Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Thyroid Hacks with Dr. Ruben Valdes: Rational Wellness Podcast 154
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Dr. Ruben Valdes talks about Thyroid Health and How to Improve it with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

4:08  Thyroid hormone is the master hormone and is the only hormone that is received by cells at the nuclear level.

5:40  The thyroid produces the inactive form of T4 which then has to be converted into T3, the active form.  In severe cases of Hashimoto’s, patients can go through a thyroid storm when the body starts destroying the thyroid and all the stored thyroid hormone gets released and they end up with too much of the active form of thyroid hormone, T3.  They may get strong palpitations and they will get very hot and this is very damaging to the other organs in the body.  Therefore, you don’t want too much of the active form of thyroid T3 floating around the blood stream. It is much safer for the body to produce T4, the inactive form, and let the various tissues convert the T4 to the active T3 form as needed. 60% of the thyroid hormone conversion takes place in the liver, 20% in the intestines by our gut microbiota, and the other 20% in various tissues thoughout the body like the skin and bones.

8:26  There are various nutrients that are required for synthesizing thyroid hormone, and then for this T4 to T3 conversion, including iodine. The thyroid always needs iodine but taking too much iodine can make Hashimoto’s worse.  It can be an immune trigger and taking a high dosage, like 12.5 or 25 mg found in Iodoral, can be especially dangerous. Diagnosing Hashimoto’s can be tricky since sometimes the patient can be negative for TPO and TGB antibodies and there is a third set of antibodies, alpha and beta tubulin, which are measured as part of the Cyrex Array 5, which is the multiple autoimmune reactivity screen. Alpha and beta tubulin are structural cross fibers that are found in different tissues, including the brain and also the thyroid, though it is much more rare than TPO and TGB.

14:02  Dr. Valdes has a standard thyroid panel that he likes to run that includes the following: 1. TSH, 2. Total T4, 3. Free T4, 4. Total T3, 5. Free T3, 6. Reverse T3, 7. TGB antibodies, 8. TPO antibodies, 9. Thyroid binding protein, 10. Thyroid binding globulin, 11. Alpha tubulin, 12. Beta tubulin. It is important to compare Total T3 to Free T3.  For example, if your Free T3 is in range, say 2.4, which is on the high end of the range, but their total T3 is 71, which is on the low end. This indicates that not enough of the T3 is bound, which indicates an issue with thyroid binding protein. If you don’t measure reverse T3, then you will not know that some of your free T3 is actually reverse, inactive T3.

17:20  Most traditional MDs usually just run TSH and TSH is important and a high TSH will drive thyroid gland hypertrophy and can even drive thyroid cancer.  So it is important to suppress TSH.  Dr. Valdes likes to see TSH between 1 and 1.5, which is a bit extreme, whereas most experts look at normal as being between .4 and 4.0 or 3.5. 

20:58  Reverse T3.  When the body is converting T4 to T3 it removes one of the 4 iodines from the carbon ring.  It is supposed to remove the iodine from the outer ring, but if it removes an iodine from the inner ring, then it becomes an inactive form of T3 known as reverse T3.  You can have a patient that has a high T3 but yet feels badly, their hair is falling out, they are tired, and they’re moody.  High cortisol, chronic stress, chronic inflammation, and infections will drive cortisol up and impair liver detoxification, which can result in forming more reverse T3 when the T4 to T3 conversion is happening in the liver.

25:19  Dr. Valdes said that his experience is that when you just place patients on Cytomel, which is just T3 alone, patients may feel amazing for the first few months and then they start to tank because they develop thyroid resistance.  Dr. Valdes likes to use GTA Forte from Biotics as the preferred thyroid medication, which is actually a nutritional supplement.  It is a glandular with some added cofactors, including the minerals zinc, copper, rubidium and selenium, and the antioxidant Superoxide Dismutase.  Dr. Valdes pointed out that Armour thyroid has a portion that is synthetic, so a purely glandular product like GTA Forte is to be preferred.  He also likes the prescription product Nature Throid.

33:40  Thyroid Binding Globulin.  If you have a high Total T3 and a low Free T3, this indicates an overproduction of thyroid binding globulin (TBG). TBG usually follows Sex Hormone Binding Globulin (SHBG).  Dr. Valdes then likes to run a DUTCH test, which is a Dried Urine Hormone test to look at how well they are metabolizing or clearing their estrogen.  If they are not clearing their estrogen or metabolizing it safely, then you need to address metabolism and detoxification issues.  If it’s a male, DUTCH can tell you if they are aromatizing some of their testosterone into estrogen, and if so, is it primarily estrone, estradiol or estriol.  You also want to see if men are overconverting their testosterone into estrogen.

36.55  The underlying causes of Hashimoto’s thyroiditis (primary hypothyroid) can include HLA DR-DQ susceptibility to biotoxins, heavy metals, leaky gut, chronic infections, insulin surges, estrogen surges, cortisol surges, food sensitivities.  Which direction to pursue will have to do with the history. 

40:55  Dr. Valdes does a very detailed history on every patient and he uses the Living Matrix software that uses the history taking model developed by the Institute of Functional Medicine.  This model helps him to see which direction to go when trying to discover the underlying, root causes of the thyroid problem.  Should he focus on defense and repair, assimilation, communication, their energy system, or the structural integrity of their organs? Then he will use detailed testing to help zero in on possible causes based on the history. 

42:54  If he suspects biotoxins, like mold, Lyme, cauatera, bloom, spider bites, and snake bites, he will run a HLA DR-DQ.  Lyme starts out as an infection but the Borrelia produces a biotoxin. Other markers are C4A, TGFB1, MMP9, and VEGF, which are part of the Richie Shoemaker protocol.  Dr. Valdes does not find the urine mycotoxin tests that helpful.

 

 



Dr. Ruben Valdes is a Doctor of Chiropractic and an expert in Functional Medicine. He is the Chief Content and Marketing Officer of Novis Health Systems, a Functional Medicine franchise. He wrote 3 books, including The Chiropractic Entrepeneur, From Diabetic to Non-Diabetic, and The Thyroid Hack. Dr. Valdes can be contacted through Novis-Health.com.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available.



 

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello, Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy listening to our Rational Wellness Podcast, I would very much appreciate it if you could go to Apple Podcasts and give us a ratings and review. For those who’d like to see a video version, you can go to my YouTube page, Weitz Chiro, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Today, our topic is a Functional Medicine approach to thyroid health with Dr. Ruben Valdes. The thyroid is the master regulatory gland and it’s found in the front of the neck below the Adam’s apple. The thyroid produces three main hormones, T4, T3 and calcitonin.  Calcitonin plays a role in regulating blood calcium levels. T4 and especially T3, which is a more active form, affect metabolism, appetite, gut motility, heartbeat, breathing rate, the mitochondria and many other functions in the body. Too little thyroid production, hypothyroidism, including Hashimoto’s autoimmune hypothyroidism, which accounts for 90% of cases of hypothyroidism in the US, can result in weight gain, a lack of energy, brain fog, feeling cold, constipation, hair loss, infertility, et cetera. Too much thought production, hyperthyroidism, including autoimmune hypothyroidism called graves, will speed up the metabolism and cause weight loss, hair loss, et cetera.

 The traditional medical treatment for hypothyroid is to prescribe synthetic T4 thyroid hormone, also known as synthroid, and that’s pretty much the extent of the treatment. Occasionally, some T3 may also be prescribed as well, but there is never any attempt to figure out the underlying causes for the thyroid to determine why this thyroid stopped functioning properly. Similarly, for the traditional medical approach, in cases of Hashimoto’s thyroiditis, there’s virtually no focus on the autoimmune condition that’s causing the thyroid to malfunction, with all the focus being on reducing TSH levels using thyroid hormone, but from a functional medicine approach, we want to discover some of the underlying triggers and causes for hypothyroid and correct these. When there is autoimmune thyroiditis, we need to look for some of the reasons why our immune system has gotten so out of balance and make some changes so we don’t see a continued destruction of the thyroid gland.

