger?

Ananda More:                   Well, so I don’t want to say that diluting it more actually makes it stronger. We think homeopathy is an energy medicine. By diluting it more, you’re changing its signal. For one person, a higher dilution may be more effective. For another person, a lower dilution may be more effective. But in terms of this idea of dilution, what’s important isn’t just the dilution, but rather this process that we call succussion, which is we have machines or we do it by hand, and we hit these glass vials very hard against a surface. This actually causes very high temperatures to happen in those bottles for microscopic moments in time.  We believe what’s happening is it creates nano particles as it breaks down the material within the vial. It also sloughs off nano particles from the glass as well, and silica is a conductor. There’s a lot of things that are happening that isn’t just diluting a substance until it disappears.

We don’t have exact clear answers at this point, but we have several theories. We have discovered that there are nano particles of source material and very highly diluted remedies. This has been seen over and over. They’ve done this with metals like gold. They’ve done this with organic substances now too. What they do is they put the remedy under an electron microscope and look for the nano particles and see if there’s any trace. Then they have special ways using spectrography to understand what that source material is that they’re looking at.  This has been replicated dozens of times. We know for a fact now that there are nano particles in these solutions of the source material. How that relates to the mechanism, we’re not sure. How are those nano particles maintained in that solution? We don’t know, but they are there. They’re observable.

There’s ideas around now nano clusters, so actual formation of the water molecules and various … I have a cat that’s trying to get on my keyboard. He likes the keyboard. We can see these nano structures of the actual water molecules where they take on specific structures. Those have been observed. We can measure a difference in electromagnetic resonances or fields from remedies that have been actual just water to homeopathically prepared water. We have, what was it? Polar dyes. Studies have been done using polar dyes where they bring the remedies to very low temperatures. As they rise, these dyes change color and respond to usually material in the water. But what they’re doing is they’re actually responding as they should in the homeopathic remedies, if that substance was in the water, where they don’t with the plain water.  We can actually measure and see differences within those preparations. There’s still a lot to understand where it’s just at the infancy of the science, but it’s not because it’s unscientific. It’s because the technology’s just catching up that’s allowing us to look at these models. The funding is lacking.

Dr. Weitz:                            How did you come to make this documentary, Magic Pills?

Ananda More:                   So the story about Cuba that I just told, I was sitting at a conference, and Dr. Bracho from Cuba came and presented their results. I thought to myself, “Everybody needs to know about this. If this was a vaccine that had no adverse reactions, that could be prepared within minutes, or not minutes, but could be prepared within a manner of days, enough doses to reach two and a half million people, you don’t need cold chain, and it’s that effective and long lasting? Wouldn’t everybody know about it? Wouldn’t this be headline news?” But nobody heard about it.  I was racking my brain as to what do we, as a homeopathic community or scientific community need to do to get that data out there to let people know what’s going on, because in my view, this was all being suppressed. That’s where the idea of a film was born. I’d seen movies have incredible results in terms of changing how we respond to things like black fish and our responses to Sea World and how we raise animals, or rather marine mammals and how we keep them. Things like that. I was hoping that we could have a larger influence through a film and reach more people.

Dr. Weitz:                            Cool. Can you talk about the Australian National Health and Medical Research Council report that found that their conclusion was that there’s no good scientific evidence that homeopathy is effective?

Ananda More:                   Yeah. So this has been a very, very influential study. They’ve really shifted policy in Australia, according to what the study has said. They’ve done the same in the United Kingdom where homeopathy has been part of the culture there for a long time. The royal family, themselves mostly use only homeopathy, and they have these incredible homeopathic hospitals across the country. Homeopathy was covered by the national health system there and it was part of your public healthcare plan. Suddenly with the use of the study and some other commissioned reports, they decided that, “Oh, there’s no evidence that homeopathy works, so therefore we shouldn’t fund it anymore.” But the study is very problematic. From the point in time where they reached out to other scientists to say, “Can you look at our methodology and give us some feedback?” They got a lot of feedback, because their methodology was very poor, but they didn’t respond to those criticisms, and they didn’t change how they were doing the study.

When the report came out, it’s supposed to be a review of all of the literature out there, but their final data is based on five and only five studies, because they created a, in a way, very arbitrary data set that they decided was what qualified a good study versus a bad study. Part of that data set was a study that was over 150 people. That may sound reasonable, but if you look at the NHMRC’s guidelines, what they think is a good study is over 20 people. When they really cherry pick the data down to five studies, four of which were negative, one of which is one of our best studies showing that homeopathy works, which is a study on diarrhea in children, and they, based on these five studies, they didn’t even address the one study that was positive and didn’t look at it. They just said there is no evidence for any disease to say that homeopathy works. Also, yeah, just the rabbit hole just keeps going and going and going around why didn’t they look at these studies? Why didn’t they look at those studies?

When the Australian Homeopathic Association reached out and tried to get … Well, they did a freedom of information request to learn more about the study, they learned that there had been a previous study that had been done. That previous study had been done by a very well respected scientist. They’d seen the feedback on that study, which said that the methodology was of very high quality, and yet that study was buried. The lead scientist on that study was fired, and they decided to make a whole new study. They’re refusing to release that first report.

Dr. Weitz:                         Wow.

Ananda More:                   On top of that, this current report was rejected for peer review because its methodology was so poor.

Dr. Weitz:                         Wow.

Ananda More:                   So now we’re using this to uphold that homeopathy doesn’t work, and yet it couldn’t even get published, an anti-homeopathy study that couldn’t get published. I think that’s very meaningful. Now there’s a campaign, and it’s a global campaign, so I invite everyone who’s listening to this to go and sign this petition to release that first report. That could be a game-changer. People can go to releasethefirstreport.com. There’s tons of information, a real in-depth analysis of what is wrong with this study. Other people won’t say it, but I’m willing to say that I think the study is quite fraudulent and had something to prove that they couldn’t prove the first time. Yeah, I invite everyone to go there, learn more, sign, share. I think it’s really important.

Dr. Weitz:                         So how about in the United States? I understand the FDA has taken note of this report and issued some sort of a warning or something.

Ananda More:                   So homeopathy has been, in a sense, accepted by the FDA since its inception. Homeopathy was grandfathered in. The senator who brought in the bill to create the FDA was actually a homeopath himself.

Dr. Weitz:                         Really?

Ananda More:                   Yeah. So there’s a long-

Dr. Weitz:                         What was his name?

Ananda More:                   Pardon?

Dr. Weitz:                         What was the name of the senator?

Ananda More:                   I can’t remember his name. I’ll have to look it up.

Dr. Weitz:                         Wow. Interesting.

Ananda More:                   Quick Google search. But homeopathy has a long history in the US. We’ve had homeopathic hospitals, which still exist today. They’re just not homeopathic anymore, like the Hahnemann Hospital in Philadelphia. There is a memorial to homeopathy that was built by a president in Washington, DC.

Dr. Weitz:                         Really?

Ananda More:                   Yeah.

Dr. Weitz:                         Which president built it?

Ananda More:                   Again, I can’t remember his name. I’m not very helpful there, am I?

Dr. Weitz:                         You Canadians, you don’t know anything about American history.

Ananda More:                   It wasn’t a major president whose name was burning in my ears.

Dr. Weitz:                         That’s okay.

Ananda More:                   Resonate. But now the FDA has decided out of nowhere that they wanted to change how homeopathy is the oversight, how it’s overseen. They created this draft document which basically in a sense states that homeopathy is legal. It stated that we brought homeopathy in, but these remedies haven’t gone through the new drug application process. Therefore, we’re going to pursue this on a risk basis, on a high risk basis.  To the industry, they were saying, “Don’t worry. We’re only going to address remedies that are going to people that are immunocompromised and babies and things like this where there may be a risk to them using these remedies.” But in all honesty, what’s the risk if there’s no active ingredient in it? It’s not going to hurt anyone. It’s non-toxic, and in many situations, it’s the only medicines available to pregnant women and compromised individuals, people like that.

The other issue is that they’re basically setting themselves up to make homeopathy illegal with this document. In order to go through a new drug application process, it’s at minimum around $300 million. We have thousands of medicines. There’s a level of individualization to homeopathy, so you could have one remedy that could be good for 50 different ailments in 50 different individuals in different ways, and the kind of research that the FDA requires is very pathologically centered and per drug rather than homeopathy as a whole, which does not allow for individualization and using homeopathy as it’s actually used in practice.  Being able to pass those requirements are very doubtful, and our industry isn’t big enough to be able to afford that kind of money to pass every medicine for every possible indication. It really complicates things, and it’s basically setting the stage for the removal of homeopathy in the United States.

Dr. Weitz:                            Yeah. No, I can totally understand that. On the one hand, I saw a recent report where the FDA stopped the use of a particular brand of homeopathy, because they found bacteria or something in some of their products, and that sounded totally reasonable and sounded like what they were talking about. On the other hand, we have to understand in the United States especially, and I don’t know how many other countries follow this, but our government is increasingly controlled by big corporations and even the heads of the FDA and these other agencies are often lobbyists or people who work for these big corporations because of the way that the government is set up with the lobbying and everything.  For example in California, where I practice as a chiropractor, all the individual healthcare plans include no chiropractic coverage. How can that be in a liberal state like California where people use chiropractic and other alternative medicine quite readily?  It came down to lobbying, and the chiropractic profession didn’t do a good job of lobbying to make sure that chiropractic, which is relatively inexpensive, was going to be included in the new healthcare plans.  They wanted to cut something, and that was a low-hanging fruit they could cut.  It was based on lobbying. That’s I think one of the risks for homeopathy in the future is that everything seems to be based on influences based on the amount of funding.

Ananda More:                   Mm-hmm (affirmative). Yeah, and like what you’re talking about, there’s been a few situations recently where they have found bacteria in remedies. There is a story of Highland’s Teething Tablets, which garnered a lot of news because of their belladonna content, or deadly nightshade. Again, there was a freedom of information request done on that data, and it was so arbitrary. These supposed cases of death attributed to this remedy had nothing that was very hard to attribute the death to the remedy. You’d see cases like a child born without kidneys or who then had a dose of this remedy and died three months later. They were just completely … It just looked like falsified data. A lot of the data had been doubled as well. So they had to do a lot of filtering, and they claimed it was hundreds of thousands of complaints when you really looked at it, half of them you didn’t know what the complaint was about. Half of them were replicated from other things. Half of them had nothing to do … I keep saying half, but it dwindled down to almost nothing, in terms of complaints.  If you really took those teething tablets, in order to intake enough to have the minimum level for toxicity, you’re looking at taking hundreds of boxes or consuming hundreds of boxes of this medication. It really feels like there’s a witch hunt out there.

The other problem around that with this document is that if it passes, they’re actually removing the manufacturing guidelines for these remedies. There’s a document called the CPG 400.400. Within that document, it outlines proper manufacturing practices. The FDA has every right to go after these manufacturers who aren’t maintaining the purity of their remedies. What they’re doing is they’re getting rid of that. Suddenly you can’t even go after them with proper manufacturing, and we can’t even assess whether they’re selling a product that they say is what it is, because there’s no manufacturing guidelines.

Dr. Weitz:                         Wow, so you can’t go after the big pharma companies are having this stuff made in China that has all kinds of proven toxins.

Ananda More:                   But that’s very specific to homeopathy. That’s what they’re removing, the guidelines for manufacturing a homeopathy, which makes no sense.

Dr. Weitz:                         Right.

Ananda More:                   There is this fantastic group of mothers that formed in the United States headed by this very vibrant woman named Paula Brown. These were all moms who depend on homeopathy on a daily basis. It really amazed me, because we have public healthcare here. I can go to the hospital, and it doesn’t cost me anything out of pocket. But a lot of these-

Dr. Weitz:                         What a concept? You socialists.

Ananda More:                   Yeah, I highly recommend it. But these women were either didn’t have access to healthcare, couldn’t afford these hospital visits.

Dr. Weitz:                         We’ve got the greatest system in the world where a simple emergency room visit for a flu can cost you $3,000.

Ananda More:                   Yeah. I can’t wrap my head around that in any way, shape, or form, because I’ve never experienced that. But you see these women who were dependent on drugs and suddenly lost their plans and couldn’t get their thousands of dollars worth of medications anymore. They couldn’t afford to take their kid to the hospital. They saw miracles happen with homeopathy, so they really stand behind it. You hear these stories. They’re just astounding. They were so terrified of losing access to homeopathy that they formed this organization called Americans for Homeopathy Choice.  These women have been a powerhouse in the US, in terms of lobbying for homeopathy. This document that the FDA, this draft would have passed already if it wasn’t for them. They’ve put in place a petition and were asking for people to write letters to the FDA to support this petition. It’s not the kind of petition that everyone signs. It’s a petition specifically for them that’s clogged up the passing of this document. People can go to homeopathychoice.org and learn more, sign up, and write their letters. There’s all the instructions there as to what needs to be done.

Even if you don’t believe in homeopathy, I think this is about protecting our rights to freedom of choice. It’s a basic human right to decide how you want to treat your body and how you want to medicate yourself. If you want to try other options first in a safe manner, I think that’s absolutely a human right.

Dr. Weitz:                            I totally agree with you on that. There’s many cases now in the United States where those options are being taken away, where vaccines are being made mandatory to send your kids to school, and there’s a lot more things, a lot more cases where those individual choices for choosing your own healthcare, making your own healthcare decisions are being taken away.

Ananda More:                   Mm-hmm (affirmative).

Dr. Weitz:                            Well, this has been a very interesting interview, Ananda. Thank you so much for joining us.

Ananda More:                   Thanks so much for letting me talk and spread the word. I appreciate it.

Dr. Weitz:                            So how can listeners get a hold of you, if they want to talk with you or if they want to get more information about homeopathy? I’ll put links in the show notes, of course?

Ananda More:                   Brilliant. Well, we have made this … I think it’s a fantastic documentary called Magic Pills. We’re inviting people to screen it all over the US. We have a goal of 1,000 screenings. It’s actually been screening all over the world. It’s been in a bunch of film festivals. But what we want to do is bring it into people’s homes. There’s this model of you can screen the film in your own living room, invite your friends and family to come watch it. Or you can screen it in the church, a theater, all kinds of different places are being used. Coffee shops, museums. But we want to make it really accessible, and we want people to come together so there could be a really great discussion afterwards and a building of community around the issues presented.  We invite you to go to the website, magicpillsmovie.com. There’s lots of information there on how to make that happen. Through the contact us link there page, you’ll definitely reach out and you’ll hit me. Could also check us out on Facebook, which is Magic Pills Movie. We’re pretty active there as well. Those are the two excellent ways to reach us.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Men's Health with Dr. Myles Spar: Rational Wellness Podcast 83
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Dr. Myles Spar discusses Men’s Health 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

1:22  Some of the ways in which men’s health is different than women’s, is that men die younger. They have higher rates of heart disease. They may have issues with erectile dysfunction, prostate problems, and low testosterone especially as they age. Men, on average, die five years younger than women.  According to the Harvard Health Blog, the reasons why men die younger are that: 1. men tend to take bigger risks, 2. have more dangerous jobs, 3. die of heart disease more often, 4. are larger than women, 5. commit suicide more often than women, 6. are less socially connected, and 7. tend to avoid doctors.