Our goal today is get a better understanding of what some of the mechanisms of hypothyroid are, including autoimmune, how to properly analyze and improve thyroid health with the proper thyroid panel, and then figure out some of the root causes and how to correct them using a functional medicine approach. Dr. Ruben Valdes is a doctor of chiropractic and an expert in functional medicine. He’s the Chief Content and Marketing Officer of Novus Health Systems, a functional medicine franchise. He wrote three books, including From Diabetic to Non-diabetic, The Thyroid Hack, and his newest book is Awakening from Alzheimer’s. Dr. Valdes, thank you so much for joining me today.

Dr. Valdes:          Thank you so much for having me, Dr. Weitz.

Dr. Weitz:            Dr. Valdes, can you explain, what’s the role that the thyroid plays in our metabolic functions and our overall health?

Dr. Valdes:          Absolutely. Thyroid hormone is what I like to call the master hormone. It’s the only hormone that is received at the nuclear level. You know that every other hormone has receptors on the surface cell of the wall, whether it’s insulin, testosterone, estrogen, cortisol, you name it. They’re all received and affect the outer membrane of the cell. Thyroid hormone, specifically activated T3, is the only hormone that makes it all the way in through the cell wall and stimulates nuclear activity. If you remember, obviously DNA is what lives in the nucleus of the cell, so it initiates transcription and translation. Everything in our body is dependent on transcription and translation, from our ability to grow hair, to our ability to grow nails, to our ability to produce cells to repair, to regenerate, to produce oil in our skins to regulate our metabolism. Everything is DNA dependent. Imagine what the consequences long term of having your master hormone become disordered, diseased and dysregulated are and can be.

Dr. Weitz:            Interesting. The thyroid produces the inactive form of T4, which then has to get converted into T3, which is the active form. I wonder why the body has set that up? What’s the evolutionary advantage of producing an inactive form that has to be converted into an active form? Wouldn’t it be easier if the thyroid just produced the active form of T3?

Dr. Valdes:          Well, that’s a great question actually, and a very smart question. The reason why that would be catastrophic is because what would happen is the moment that that active hormone is immediately released from its origin site, the thyroid, everything around it would immediately absorbed and uptake this very critical master hormone. We actually see that in very severe cases of Hashimoto’s, when people are going through something called thyroid storm. When that happens, there’s very aggressive, very active destruction of the thyroid, and all of that stored T4 and the little T3 that’s stored is released, and you’ll see a lot of metabolic activity centrally. They’ll get very, very strong palpitations. This will get very, very hot, and it just puts all this tissues that are around the thyroid in danger. The body being as brilliant as it is, is going to first create primarily the inactive form so it can be bound, transported, converted, and then taken to the sites where it’s actually needed.

Dr. Weitz:            Cool. Where does most of the conversion of T4 to T3 take place?

Dr. Valdes:          60% of that conversion happens at the liver by an enzyme called 3,5 deiodinase.  Another 20% is happening in the lining of our guts, primarily by our gut microbiota, and then another 20%, which is not really very effectable, or alterable, happens at the level of our bone and skin, and other peripheral tissues. Now, when you look at a panel and you look at where their total T3 levels are, sometimes it can be a dead giveaway. People that normally would have, or typically would have very, very low levels of T3, I’m talking maybe in the 70s or less, almost always you can immediately assume that that’s liver, right, because when it’s gut that 20% usually won’t drive it that low. Sometimes the levels themselves can immediately begin to tell you where some of these under conversion patterns might be happening, even before you look at the rest of the lab work.

Dr. Weitz:            Interesting. What are some of the nutrients required for synthesizing thyroid hormone, and then for this T4 to T3 conversion?

Dr. Valdes:          Yeah, so nutritionally, the thyroid always needs iodine and this is such a controversial topic, as you already know, because for patients with Hashimoto’s thyroiditis, and Hashimoto’s thyrotoxicity, iodine becomes extremely toxic.  As a matter of fact, it can be an immune trigger that makes the Hashimoto’s worse, right?  There’s all this information out there and all these people talking about, “Hey, low thyroid. Take iodine,” and they’re unfortunately making the primary reason why they have hypothyroidism worse, crazily.

Dr. Weitz:            In fact, in certain Functional Medicine circles, very high dose iodine supplement called Iodoral at 12.5 or 25 milligrams, whereas the average dosage of iodine in the diet’s supposed to be about 150 micrograms, which is what you usually see in a multi, they’re promoting the use of these super high dosages of iodine.

Dr. Valdes:          Yeah, and it’s very, very sad. It’s very sad to see because before that… it’s not a wrong intervention. It can be a good intervention, but at the right time. Way before somebody would jump on that wagon, being primary hypothyroid, meaning they have Hashimoto’s disease, we first have to confirm that the immune system is going into remission, that it stopped its attack on the thyroid, so then the thyroid can utilize that nutrient effectively. If you’re uptaking those high doses, you’re getting a surge. Those surges are very, very immuno activating, and you’re making the primary condition worse. There is a time and a place for an intervention like that. It just has to be done at the right time.

Now, we can speak a little bit, as we move forward, about secondary hypothyroidism, which is not that commonly talked about, meaning the gland itself is healthy, but there’s other factors in the body that are ultimately influencing how effectively and successfully that gland is creating hormone, and how the body’s converting the hormone. For those patients, if it is confirmed that in fact it is not Hashimoto’s, then we have to talk a lot about how many people are tested, and since they test negative for TPO or TGB, they’re told, “No, you don’t have Hashimoto’s,” when in fact the majority of them actually do. We’re now even discovering and learning about a third form, about a third set of antibodies that are more rare, but that can also be diagnostic of Hashimoto’s disease called alpha and beta tubulin.  The prevalence of true secondary hypothyroidism is actually very small 3 to 4%. For those patients, iodine intervention right off the bat might not be a good… might not be a bad idea, but for the majority of people, if you’re not going into that level of depth, then you’re actually placing the patient at risk of having… re-triggering of their autoimmunity.

Dr. Weitz:            That’s interesting. That’s the first time I’ve heard about these two new antibodies to look for autoimmune thyroid.

Dr. Valdes:          Yeah.

Dr. Weitz:            Can you repeat what those are again? Where is that testing available?

Dr. Valdes:          Yeah. They’re called alpha and beta tubulin. Alpha and Beta tubulin are cross fibers, structural cross fibers that are found in different tissues. They can, at times, be found in the brain. They can be found in other areas of the body, but they’re very prevalent in the thyroid. The best place to run those is through an RA-5 from Cyrex Labs. They’re included in their multiple autoimmune reactivity serum.

Dr. Weitz:            No wonder I’ve heard of it. Okay.

Dr. Valdes:          Yep. Yeah, so they’re in there and we’re now learning that it is a rare form, and it can act very similar to thyroglobulin, which clinically we tend to see people with elevated thyroglobulin antibodies that have autoimmune thyroid tend to have a more severe version of the problem than just the TPO antibody itself, because TPO is just attack on the enzyme which alters hormonal production, versus TGB is actually going after the structural components of the thyroid. When those patients are under attack, their ups and downs are a lot more severe. The severity of the condition tends to progress very rapidly.  Patients with alpha and beta tubulin tend to present more like TGB than TPO. Interestingly, I had a case of this recently in a young girl, and 31, losing her hair, her hormones all over the place, very dry skin, always cold.  We ran the classic 11 markers and everything looked good. I was like, “You look fine.” Her TSH at 1.8, her TPO, TGB normal, everything else normal, but it looks so much like Hashimoto’s.  We dug deeper and it came back positive for alpha and beta tubulin. It was interesting.

Dr. Weitz:            Interesting.

Dr. Valdes:          Yeah very.

Dr. Weitz:            Why don’t we go through testing now? Why don’t you tell us what your standard profile is? You mentioned 11 standard tests that you do.

Dr. Valdes:          Yeah. For most patients, we’ll run the classic TSH, T4 total, T4 free, T3 total, T3 free reverse. We’ll run both antibodies, TGB, TPO. We’re going to run thyroid binding protein, sometimes sex binding protein, and then if necessary, alpha and beta tubulin. That puts us at 12.

Dr. Weitz:            Right.

Dr. Valdes:          If we don’t run the sex binding globulin, that’ll put us at 11.

Dr. Weitz:            Now, it’s become a standard in some of the functional medicine circles to just run a panel that includes free T3 and free T4. What does adding a total T4 and total T3 give you?

Dr. Valdes:          Well, it tells us a lot. I don’t know who would do that and why because thyroid binding protein is a very important player. You want to know, even if the T3 levels look good and they’re in the functional range, it’s like, okay, great, you have enough free, but you really can’t make assumptions based just on that. Number one, you really want to know how much of that hormone is actually bound anyways. Having a comparison of total T3 to your free T3 is going to speak into how well your thyroid binding protein is binding. Let’s give you an example. What if your T3 is in range, I don’t know, at 2.4 on the high end of the range? You’re like, okay, this is good. Their symptoms are going to be okay, but you look at their total T3 and they’re 71. Right? There’s a problem right there because your total T3 levels are low, and there’s probably some type of issue with thyroid binding protein where not enough of it is bound.

Yeah, you’re having enough to three, but your overall production and conversion is crappy. Right? I want to know that. In addition to that, we can never assume that all that free T3 is active, because part of that free T3 that’s being counted is actually reverse T3 that’s being reported just this T3. When you look at your total T3 value, that includes active and reverse T3. It’s all bundled in the total T3 count. When you look at free T3, you’re getting active and you’re getting reverse. You don’t know, just by looking at free T3, that all of it is active together. I would say to a certain extent, it is a disservice and it takes us back to the very thing that we’re trying to get away from in Functional Medicine, which is just dealing with symptoms, which is the whole conventional approach. Our idea is to get a full picture of everything that’s going on with that patient, with that pattern in order to be able to promote health to the highest level.

Dr. Weitz:            Right. Traditional doctors a lot of times just run the TSH. That’s all they’re really concerned about.

Dr. Valdes:          Yeah. I mean, let’s be fair, that’s important. A high TSH is going to drive hypertrophy in the gland. It can drive cancer. Yeah, they’re trained in pathology. They’re trained in disease. Suppressing TSH is, in fairness, important. It’s a good thing. However, baby, If we begin to talk about the things that also matter, like quality of life for these patients, the elimination of the very symptoms that took them into their doctor’s office in the first place, right?

Dr. Weitz:            Right.

Dr. Valdes:          The things that they actually want help with, they’re untouched by just looking and treating their TSH. Yes, it’s a very incomplete picture and on top of that, most doctors are utilizing the reference range which, pardon my French is absolute garbage.

Dr. Weitz:            What range do you like to use for TSH?

Dr. Valdes:          Well, I’m a little bit of a Nazi. I like it to be one to 1.5, and that’s not really…

Dr. Weitz:            That’s extreme.

Dr. Valdes:          It is extreme. Yeah, it is extreme. Most of the time they’ll say from point A to 2.3 is acceptable. If somebody is above the age of…

Dr. Weitz:            Most traditional doctors have a range of up to four or 4.5.

Dr. Valdes:          That’s right. Yeah, and by the time someone’s anywhere close to four, their life is collapsing, man. They feel so terrible. They’re being told… and I see it all the time, they’re like, “Yeah, my thyroid was checked and I was told I was good. Go home. Don’t worry about it.” Until you go up that extra fraction of a point. “Wait, now it’s time to put you on a drug for the rest of your life,” which, surprise, surprise, is the number one selling drug in America. Synthroid and Levothyroxine.

Dr. Weitz:            Yeah. What about when patients get older? I heard one prominent functional medicine doctor say that once you’re past 60 and you… TSH up to 10 is still okay.

Dr. Valdes:          Okay, wow. Yeah, I find myself challenged by that statement. Absolutely. As we age, there’s a lot less concern about that range. Normally, I’m typically pretty comfortable with patients around the age of 65 being three, 3.2, I’m a lot less strict, and primarily because now you begin to enter the risk of arrhythmia’s and cardiovascular stuff. Yes, allowing that range to be broader and less strict in people that are older is most of the time okay. 10? I don’t know that I would ever be comfortable with. I would honestly have to see the research that would support that, but up to date, I haven’t seen studies that would support allowing a TSH to be that high again because of the risk that that poses to the thyroid around nodulation, and that’s a risk that will be present until somebody is 80 or 90.

Dr. Weitz:            Right. You mentioned reverse T3. Let’s talk about reverse T3 and what the significance is.

Dr. Valdes:          Yeah. Reverse T3 is like an isomer. That means a mirror molecule. When the enzymes that create the conversion into T3 are working, sometimes they’re working very rapidly, and they’re going to remove the wrong iodine from the ring. T4 is called T4 because there’s four iodine around the ring. Normally, if my memory doesn’t fail me, the iodine that we want to remove is on the fifth carbon, but sometimes if the iodine on the third carbon is removed, it creates this mirror molecule. The problem with it is that it looks identical. It’ll be bound to protein. It’ll be transported, but it can’t fit in the nucleus. It can’t fit on the receptor, so making it ineffective, an ineffective, inactive form of T3. There’s a lot of people that, for one reason or another, too much of that conversion goes the wrong way and they start over making this reverse form of the hormone.

Now, a lot of times, you might look at their total T3 and you’re like, “Wow, it’s 120, 125. This is fantastic,” and you look at them and they look like garbage, right? They’re exhausted, their hair’s falling, they’re tired, they’re moody. Their husband or their wives are ready to kick them out of the house, and it’s because it’s because when you dig deeper, more than 20% of that total hormonal conversion is becoming this inactive form. There’s a lot of things that drive that. The most common, historically, is high cortisol. High cortisol, chronic stress, chronic inflammation, infections will drive cortisol up, and it’ll impair or alter phase one, phase two detoxification pathways. It can also alter gut inflammation, gut microbiota, also altering the conversion into reverse T3. Yeah, definitely a very important piece to look at.

Dr. Weitz:            If you see an alteration, do you look at the T3 to reverse T3 ratio? Is that how you analyze it?

Dr. Valdes:          Possibly I mean, if I’m going after symptoms and you’ve had those patients where you’re like, they need to start feeling better yesterday, right? Because we want them in care. This is the patient that’s been to six other doctors and nobody’s been able to help me feel better. That’s the patient where you take that approach. You want to increase their free T3 right out the gate as much as possible. However, for a long term strategy, for a long term plan, again, we have to go back to the entire panel and just make sure that things balance out the way that they need to.  Reverse T3 is always going to be there and it’s not a problem as long as it represents less than 20% of their total T3.  Yes, I would say absolutely.  Looking at that ratio, especially initially, to clear symptoms is going to be very valuable, but down the road, you always want to look at the entire cascade of fibroid conversion, clearing, transport.  You want to look at all the pieces to have a sustained recovery.