3:45  Dr. Spar said it appears to be masculinity that results in men dying younger than women. In countries where the masculine machismo is more prevalent and they engage even less in the behaviors we know contribute to longer life and healthier living, are countries where men’s health is actually worse.  Dr. Spar said that we need to figure out how to message wellness to men so that they respond, which is what his professional mission has been about.

4:31  Dr. Spar said that the five factors that most contribute to premature death in men are 1. lack of exercise, 2. drinking too much, 3. engaging in risky behaviors, 4. smoking, and 5. being overweight.

5:29  We need to message in a way that men will tend to respond. Talking about a prevention and wellness approach means a lot to us as practitioners, but it only resonates to someone who is fairly abstract thinking, while guys tend to be more specific results oriented. Dr. Spar explained that we need to message to what matters to that person, such as performance at work, losing weight, getting cholesterol down, sexual function, etc. Men tend to respond to a more performance oriented message. but there are also lots of women who also think in this goal oriented way of thinking. 

7:11  When working with men to lose weight it is important to measure not just weight but bodyfat percentage and setting goals and holding men accountable.  Dr. Spar finds that apps like Strava are helpful in using technology that helps with accountability and tracking improvement or not. 

9:25  Dr. Spar prefers to look at genetics to see if his patients have trouble with detoxification. He uses either Pathway Genomics or PureGenomics from Pure Encapsulations that allows you to put your 23and me raw data through. But he is concerned about a report that such programs that analyse genetic data tend to have up to 20% errors when reporting on the SNPs of these genes.

12:17  To help men reduce their risk of heart disease, men need to have an advanced lipid profile, since the tests that are run with the annual physical exam are inadeguate in assessing the risk for heart disease. Dr. Spar likes to use the Cardiometabolic Profile from Spectracell, which looks at LDL particle size and number and also at inflammatory markers like CRP. We also need to look at Lp(a), which is a huge risk factor for heart disease.  Take the case of Bob Harper, the trainer from Biggest Loser who appears to be in great shape, and had no risk factors except that he had a high Lp(a) and had a near fatal heart attack.  It will also look at homocysteine, which is a risk factor for heart disease and is easy to lower with the right supplements. And homocysteine is also an indication that you don’t methylate well, if you haven’t had genetic testing. Your primary MD will usually not order such an advanced lipid profile because it’s usually not covered by insurance and they usually avoid such conversations.  Dr. Spar also likes some of his patients to get a coronary calcium score to see directly if there is any plaque in their arteries, which is another useful test that is not covered by insurance. But despite some patients’ concerns, there is very little radiation associated with such a limited scan and there is no radioactive dye.  If he has a patient who has cholesterol problems and he has them on fish oil and plant sterols and he is deciding whether to place them on a statin, the coronary calcium scan can help him and his patient make that decision. 

17:08  Men tend to have lower testosterone levels today because of 1. stress and anxiety, since our bodies shut down reproductive drive if we are under stress, 2. environmental toxicity, which especially seems to affect free testosterone, and even lowers sperm count, and 3. opioids, which have been correlated with lower testosterone levels.  Testosterone should ideally be in an optimal range betweeen 350 and 900. Too much and too low can both be risks for heart health. Men should also have an optimal range of estrogen with an ideal estradial range of 15-30. Men who are taking a lot of estrogen blockers can be causing themselves harm with respect heart and bone health if they drive their estrogen down too low.

23:50  Natural ways to raise testosterone levels include: 1. zinc and chrysin are both natural aromatase inhibitors and will block the conversion of testosterone to estrogen. When you take zinc you should also take 1/10 as much copper. 2. Chinese panax ginseng, 3. Tribulus, 4. Maca root, 5. stress management techniques, including meditation, yoga, Tai chi, journaling, prayer, some breath work, 6. 7-9 hours of sleep per night is very important 

26:45  Free testosterone levels seem to be often very low, even more so than the total testosterone.  Some of this can be due to thyroid and liver problems, but most of this is probably related to increases in SHBG (sex hormone binding globulin), which may be related to environmental toxins.  Dr. Spar noted that when tracking men whom he has placed on topical estrogen supplements, he will track them with saliva free testosterone levels, which is more sensitive for this than serum. This is part of his tack180.com program.

31:57  Dr. Spar does measure PSA levels in men, especially if he has placed them on testosterone.  We do know from the work of Dr. Abraham Morgentaler that testosterone does not cause prostate cancer, though if someone has prostate cancer, we don’t want to give them testosterone.  Dr. Spar will do a digital exam and if the prostate is enlarged he will also check a free PSA. If the PSA is elevated, will have the patient get a prostate MRI. If that is positive, only then he will recommend a biopsy.  This reduces unnecessary biopsies.

                                                                                          

 



Dr. Myles Spar is a Medical Doctor who practices in Hollywood, California and he is a leading authority on men’s health. He is a co-author and editor of a comprehensive book on men’s health, Integrative Men’s Health. Dr. Spar provides a lot of useful information on his website, MDSpar.com where he offers his Tack180 program of comprehensive men’s care.

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. 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 will find out about the Rational Wellness Podcast. Today we are going to focus our discussion on men’s health, with our special guest, Dr. Miles Spar. We’ve talked in prior episodes about prostate health, and libido, with Dr. Geo Espinoza in episodes eight and number 48. These are important issues for men. But today, we’re going to talk about these and other factors in an overall approach to improving men’s health.

Some of the ways in which men’s health is different than women’s, is that men die younger. They have higher rates of heart disease. They may have issues with erectile dysfunction, prostate problems, and low testosterone especially as they age. Men, on average, die five years younger than women. What are some of the reasons for this? According to the Harvard Health Blog, men tend to take bigger risks, have more dangerous jobs, die of heart disease more often, are larger than women, commit suicide more often than women, are less socially connected, and tend to avoid doctors. As a chiropractor, I can definitely endorse this, because my practice, like most chiropractors, is 60% women, and a lot of the men who come in are only there because their wives or girlfriends pushed them to come in.

I’m happy that Dr. Miles Spar will be joining us today. He’s a medical doctor in Hollywood, California. He practices Functional Medicine, and he also directs the integrated medicine program at the Venice Family Clinics, Simms/Mann Health and Wellness Center. Dr. Spar is a leading authority on men’s health. His comprehensive book on integrated men’s health was published in 2014. When Dr. Spar sees patients, his consultations usually include an analysis of genetics, nutrient levels, hormones, and advanced cardiovascular testing. Dr. Spar is also an iron man athlete, and he works both with Hollywood celebrities, and professional athletes, including being a medical advisor for the NBA. I’m honored that you’ll be joining our podcast Miles, to speak about men’s health.

Dr. Spar:              Thank you. Thanks Ben. It’s great to be here.

Dr. Weitz:            Absolutely. So, do you agree with those reasons the author of the Harvard Health Blog wrote about why men tend to die younger?

Dr. Spar:              Yeah I do. I think it’s definitely proven at this point, that it’s not genetic, it’s not biologic. There’s differences in life expectancy between men and women, but those differences change over time, and across cultures. If there’s really biology, it would be a fixed difference or more close to a fixed difference. It really just seems to be, it’s more like masculinity is killing us, as opposed to being male. There’s a really interesting report, just a couple of weeks ago, the World Health Organization put out on the status of men’s health in Europe saying very similar things to what you quoted from that Harvard blog, that the countries where the masculine machismo is more prevalent, are countries where men’s health is actually worse. There are countries where they are engaging even less in behaviors we know contribute to longer life and healthier living.  Absolutely, I think it’s coming upon us to really try and figure out what are we doing wrong, and messaging wellness towards men. Why aren’t they responding? What can we do differently. That’s really what my professional mission has been all about.

Dr. Weitz:            Of those factors we mentioned, which ones do you think are the most important?

Dr. Spar:              Basically I think there are five that are most important. There are five that are most likely to contribute to the decrease in mortality, the decrease in life expectancy, because they contribute most to the preventive causes of premature mortality. That’s basically lack of exercise. It’s a lot of what you mentioned, but I think … I can’t narrow it down to one. I think it’s lack of exercise. It’s drinking too much or not moderating alcohol. It’s taking risky behaviors. It’s smoking. I have a little thing here. It’s also maintaining a healthy weight. Men are more likely to be obese than women, and I think that may be the most important cause of it right there.

Dr. Weitz:            Yeah great. How do you address some of these issues in your practice?

Dr. Spar:              I think, first of all, like I kind of refer to we don’t message what we’re trying to do to men very well. We’ve been using this prevention and wellness approach, which is great, and it means a lot to us as practitioners, but it only resonates to someone who is fairly abstract thinking, able to put off things now for future benefit. By and large, guys are a little more result oriented. “What do I need to do now, and how is it going to impact me now?” It’s more about results, outcomes, specific goals, as opposed to broad ideas of wellness or prevention. I think part of what we need to is really think about messaging that’s directed at what matters to the person that you’re in front of. Is it about performance at work? Is it about losing weight? Is it about being more on mentally? Is it about getting cholesterol down? Is it about sexual function? Then making very specific recommendations that will impact that particular goal that’s of concern to that person. I call it a men’s approach, that it’s really about performance oriented, but it’s really not just for men.

I think that would help us in general, because there are a lot of people who think in this more stereotypical masculine way that’s result oriented, goal oriented that is more abstract and wellness orientated. By and large, that’s more men than women, but this is a caveat to our whole conversation today. When we talk about men, I really mean anyone who thinks in a stereotypical male way. It doesn’t have to be a person who’s a male in gender. That’s the first step, is really more goal results oriented way of talking about why it’s important to make behavior change.

Dr. Weitz:            You mentioned weight gain and obesity. How do you specifically deal with that with men, and how do you come up with more … How do you approach it in a way that’s more impactful than just making general recommendations, “You should lose some weight”?

Dr. Spar:               Yeah. Good question. I think it’s about measuring and holding patients accountable and having real milestones. As opposed to a general grid. “I have this great anti-inflammatory diet. Here’s what you eat. Here’s what you shouldn’t eat.” That doesn’t work as well as, “Okay, let’s look at specifically what you’re eating, meet with a nutritionist, and then let’s measure not just weight because with guys oftentimes they’re working out and then they don’t lose weight because they’re building muscle mass, so let’s look at waist circumference or let’s put you in a DEXA scan, which you can do now pretty inexpensively and check your body fat percentages. Whatever single measure can really be important to that guy, find that, and then check it periodically because guys like to compete even if it’s against themselves or against other people.  That’s the other part of that. I think physical activity is as important as diet. With guys especially trying to get them to engage. I love Strava, which is an app that’s like a social media/competition app or Weight Watchers even now has a great app. They’re using some kind of technology that helps have accountable measures. It’s all about having a measurement that you track and being able to show improvement or lack thereof and then figuring out where do we need to change our tactics.

Dr. Weitz:            Yeah, we use bioimpedance in our office, and that’s helpful.

Dr. Spar:              That’s great. Something that you use the same one each time, then it really is good. It’s showing changes, and then you know if you’re going the right direction or not. I think guys especially, everybody, especially guys like to feel like you’re holding yourself accountable. As a practitioner you’re going to say, “Look, I know this is going to work, and we’re going to show it’s working. If it isn’t, we’re going to change things. Then they like to see that they’re making improvements in black and white.

Dr. Weitz:            Do you ever look at toxins as a factor in having trouble losing weight or so many other health issues?

Dr. Spar:              Yeah. I like to do both looking at toxins and looking at genetics because sometimes people have genetics where they’re not detoxifying as well, so I like to do genetic testing to see if they need issues with detoxifying because it may be that they’re being exposed to the same amount as everybody else, but their hormones are getting messed up because they’re not clearing them out. Even if you do measure their testosterone, TSH and all that, it’s kind of okay, but their hormones aren’t operating as maximally because there’s so many toxins. Some of that is determined I think by how good their liver is at clearing things out. We can measure that through some of the genetic tests. They can tell us, “Oh, okay. This person really does have a propensity to not clearing stuff out, so let’s give him supplements that help boost whatever phase of detoxification they might need help with.”

Dr. Weitz:            What’s your favorite genetic panel?

Dr. Spar:              That’s a really good question. I play with all of them. Right now I’m using Pathway Genomics. It’s not really my favorite, but I like it for right now in terms of price and availability. I also like Pure Encapsulations products. It has this free if you’re one of their clients. It has this thing called PureGenomics, which is great. You can run 23andMe data for free through there. You get a great report.

Now the caveat is I’m concerned because I’m hearing that there is concern with some of these secondary data analyses from 23andMe data, that there have been found to be quite a bit of misinterpretation. I take it all as one piece of evidence. None of them is going to be a sole decision maker for me. It’s just if someone comes in with symptoms that could be relating to, let’s say, detoxification, then I look to see how are they detoxifying. How is their SOD? How is there MTHFR or some of these other genes? To see, okay, that could explain it or, “You know what? This doesn’t even make sense. I don’t really think this is significant.”  I mean I think hopefully whole genome sequencing will become more affordable, and that’s going to be a lot more reliable than any of these tests that look at individual SNPs.

Dr. Weitz:            What was that concern about the 23andMe?

Dr. Spar:              There are some just some studies that are showing that these Promethease and PureGenomics and some of these other programs that basically do secondary data analysis, they basically take the raw data from 23andMe and run it through their systems, that there’s a lot of error.  I forget the numbers now. I wish I could tell you. It was 20% or more were recording genes that were just inaccurate, that patients didn’t have those genes as it said they had.

Dr. Weitz:            Oh, wow.

Dr. Spar:              Yeah. It was really high rate of error. It definitely gave me some pause.

Dr. Weitz:            Interesting. Yeah, we’ve been utilizing that service as well. How do you deal with the heart disease risk that men have?

Dr. Spar:              Well, I think it’s important number one to look beyond just the general annual physical lipid panel. That’s a big thing. I think that just plain old cholesterol and LDL cholesterol is one part of the picture. You need to really look at these advanced VAP panels like Berkeley Heart Lab or I use SpectraCell, one of these advanced panels that looks, A, at things that go beyond the plain lipid panel. So they look at lipid particle number and particle size. Do they have a bad pattern of LDL or bad kind of cholesterol. You can have the worst pattern or the not as bad pattern.  Then especially looking at other markers because we know that heart disease number one is plaque and inflammation. Those are the two essential parts, right? We know that cholesterol can increase risk for plaque, but if their inflammation markers like CRP are really low, I’m less concerned. It’s really important to measure that. Then we know things like Lp(a), separate from cholesterol, a huge risk factor for heart disease. Bob Harper made that famous. He’s the guy that is a trainer on Biggest Loser, really in shape guy, had a heart attack or at least needed a stent placed emergently, and I think it was a heart attack.  Then there was a big article in the New York Times about the fact that his only risk was his high Lp(a) back in January or February of this year, your listeners can look that up, by this really good science writer for the New York Times. It really brought to light how important that marker is, which unfortunately isn’t always covered by insurance, but it’s a really important mostly genetically based risk.

Dr. Weitz:            I think that’s one of the big factors why when someone goes for their typical annual physical and they get this very limited number of blood tests, especially today, which when it comes to lipids is maybe going to be like LDL and HDL, total cholesterol, and triglycerides and sometimes even less because that’s what the insurance is going to pay. Unfortunately, most primary MDs are trying to stick with the insurance guidelines, and so unfortunately I think short changing the patients.