Dr. Weitz:            I’ve heard a few docs talk about this reverse T3 and this reverse T3 ratio and say that when that’s out of whack, they basically add T3 to the patient.

Dr. Valdes:          Yeah, and I have mixed feelings about that for numerous reasons. A lot of the T3 that’s out there, like Armour Thyroid and Cytomel specifically… Cytomel and I don’t get along.

Dr. Weitz:            Yeah, Cytomel is specifically T3 because Armour is basically a combination of T4 and T3, and maybe T2 and T1 as well because it’s coming from desiccated pig thyroid, right?

Dr. Valdes:          Yeah, absolutely. My experience has been that when you supplement or when you replace primarily T3 and only T3, the first two to three months the patient is going to have this… it’s like they come back to life. They’re like, “My god, this is amazing. You’re the best doctor in the world,” and then all of a sudden they start tanking. They start tanking and keep tanking and keep tanking. What I have learned is that they begin to develop thyroid hormone resistance, almost every single time, and that’s one of the reasons why Cytomel is no longer prescribed willy-nilly. When that thing came out originally, It was like, “Cytomel for you. Cytomel for you.” That’s gone away. It’s rare that you would see rarely any patients, and when I have somebody that comes into my office, they’re like, “Yeah, I’m on Cytomel.” I’m like, “Man, your doctor’s probably from the 19th century.” The problem with it… yeah. The problem is that the body, again, did this, designed this…

This was designed very specifically from conversion to T4, to binding, to transport, to delivery into the cell. There’s something. I’m almost sure that at some point, we’re going to find that there’s probably some type of tag or something that’s going on the hormone once it’s converted to gate it or allow it through the membrane. I haven’t seen that yet, but I have a feeling that as we continue to learn more about this, and we continue to learn more about Transcriptomics, I’m almost sure we’re going to find some type of tag that is placed on that hormone once there’s conversion. I think that’s really what it boils down to. We always need to go back to conversion. Conversion is the key. If we’re just replacing T3, it can be very beneficial to get the patient out of the dump for that initial two to three month window, but over time they’ll start getting worse because of thyroid hormone resistance. The nucleus will stop uptaking it.

Dr. Weitz:            What form of thyroid medication do you find most effective?

Dr. Valdes:          Yeah, so we’ve used GTA from Biotics for a long, long time. It’s tested, and one of the things I like about it is that it really is primarily T4. It does have a little bit of T3, T2, T1, but it is primarily T4. In addition to that, I’ve also…

Dr. Weitz:            You’re saying, instead of a prescription medication like Synthroid, you’re using a nutritional supplement?

Dr. Valdes:          Yep, absolutely.

Dr. Weitz:            Wow.

Dr. Valdes:          Patients love that for many reasons. I still haven’t seen…

Dr. Weitz:            Now, the critique probably is going to be, “Hey, this is not really standardized. You can’t count on this like a prescription medication.”

Dr. Valdes:          Yeah, I mean, if… I’ve heard that a few times, and if you go to Biotics, they will literally stab you if you make a statement like that because it is very standardized. We know very, very well what the dosage that’s going into that patient consistently, and we see it be consistent over time. We can see it both in the way that they respond to it clinically and through their labs.

Dr. Weitz:            What is this product? Because I’m not familiar with it.

Dr. Valdes:          Yeah. Biotics has something called GTA.

Dr. Weitz:            Right.

Dr. Valdes:          They have simple GTA-Forte and GTA-Forte II. It was just…

Dr. Weitz:            I’m assuming this is a glandular product.

Dr. Valdes:          It is. Yeah, it is primarily a glandular and they’ve added a few cofactors that are also important for transport conversion. It’s a very, very good product.

Dr. Weitz:            Now, why would this be better than an Armour?

Dr. Valdes:          There is a portion of Armour that is synthetic and when you run… anytime, when you run into a synthetic, you’re going to have transport and conversion.

Dr. Weitz:            What part of Armour is synthetic? I thought it was…

Dr. Valdes:          No. Part of the T4 in Armour is actually synthetic. From my understanding, and in addition to that, it’s also my understanding that there are some binders or fillers in the encapsulation. I can only speak into my clinical experience with both products, what I’ve seen, and historically I’ve seen a much better result from GTA. There’s also another one that is prescription called Nature Throid. I’ve also seen very comparable results from Nature Throid to GTA. Those are the two-

Dr. Weitz:            Nature Throid and WP Thyroid is another popular product.

Dr. Valdes:          Correct. Yeah. Clinically, they’re the two that I’ve seen the best outcomes with historically, as far as thyroid hormone replacement.

Dr. Weitz:            Now have you actually taken patients off of Synthroid and put them on this product from Biotics?

Dr. Valdes:          You’re funny. Legally…

Dr. Weitz:            Sorry doc, didn’t mean to put you on the spot there.

Dr. Valdes:          The answer to that is threefold.

Dr. Weitz:            You and I are both doctors of chiropractic and we don’t prescribe medication.

Dr. Valdes:          In conjunction with their prescribing physician, the answer to that question is absolutely yes. 97 or 98% of my cases come off of Synthroid or Levothyroxine and permanently to then utilize a bio identical or a glandular.

Dr. Weitz:            This product from Biotics, it contains T4 and T3.

Dr. Valdes:          Yes. Yeah. It just, it just follows thyroid composition, right? The thyroid is roughly 92, 93%, depending on the research. Then there’s a small percentage in there of T3, so that’s exactly what you’re gonna find in the glandular product.

Dr. Weitz:            What kind of dosages are you typically using for this product?

Dr. Valdes:          Yeah, so when you look at the equivalent there’s GTA single is the equivalent of about a 0.33 Synthroid or Levo. You can kind of play around with that if they’re on 0.75 and if they’re on 0.50, you can play around with that dosing. It’s also always very important to understand that a glandular is going to convert better and transport better than a synthetic every single time. And so sometimes the equivalent has to be a little bit lower on the glandular side in comparison to the synthetic side. From there, they have the GTA-Forte, which is basically two times stronger than the GTA basic. You just double that. It would be 0.66, which in reality is the equivalent of a 0.75 functionally.  They have the GTA-Forte II, which doubles the strength. I think they add a little bit of copper into that one. I’m not super in love with that. We get so much copper exposure from environment, from water from food, that I don’t really tend to find that I need to be giving these patients more copper especially, because of how prevalent copper has become.

Dr. Weitz:            Copper piping-

Dr. Valdes:          Yep.

Dr. Weitz:            … leading to copper in the water.

Dr. Valdes:          Yep, yeah. And then in the food too. Most people really need to be on a ton of zinc to redox the copper out of their body. I’m never a fan of throwing stuff at people that has more copper, especially because of all the work that I’m now doing on the cognitive side of things and finding copper is such a huge player in cognitive decline. So yeah, most of the time I’ll stick to either GTA, GTA-Forte, and then I’ll dose two capsules. One capsule based on where they are with their synthetic.

Dr. Weitz:            Okay. You mentioned thyroid binding globulin as far as the testing, and I don’t think most practitioners pay a lot of importance to this marker. Maybe you could talk about that for a minute.

Dr. Valdes:          Yeah, so it is and can be a very important marker to look at. When you start seeing ratios of total T3 and 3T3 that are off. Example a person that has a very high total T3 and then a free… Sorry, yeah, high total T3 and a low 3T3, then you know that there’s probably going to be an overproduction of thyroid binding protein. That’s the time that you might want to go and check it. Most of the time it follows sex binding globulin, so they either rise or drop together. They respond to the same factor. A male that’s estrogen dominant, you’ll see that they’re going to have higher sex binding proteins, higher thyroid binding proteins. A female that’s estrogen dominant, you’re gonna see the same thing. Then you start kind of seeing more of the endocrine picture of this unique patient.  It’s not a determining mark, but it can be a very indicative marker of the overall picture of what’s going on with that thyroid. I like to have it, I like to see it instead of just going back to it and running it at a later…

Dr. Weitz:            If you see a higher load thyroid binding globulin, so if the binding globulin is high, what do you think and what do you do?

Dr. Valdes:          Yeah, most of the time you want to think estrogen. When I see it, the next step that I take is I run a DUTCH test, which is the Dried Urinary Hormone test. The DUTCH test will tell me if they’re aromatizing, they’re over converting… If it’s a male over converting their testosterone into estrogen, which type of estrogen is predominant estrone, estradiol or estriol. It’ll also show me the metabolites. A lot of people, whether male or female, might not be producing a ton of estrogen, but they might be having a problem clearing estrogen. If you don’t look at the metabolites, you don’t have a clear picture of what’s going on with estrogen. All of a sudden estradiol is maybe on the low end of the range, but you look at their metabolites and they’re accumulating, they’re bio accumulating, and these metabolites have effect.  They’re doing the same thing that estrogen would be doing. All of that stuff is really important because now we begin to talk about clearance and detoxification issues, or we talk about hormonal production issues, or we are now jumping into adrenal issues with the HEA and pregnenolone steal and all of those things, so the picture just keeps getting broader as to why this person is having that symptom that every thyroid person has, but the reasons why they have it are very unique to them.

Dr. Weitz:            Interesting. Let’s go through some of the underlying causes of hypothyroid especially of Hashimoto’s autoimmune. And then how do you work it up, and what do you do about it?

Dr. Valdes:          Yeah. So we are very keen on testing. We do believe you know that just to test as much as we can, as much as we can and I’ll give you an insight of how my brain works. When you look at primary hypothyroidism, Hashimoto’s. 97% of cases that are hypothyroid are Hashimoto’s. There’s going to be varying severities. Recently I had a kid 19 years old, most of his hair had gone, eyebrows gone, fatigued out of his mind, moody, gaining a ton of weight, very rapid, very severe progression. Then you’ll see this female that the problem started when they were 23, and they’re now in their 50s, they’re still somewhat lean. Their energy weans and waves but for the most part is good. So all of that is already speaking into the severity of the immune triggers.

Most of the time when somebody is progressing very rapidly, it usually will be things that make the immune system insane, right? We’ve been looking a lot into the world of biotoxin illness. People that are HLA DR-DQ susceptible to some of these bio toxins, because these people can’t clear the thing that is making their immune system bananas. Certain heavy metals also have the ability to drive the immune system bananas too. Especially in people that might be genetically susceptible to autoimmune disease. From there, if you take it a notch down, almost always you’re going to be looking at gut. The gut, if it’s super permeable, they’re going to have that molecular mimicry mechanism, and that’s just going to be driving this thing like a bat out of hell.

From there, then we can go into the infections layer, we can talk about viruses, we can talk about Epstein-Barr, we can talk about all that stuff that predispose to a baby born, C-section, no breastfeeding, whatever, you know, that type of stuff? Pregnancy being another huge trigger, I would say almost right below that. And from there the rest of the factors from, insulin surges, estrogen surges, cortisol surges, food sensitivities, lesser toxic exposures. The reality is to be able to really assess what is driving the immune system to do what it’s doing, it’s impossible to do without really testing the crap out of the patient. That’s one of the biggest barriers for a lot of patients into care, and also for a lot of doctors in being able to deliver.

Dr. Weitz:            You mean because the testing is expensive?

Dr. Valdes:          Exactly, yeah. Because it can be very expensive. we can talk about this some other time. But that kind of took us back to the drawing board. And it’s how do we redesign this functional medicine model, so we’re not placing the patient in front of exorbitant costs, and we can get them into care successfully and affordably. That’s kind of… As doctors, we have to think about that, as much as we don’t want to, we have to think about that, and how to really deliver highly successful care.

Dr. Weitz:            Right. So your first layer obviously depends on the history and everything else, but is to look at… If I understand what you just said, is to look especially at toxins. Is that first things you start to rule out?

Dr. Valdes:          Yeah, so it depends. Let me let me explain myself. Every patient that comes into the practice is going to go through a software called the LivingMatrix. The LivingMatrix was developed in partnership with the IFM and Cleveland clinic’s, and it’s a very rigorous process of gathering-

Dr. Weitz:            IFM is the Institute of Functional Medicine. Yeah.

Dr. Valdes:          Yeah, exactly. And so, this is the tool that’s now being used to publish studies like the promise study and all that.

Dr. Weitz:            As a way to organize their history.

Dr. Valdes:          Correct. Once I gathered data, I see the health history timeline, that converts into the functional medicine matrix. It tells me, it begins to tell me what are the areas that this patient is having major difficulties with? Is it defense and repair? Is it assimilation? Is it communication? Is that their energy system? Is it structural integrity of organs? Once I see that I can begin to make the best decisions I can about their testing. Again, this will also help me understand the severity and the velocity of the progression. When I see defense and repair issues, when I see assimilation issues, when I see communication issues, and this person went from zero to 60, in five minutes, I’m immediately thinking either biotoxin or metals, right?  Because it’s one of those things that just drives the immune system bananas.  If I’m seeing defense or repair assimilation, but the progression is going slower, then I’m kind of shifting my thinking a little bit.  I always want to come in with the most likely diagnostic test, and that’s kind of my entry point. From there, I continue to test based on those initial findings.

Dr. Weitz:            How do you test for toxins? What kind of studying do you do?

Dr. Valdes:          Yeah, so if it’s going to be biotoxin, the first layer is running a test called HLA DR-DQ. It’s a genetic test.

Dr. Weitz:            Biotoxin we’re talking about like mold?

Dr. Valdes:          Correct, yeah. Mold, Lyme, ciguatera, bloom. Rare certain types of spider bites or snake bites.

Dr. Weitz:            You consider Lyme a toxin, isn’t that more of an infection?

Dr. Valdes:          It’s both. Yeah. When you get bitten by a tick you, you contract the Borrelia infection. But the Borrelia infection produces a biotoxin, and that’s what makes people very sick. In Lyme, when you look at people that get Lyme, 22% of them can go on to develop post Lyme syndrome, which is that long term drawn out disease that people can get. That’s very consistent with mold. That’s very consistent with MARCoNS, which is multiple antibiotic resistance stuff in the sinuses. That’s very consistent with people that are exposed to Ciguatera toxin in deep water fish. We’re learning that for this percentage of the population that have these genetic susceptibilities. These things are huge deal. They’re a huge deal, because what happens is HLA DR-DQ codes for the antigen presenting cell.  That cell that’s going to bind the antigen and then present it to the immune system. What happens is the site where biotoxins would bind to is misshapen. Biotoxins are very small, they’re smaller than point three microns, they can’t bind so the immune system can never clear the toxin. The body’s very smart, it’s going to still try and get rid of it, so it’ll go through the liver, it’ll be pushed through the bile. But bile emulsifies it, reabsorbs it and it goes back into the body and it just keeps circulating in the body. There’s a very specific domain of the immune system that becomes chronically activated because of these toxins. Markers for that are C4A, TGFB1, MMP9, VEGF. That part of the immune system just starts going… We are learning that this category of patient is incredibly susceptible to not just Hashimoto’s really any and every autoimmune disease in the spectrum of autoimmune disease.

Dr. Weitz:            For those who are practitioners who are listening to this, you may recognize that I… believe you’re talking about like Ritchie Shoemaker’s Protocol?