Dr. Spar:              Yeah. I mean there have been studies showing the annual physical as it’s currently done literally is a waste of time. It doesn’t provide any change in mortality or morbidity. There have been articles in the New England Journal of Medicine and JAMA and in very prestigious, very conservative journals about that. It’s because it’s all based on what insurance says as opposed to what is really optimal in terms of preventative medicine and evaluating risk, which is unfortunate because then it puts us in this position of saying, “You know, you really do need this test and this is how much it’s going to cost, and I’m not making money off of it, but you really need this.”  Patients who are low income, it’s not fair.

Dr. Weitz:            MDs rarely even offer patients that choice, though.

Dr. Spar:              Right because it’s a whole discussion that they don’t feel like to have. Either they don’t know about it because they don’t learn about it.  It kind of goes down they only learn about what’s in the annual physical or they’re like, “Okay, I know he needs this, but I got three patients waiting. Do I really want to go into ‘Well, you need this. This is why. Is it covered or not covered.'” They’re just like, “No, I’m just going to check off the lipid panel.”  It’s really unfortunate.

Dr. Weitz:            Yeah.

Dr. Spar:              Then the other marker I would say in there that I didn’t mention is homocysteine. That’s if someone can’t afford genetic testing that’s kind of a hint that they might have like an MTHFR, a gene where they don’t methylate their B vitamins well and don’t clear homocysteine.  Homocysteine is easy to lower, and it’s a very known risk factor for heart disease.  That’s part of it. And then imaging, I really think again is not covered by insurance but is not that expensive.  It’s like $200 for a coronary calcium score.

Dr. Weitz:            Right.

Dr. Spar:              To me, I love those because if somebody does have high cholesterol, but they don’t really want to go on a statin and I don’t really want to put them on a statin, we’re trying fish oil, we’re trying plant sterols. They’re watching their diet. The thing that will help me decide, “Okay, do we really need a statin or not?” is something like a phenotypic test. Is that risk translating into real disease? The way to look at that is something like a coronary calcium CT scan, which is only a few cuts, a couple inner bugs, and we can see do they have plaque or not, and if they don’t, then I know, “You know what? Don’t worry about it. You have some cholesterol, but it’s not really manifesting as plaque,” versus, “Ooo, you have a high calcium score of 100, we’re putting you on a statin.”

Dr. Weitz:            I think the reason why you mentioned that it’s just a few cuts is to point out that it’s not a lot of radiation.

Dr. Spar:              Right. Exactly. Some people get scared of having too much CAT scanning. This one, there’s no contrast dye that they’re injecting in you. It’s really limited to just looking at the arteries around your heart.

Dr. Weitz:            Right. Good. Yeah. Let’s bring up the testosterone topic.

Dr. Spar:              Yes.

Dr. Weitz:            First of all, we’re seeing lower levels of testosterone in men over the last several decades. Why is that?

Dr. Spar:              Good question. I don’t know that we know. I mean, I think the hypotheses that seem most likely are number one, anxiety and stress. There’s just more stress. There’s less time to do what we need to do. There’s less people unplugging and relaxing. We know that reproductive drive is completely directly correlated with or inversely related with stress. Women stop menstruating when they’re really stressed. Men stop making testosterone. It’s literally evolution protecting our progeny because if our bodies sense stress or crisis, and that can be emotional stress from work or from relationships just as much as being under attack from a saber tooth tiger, it’s going to say, “Whoa, we need to protect the home front. We can’t make progeny that we may not be able to protect. Let’s shut down reproductive drive and just focus on survival.”  It’s kind of hard where it ends. Stress lowers testosterone. I think that’s a lot of it.

I think some of it is environmental toxicity. We see that in to some degree this difference between total testosterone and free testosterone, which I know you were going to ask about anyway. Basically, some guys like their total testosterone is okay, but they have so much of this binding up protein called sex hormone binding globulin that their amount of testosterone available to really work is low. Some of that, I think, is due to environmental toxins that affect the liver and then the liver makes more of that protein.  I think between the stress and the toxins, those are probably the most likely. We see fertility going down. We see sperm counts going down. There’s something really affecting reproduction in general in men and women, but you can see a direct correlation in men.

Then opioids as well I guess would be the third one. We hear a lot of this opioid epidemic. Opioids are very directly correlated with lower testosterone, completely, even if you’re just appropriately taking them for a couple of weeks after having surgery or something. Your testosterone is going to go down while you’re on them.

Dr. Weitz:            Yeah. Opioids have all sorts of negative effects on the gut, every system of the body really. When it comes to testosterone levels, it’s interesting that really high levels of testosterone like professional body builders have will increase their risk of heart disease, while really low levels also increase their risk of heart disease. Then, yes, testosterone levels lower. A lot of times there’s higher estrogen levels, and it’s interesting that that’s a negative for men.  For women, higher estrogen levels are very protective for heart disease, which is one of the reasons why women have lower risk of heart disease.

Dr. Spar:              Yeah. I mean, I think there’s this whole controversy about testosterone, but it shouldn’t be a surprise that it’s not good if it’s too high or too low. I mean, we know with thyroid for example if it’s too high you can have problems. You can have palpitations and a risk of heart attack. If it’s too low, you get a wheeze and constipated, and you can even have all sorts of skin and other immune system conditions. All hormones are very finely tuned. They affect each other. It’s the same with testosterone. There’s definitely evidence too low testosterone affects increased risk for heart disease, increased risk for obviously osteoporosis and bone problems, and too high of testosterone increases it as well.  Really, it does need to be in the optimal range. I think that’s part of the issue with guys like bodybuilders that are taking too much of it. It’s not like … I don’t know if there’s any good example, but it’s not like more is better. You know? I mean, more is better if they’re low and they’re just getting it to the upper 25% of the normal range.  If they’re taking it over the normal range, it’s not good.

Dr. Weitz:            Yeah, what bodybuilders are taking though is nowhere close to the normal range, you know?

Dr. Spar:              No, no.

Dr. Weitz:            They’re taking thousands of times above what the normal range is.

Dr. Spar:              Exactly. They get results in terms of muscle mass, but they also get dangerous side effects, liver, heart disease, all sorts of issues. I think the estrogen is the same thing. You want it in that what’s normal for men. That’s the other thing bodybuilders and some guys do. They’ll read it in Men’s Health magazine or these magazines to take all these estrogen blockers, and then they take too much, and their estrogen is unmeasurable. They think that’s great, but that actually puts them at risk for osteoporosis because you want between 15 and 30, if you’re measuring your estradiol level. If it’s much higher than that, no it’s not good. You can get breast tenderness and issues if you do maybe take a blocker a couple of days a week.  These guys who are taking blockers like every day, and they feel great that their estrogen is unmeasurable, are really in trouble.

Dr. Weitz:            You think 15 to 30 is the sweet spot for estrogen for men?

Dr. Spar:              Yeah, for estradiol specifically. Yes.

Dr. Weitz:            Estradiol. Yes. What about for testosterone? When you look at these testosterone tests, let’s start with the total testosterone. The range on some of these labs is 150 to 900, which is a big range.

Dr. Spar:              Yeah. I know. I think for a total really if it’s under 350, they’re likely to have symptoms.  First of all, with testosterone I rarely just treat the number. If it’s in the 100s, I will treat the number.  Even if they don’t have symptoms, that’s dangerous for bone and heart health and even diabetes risk. If it’s in the 300s, likely they’re going to have symptoms if it’s under 350. So the symptoms that a guy can have, they may not report sexual function issues, but they could have depression. They could even be put on antidepressants because nobody checked testosterone, but really they’re depressed because their testosterone is low.  They can have low energy.  They can just have lack of muscle mass or losing muscle mass or losing weight. Sometimes guys won’t talk about having issues with sexual function, but they’ll talk about these other things.  Those all can be improved if you get the testosterone normal.  I would say probably 350 is the lower limits of normal, optimal, and up to maybe 900, probably much above that you risk the blood count getting too high. You risk acne. You risk getting that kind of road rage kind of feeling.  There’s probably no extra benefit of getting it to 1,100 versus 900.

Dr. Weitz:            What are some of the strategies for helping to normalize or elevate testosterone levels besides taking testosterone?

Dr. Spar:              A couple of things. Number one, you can take some things that naturally do block some of that conversion of testosterone to estrogen, like zinc for example or there’s a natural herb called chrysin which you can even put into a topical thing. Those help a lot.  The conversion, you know we all convert testosterone to estrogen via this enzyme aromatase.  Those are natural aromatase inhibitors, so they will naturally boost testosterone a little bit.

Whenever you take zinc, you want to take a little bit of cooper with it in a ratio of about ten to one zinc to copper because they go together, so they are supplements that will have those combined. Those are kind of natural ways.  Other than that, there are other things that help boost libido and male energy, but they don’t boost testosterone per se.  Still, I think they’re worth using if testosterone is mildly low and somebody has symptoms.  For example, in Chinese medicine the ginsengs, we all know about, right? Especially Panax ginseng. In Indian medicine there’s Tribulus, which is kind of like the Ayurvedic form of ginseng. In South America, there’s Maca root, which is what they call Peruvian ginseng. Every culture kind of has their own male energy formula.  I really like Tribulus.  Maca has been really well shown to help with mood changes. There is a good study showing men on I forget if it was Celexa, Prozac, one of those SSRIs, which are known to cause sexual side effects taking Maca I think it was about two grams a day.  This was like a very well peer reviewed study.  They had a decrease in those side effects after they started the Maca, those sexual side effects.  I think that’s a great thing to try.  Those don’t raise T per se, but they do help some of the symptoms of low T.

Dr. Weitz:            Right. Tongkat Ali, have you tried that herb?

Dr. Spar:              No, I haven’t.

Dr. Weitz:            Yeah, check that one out. Look into the research on it.

Dr. Spar:              Okay. Great. Yeah, I definitely will. Obviously the other things we talked about that are real important. We talked about how stress lowers testosterone, so one of the most important interventions to increase testosterone is to find some stress management approach, whether it’s meditation, yoga, Tai chi, journaling, prayer, some breath work. I counseled a guy to do every day to really help decrease the impact stress has on the body. That’s probably the most powerful thing.

Dr. Weitz:            I found sleep to be really impactful as well. So many of us are sleeping four, five, or six hours a day.

Dr. Spar:              Yeah. That’s true. Most people do need seven to nine on average. You can get away with one or two less than that, but over time that absolutely decreases your ability to deal with the stress of life and then that’s going to cause a cascade of events. Yeah, that’s a really good point.

Dr. Weitz:            To bring up the free testosterone thing, I’ve noticed a huge percentage of men with low free testosterone levels. Even if their total testosterone level has sort of been normal or mid-range.

Dr. Spar:              Yes. Yeah, I don’t know that we know exactly why. Like I said some of that is from this increase in this binding protein, HDGN. We don’t know why that’s raised. We know thyroid disease and liver disease affects it, but it seems like more and more guys are getting a lot of testosterone gunked up with this SHBG, and I suspect myself, and I don’t have a lot of scientific basis for it, that it is part of this environmental toxicity affecting the liver and liver manufacturing more of this.

Dr. Weitz:            A lot of these environmental toxins are estrogenic substances.

Dr. Spar:              Exactly. The program I do called Tack 180, and in the show notes I’m sure you’ll have a link to that, it’s tack180.com that does a lot of this testing like we’ve talked about. I do saliva testing in addition to the blood. The blood is good for checking total, and you can check free as well, but the saliva is really good because it only checks the free really available testosterone and especially if I’m using topical testosterone replacement for a guy. Sometimes that salivary will really help me hone it in better because you can kind of overdose pretty easily a patient on topical testosterone just checking serum levels. The saliva will help you catch if you’re using too much or not.

Dr. Weitz:            Just in conversations with some patients who have used topical, they often feel like it doesn’t do much especially that AndroGel stuff.

Dr. Spar:              Yeah, it’s funny. You know, I think it’s like 50/50. I don’t know the percentage, but some guys it absolutely works, and it’s great. Some guys it does nothing. A, they don’t feel anything, and, B, it doesn’t even raise the level much. It must have something to do with the carrier and whether it gets absorbed or not. Just so your listeners know, bioidentical testosterone, it’s all the same. It’s much less complicated than with women, right? With women you can have all these nonbioidentical estrogens and progesterones, but, man, it’s all the same testosterone compound. It’s all pretty much bioidentical.

Dr. Weitz:            Yeah, there’s no testosterone coming from horses.

Dr. Spar:              Right. That would be right. I guess if they would take like stallions maybe they could get some or something.

Dr. Weitz:            Actually, that could be a big seller.

Dr. Spar:              As opposed to the mares, yeah. Okay. Let’s delete that. It’s going to be my patented thing. I don’t know how we’re going to collect it, but we’ll figure it out. Yeah, it is all the same. That’s why sometimes I like to go with compounded because you can put it in a carrier that might work better than whatever AndroGel uses. You can put it in a cream instead of a gel so it’s a little less sticky. You can use less volume and make it more concentrated so it’s less done. I’m using more and more of clomiphene, which is a pill so it’s easier, but it is off label. It’s not FDA approved for men. It’s approved for women. It’s safe. Urologists started using it a lot a few years ago, and so those of us doing men’s health started looking at that. It’s been out for a long time, so it’s available generically. It’s not that expensive.  It especially is good because it helps get the testosterone to be made by the patient themselves, so it stimulates their own testicle production so you’re not taking over completely the testosterone by putting it in either injecting it or topically. You’re just kind of fooling the pituitary gland into telling the testicles to make more testosterone.

Dr. Weitz:            Yeah. Dr. Elkin who’s in my office on Tuesdays, he’s an integrative cardiologist, he likes to use that in combination with HCG.

Dr. Spar:              Yeah. They work in a similar way, so it’s working on the level of the pituitary and hypothalamus. The other thing people don’t talk about when you use testosterone testicles shrink because you’re really taking over production. I don’t care with doctors say. You are taking over production unless you’re adding in HCG or clomiphene. As soon as the body senses you’re taking much higher doses of testosterone than you would make on your own, they’re like, all right we’re good. You’re just going to handle it through the shot or the topical. And the testicles stop producing and do shrink. That’s a concern for a lot of guys.

Dr. Weitz:            Over a period of time if men stay on that they may lose the ability to product their own testosterone, right?

Dr. Spar:              I don’t know if that’s true. I don’t think we know that.

Dr. Weitz:            I know it’s the case with former body builders because I used to treat a lot of these guys, and that was pretty common. They would take them in crazy excessive amounts.

Dr. Spar:              Right. Yeah, definitely if you’re using high doses like that. If you’re using just kind of therapeutic doses, I don’t know because the reality is guys are guys, right? No offense. They don’t use it all the time. Even guys on it for years are missing a lot of doses that are going on. They run out. They forgot how they felt off of it, so then they stop. It really ends up not being an issue. Most guys are not on it day in and day out for years unless they’re like you said body builders or something.

Dr. Weitz:            Do you use PSA to screen for prostate problems? I just recently had a physical with my primary care doctor, and he said, “I don’t believe in PSA anymore.”

Dr. Spar:              Yeah. No, I definitely do if they’re on testosterone. You have to. I do believe in annual exams.

Dr. Weitz:            But even if they’re not?