Dr. Valdes:          That’s right. Yeah, absolutely. Yeah. I had the privilege of learning from Ritchie Shoemaker. Two years ago, he had a kind of like, really cool workshop down in Miami and I got to meet him and learn. Brilliant, brilliant dude. I really believe that his work is on the tip of the arrow for what we’re going to be doing as Functional Medicine doctors in the next 20 years because of this understanding of transcriptomics, and how signaling into our genetics is really what drives health or disease.

Dr. Weitz:            Can we screen for mold without doing these markers? What if we just did like a Great Plains urine mycotoxin test or something like that?

Dr. Valdes:          Man, you’re going to get me in all kinds of trouble. Well, there’s a lot of people that promote these tests like that however, unfortunately when we look at the hard data, there’s really no major validity to that type of approach. And it pains me to say it because there’s a great practitioners that live and die by it, and I hate being that guy that, but when we look at… 

Dr. Weitz:            The urine mycotoxins testing is not accurate you’re saying?

Dr. Valdes:          I mean, I’m not saying that, I’m saying…

Dr. Weitz:            There’s no science to back it at this time.

Dr. Valdes:          No, there is some science, it’s just the clinical relevance. The type of assumption that we can make based on that data is not very solid. Let me say that a different way. You could be living in a home that’s full of mold, but if your genetics do not make you susceptible to that exposure, the reality is it’s not really a major threat, for the most part because you have the ability to clear it. So…

Dr. Weitz:            Right, but this is a way to test your body excreting these mold toxins. No?

Dr. Valdes:          I’m going to kindly turn down my response on it simply because the validity of those tests is just not all the way there. And…

Dr. Weitz:            Those serum markers that you mentioned are indication of the body having this inflammatory reaction?

Dr. Valdes:          Yep. One of the things is the problem with molds is the toxins that they produce, number one. The toxins they produce are 0.3 microns small. No test that’s out there currently, yet has the ability to detect these particulates, even though we know they exist, we know they’re there. First step, from a clinical point of view, if I’m going… If me, this is my thought process. If I’m going after an autoimmunity, I need to know if this person has the predisposition, the genetic factors that would make them vulnerable to this problem?

Dr. Weitz:            Okay.

Dr. Valdes:          If they are, then there’s more important questions to answer than if they’re peeing fungal metabolites right?

Dr. Weitz:            Okay.

Dr. Valdes:          There’s more important questions to answer that.

Dr. Weitz:            Okay, I don’t want to go too far down the mold rabbit hole. I realized we could spend another hour on that. Let’s move on. How about nutrient status? Which are some of the most important nutrients, and how do you test for these?

Dr. Valdes:          Yeah, I’ve actually gotten away a little bit, and I want to get your opinion on this too, because I’ve kind of moved away a little bit from testing nutrient status for a few reasons. One of them is I’m going to be supplementing and replacing most nutrients that are going to be important therapeutically. There is value to that. There is a lot of value in understanding nutritional status, because there can be issues around absorption, around transport. Because of the cost, I’ve opted to prioritize some of the more heavy hitting tests initially, before jumping into that especially because I am going to be intervening with a very broad spectrum set of nutrients.

It’s kind of give and take. Now, to the defense of that, let me say that a lot of people that have Hashimoto’s, all autoimmune diseases have little families, they’re called serotypes. The two closest family members to Hashimoto’s disease are celiac and pernicious anemia. With celiac, there’s going to be a ton of nutritional deficiencies because of absorption issues, and with pernicious anemia, you’re going to have methylcobalamin, methylfolate absorption issues. So it’s like, there can be. If my concern level is heightened this person is developing more autoimmunities, I have a suspicion of celiac, I have a suspicion of pernicious, probably, I’ll go down that route. Outside of that I look at organic acids from the DUTCH test, which is going to give me all of their B metabolites.  I’m going to look at other neurotransmitter precursors too that are important to me. I’ll look at vitamin D, and I’m always going to work with the fat soluble vitamins A, D, E, K in addition to the rest of them. I don’t know, that’s kind of how I handle it. Are you currently doing full nutritional testing?

Dr. Weitz:            We do include some nutritional testing. We’ve got a bunch of serum markers in one of our initial panels, and then some of the patients I’ll have them do like a NutrEval. I have found it to be helpful. I had one patient recently that has Hashimoto’s and the zinc was really a high marker, and also had a genetic SNP that made it difficult to absorb zinc. Even though zinc was already in the diet and in the multi… I might have been hesitant about really beefing up the zinc, and really beefing up the zinc for this patient made a huge difference.

Dr. Valdes:          Excellent. Yeah, well, that’s truly cool to hear. Let me rephrase that. We do test metals, both nutritional minerals and heavy metals. We do that through Quicksilver. For a nutrient like zinc, I would have data but I was thinking more like… Oh, and we also check for-

Dr. Weitz:            Selenium, or vitamin D, or…

Dr. Valdes:          Right. Well that we check through serum. We also get glutathione metabolites through urine. So yeah, I think that to a certain degree, we [crosstalk 00:53:12] do get a lot of them just not all of them.

Dr. Weitz:            You do some nutrients through serum?

Dr. Valdes:          Yeah. Well, I mean, yes, we do some of the basic nutrients vitamin D and the…

Dr. Weitz:            Right. Iron is super important for thyroid.

Dr. Valdes:          Right. Iron and Ferritin, the works, of course.

Dr. Weitz:            Yeah, okay. I think we’re closing in on an hour and I have a patient coming up so-

Dr. Valdes:          Okay.

Dr. Weitz:            … I know there’s a lot more we could talk about, but I think we’re gonna have to bring this to a close in the next couple of minutes. Where should we go to end this?

Dr. Valdes:          I don’t know, man. I think we-

Dr. Weitz:            I know there’s a ton stuff still to talk about, but…

Dr. Valdes:          Yeah, I think that maybe two things. If you and your audience like the conversation, we can continue it. We were starting to talk about the triggers of Hashimoto’s and how to go about those. We didn’t really dive into secondary hypothyroidism if that would be something of interest for your-

Dr. Weitz:            Okay, why don’t we plan to do a part two, and we’ll go into those things.

Dr. Valdes:          Excellent. Would love to be back if your listenership is excited about this stuff.

Dr. Weitz:            No, I think so. I think you’ve really delivered some good, interesting takes on some of this information, so I think it would be helpful. Let’s give your information about how listeners and viewers can contact you and find out about some of your programs that you offer. For practitioners, you’re also… have this functional medicine franchise that’s-

Dr. Valdes:          Yeah, that’s correct.

Dr. Weitz:            … available.

Dr. Valdes:          Yeah, so our company is Novis Health for consumers and patients dealing with hypothyroidism. We have two centers currently on our way to have four before the end of the year. Very excited about that. We deal primarily with hypothyroidism and some other metabolic disorders. Our website is www.novis.health. We are beefing that site up big time to become an authority site pretty soon. Then for doctors, our mission and our belief is to have functional medicine available to everyone that needs it. We want a functional medicine facility in every corner, just like we have these days massage and all those things. We want to make it available. We know that the main hospital systems are never going to make that happen, so it’s up to us to join forces and really all drive in the same direction.  One of the things that frustrates me a little bit about Functional Medicine is that everybody wants to be a voice and everybody wants to be heard as a provider, and that’s super important to become that expert, to become that celebrity. But we can only succeed long term to the degree that we’re unified and all fighting for the same thing, and that’s really what we’re trying to do. We’ve built very strong business models around our doctors in order to make sure that they can do what they love doing, which is taking care of their patients, taking care of their practice, having freedom of time, having freedom of practice, having financial freedom. If you’re interested in that it’s novishealthsystems.com. Very successful model for those that are wanting to really grow and expand in the world of functional medicine.

Dr. Weitz:            Excellent. Thank you, doc.

Dr. Valdes:          Thank you. Have a great day, and thank you for having me.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Deep Insights into COVID-19 with Dr. Peter D'Adamo: Rational Wellness Podcast 153
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Dr. Peter D’Adamo, gives us some Deep Insights into COVID-19 and which Natural Strategies can be Beneficial with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

4:45  The Spanish influenza of 1918-19 came in the spring of 1918, faded in the summer, raged even worse in the fall, and then the following summer it just went away. But that’s because close to 80% of people were infected and 50 million people died and it created a herd immunity. On the other hand, viruses tend to mutate to become less deadly because it is better for the virus is if doesn’t kill the host.  So this virus may become less deadly over time. 

7:11  We should be asking how can we modulate the situation so that we can improve our chances besides staying home and doing nothing and going to the hospital when you are really sick? What can we do to increase our chances of having a favorable outcome if we do get infected, so we don’t end up in an Intensive Care Unit at a hospital?  Our health care system isn’t designed for prevention or to help us develop some strategies for strengthening our immune system, unless its been shown in a double blind, placebo controlled trial, which can take years. A lot of the clinical trials going on in China now are including antiviral drugs plus vitamin C or antiviral drugs plus Chinese herbs. But that does not seem to be happening here in the US.

11:10  There are a lot of crazy ideas on social media these days, such as that elderberry could cause a cytokine storm because it is an immune stimulating herb, which is really ridiculous.  If Elderberry was a strong enough immune stimulator to produce a cytokine storm, it would be a great anti-cancer nutrient.  But in fact, it’s immune strengthening properties are not strong enough to cause a significant release of interleukins and cytokines.

14:12  This may be similar to the fears among oncologists that taking antioxidant vitamins will interfere with chemotherapy. Dr. D’Adamo pointed out that this concept really started with a letter to the editor from Dr. Robert Watson of Watson and Crick who figured out the structure of DNA who argued that since chemotherapy kills cancer cells partially by inducing free radicals, then taking antioxidants like vitamin C would block the chemo effectiveness. But this may be partially because Dr. Watson was very competitive with Linus Pauling, who pioneered the benefits of vitamin C, since Pauling was working on a different model of DNA from the model that Watson developed. The idea that some vitamin C will uncouple the effectiveness of powerful chemotherapeutic drugs like Cisplatin or Taxotere is like thinking that putting your lunch on the train tracks will cause the train to derail.

17:28  Older folks are more affected by COVID-19 than younger and it is typically attributed to the fact that older people tend to have a weaker immune system but Dr. D’Adamo thinks it is more related to a drop in antioxidant function. The coronavirus has a spike protein that interacts with the ACE2 receptors, which are part of the renin system that regulates blood pressure and controls the vasculature. There is a separate gene known as TMPRSS2 that’s related to the effectiveness of the SARS COVID virus to activate the ACE2 receptor and to reproduce. TMPRSS2 is affected by our internal antioxidants, including SOD and catalase, as well as affected by sulforaphane, which comes from cruciferous vegetables, esp. broccoli sprouts.  Sulforaphane dampens the capacity of this TRMSS2 thing to participate in ACE2, so we should increase our consumption of sulforaphane whether through foods or supplements or both.  Green tea can also help to modulate TMPRSS2.

24:58  Some Functional Medicine practitioners have cautioned against taking too much vitamin D and vitamin A since it might increase the expression of the ACE2 receptors. The first problem with this idea is that even if taking a lot of vitamin D does increase the ACE2 receptor, since the ACE2 receptor is already ubiquitous in the body, how much could it really be increased?  If at all, it will be by an insignificant amount.  And this is theoretical.  But studies show that if you are vitamin D deficient, you have a much higher rate of progressing to ARDS, acute respiratory distress syndrome, which is the progression that kills you.  Additionally, higher levels of vitamin D are protective against cytokine storms and patients who end up on a ventilator are more likely to survive with higher levels of vitamin D. 

29:53  Chloroquine, zinc, and quercetin.  Dr. D’Adamo wrote a blog post, COVID-19: Chloroquine, zinc, and quercetin. Chloroquine and hydroxychloroquine are an antimalarial drugs that are quinine analogues and come from the same cinchona tree that quinine comes from.  Quinine can only contain 83 mg of quinine and to get a therapeutic dosage you would need 600-800 mg, so quinine water will not be therapeutic.  There are two mechanisms by which chloroquine could help fight the coronavirus. 1. The virus gets into the cells through the ACE2 receptors and then convinces the ribosome to make virus proteins so it can proliferate. The viral proteins then create a bubble called an endosome which then gets released to the outside of the cell.  Chloroquine raises the pH of these endosomes, which require a low pH to reproduce, thus reducing viral replication. A natural substance that also does this is a Chinese herb, Scutellaria baicalensis, also called Chinese skullcap.  2. Chloroquine is a zinc ionophore, which means it facilitates getting zinc into the cells. Zinc has an electric charge that makes it very difficult to get into our cells.  When the zinc concentration goes up inside the cell, the ability of the virus to reproduce is diminished. A natural substance that is also a zinc ionophore is quercetin. Dr. D’Adamo recommends 15-20 mg of zinc per day along with 25-500 mg of quercetin and 500 mg of Chinese scute taken twice per day. Dr. D’Adamo does not recommend taking high dosages of zinc, since it can interfere with other things.

39:00  Melatonin is a nutrient that many people take to help with sleep. When a patient with COVID-19 gets into an acute stage it is because there is rampaging inflammation due to our primitive, innate immune system that we share with lizards. This is in contrast to our acquired, adaptive immune system that involves us forming antibodies to fight off viruses and bacteria. Our innate immune system involves immediate responses and is like a shoot-first-ask-questions-later-type immunity.  It releases these inflammasomes, including NLRP3, which is the functional inflammasome involved in things like the cytokine storm that can occur in COVID-19 that lands patients in Intensive Care.  Melatonin has been shown to keep NLRP3 levels low and this can be accomplished with low levels of melatonin, such as 1-3 mg.

44:12 Stinging Nettle Root.  Stinging Nettle Root (not the leaves) is beneficial for reducing elevated levels of Sex Hormone Binding Globulin in men, while stinging nettle leaves helps with allergies. Stinging nettle root contains a lectin that interacts with the ACE2 receptor and with the spike protein on the coronavirus and may potentially help to reduce the viral proliferation of COVID-19.  The recommended amount is 500 mg of stinging nettle root twice per day.  The lectin in leeks also inhibits the ability of the spike protein from bonding to the ACE2 receptors.  The stinging nettle lectin and the leek lectin are like naturally-occurring, targeted monoclonal antibodies.

47:00  Lectins are also very similar to blood types because each blood type forms antibodies to some of the other blood types. Every infectious disease has a prediliction to one blood type over another and COVID-19 prefers blood type A, while type O is better protected against coronavirus.

52:23  Vitamin C is very protective and Dr. D’Adamo said that he takes 2-3 gms twice per day.

53:23  Resveratrol has some similar benefits as quercetin and may help the heart as well, since myocarditis occurs in some acute patients. Dr. D’Amato said that he if he were an ER doctor he might add some taurine into the IV bag, since it can be helpful for myocarditis.

56:00  Larch arabinogalactin may also be able to help control inflammasome activity, since arabinogalactan is one of the components of the viral membrane that the BCG vaccine is composed of, which seems to provide some protection against COVID-19.