Dr. Spar:              Yeah. I mean, it’s really important. I mean, we know testosterone treatment does not increase risk for prostate cancer. That’s been proven. Abraham Morgantelar from NYU or Columbia proved that. If somebody gets prostate cancer, you don’t want to keep giving them testosterone. Yeah, I do screen for it with PSA. You know, in the other patients it’s tough. I will have the discussion. Basically I always do a digital exam and feel the prostate. If it’s enlarged, I will check it. I usually try and also check a free PSA. I think on one hand, yes, it’s like what do you do if the PSA is elevated. Half the time it’s just causing stress and worry, and it’s nothing, but the good thing is nowadays most men have access to a prostate MRI. That can really make the need to jump from a high PSA to biopsy much less likely.  They can instead have an MRI if the PSA is a little high, and if the MRI is fine, they don’t need to have the biopsy. If the MRI is not fine, they know exactly where to go for the biopsy so they’re not just doing a ton of random punches. The MRI helps me feel better about ordering a PSA.

Dr. Weitz:            Unfortunately, once again, we have another situation where you’ve got a procedure that’s not always covered by insurance.

Dr. Spar:              Right, right. Usually if the PSA is over 4, at least in my patients who are mostly PPO kind of insured, they’ve had it covered. Sometimes you have to go through the urologists, but usually they can get it covered.

Dr. Weitz:            Right. I think the big issue with the PSA test is that men who have positive PSA who show elevated PSA levels sometimes jump to biopsy and then just jump to surgery and then have a lot of side effects when maybe it was a slow growing prostate cancer that they could’ve monitored for years without any problems.

Dr. Spar:              Exactly. It’s heartbreaking. It really is. We’re trying to figure out. We need better tests to know which ones are just there and will never cause problems and which ones are scary.

Dr. Weitz:            Yeah. I think we’re doing a disservice though to not do the PSA. We just need to make sure that when they get it that they don’t panic and rush out and get a procedure that can cause incontinence and impotency when they might not need it.

Dr. Spar:              Right. Exactly. Yep. The free PSA even if there’s not access to the MRI it’s a little bit helpful. It kind of breaks out if someone has an elevated PSA into the percentage that is what’s called free, and that correlates with the likelihood that that elevated PSA is just enlarged prostate versus cancer.

Dr. Weitz:            Right. I think those are most of the questions that I had. Is there any other issue you’d like to raise?

Dr. Spar:              No, not really. I think it’s just important for listeners to know that, number one, there are ways to help men make behavior change, and I think it’s really, really important whether you’re a practitioner or patient to do that. It’s Movember right now. I’m not sure when this is going to air, but this is men’s health month. It’s literally life and death. I mean, it sounds like a hyperbole, but men are dying because they’re not resonating with the message you are giving. I just encourage listeners to really think about one step at a time. Don’t talk about big global prevention messages. Talk about one thing you or your patient can do to decrease the risk of getting some kind of problem. Make sure they understand how it affects something they’re concerned about. Make it goal oriented.

My whole tag line is when you’re healthy you can win. When you’re not healthy, there’s that saying, I forgot who said it. Somebody who is healthy has a thousand dreams. Somebody who’s unhealthy has one. That’s really something to think about.

Dr. Weitz:            That’s great. That’s a great note to end on. How can listeners get a hold of you and find out about what you offer?

Dr. Spar:               Sure. My website and blog and everything is at drspar.com. D-R-S-P-A-R dot com, and then the program I have for optimal men’s health is called Tack180, T-A-C-K 1-8-0, so Tack180.com. Really, I encourage you to sign up for my newsletter. It’s very brief. It’s once a week, just three nuggets of information that are germane to men’s health, and you can sign onto that right on the website.

Dr. Weitz:            That’s great. I’ll put links to that in the show notes. Thank you, Miles.

Dr. Spar:               Thank you. Appreciate it. It was a pleasure.

Dr. Weitz:            Yeah, excellent.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Breathing with Emma Ferris: Rational Wellness Podcast 82
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Emma Ferris discusses proper breathing 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

5:20  Most of us come out as belly breathing babies, but then either trauma or infections or stress lead to bad breathing habits that we get stuck with.  So then we need to retrain these people to use proper breathing techniques. 

6:17  Emma explains that when you feel stress, your sympathetic nervous system takes over and results in faster, shallower breathing through our mouth, rather than slower, deeper, belly breathing.  This shallow, fast breathing tends to recruit our neck muscles, like our scalenes, SCMs, and our upper trapezius muscles and can contribute to neck pain.  We should be using our diaphragm as our primary breathing muscle.  Activating our diaphragm helps to support our back. Taking a longer exhale will tend to activate the parasympathetic system, that teaches the body that it can go into the rest, digest, and recovery mode.

10:11 When you’re breathing too fast, you breath out too much carbon dioxide and your blood chemistry shifts, making your body more alkaline.  When your body becomes more alkaline, you get more anxious and you may have trouble sleeping.  This reduces blood flow to the brain and also to the fingers and toes. 

13:45  The importance of deep, belly breathing is that you use your diaphragm to breath. If you breath fast and shallow through your chest, you’ll end with tightness and trigger points in your scalene, SCM, upper trapezius and your other neck muscles. Your diaphragm on the other hand has several roles, including respiration, speech, and stability. Using your diaphragm helps to stabilize your lower back by building up the intra-abdominal pressure. Manual therapy and chiropractic manipulation can be helpful for reducing trigger points in these neck muscles, the ribcage, and the diaphragm. 

18:40  When you are in sympathetic, stress mode it tends to shut down three systems in the body: 1. Hormones, which results in more infertility, 2. Immune system, so you tend to get more colds and flus, etc., 3. Digestion, so IBS is more common. If you are running away from a lion, it is no time for digestion.  This is a result of our inability to handle stress. Breathing is a strategy that can help.

29:30  When Emma works with athletes she will often have them use a device called a PowerBreathe, which is an inspiratory muscle training device. It is like dumbbells for your diaphragm and it makes it harder to take a breath in.

 

 



Emma Ferris is a physical therapist and acupuncturist from New Zealand who created an online breathing hub called The Butterfly Effect and The Big Exhale breathing course to help patients recover from dysfunctional breathing patterns.

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 are enjoying listening to the Rational Wellness Podcast, please go to iTunes and give us a ratings and reviews, so more people can find out about the Rational Wellness Podcast.

Our topic for today is breathing. How important is breathing, what proper breathing is, why breathing properly is important for our health, and how improper breathing can lead to the following health consequences: neck and back pain, the inability to recover from injuries, fatigue, depression and anxiety, stress, concentration and memory problems, reduced performance for athletes and the inability to work through emotional trauma or grief.  While there are a large number of different breathing techniques out there, especially when you start looking at all the different forms of breathing coming out of the yoga tradition, but when it comes to the more therapeutic forms of breathing, breathing through your nose and deep, slow belly breathing, rapid and shallow rapid mouth breathing seemed to be two of the more important concepts I’ve come across.

Today, our special guest is Emma Ferris. She’s an acupuncturist, a Pilates instructor, a registered physio therapist, and a public speaker, and she’s joining us all the way from New Zealand. Emma created an online breathing hub called the Butterfly Effect, and she offers the Big Exhale Breathing Course to help patients recover from dysfunctional breathing patterns. Emma, thanks so much for joining us today.

Emma Ferris:                      Thank you Ben for having me.

Dr. Weitz:                            Good. So, can you explain how you became so interested in breathing as a form of therapy?

Emma Ferris:                      Well, breathing kept coming up in my life with my experiences, both with my patients as a physical therapist, but my first exposure to learning about breathing was when I was around 12 years old. I struggled with a speech impediment and a stutter. And so for me, I started at a very early age getting some speech and drama and therapy for that. And, one of the most important things for that was learning to breathe. I particularly learned to breathe into my belly. So I learned that, but I never connected the dots as I went through my physical therapy training; we often put things in silos, which they often do in medicine and healthcare. Cardio, respiratory was over here, and neuro or the brain work was over here, and then muscular, which I was really fascinated with by fixing necks, back pain, all that sort of stuff; that was what I loved.

But, what really changed for me was the patients that I couldn’t fix, and it frustrated with me. You know, the neck pain and back pain that kept coming back. People that struggled with the multiple symptoms that when with it, the fatigue, anxiety, the poor sleep, and I guess in my training and in my life experiences, it wasn’t really explained how key that was until I began to dig a bit deeper and look at what the underlying causes and what the wires, and that’s obviously what you’re all about here too, Ben, is finding out what the why behind people getting to that place of dysfunction.

So, definitely in my patients, it began to show up for me. Then, I had my own life crisis when I was around 28 when I got pregnant with a condition called hyperthermesthesia. So, it’s extreme morning sickness. I realized that all the things I’d done before that point with my life; I had a busy physio practice, I was teaching, I was running workshops, and my body was running on empty before I even started to carry this little baby, little human being. I ate okay. I did a bit of exercise, but the reality was that’s not good enough, and my nervous system was just shot.  So, I learned then that what I’d been doing beforehand wasn’t good enough, and so I went into this process of researching and trying to formulate my own thesis, and I became a bit of a mongrel with breathing. So, I got all these different ideas from yoga and Pilates and Butyeko and Greycliff breathing, all these different versions. And, what really stuck with me for learning about breathing was it’s actually the story about why we connect with every person, why that’s important and why breathing as it makes a difference, but the reason they got here in the first place. You know, what was the stress and trauma, what was the environment that got them to learn to need to change?

And, I think that’s so important because most of us come out breathing like babies that are beautiful belly glorious breathing. So, we don’t come out sometimes when people don’t come out screaming and yelling and appraising very well, but most of the time we’re naturally belly breathers. So, things happened along that process, whether it’s trauma, illness, infections, stress, and then the habit gets stuck, and so I’m all about looking at the why, but retaining the habit and looking at the science behind it and the muscles because it, as a physical therapist, that’s what I treat a lot of, you know, motor patterns, dysfunction, and that actually has a huge trouble with breathing retraining. Yeah.

Dr. Weitz:                           So, that’s interesting. So, we start out as mouth breathers. Is that what you said?

Emma Ferris:                      No, we start as nose breathers.

Dr. Weitz:                           Oh, okay.

Emma Ferris:                      But, belly breathing. Sorry, so we start out as beautiful, slow belly breathing. Watch a baby sleep. It’s just glorious. And, they do it so naturally.

Dr. Weitz:                           Right. So, can you go into some of the details about what’s proper breathing is and, and why is it so important to breathe through your nose rather than your mouth?

Emma Ferris:                      Yep. Well, I’ll go into the nose and the mouth breathing constantly mistaken, but a lot of it’s all about the reaction to stress and how our body’s nervous system gets overridden with breathing. So, breathing is both under conscious and unconscious control. And, that’s a really powerful point because we have the power to actually override our autonomic nervous system, which more often than not gets pushed with our busy modern day lives or the stresses we have in it, and that changes us to push into what we call your sympathetic nervous system, much of which I know you’ve talked about before on the podcast, and the reaction to stress, whatever it is, whether it’s past, present or future, drives us to change our breathing. So, if you imagine that lions are chasing us, we take a big breath in, we inhale, and we use our neck and shoulder muscles.  We prepare our hip flexor muscles that like to get us out of danger, and we use those muscles to mobilize and get more air in. Now, that’s really important for that stress with danger that’s coming after us, but if that danger is a relationship issue or a problem with somebody at work or you’ve had back and neck pain for a long time, and even the thought process behind that keeps you stuck in that space of going, oh, this is dangerous. I’m sore. I’m going to get sore if I do this. In a response to a dangerous activates that fierce into our brain to trigger that reaction, and so the problem is we get stuck in that cycle, and one of the main things that changed is our breathing. So, we become faster or begin to breathe through our mouth because that’s a fast way of getting air in and getting more oxygen. which again is important for exercise, in and times of stress, to get us out of danger, but not all the time. So, as learning why we use it, people say to me, “Should we be using our nose all the time?” And, it’s like, well no, that’s not practical because when you walk up a hill, your body’s going to need to get more oxygen in, so you need to be able to go to mouth, but it’s as soon as possible going back to that nose breathing and reconnecting with it.

So, the reason why the nose is important is because it’s got two holes versus one for the mouth, and so it slows the air down. Like, it’s simple concepts, but if you can use that, it slows the air down, which is really important for your diaphragm, and the diaphragm is your main breathing muscle, and that sits between your rib cage and your stomach, so to say, and your lungs, and learning to use your diaphragm in the right way is really what for me, changes people’s perception and understanding of breathing, so it’s not about taking big breaths, and that’s the content I want people to be aware of as well.  When you say take a big breath, it’ll calm you, that doesn’t actually work always. That can actually stimulate you more. So, for me, it’s about low, slow belly breathing and long exhale, which is why my program is called the big exhale, so then you need to get out of that fight or flight inhale mode and learning to drop the chest down, and that’s really important for neck and back pain, which we can talk about it a bit more later on.

Dr. Weitz:                           Why is it more important to have a longer exhale?

Emma Ferris:                      Well, that’s one of the easiest ways to activate that parasympathetic nervous system, so activating that teaches the body that it can go into that rest, digest, and recovery mode. And, that’s why in Yoga and pranayama and all the techniques like Tai Chi work on lengthening the exhale, free diving, Pilates, meditation; naturally they’re getting your comps of your breathing, which is activating that parasympathetic nervous system.  That’s why people feel good doing those activities that you don’t always know why. So, and the other reason is that we’re not meant to be driven into that fight or flight response. And, we do, when our blood chemistry changes over time, when we’re breathing too fast. And, I know you’ve talked about this before with Rosalba Courtney, who I’m a really big fan of; she’s a wonderful breathing teacher around the world, an osteopath from Australia. Now, the blood chemistry shifts when you’re breathing too fast. What it does is your, by breathing out too much carbon dioxide, which is way more important than oxygen, you end up increasing your pH and making it more alkaline. So, over time that if your body stays in that state, it thinks that that’s normal, that new level of CO2 balance is what you’re supposed to go to and keeps you driven physiologically to breathe in that vast state.

So learning to lengthen your exhale also overrides that new level of normal or what you think is normal, and that’s really important for anxiety, patients who struggle with anxiety, with a shortness of breath and a suffocation response. And, so a lot of the techniques that are out there are great, like Butyeko, which gets you to lengthen your exhale to increase that CO2 liberal response, so that your brain goes, okay, I can now hold for longer. I don’t feel that fear and danger response of suffocation, which means I need to take a big breath in and gets you stuck on the inhale mode.

Dr. Weitz:                            Most of us think that the whole purpose of breathing is just to get oxygen. So, can you talk about why getting enough carbon dioxide is important?

Emma Ferris:                      Well, CO2 has a really big impact onto both the pH, like I say, because it actually shifts the … By breathing out too much CO2, you shift the pH, and then your body’s going to try and replace that acidic component, and it’s going to start leaking bicarbonate into the blood. So it has a bit of a knock-on effect and disseminates systems. One of the other impacts is the brain, so when you change that pH and the CO2 depletes, you actually reduce the blood flow to the brain, which is why there’s a connection with memory and concentration, brain fog, or whatever you want to call it, processing and cognition, and for learning, that’s a really important part for children and for adults. And, one of the things that I find really powerful was when people get stuck in that fastest stressed breathing and our habits contribute to that, like caffeine or alcohol that can shift our breathing. But, stimulants we don’t realize then that our body will be shifting its blood chemistry, and it takes a while to recover. And, even those habits and stimulants can actually then create a shift in the blood chemistry, which then creates more anxiety and other components of poor sleep that gets you stuck in that cycle.

So, the pH is pretty powerful. One of the other things is it actually causes, with that shift in pH, your blood is going to go from our limbs and our extremities because we don’t, we’re not worrying about feeding the blood into the limbs and the hands when you are in that stressed state, and this is important for athletes as well, so it’s going to divert blood flow to areas that need it, like our organs. And, so we can get cold fingers and toes. This is one of the signs of breathing dysfunction. I get tingling in fingers and as well. And, so there’s a change even in blood flow and our brain and our organs. We just divert things around because of that physiological push.

Dr. Weitz:                            What’s the importance of deep belly breathing as opposed to, I guess more shallow chest breathing?

Emma Ferris:                      Yeah, one thing is that as changing the right breathing muscles to work, so most of the breathing, like 70 to 80 percent of our breathing should come from our diaphragm, our big belly breathing muscle. So, what happens when you’re stressed and you start to use the inhale?  You’ll get stuck with what we call breath stacking, where you breathe in and you hold, and then you might do that a little bit, but then your brain goes, oh, I feel like I’m suffocating. I’ll take another breath in. Then, you get stuck in that mode and using our backup breathing muscles and what I call your parachute reserve.  And these are your neck muscles, your scalenes on the side of your neck, your sternocleidomastoid from the front of your neck all back up into your head and your skull down into your sternum and your upper traps, those muscles that get really sore and tight on the back of your shoulder.

Now, we’ve seen them all the time. Clinically, I know you do too, Ben, with our patients. I gave you a cue there, and this is a really important point because we’re using those muscles between, depending on your breathing, that breathing frequency between 17,000 and 210,00 times a day, the amount of breaths we take. So, if you’re using the wrong muscles in the first place, you’re going to cause more trigger points, those achy, knotty spots that can become active and referred to be trigger point index or trigger front for zero down the arms. So, that’s one of the main ones is that you’re actually using the wrong muscle all the time, and it’s like a reverse drug when you start using the top part and not the bottom part. So, teaching them how to use the diaphragm is really important, but also what I talk about is 360 degree breathing.  So that diaphragm has attachments right from the front of your stomach all the way around the ribs down the sides because it’s like a dome and all the way into your lower back into by your L1, L2, your lower vertebrate, and your hip flexor, your fight or flight stress muscle, and it has that neural connection through the ear, which is pretty powerful. So, learning to activate the diaphragm is really important for both intraabdominal pressure, and there’s a lot of research now looking at diaphragm function and dysfunction with back pain, and when someone has an episode of back pain, one of the first things we’re going to do is inhale and protect, and they actually lose that activation of the diaphragm, which actually is needed to actually stabilize. So, you get in this vicious cycle because of not breathing right, and they create more trigger points because the physiologic physiology changes, and then they also feel more stressed and anxious about being in pain. And, so when I go to bend or twist, they go, “This is how I injured my back last time; I’d better protect.”

So, from the point of view of the diaphragm, it has several roles: respiration’s king, speech is queen. And, I guess the next one is stability. So, if you’re walking up a hill, first thing that’s going to go is stability. You start to not stabilize very well. And, then you speak each, and then respiration. So, that’s always going to be the key thing. So, you start to recruit from other muscles. So, it’s really important to look at that role of diaphragm, but to understand that it actually, it’s a one way muscle, and that only works on the inhale, and then if you learn to lengthen your exhale and relax as a diaphragm recoils back up, then you can activate that parasympathetic nervous system.  But, a lot of time, when I’m looking at people that have been training yoga or training other techniques, they’re actually forcing the air out and causing that CO2 balance to actually be shifted just by the way they’re breathing, so a lot of it’s just conscious retraining and moments.  You know, I had to lie down for 20 minutes. It can be I’m going to stop right now on my drive around LA or New Zealand and just cause an exhale. You know, simple things add up.

Dr. Weitz:                            You’ve refined restrictions in the diaphragm and have to use manual techniques to free those up. Yeah.

Emma Ferris:                      Absolutely, and, all of those breathing, so scalenes, verse ribs, upper traps, and I use a lot of dry needling or I think … What do you guys call it over there? Trigger point needling, and that’s really effective for releasing the result of the poor breathing pattern, but unless you change the breathing pattern, the driver on the why it comes back. So I love the manual therapy for that.

Dr. Weitz:                            Yeah. We find chiropractic manipulation also beneficial in those cases as well.

Emma Ferris:                      And, particularly for thoracic because if you’re not getting thoracic mobility and ribcage, you’re not going to get that lower stability. So, I 100 percent agree because that also goes into that parasympathetic loop, automatic nervous system.

Dr. Weitz:                            Yeah.

Emma Ferris:                      So I love manual therapy. There’s so many ways of getting somebody into a calm state. That’s why I love acupuncture as well to go look, what is the right formula for a person in front of you?

Dr. Weitz:                            Yeah. One of the things, one of the conditions we didn’t talk about or I didn’t mention, which comes to mind when you talk about rest and digest, is IBS or CBO, and I could see how breathing be really super important for those patients because if they’re always in this sympathetic mode, they’re never going to properly digest their food, and it’s going to increase all their digestive symptoms.

Emma Ferris:                      Absolutely, and the same stress mode … If you’re stacking stress on that sympathetic thing, they usually change the bacteria in your stomach in the first place. So, one of the great things with learning to use a diaphragm and is that you’re actually going to pop through, you get the empty stomachs to actually work in the right way, get the blood flow, and when you are in a stressed state, blood flow is diverted from your bowel and your stomach because when you’re running away from that lion, you’re not worried about processing food. There are three areas that get shut down hormones, so particularly females, and we’re seeing that a lot with infertility problems these days, but that cycle and upset from that by being stuck into the sympathetic drive and immunity, so we get colds and flues, we’re rundown, or we’re stressed and particularly the digestive system.

So, there’s so many more problems these days all because of our inability to manage stress, and that comes in so many forms, and there’s a lot of pressures and by society that drives us, and I just think as the more that we can get this understanding out because people are hungry. There’s a groundswell of looking at techniques that are focused on holistic treatments like the manual therapy, like acupuncture, like yoga, because it makes you feel good in a way that is not a pill in a bottle. It’s very hard to override that nervous system.

Dr. Weitz:                            Yeah. When it comes to nose breathing, when I talked to clients there’re so many people that have problems with allergies and with you know, issues not being able to breathe properly. How do you deal with some of those issues if you’re trying to get them to breathe through their nose, and their sinus passages are partially clogged, or they have deviated septum, or they have allergies, or they have, you know, some of these chronic respiratory problems?

Emma Ferris:                      They’re huge problems, and that can be the driver in the first place for getting stuck in the habits, but then also that habit of mouth breathing gets them stuck with the sinus problems as well because they’re not actually using that nose as a filter and keeping the blood flow through there. So, it’s really problem solving for the individual. And, so one of my first steps for someone struggling, getting them back to the doctor and check for any polyps and any problems in teeth. And, then there’s simple things that you can do, like sinus rinses for instance. Have you done them, Ben, a sinus rinse?

Dr. Weitz:                            Yeah.

Emma Ferris:                      People don’t always like them, but they’re so satisfied, and that’s a really good way of cleaning out the nose and allowing it to get that filter through. And, one of them is learning to breathe through both nostrils because you actually switch nostrils through the day that you break through. Do you know that?

Dr. Weitz:                            No.

Emma Ferris:                      So, every one to four hours, you’re switching nostrils, so one side becomes the one you’re breathing through. And, the other side is the cleaning system. So, if you have one side that is actually blocked, you have a deviated septum, then even in your sleep, you’ll be switching through the mouth breathing because you’re short of air. So, getting that correct is very important, and during those steps, before you try anything like mouth taping, because that’s not for everybody. You’ve got to check people’s saturation and stuff as well, but you know, I use it myself. I use it on different patients, and it’s very successful. So again, it’s not a one size fits all model for nose breathing but learning to-

Dr. Weitz:                            How do you decide when somebody, when it’s appropriate for somebody to do mouth taping, and can you explain what mouth taping is? This is where you use special tape to shut your mouth while you’re sleeping, right? To keep it closed.

Emma Ferris:                      Yeah, absolutely, and you don’t need to have much on it because a lot of people can even open your mouth. People go, “Oh, that feels really scary. I don’t like the idea of that.” And, it’s always a bit of a jug of patients, you know, they keep them quiet, and I said, look, you can say goodnight to your partner and husband then rollover and then take your mouth up. I have to see it, but it’s actually really effective in getting that diaphragm to actually activate when you’re sleeping in the first place instead of going to that mouth breathing, but really what people got to think about is … I’ll come back to nose taping in a second, but you’re breathing at night is a consequence of what you’ve been doing with your habits in the day. So, if you have been caffeinated, if you have, which is very strong culture we have, and you’ve been pushing your body hard and driving it hard, and you’re basically running a marathon through the day with your breathing, then when you go to sleep, your body’s not going to go, oh, I’m going to go calm and relax. It’s going to go really fast, be fast, be fast. And, so you’re not going to sleep well; you’re not gonna get into that nice delta wave when you’re sleeping. You’re gonna keep that mouth breathing.

So, taping is again as dependent on to make sure that people can breathe through here. So, I do a test to check that they can put like a knife or a spatula under there, and we can say if they’re breathing through both nostrils. I can check the nozzle sides. I usually get an EMT to check or a Dr. to check to make sure there’s no polyps or anything else, and we checked saturation as well, so make sure when you do practice, that’s a practice that before you go to sleep, have a lie down and see how that feels and that I get too anxious or short of breath with that and that saturation levels don’t drop down.  So, it’s kind of a looking at the why behind that person. It’s used really commonly, but again, don’t use it for just everybody. I have a lot of athletes because they have already been breathing too much mouth breathing too much in the daytime, and what they try, and they don’t realize that that’s still contributing to the recovery at night. And, so when they start doing that, they sleep in the muscles, at least teens. They don’t need as much magnesium, which is to relax muscles and help with recovery.

Dr. Weitz:                            Interesting. Can everybody change their breathing? Or, are some people just stuck with mouth breathing?

Emma Ferris:                      Well, there’s some physiological reasons which will be driving you to breath faster. And, so there could be. It’s really important to get checked out by your doctor. What we find is that breathing dysfunction is often the last thing that gets diagnosed, and for reasons like diabetes, that can be a real reason why you’re driving faster. I have a lot of patients. I work with a lot of people with Parkinson’s as well, and the anxiety behind that also drives you to breathe faster within the breathing faster drives you to have more anxiety. And, so that has low dopamine as a big part of it. So, there are some people that need even medical support to help shift and get them into a good space. Like, I don’t say that this is going to cure everybody, like there’s not a one size fits all model, but learning to use breathing as an adjunct like with asthma, it’s a really important part. It’s like 40 percent of people that are asthmatic also breathing dysfunction in them, so you can use breathing alongside your other tools into that you can wean off or get the support and work with the respiratory physio to help get that under control.

So, there’s lots of conditions that also benefit highly from training your breathing, become a conscious of it, but anybody can do it, and in regards to how long it takes, it depends how long you’ve been stuck in that fight or flight mode. And, I have a patient that I worked with recently or the last last year really, and he’s a good example of someone that he came into his doctor with several factors, not sleeping well. He’s 40. He was going through a cardiac experience. So, he went to the emergency room thinking he was having an anxiety … Sorry, having a cardiac, a heart attack, and he was getting tingling in fingers and arms, and so many symptoms, the body, stomach problems, erection dysfunction, which is also a sexual dysfunction can be also linked to breathing function because you’ve got to be able to get arousal both sympathetic and parasympathetic with your breathing. So that’s an important area to look at all aspects.

So this guy, because Dr Stefanie was very switched on and went, “I think your breathing’s part of it,” and sent them him to see me, and over three or four sessions, that stress dropped down dramatically, and it was a huge shift for him. And, so he’d basically been, the why behind it though was he was going through a huge a court case trying to get custody of his children through a big divorce, and that had been driven him, and he was really PTSD; he was posttraumatic stress given his marriage, struggling with balancing business and life, and it wasn’t until he got those tolls he can recover, but there was a lot more behind the scenes for that too with family experiences, and so you’ve got to dig deeper and not go there’s not just a habit. There was the driver and the why behind it.

And, when he started to see that his breathing pattern was actually linked to emotions, so when he came in, I’ll be like I, “Okay, so what’s the fear today, mate?” Because, he’d be out here and holding that upper chest, breathing in, and beholding and be like, “Okay, no, this is what’s happening in my life.” And, when we actually talked about and expressed it, it dropped away and belly breathing, they need to do actually to activate the diaphragm is also linked in with your emotions with happiness and joy. So, that’s one of the powerful things I find too is that it’s not just about breathe through your nose and breathe through your belly and actually has an impact on our emotions. And, the research for me that has changed it was a few years ago now, in 2011. It was a guy called Pierre Philpot, and he did this research study. And, I love it because for me, emotions is important in life; we connect; we interact with people. Relationships are huge. So, what it showed was he had this group A, and it looked at four emotions: sadness, joy, fear, and anger. And, he asked that first group to think of those emotions and then look at their breathing patterns.  And, each emotion had a separate breathing pattern. So, I look at it clinically; we see that fear and anger is upper chest breathing. We see. Sorry, fear is upper chest breathing, anger as bracing and holding through our stomachs and obliques, which has a big impact onto a stomach and digestive system. Sadness is often that depressive, a posture that slumped down teenagers, posture that impacts, again, the way we breathe. And so, and the joy breathing is that belly breathing opening up into their stomach. So, what he found in the other group, group b, who knew nothing about group a, once he said, “Breathe in these four patterns, and then what emotion do you feel? The top summary of it.” And it was either the joy, sadness, fear, or anger. So, we have the power to change our emotions by the way we breathe, and we have the power to change our breathing by the way, our emotions, which is why coming back to the simple practices like gratitude, which, you know, hard to put the science behind that, but it’s getting there, you know, and mindset and our shifts behind that has a huge physiological impact onto our body and the way that we breathe in and breathing has a huge impact onto the way we sleep, the way we play, they way we love. That’s huge.

Dr. Weitz:                            Cool. So, you work with people in a one on one basis as well as offering group classes, right?

Emma Ferris:                      Yes, absolutely.

Dr. Weitz:                            So, when you’re working with a professional athlete, how is that different and do have them try to breathe through their nose while they’re running or doing their athletic performance?

Emma Ferris:                      Yeah, so it depends on the athlete and what their sport is. Many athletes need to train specifically for what they’re doing, like swimmers and rowers and cyclists all have different aspects, and many of the sports that actually impact diaphragm position like rowing and cycling ’cause they’re bent forward have more breathing dysfunction in the first place, so they’ve got to work harder to control that, and that one is a high link with back pain and neck pain because of that, because they’re having to switch between. So, the reality is when I look at training somebody, it goes back to breathing pattern first. So, how are they breathing? Have they got the right control? Can I activate the diaphragm? And, you might have to train them for a while to get that right in the first place. Once you’ve got pattern right, then you go to strengthening, and I use a great device called a power breathe. Have you heard of that before?

Dr. Weitz:                            No.

Emma Ferris:                      So power breathe is a … So, I’ve talked about exhaling being really important in that first phase, it really is getting that long exhale and activating because if you can’t exhale, you can’t inhale. It sounds really silly again, but if you don’t get that diaphragm to lift up and exhale, you can actually get the power into it to actually get the right inhale into the base. So, for that second stage, particularly for athletes, though I do use this to people that got anxiety, neck pain, back pain, COPD problems as well. We use a device called power breathe and that is inspiratory muscle training. So, it’s training your diaphragm to actually be strong for the activity. And, it’s pretty powerful. It’s only the science behind it, the research shows 30 breaths twice a day using this inspiration master trainer is enough to get the same results as a … So, there was one research study that showed over six weeks, I think it was, four to six weeks later the research.  And, one group was using the inspiratory trainer, and the other group was using, was running 45 minutes five times a week, and they had the same changes in the respiratory function from doing the diaphragm strengthening. So, it’s, you know, it’s a lot, a lovely adjuncts to training for people because they can actually get really good changes in physiology because the diaphragm is getting thicker, and it also shows after six weeks of using that, that your diaphragm thickens up to around 13 percent, which is quite a lot for work-

Dr. Weitz:                            Well, how does this device work? Does it wrap around you or something like that?

Emma Ferris:                      I actually brought one from the clinic I was going to show, you know, it’s in your mouth, so you put in your mouth, and you’re going a quick breath into using a diaphragm and to get in there. So, it’s a quick, breath in, fast and hard. You’ve got to work at least 50 percent resistance to get the diaphragm. So, they learned from the research as well that you can’t go at like resistance training for like 30 percent on your one rep maximum isn’t actually enough to get the changes in your diaphragm strength. I think it needs to be that 50 percent to 60 percent mark, and so I teach people in the clinic that you can work at it to sort of feel what that energy is or that level is for you when you train it. There’s a company out of UK that’s created them, and there’s a wonderful respiratory physiologists, and she is Allison Connell I want to her say name is that’s loved a lot of this research, and there’s great research now even in New Zealand, physio, and Aukland is looking has led to the break of breathing at the diaphragm, changing the strengthening and the dysfunction that occurs, people with anxiety, with back pain, and looking at that under ultrasounds, which is pretty cool seeing those changes.

Dr. Weitz:                            I’ve seen people in the gym with these things, so it’s some sort of a mouthpiece. And what does it do exactly, makes it harder to get a breath in?

Emma Ferris:                      Absolutely. I mean it’s like breathing through lots of straws. So it kind of risk for respiratory through there, so it’s like dumbbells for your diaphragm. And, so if that’s targeting that breathing muscle, you still want the pattern to be right though. Some of the research I went and saw a respiratory researcher in Canada about two years ago who was researching the respiratory training with athletes. And, what they noticed was the pattern store. If you don’t breathe in the right pattern, all your training is the upper chest breathing muscles, and what he wants to do is that diaphragm, so it might mean you turn the resistance down, and you work on the pattern, but then that diaphragm strengthens to actually help pay for working in a high level when you go and run or when you go and lift something, it’s going to naturally activate and do its job, so it doesn’t fatigue faster. And, what I loved about the research there as well, another, I think it was in the UK, they looked at the blood flow and the limbs.  So, they’re looking at when you were doing your exercise and training. So, I think this is cycling athletes; they looked at the blood flow in your veins and the legs, and what they found is after six weeks of doing the the inspiratory master training with the power breath thing, it was a device they used, they reduced the … The blood flow stayed in the limbs for longer. So, what it showed was the body’s stress response was better. So, the body didn’t go all right, I can train harder, and then when I get fatigued I had to pull the blood in, and it could actually keep the blood and the limbs for longer, which is really important for athletes, for endurance and for training. So, lots of consequences with using something like that. 

Dr. Weitz:                            How do you tell if they’re using their diaphragm? Do you put your hand on their diaphragm?

Emma Ferris:                      Yeah, I’m very manual with that. So, very much feeling that, you can see it. You can get them to put hands on their chest while I’ve got one hand here, and they don’t all use a mirror, biofeedback in any way that you’ve got. Posture’s a huge part of that, so if you slumped down and then you’d try and breathe, your diaphragm is going to start recruiting somewhere else. If you lift up too much, you’re gonna use your upper chest. So, even teaching people when your choose is like good simple habits add up, and that’s like a modeler for me is small changes make a big impact with what we’re doing.

Dr. Weitz:                           We work a lot with posture, and that’s super important, and it goes hand in hand with the breathing.

Emma Ferris:                      Yeah, absolutely. So using that posturing, raising that with your breathing is a very powerful tool, and then add some credit to it that you’re doing really well.

Dr. Weitz:                           Great. So, any other final thoughts you want to have for our audience? I think we got some good information to help folks with their breathing.

Emma Ferris:                      I think my take-home and something that I really like people just to be aware of is just take a moment and enter the day as many times you can is just to exhale, and the one thing I can say is you can do it out the mouth just once. Do it for me now, Ben. Breathe out the mouth, go uh, noticing your chest drops down, so that’s like a little valve release, then go back to nose breathing, but that little we exhale just drops you bit more into that calm part of that nervous system that needs a bit of love and attention. So, do it when you had the kids, when something’s winding you up, when you’ve got a traffic, wherever you are. I don’t have much traffic in my small town in New Zealand where I live, but you never know in LA and around the world.

Dr. Weitz:                           Oh yeah, LA traffic is brutal all the time. Yep.

Emma Ferris:                      Take moments. Take moments and use it to change that breathing. And, when you think about that, a lot of conscious drop, see what emotion you can bring up. Can you create joy? Can you shift your mindset, which will then impact your nervous system? Okay, take power back.

Dr. Weitz:                           I’ll be using it on the drive home because I’ll be hitting the 4:00 traffic. And then I’m going to go vote after that. So, I’ll need some stress reduction there too.

Emma Ferris:                      And, the next few days, good luck in New York is all I can say.

Dr. Weitz:                           God help the world.

Emma Ferris:                      And, please help us out over here.

Dr. Weitz:                           So how can listeners get a hold of you and find out about your programs?

Emma Ferris:                      Well, there’s a few ways. I have my online breathing hub called thebutterflyeffect.online. So, if you go through or search the “big exhale” or my name “Emma Ferris.” I’m not related to Tim Ferriss. I’ve got only one s at the end of my name. You can find me there, and there’s lots of ways. I have a free online Pilates video, 15 minutes that you can do, which helps work through some of the stretches that I do because what I find is if you can’t get the neck muscles and chest muscles and the hip flexor to release in the breath flow dropdown. So, that’s the place to sign up and join in and watch that. I also have my online breathing course called the big exhale, and that’s a 30 day program, but you can do it over a whole year. And, the first five days of it are free, so if you want to sign up for the big exhale, you can do that. Or join me on a workshop, come to New Zealand’s, come on my retreats, or meet me around the world in Malaysia or wherever the next one’s gonna be I have tour retreats in the states, so I can fly over and change the way that we breathe in the states post election.

Dr. Weitz:                           Sounds good.

Emma Ferris:                      Yeah.

Dr. Weitz:                           Emma, I really enjoyed this.

Emma Ferris:                      Thank you. I appreciate you having me on.

Dr. Weitz:                           Okay. I’ll talk to you soon.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Autoimmune Gastritis as a cause of SIBO with Angela Pifer: Rational Wellness Podcast 81
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 Angela Pifer discusses how Hypochlorhydria can lead to SIBO and IBS with Dr. Ben Weitz.

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Podcast Highlights

6:26  Low stomach acid or hypochlorhydria can result in Small Intestinal Bacterial Overgrowth (SIBO), which is the cause of IBS in the majority of cases.  Low stomach acid can be caused by chronic stress or hypothyroidism. There are pathogens that come into the digestive tract through your food and we need hydrochloric acid and a pH of 3 to kill such pathogens. Such acidity also signals gastric emptying, a release of digestive enzymes, and a release of bile, all of which help to reduce bacteria in the small intestine. And when it comes to treating SIBO, it is easy to just think that we have to kill the bacteria. However, to really fix the gut, we need to help reset and rebalance and reseed to cure SIBO and get someone to a negative breath test. 

12:17  There are certain symptoms that might make you suspect that your SIBO patient has low stomach acid, such as when they feel that food is just sitting there and does not move through their stomach normally of if they say that they’re not breaking down their food. You might also suspect low stomach acid if there are intact pieces of food in their stool or if they have peanut butter stool that is very sticky and requires multiple wipes. We can also look at a Spectracell Micronutrient test and look at nutritional deficiencies like iron or B12, which might be trending lower if they have low stomach acid.

13:38  Once you suspect a patient may have low stomach acid, Angela will rule out H. pylori as a cause and she recommends looking at the urea breath test for H. Pylori and she also likes to order a GI Effects stool test and include a stool H. pylori antigen test.  She finds that more sensitive than the blood antigen test for H. pylori.  Interestingly, if H. pylori grows in the antrum or lower portion of the stomach, H. pylori can cause increased hydrochoric acid production and ulcers.  But if the H. pylori grows in the fundus or upper portion of the stomach or in the body, or corpus, the areas where the parietal cells are that make the hydrochloric acid, it can lead to decreased acid production.  If there is chronic burping or you have any kind of burning or warmth in the stomach or a sense of fullness, we need to rule out H. Pylori.  If you suspect it is a chronic case of hypochlorhydria, then Angela will look at advanced markers, like anti-parietal cell or anti-intrinsic factor antibodies to see if it is a case of atrophic autoimmune gastritis. If there is no H. pylori, then we should see what can be done with diet, lifestyle, and supplements. If they are stressed and in sympathetic mode, then we need to work on stress reduction and this could include the Wim Hof breathing technique. 

18:55  When Gastroenterologists do an endoscopy and biopsy for H. Pylori they usually biopsy the antrum and the duodenum to look for celiac.  They will miss H. pylori in the fundus or the body of the stomach.

20:33  When it comes to Atrophic Gastritis, one cause is H. Pylori and the other cause is autoimmmune gastritis, in which you get antibody production against the parietal cells. We routinely check of celiac, despite the fact there is only a prevalence in the US of .5 to 1%, whereas autoimmune atrophic gastritis has a prevalence of 2 to 8% and we hardly ever screen for this and the rate is going up.  These parietal cells that produce stomach acid also produce intrinsic factor, which is required to absorb B12.  And if they are not making stomach acid, then they will not be breaking down their proteins to be able to absorb B12.  If you suspect a patient of having low stomach acid you can send them for a Heidelberg test.

27:26  When you are treating a patient who has low stomach acid because they have been on PPIs, Angela will work with their MD to slowly wean them off the PPIs.  Angela likes to add in bitters, like Bitters 9 or Bitters X from Quicksilver Scientific, to stimulate their own production of digestive enzymes and hydrochloric acid production. She has them use the Bitters X and do one or two pumps and hold it in their mouth for 90 seconds, swishing it around, before swallowing it.  She will also have them cook all their vegetables and eat smaller, more frequent meals, and chew their food three times more than they think they need to. She will also sometimes add digestive enzymes. She will have them use a little baking soda in water if they need to to take the edge off.

31:10  Angela treats autoimmune atrophic gastritis by treating both the gastritis and also by treating the underlying autoimmune condition.  We have to look for the triggers for the autoimmune condition, whether they are stress, environmental toxins, food sensitivities, etc. We need to treat the nutritional deficiencies that result, including vitamin B12 and iron.  They may initially need iron and B12 injections.  Such patients may need hydrochloric acid supplementation for life.

 

 



Angela Pifer is one of nation’s foremost Functional Medicine nutritionists in Seattle, Washington with a focus on Gastrointestinal Disorders like SIBO and IBS. Angela is known as the SIBO Guru. Her website is SIBO Gurushe has launched a gut prescription recipe site, Gut Rx Gurus and a FODMAP-free line of bone broths, Gut Rx Gurus Bone Broth.

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



 

Podcast Transcripts

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

So on this episode of the Rational Wellness Podcast, we are going to focus on low stomach acid as a cause of SIBO. Small Intestinal Bacterial Overgrowth, abbreviated as SIBO, is the cause of irritable bowel syndrome in the majority of cases. While the large intestine or colon is lined with trillions and trillions of bacteria, the small intestine is relatively free of bacteria. This is because this is where most of the absorption of nutrients from our food occurs, and if there were a lot of bacteria lining the small intestine, it would interfere with that important function.

There are a number of mechanisms that prevent more than a small amount of bacteria from growing in the small intestine. These include the migrating motor complex, which are the peristaltic waves that occur when you haven’t eaten for more than three or four hours, when you hear your stomach gurgling. These help to sweep out any bacteria out of the small intestine. There’s also the GALT, or GI-Associated Lymphoid Tissue, which is the immune system that surrounds the digestive tract. This tends to remove pathogens that enter our body with the food. Then there is the hydrochloric acid secretion from the stomach, and this also serves to kill unnecessary bacteria as well as help us digest our protein. Bile, which is secreted by the liver and stored in the gall bladder, which not only helps us digest fat, but has an antiseptic function, and stands to scrub away bacteria from the small intestine. You also have digestive enzymes, which besides helping us digest our food, have an antimicrobial function. And then we also have the ileocecal valve, which is a protective barrier to stop bacteria from migrating from the colon back up into the small intestine.  When any of these processes and structures fail, it can facilitate the growth of SIBO. Today, we’re going to focus on what happens when you have inadequate amounts of hydrochloric acid produced by the stomach.

Our special guest is one of the nation’s foremost functional medicine nutritionists, Angela Pifer, who practices in Seattle, Washington. Angela specializes in treating patients with functional gastrointestinal disorders like SIBO and IBS, and she’s known as the SIBO guru. She lectures around the world on such topics, and has launched a gut prescription recipe site, Gut RX Gurus, and a FODMAP free line of bone broths, Gut RX Guru Bone Broth. Angela, thank you so much for taking time out of your busy schedule to speak to me and our listeners.

Angela Pifer:                      Thank you, Ben. Thanks for having me.

Dr. Weitz:                          Great. So how did you get interested in treating patients with gastrointestinal disorders?

Angela Pifer:                      Gosh, you know, I’ve been in practice about 13 years, and it was just out of the gate, the gut has always fascinated me. There was never anything else. It wasn’t even a thought, and I loved it. To me, there’s some other things going on with the body. We can look at the brain and everything, but we start with the gut in so many cases, don’t we? Like you know, how we’re digesting, how are bowel movements moving along, is digestion working from top down? Like we have to look at all of that to see how we can then support the body and the system with almost everything else. So it’s really kind of this hub, and working with people with functional or chronic gut presentations has always just fascinated me.  And honestly, I think that population as a whole, my lovely patients and anyone out there who’s listening who has a functional gut disorder being in that chronic state, they need help. They need support. They need hand-holding, and they really need someone to sometimes step in and be that hub between all their other specialists, because everyone seems to be going off in a different direction sometimes when they’re seeing different specialists, and to have somebody pull everything together is really really helpful.

Dr. Weitz:                          Yeah, absolutely. You know, if you deal with Functional Medicine, the gut has got to be one of the starting places for almost everything. I just saw a patient this week, and her big complaint is that she’s having unexplained seizures, one after the other, and she’d been to the neurologist and nobody could figure anything out. So we did some stool tests, and she’s got all kinds of things going on in her gut. You can’t even believe the things happening there. Layers and layers. And it turns out, she’s had all these gut symptoms which she was really sort of used to and not even complaining about, and now she’s doing so much better just by fixing her gut.

Angela Pifer:                      Yeah. And I say the word complacency with so much love and respect and empathy for a person, but I think they have this known sense of norm. “This is what I deal with day in and day out, this is just how it is,” and over time, they adapt to it.  Never liking it, but adapt to it, and it isn’t until you show them what it really feels like to not have to sit with that, it’s mind-blowing sometimes what they’ve had to deal with, right?

Dr. Weitz:                          Yeah, no, absolutely.

Angela Pifer:                      Yeah.

Dr. Weitz:                          Yeah, they don’t know what it’s like not to be constipated or not to have gas.

Angela Pifer:                      Yep. Yeah yeah.

Dr. Weitz:                          So can you explain how low stomach acid can be a cause of SIBO, which is the cause of IBS in a majority of cases?

Angela Pifer:                      Yeah, absolutely. So when we look at SIBO, we really have to always consider that SIBO is a secondary condition. It’s never a primary condition. It was set up because something else has happened, some other thing or things have happened. And so we have to try to get at the root of what is setting this up for the person. You know, SIBO needs to be addressed, but we have to look at everything else as well to fix that root cause. So SIBO doesn’t continue or come right back or be reoccurring because you’re not fixing the real correct thing here.  So one of the very big contributors can be low stomach acid.  Low stomach acid can be caused by a few different things.  Low stomach acid could be caused by really really really chronic stress, it could be caused by hypothyroidism as well.  So it’s this spiderweb of connections that we have to get in and try to figure out this root cause for people.  And we’re starting to look at low stomach acid, I mean this is, you know, it’s like not chewing your food. This is like a major component and stuck within the digestive tract, and if you can’t use low stomach acid to actually break your food down properly … And really the main thing is we’re talking about SIBO is to clear up pathogens that are coming in.  You know, we need that proper really acidic pH that’s under three pH to actually clear everything off, otherwise we’re just gonna get bombarded with things that we’re taking in by mouth multiple times a day.  We want that first step, it’s a really big line of protection there.

We also have to look at, we’ve got a pH at that acidity for a reason, and it signals gastric emptying properly, it signals the proper release bile, it signals the proper release of digestive enzymes. So as you were talking about in your intro, bile being needed as well to clear out the intestinal tract. We have a lot of conjugated bile with our intestinal tract. It actually acts as a detergent. And every time we eat some fat, your gall bladder goes squish squish. It’s like a stress ball, squish squish. And it’s gonna release some bile, and with that, that will help your emulsify your fats. Then it’s also coming through as a detergent and clearing out that small intestine. And it also happens in between meals, so it doesn’t just happen that you get a bile release with your meals, you also get it in between meals, and that’s gonna piggyback the migrating motor complex and those cleansing waves that come down.

So in your intro, I’m going to disagree just a little bit here because I think it plays into the conversation we have about what the heck to do with SIBO. I think if we start to compare the trillions of organisms that are in the large intestine, there’s so many massive amounts of organisms in the large intestine that when you look at the small intestine, it seems quite minuscule. And yet if we look at the small intestine just by itself, we’re looking at millions and upwards of billions of microorganisms per milliliter, per teaspoon of fluid. So it’s not sterile by any means, there’s lots of organisms there. But we also have forward-moving matter. Everything’s moving forward, it’s not hanging out like it does in the large intestine where everything hangs out there and ferments and we get all this beautiful relationship with our microbiota in that area. Things are moving through a lot faster, so we don’t get this big buildup of organisms in the small intestine. And we’ve got bile moving through, like there’s lots of mechanisms to help keep the organism load at a specific load.

When one of those mechanisms, or multiple mechanisms, goes wrong, of course, then we get a buildup. And then we get fermentation happening in the small intestine and lots of other things that could come with SIBO that’s quite debilitating, because that small intestine is not meant to stretch, and that causes a lot of pain. And we don’t get as much gas movement of course, out or just spilling across the intestinal lining.  So why I say that is so many people think SIBO, “I gotta kill it.” And we can’t Drano that small intestine, we want to look at this as a re-balancing. Really fixing the underlying issue, getting on the mechanisms and what’s going on there, but then re-balancing and just taking the person to that level. Not “kill kill kill,” and then stepping back, because that’s not gonna work either. We’ve got to help reset and re-balance and reseed, affect change with the immune system, and there’s so much that goes into play with this even once you get somebody to a negative breath test. There’s so much healing on the other side to make all this beautiful work that you’ve just done stick.

Dr. Weitz:                          Do you sort of use the four R or five R program as kind of a backbone of your approach?

Angela Pifer:                      Yeah, you know, I don’t. Not with SIBO specifically. There’s so many other things I do. I mean as we start to look at autoimmune and others, I know we’re gonna talk about an autoimmune condition as we talk here. But in terms of SIBO, I don’t … There’s so many beautiful things that that four R program does, and there’s bits and pieces filled in along the work that is done, that really it’s more, you know, stabilize the patient and whatever that means. We’ve gotta evoke change with the diet, oftentimes. We don’t always have to go drastically low, but we wanna adjust the diet to make sure they’re nourished, adjust it to how they’re digesting and absorbing, adjust it to make sure their symptoms are somewhat calmed down so they can hang out in this period of time as we treat properly, you know. So there’s a lot of change that happens with the diet.  And in terms of kind of that whole repletion, we’ve got to get on the other side of actually treating SIBO to get to that point where we can start to work on more of that reseeding of the gut, a lot of immunoregulatory support at that point. And it’s bits and pieces, but not the perfect four R.

Dr. Weitz:                          Okay. Sounds good. So when would you suspect low stomach acid as a cause for a patient with SIBO?

Angela Pifer:                      You know, I would say that I actually assess that with every patient. It kind of comes out of the gate when you’re doing the intake with the patient, and they start to talk about different symptoms that they have, 

Dr. Weitz:                          What symptoms would make you think about low stomach acid?

Angela Pifer:                      Yeah, absolutely. Food just feels like it’s just sitting there and not moving through their stomach.  A little bit bit of food makes them feel full fast.  It could be that we start to look at, you know, they’re not breaking down their food, they see a lot of intact pieces of food in the stool, or even peanut butter stool, I call it.  So it’s really sticky stool, it takes a lot of wipes.  They’re probably not breaking their proteins down, so then we would look back upstream and figure out what’s going on there, which low stomach acid is oftentimes a culprit at that point.  I would say what I see with a lot of patients is a lot of burping.  Food just feels like it’s a heavy weight in their stomach.  They need to space their food out because they don’t feel like they’re digesting at a quick enough clip that they can eat a little bit more consistently than that. And then as we step back and look at labs, you know, Spectracell and nutritional markers, we can look at different things to see if their iron is trending lower or B12 is trending lower, and we would see that if they have low stomach acid.

Dr. Weitz:                          Okay. Once you suspect that a patient has low stomach acid, how would you figure out what is causing the low stomach acid, whether it be a H. pylori infection or autoimmune-related or something else?

Angela Pifer:                      Yeah. I think we always are gonna start with the basics, I mean unless somebody presents with a really chronic case where they’ve had just chronic low B12 over time, I’m gonna start to step into some of those advance markers, looking for anti-parietal cell or anti-intrinsic factor antibodies to see if there’s actually something going on more as an autoimmune front.  But once we start to look at this, you know, how are they digesting their food, what is their diet presenting like, can we correct this with supplements, and then what is also going on in terms of their lifestyle?  If they’re, you know, really in a sympathetic state, we work a lot on stress reduction because a sympathetic state, being more stressed chronically over time, is really gonna drive digestive chemicals away from the digestion, from top-down. So there’s a lot of lifestyle effect that we can have as we start to see people move away from that. But really, and again, I say this with great love for the patient that is sitting there feeling like this is just … ‘Cause chronic presentation, and they deal with this all the time. Most people with functional gut disorders like this feed forward cycle, stress is always gonna contribute to that, but then once it’s present, they’re having to deal with these symptoms all the time. And so stress is almost always some sort of factor that’s adding to that, and so I think there’s a lot of … You know, I introduce people to the Wim Hof breathing method, I have them make sure they’re walking an hour a day …

Dr. Weitz:                          Wim Hof is when you take a cold shower?

Angela Pifer:                      No, Wim Hof is actually … So that’s more contrast hydrotherapy. Wim Hof is actually a breathing technique. You should look him up on YouTube, he’d be interesting to have on your podcast. I don’t even know if I’ll explain it correctly. It’s this beautiful way of actually really taking in almost this hyper amount of oxygen into your blood, and huge diaphragmatic breathing technique, and then you actually ride that out a little bit. But in terms of oxygenation and capacity, people aren’t using the full lung that they have, or lungs, and moving it up. And so it’s a really interesting breathing technique to get them to use that entire space and diaphragm. Yeah, it’s very very cool.  So yeah. So I think there’s a lot that we can do in terms of just the stress piece, you know, to really help people out. So as we’re starting to look at the low stomach acid piece, you know, we’ve gotta really listen to the patient, and SIBO is going to contribute. Once SIBO is set up in terms of … And where SIBO is at the small intestine. So the further SIBO is up, and the worse SIBO is with all those contributing factors, it can start to break down digestive enzymes in that brush border, uncoupled bile. It can really interfere with a lot of nutritional absorption that we’re doing in that area. So it just depends on the patient as we’re working on, to what degree we need to come in and do any kind of intervention at that point.

Dr. Weitz:                          So how would you rule out H. pylori?  What tests do you like to use for H. pylori?

Angela Pifer:                      Yeah. I actually prefer the breath test for H. Pylori.  I really do.  The urea breath test.

Dr. Weitz:                          Okay. Why is that?

Angela Pifer:                      That’s my favorite one. Oftentimes I want to see a GI Effects so I’ll add that on, as we look at a stool antigen for that.

Dr. Weitz:                          Yeah.

Angela Pifer:                      You know, if they’ve never been diagnosed with H. Pylori, then we’ll do a blood antigen, but I really like the breath test. I know there’s a like controversy on SIBO’s presence, sometimes you’ll get a false positive. I’ve not seen that line up.  And of course we have endoscopy, right, is where rather referring over to the GI doctor. But I think the urea breath test is really pretty straightforward to me. I think the antigen test with the stool antigen actually misses it a lot more than when we see that breath test.

Dr. Weitz:                          So the notes you sent me over before we did this podcast, it was really interesting that you talked about how if H. Pylori grows in one part of the stomach, it’s associated with increased hydrochloric acid. For those of you who aren’t aware, H. Pylori is often an undiagnosed cause of ulcers because you get this bacteria that burrows into the wall of the stomach, and then the stomach produces more and more acid to try and get rid of it, and so it can often be the true cause of ulcers. On the other hand, if that H. Pylori grows in another part of the stomach where the cells that make the hydrochloric acid are, it actually destroys those parietal cells, and you end up with less hydrochloric acid from H. Pylori.

Angela Pifer:                      Yeah. So you really can’t go off of … There’s some symptoms that are present that we need to investigate if H. Pylori is present. I mean to me, if any kind of burping, if they’re chronic burping, I think H. Pylori should be ruled out. But any kind of burning, any kind of warmth in the stomach, a really early sense of fullness, we really should be ruling out H. Pylori and stepping through the sequence from there.

Dr. Weitz:                          And you also mentioned in your notes that GI docs, when they do an endoscope, they’re often looking in at that part of the GI tract where H. Pylori leads to ulcers, but not the … What’s the other part of the stomach where …?

Angela Pifer:                      Yeah, so if you think about the stomach like a kidney bean, like up on it’s end, you’ve got the fundus is up top, the body is kind of in the middle, and then the antrum is on the bottom. When we start to look at parietal cells, which produce stomach acid, they’re in the fundus and the body, so in this upper two thirds part. And then in the bottom part is the antrum, and if you look on almost every single endoscopy, they’re doing biopsies on the antrum. They’re looking for H. Pylori, and they’re gonna miss if there’s an autoimmune issue with parietal cells. And they’re also doing biopsies in the duodenum to see if there’s celiac.  So I feel like, especially as we’re gonna get into it here, we really should be assessing the whole stomach and looking a little bit beyond this. But it’s interesting that even when recommended that, it doesn’t come back as the biopsy in that area. I think they’re just on … And I say it with great respect, they do things none of us can, but that’s just where they’re looking, and they’re not looking in the fundus or the body.

Dr. Weitz:                          Yeah, interesting. Yeah, you have to try to develop a relationship. There’s not many integrative GI docs around.

Angela Pifer:                      Yeah.

Dr. Weitz:                          Fortunately we have Dr. Rhabar in LA, so …

Angela Pifer:                      Yeah. Yeah, and Dr. Mullen. Yep.

Dr. Weitz:                          Yeah. Is he in LA?

Angela Pifer:                      No, Dr. Mullen, Jerry Mullen up in …

Dr. Weitz:                          Yeah yeah yeah yeah.

Angela Pifer:                      Yeah.

Dr. Weitz:                          Yeah. So let’s talk about autoimmune atrophic gastritis. What are some of the symptoms associated with that in particular, and how do we assess for that?

Angela Pifer:                      Yeah, absolutely. Well I think when we start to look at autoimmune, there’s a lot of conversation around the CDTB toxin and autoimmunity coming from that, and that being a cause of this IBS-C or SIBO.  What we have to look at is that’s definitely a percent, that can set SIBO up, but when we’re starting to look at the population that has low stomach acid and trying to get to the root of what’s going on with SIBO, there’s going to be a small percentage there that we really do have to have, you know, a keen eye on to see if any of those people have autoimmune atrophic gastritis.  And basically what that is is you’ve got some atrophy of the stomach, and you have gastritis, which is inflammation.  So we’ve got atrophy and inflammation, and then you’ve got this autoimmune involvement.  So atrophic gastritis, there’s two types.  One is caused by H. Pylori, and the other is autoimmune atrophic gastritis.  And so basically you’ve got the autoimmune involvement and you’ve got antibody production against the parietal cells.  And so as we start to tuck deeper into low stomach acid and its implications, when we start to look at autoimmune atrophic gastritis, this is everything that we’ve just talked about tenfold because this isn’t simply more stress induced or a bit of hyperthyroid pushed in in terms of setting that metabolic rate and how much stomach acid you’re producing, or you’ve got a zinc deficiency.  All of those can be recovered fairly easily, depending on the case.  But what we’re really talking about is an autoimmune connection here with low stomach acid.

I think to discuss this, we kind of have to talk first about prevalence, because I think it seems like kind of a foreign term, and yet when we start to look at prevalence, everyone’s pretty much heard about celiac.  Almost everything is screened for celiac, especially if there’s digestive stuff going on. So even as practitioners, we’re so quick to jump on that. But when we look at celiac disease, it’s .5 to 1% prevalence in the U.S.  Very, very small percent of people, and if you have it, it’s a very big deal.  But it’s a small percent of people, and yet, as practitioners, we’re fairly quick to rule that out.  When we look at autoimmune atrophic gastritis, we’re actually looking at a 2 to 8% prevalence.  So even if we just take the 2%, it’s 2 to 4 times more likely present than celiac.  And so we really have to kind of stand up and pay attention to this.

When we look at atrophic gastritis caused by H. Pylori, that’s actually going down in America because it’s being screened for.  But when we look at autoimmune atrophic gastritis, it’s going up. It’s starting to increase as are a lot of the autoimmune conditions, right?  People are becoming more susceptible, and we can have a whole ten shows over why we think that is, right?  But when we’re starting to look at the autoimmune atrophic gastritis, basically what we’re looking at is, we’ve got inflammation of the stomach, atrophy of the stomach, we see a breakdown of the parietal cells because you’re making antibodies against those.  And when we look at the parietal cells, those make stomach acid, and they also make intrinsic factor.  And intrinsic factor is what binds to your vitamin B12, and that coupling, as it moves through the intestines, is absorbed together.  If you’re not making intrinsic factor, you’re not gonna absorb your B12, and if you’re not making stomach acid, you’re not gonna break down your proteins to get to your B12 in the first place.

So as we start to look at this patient population … This isn’t everyone that needs to be screened for this, but we have to start to look at if there’s a chronic digestive presentation here. And we really want to start to key into this is if somebody’s taking massive handfuls of HCl Betaine and they’ve been doing that for a really long time or they don’t digest their food, this is something that we should be screening them for.  When we start to look at this, you know, we kind of have this …

Dr. Weitz:                          By the way, do you ever use that HCl challenge test as a way to screen for this?

Angela Pifer:                      You know, I don’t as a way to screen for this. I refer people over for the Heidelberg test if we’re suspecting low stomach acid, especially if I see them on this level of HCl Betaine.

Dr. Weitz:                          Okay.

Angela Pifer:                      I feel for a time, that was really working for me. So setting aside autoimmune atrophic gastritis, it was working for me in terms of getting people on a certain load, and it was making a difference, and then I feel like it just didn’t work as well anymore.

Dr. Weitz:                          Right. By the way, for people that aren’t aware of what we’re talking about, this is where you give a patient one HCl tablet taken before a meal, and then you give them two or take it after a meal, and then three, and you keep increasing it until they get a burning sensation, and then you back off.

Angela Pifer:                      Yeah. Or a warming sensation, but yes.

Dr. Weitz:                          Warming, yeah.

Angela Pifer:                      Yeah. So I’ve seen that work for some people. I’ve seen other people … A lot of times when people come to me, they’ve been to quite a few practitioners, and they’ve already done that test in the past, so you know, we just kind of learn from what they’ve already been working through.

Dr. Weitz:                          Yeah.

Angela Pifer:                      Yeah. So it’s pretty interesting. So I would just go off more symptoms of what we would expect. Again, you know, total protein’s low in a lab. You’ve got B12 that’s chronically low.  Iron is low with no really good cause for it, and when you’re recovering.  You know, they’re kind of the slight, not life-long, but say for the last few years at least this has kicked in at some point, they’ve been trending more towards meat, yeah, they’re not quite getting it recovered.

Dr. Weitz:                          What tests do you like for B12 and for iron?

Angela Pifer:                      I do serum B12. And then when we’re looking at iron, it’s just the full panel.  Serum, TIBC, saturation, ferritin.  And then of course looking at all the rest of the CBC, looking up, you know… 

Dr. Weitz:                          You don’t find the need to do like methylmalonic acid or homocysteine for B12 status?

Angela Pifer:                      I actually like both of those when looking at folate and B12.

Dr. Weitz:                          Okay.

Angela Pifer:                      Yes yes. I look a little bit more at that, and of course it depends on what I see in terms of supplementation that they’ve been on, you know, for a really long time. I’m also looking at that more for folate and B12 status, and methylating. Yeah.

Dr. Weitz:                          Okay, cool. So let’s talk about treating a patient with low stomach acid.  How do you approach that?

Angela Pifer:                      Yeah, absolutely.  Well I think low stomach acid and autoimmune atrophic gastritis are gonna be really two different things in terms of approaching that.

Dr. Weitz:                          Okay, so let’s start with a few different cases.  With somebody who’s got low stomach acid because they’ve been taking proton pump inhibitors for years, how do you handle that?

Angela Pifer:                      Yes, absolutely. So with their doctors approval for coming off of medication, of course, I actually will start to add in bitters. I’ll have them cook all their vegetables.  I’ll have them eat more frequent meals just to start, and then we’re really gonna work on stress management, setting the tone for the meal, and chewing their food three times more than they think they need to.  We might need to address fat load a bit, just depending on how well their gastric emptying is going.  We might need to adjust things that way.  I work a lot with that.  I love bitters, I love them.

Dr. Weitz:                          And bitters are designed to stimulate your own digestive enzymes and acid secretion, right?

Angela Pifer:                      Yeah, absolutely. Our food, I mean it’s kind of crazy to think about, even our broccoli and brussel sprouts are bred for sweetness.  All of like the bitterness, the different species within those, they’re all bred more sweet. We’re like setting aside anything that has more bitter because the masses don’t trend towards that, right, in terms of what we’re choosing at the supermarket.  So when we give somebody bitters, it literally is bitter.  Your mouth has these beautiful taste receptors back here that just light up when you give somebody bitters, and if you even think about it if you’ve done it, it makes your mouth water. Like it’s really stimulating digestion from the top down. So I have people … I like Quicksilver Scientific, their Bitters 9.

Dr. Weitz:                          Oh, okay.

Angela Pifer:                      And their Bitters X is fantastic, and I just have them do one or two pumps 15 minutes before a meal. They hold it in their mouth for 90 seconds, swishing it around, trying to get it to the back, and then they swallow. We’ve got bitter receptors in our stomach as well, so it’s wonderful. It’s a great way to kind of help stimulate digestion there.  In terms of digestive enzymes, one of my favorites is Panplex 2-Phase by Integrative Therapeutics.  It has a low-level digestive enzyme, low-level bio-support, and just a little bit of HCl Betaine.  So I think less is more.  I wanna kind of just start with these lower levels and work up from there.  So that’s my way to approach it.  I would try to set the tone for the meal, really look at your food, smell your food, think about where it came from, what it’s gonna taste like, put that first bite in your mouth and really set your fork down and taste it.  And to me, that sets the tone for the meal and really slows people down.

Dr. Weitz:                          When you’re weaning patients off of PPIs, you have to be careful about sort of a rebound, right?

Angela Pifer:                      Yeah, you do. You know, I’ve had really great luck again with, you know, Dr’s approval on this, and really great luck in weaning people off of proton pump inhibitors. There hasn’t really been a case that I haven’t been able to do because we set everything else up first, and then depending on the medication, we might be able to halve that medication, or we just start to slowly take that every other day. And I’ll always aim that around a weekend, because if you’ve ever really watched people’s food journals over the course of a week, like year after year like I have, you realize that hunger is much more increased during the week. Like there’s just more stress going on. So I start to wean them over a weekend, and you know, have just a little bit of baking soda on hand if they need to do like a half teaspoon of baking soda and water just to take the edge off. And then they have the medication. If something comes up, nobody is asking them to sit in misery with heartburn.  It’s usually pretty good. I think most people just try to stop cold turkey, and then they realize that didn’t go well, so they feel like they’re really chained to it. So you just have to work with them to get them set up.

Dr. Weitz:                          Okay. And then how do you treat patients with atrophic gastritis, and is it the same treatment if it’s autoimmune origin or H. Pylori?

Angela Pifer:                      Yeah, so atrophic gastritis is caused by H. Pylori, and so there’s some great treatments out there for H. Pylori. What we’re talking about is the autoimmune atrophic gastritis, and that’s gonna be more from an autoimmune perspective. So you know, just as if there’s autoimmune thyroid, you’re going to treat the thyroid, but you’re also going to treat the autoimmune condition. So with autoimmune atrophic gastritis, you’re going to treat the autoimmune condition in that you’ve got to work on the whole stress cycle with everybody, getting them sleeping well, calming down the body’s reason for ramping everything up and attacking.  You want to calm down and figure out triggers, you know, where triggers are coming from, whether it’s stress, environmental, internal in terms of food and all.

And then we really want to look at treating nutritional deficiencies, making sure that they’re recovering their B12, recovering their iron. So when we look at autoimmune atrophic gastritis, the vast majority of cases aren’t even diagnosed until they’re completely at this end stage of pernicious anemia, and that pernicious anemia is basically you’ve got anemia because you can’t absorb your vitamin B12, and you need B12 along the iron pathway.  And then you’ve got this autoimmune component causing this.  So pernicious anemia is also an autoimmune condition, but it’s this end stage of autoimmune atrophic gastritis.  So most people aren’t diagnosed ’til that point, so we want to catch them before that. We want to catch them when they consistently have B12 levels of under 500, that we see indications of pancreatic insufficiency.  So they’ve got this low stomach acid and signaling of the pancreas, you know, we don’t see that and that connection. We wanna look for vitamin B12 deficiency symptoms like peripheral neuropathy.  We want to look for even restless leg syndrome, which is strongly connected to this.  That you know, again, at that beginning they’re going to have poor gastric emptying, they’re gonna feel full, they’ve got this excessive burping, sometimes they feel a little nauseous ’cause food is sitting there, and all of this has been kind of chronically presenting.  We’ve got a store of iron in our system, you know, in our body. It isn’t until we really start to see this very big shift, and same thing with B12, this really big shift with this autoimmune attack. We don’t usually start to see this rear up for a good year and a half, two years, so we wanna catch this earlier on, and it might be that chronic presentation that we get to see that with.

So again, first rule out H. Pylori. Absolutely let’s rule that out, but then let’s start to look at, you know, do we start to see B12 levels dipping down? Which is kind of hard sometimes because everyone’s taking B12. And serum B12 is a really great indication that you’re taking good supplements sometimes, so maybe we need to take people off of things for a couple of weeks to get a better read on that serum level. But we wanna look at that, we want to investigate gastroparesis if that’s there, or again, if gastritis is present, we’re going to look for H. Pylori and then start to look at iron and B12 and start to recover those.

If somebody’s gotten to the point of pernicious anemia, they might need iron shots, they might need intramuscular B12 shots, you know, the supplementation may not do it. And this population of course is interesting because they’ve got lower stomach acid and poor signaling, and oftentimes they’re gonna have slower motility. So if you’re trying to recover iron on a consistent basis, you know, you can really slow things down more because iron can be quite constipating. And iron isn’t necessarily … It can be toxic to the colonocytes as well, so you know, sometimes iron shots are gonna be a better choice depending on that patient and what’s going on there.

Dr. Weitz:                          Interesting. And of course, trying to heal the gut as well, right?

Angela Pifer:                      Mm-hmm (affirmative). Absolutely, absolutely. I think that’s going to come with it, and I think that comes with a lot of conditions after as well.

Dr. Weitz:                          And those patients are going to need HCl supplementation probably for the rest of their lives, right?

Angela Pifer:                      They probably will, and you know, I think it’s again, if somebody has an autoimmune condition, we need to be able to tell them that they have an autoimmune condition, because autoimmune comes in pairs. And also, I would say that autoimmune, you know, as we start to look at this, we need to be able to say like there is a reason that you might need ongoing supplementation, in terms of HCl Betaine, in terms of B12 support, in terms of iron support. There’s a connection to be made there with the patient, because sometimes I think, you know, patients might go from practitioner to practitioner and they’ve got these long laundry lists of supplements, and we don’t know which are necessary and which aren’t. But if we’ve got an autoimmune condition set up for this, they’re going to need to really support their system long-term because of the autoimmune condition that’s present.  And the more stressed out they get from wherever this is coming at, the worse the autoimmune cycle can get. And then you get more degradation and targeting of those parietal cells which makes everything downstream worse. So the stress management piece can’t be talked about enough with this population, but then we also have to start to look at how else are we gonna support them, and they’re gonna need supplementation lifelong. They’re going to need it, like absolutely. So they need to know that and be able to connect with that because I think people can fall in and out of favor with supplements, or you know, “I don’t know if these are even doing anything for me” kind of thing. In this case, this is really something that needs to be looked at.

Dr. Weitz:                          So can you monitor those anti-parietal cell antibodies the way you monitor like TPO antibodies with patients with Hashimoto’s to see to what extent their autoimmune component is active, or?

Angela Pifer:                      Yeah. You really can, but I think we have to be careful to say, you know, parietal cell antibodies are at 82 and they go to 72, it doesn’t mean that they’re necessarily getting better. You know, antibodies are volatile. They don’t just go up a ladder and down a ladder depending on two things. If we are in a very stressful situation, we can see a shift there. If we are fighting off a cold, we can see a shift. If we …

Dr. Weitz:                          Right, but maybe are there bigger shifts? Like with TPO, you know, antibodies for thyroid, if they have 500 and it goes up to a thousand, that’s significant, or it’s 1,200 and it goes down to 150, you still have elevated antibodies, but that’s a significant shift, whereas if it goes from 100 to 400, maybe it’s insignificant.

Angela Pifer:                      I agree. I completely agree, yeah. When there’s 

Dr. Weitz:                          Is there a similar sort of range with the anti-parietal cells?

Angela Pifer:                      You know, I think it’s going to be based on the person and what we’re looking at with both of those and where they kind of fall into. I think as we start to look at the progression and how long this has been there for people and how advanced they are, they might not be able to get those fully recovered like we’d like.  But for the anti-parietal cells, the anti-intrinsic factor antibodies, you know, we’d look at both of those, and of course if there’s a positive test, we’re gonna refer over to a GI doc to get a biopsy. But in the right place, they’ve got to biopsy the fundus or the body of the stomach to be able to actually confirm that.

Dr. Weitz:                          Cool.  Okay, that’s good.  Very interesting information.  Thank you for informing us about a condition I think most patients and even a lot of practitioners are not aware of, which is autoimmune atrophic gastritis as a cause of low stomach acid leading to SIBO.

Angela Pifer:                      Yep.

Dr. Weitz:                          So how can listeners and practitioners get a hold of you if they want to contact you, sign up for your courses, get your bone broth?

Angela Pifer:                      Yeah, absolutely. So my practice site is siboguru.com, and I’d love to have everybody visit me there.  And then GutRxGurus.com is a beautiful collection of practitioners and chefs that are in the low-FODMAP realm. And there’s a SIBO-specific category in there, and everything is low-FODMAP.  And I’ll say it really quick, I don’t as a whole put every single person that’s ever even, you know, SIBO glaring, on a low-FODMAP diet, but there’s going to have to be some adjustments, and so to be able to have a recipe set that you can go to to really fill in the gaps and give people ideas … Because we’re so used to eating what we eat, and then when we can’t eat that anymore, it’s like chicken on a plate. Like what do you do? So it’s nice to be able to have all these beautiful recipes for sauces and sweets if you need them, and the foods just really tasty. So that’s a subscription site for recipes, gutrxgurus.com.

And then GutRxBoneBroth, the first low FODMAP bone broth to hit the market, and people can order that online. It just ships directly to their door, and we actually ship beautiful high-protein, high-gelling bone broth that tastes absolutely amazing. We’ve got a big plant here in Seattle, and we sell beef and we sell chicken, and it is just absolutely delicious, so it’s just nice to have that to kind of fill in the gaps and have that as a base of a soup, because you can’t just go to a store and get a garlic-free, onion-free anything, right? Everything has it in it. So it’s nice to have a broth that people can really connect to there.

Dr. Weitz:                          Cool, great. Thank you so much for spending time with us.

Angela Pifer:                      Of course, thank you!

Dr. Weitz:                          Okay, I’ll talk to you soon, Angela.