 



Dr. Peter D’Adamo is a naturopathic physician who is also an author, researcher, and educator.  He is considered a world expert in glycobiology, principally the ABO (ABH) blood groups and the secretor (FUT2) polymorphisms. He is currently a Distinguished Professor of Clinical Sciences at the University of Bridgeport Connecticut. Dr. D’Adamo wrote the NY Times best selling book, Eat Right For Your Blood Type, followed by a long series of books on the connections between blood type and many of our nation’s most serious health problems, including diabetes, cancer, arthritis, and heart disease.  Dr. D’Adamo is the chief science advisor and head formulator at D’Adamo Personalized Nutrition. He has recently been writing a series of blog posts about the current coronavirus pandemic that tend to focus on a natural perspective on it. His website is DADAMO.com and there is a yellow banner across the top with his articles about COVID-19.

Dr. Ben Weitz is available for nutrition consultations, including remote consults via video or phone, 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 or go to www.drweitz.comPhone or video consulting with Dr. Weitz is available.



 

Podcast Transcript

Dr. Weitz:                            Hey. This is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. To learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  Hello, Rational Wellness Podcasters. For those of you who enjoy listening to our podcast, please give us a ratings and review on Apple Podcast. If you’d like to see the video version of this podcast, please go to my YouTube page and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Today, I will be speaking to Dr. Peter D’Adamo, who’s best known as the author of The New York Times best-selling book Eat Right 4 Your Blood Type that has launched a franchise movement, but today, most of our discussion will not be focused on blood types. We are recording this while we’re in the midst of the COVID-19 coronavirus pandemic. I plan to discuss with Dr. D’Adamo some integrative strategies for reducing the risks of contracting the coronavirus and for increasing the likelihood of having a minimal response if we do get infected.

Dr. Peter D’Adamo’s a naturopathic physician who’s also an author, researcher, educator. He’s considered a world expert in glycobiology, principally the ABO blood types and the secretor FUT2 polymorphisms. He’s currently a distinguished professor of clinical sciences at the University of Bridgeport in Connecticut.  In 1996, Dr. D’Adamo wrote The New York Times bestseller Eat Right 4 Your Blood Type, followed by a long series of books on the connections between blood type and many of our nation’s most serious health problems including diabetes, cancer, arthritis, and heart disease.  Dr. D’Adamo is the chief science advisor and head formulator at D’Adamo Personalized Nutrition and he’s recently been writing a series of fascinating blog posts about the current coronavirus pandemic that we will focus on today.  So, Dr. D’Adamo, thank you so much for joining me today.

Dr. D’Adamo:                     Thank you for having me, Ben. It’s a pleasure.

Dr. Weitz:                          Good. So, why don’t we start with perhaps. I definitely want to get into some of these fascinating blog posts you’ve written as well as maybe some of the ideas you expressed in that incredible webinar you did with doctors Brady and LePine, but do you have any sort of overall thoughts on where we are in terms of this coronavirus pandemic right now?

Dr. D’Adamo:                     Well, we’re definitely at a tipping point. The question’s going to be essentially how effective the strategies that people have adopted with regard to the social distancing and whether or not that can drop the infection rate down and whether or not they can get it right with regard to when they guess about the idea of being able to bring people back into society, but I think a lot of that’s still optimistic.  Unfortunately, I think under the best of all the models, you’re looking at something that could be like maybe middle July, but you still are not looking at things like sporting events and movie theaters and things like that. There’s actually no date that’s actually has been put forward for that kind of a group-type thing, but I think-

Dr. Weitz:                          And it would probably have to be different for different parts of the country, I would think, as well.

Dr. D’Adamo:                     It really does. Then, the other side is going to be the quality of the testing that is done, the antibody testing has a fairly good reliability, but put in combination with actual PCR testing for the virus, it gets a lot better, but you’re still going to have situations where there are going to be hot spots that are going to pop out here and there. The only thing that would be saving grace for that would be that if the numbers are low enough, you can go back to doing the contact tracing that they got wrong the first time. Then, basically go and kind of do an Ebola thing where they sort of just put a perimeter around it, get all the people and get them into quarantine and then let that localized thing burn itself out.

Dr. Weitz:                          Is it possible that this virus might just sort of peter out the way other viruses have? I know the Spanish influenza of 1918-’19 raged, it came in the spring. It kind of faded a little bit in the summer. The second wave was even worse. Then, the following summer it just went away and that was it. They didn’t have a vaccine or anything.  SARS kind of just sort of faded out, too, after about six months.

Dr. D’Adamo:                     See, the difference with the Spanish influenza is that they got a brute-force type of herd immunity because they had no real public health measures, so they just took their lumps. I mean, you have millions of people who died from that. Then, after two or three rounds of exposures, you had enough herd immunity, which it has to be, I think, about 80% of the population.

Dr. Weitz:                          Oh! 80%. Wow!

Dr. D’Adamo:                     80% population has to have a prior exposure in order for herd immunity to work, but reality is that, yeah, there are factors that can sometimes come into play. We notice that, with certain viruses, they tend to attenuate over time, that the-

Dr. Weitz:                          What happened to the first SARS virus, that it just sort of went away?

Dr. D’Adamo:                     Yeah, yeah. There’s a couple of things about this virus that gave it a kind of a special significance. We know that most people know that attaches to the ACE2 receptor in general, although there are other slight variations to that, but one of the things that makes that so particularly significant, there’s a virus developed what’s called a furin convertase or furin cleavage convertase. It also latches onto a chemical made by the cells called furin. That really ramps up the infectivity. That’s why, for instance, the infectivity index is high. It may be that something like that, which was gained surreptitiously, maybe lost surreptitiously, because parasites, they really don’t want to have to kill the host.  I mean, my brother-in-law in your guest room, he wants you to live because you’re giving him a free room. So, viruses typically or most other parasites, they tend to become what they call saprophytic over time. They develop ways to not completely … Now, this might take a very long time and by that time we might have other solutions altogether, but really, you had kind of hit the nail on the head when you did the introduction, which is how do we modulate this in a way that the average person has the best possible chance to not have to go through the ICU and then into the whole respiratory arrest kind of thing.  It’s an interesting place that we find ourselves with the government on this because their advice is comprised entirely of, “Stay home until you’re too sick and then go to the hospital.”  Now, you think that there’s acres of opportunities in that time frame to be able to do things, to basically change your odds or moderate your odds or take yourself through this process, so that you get perhaps maybe a bad case of the flu and you hydrate and you take a few assistive-type preparations or maybe a nutraceutical or whatever, but the government doesn’t really have a plan for that, because our health care system isn’t designed to react to a new disease for which we have no cure.  So, everybody can talk about, “Well, this is unscientific. We don’t have double-blind studies. We don’t have this and that.” The truth is, you remember, you seem old enough to be able to remember the AIDS things in the 80s. You had ACT UP back then who were saying like, “Hey. A double-blind, multicenter, placebo-controlled trial is great, but I’m going to be dead by then.”

Dr. Weitz:                            Right. And in fact, there’s hundreds of trials going on right now with new antivirals, existing antivirals, a whole series of other drugs that been on the market for other things.

Dr. D’Adamo:                     Look at our own particular blind spot in terms of integrative-type things. You go to clinicaltrials.gov and you look at the ones that were being done as a result onto Wuhan and they were all antiviral plus vitamin C, antiviral plus traditional Chinese medicine.  When was the last time anybody here said, “Oh, we’re going to test a drug and, by the way, we’ll give you some Chinese herbs to go with that, too.”  So, there’s just a real blind spot because we’re just so locked into this model that we have to have really, really clear, concise indications that the drug is effective and that we have the indications together, but this is an ad hoc situation. You can’t just go into a situation like this with your fists clenched. You’ve got to open them up because this is going to be a situation where you’re going to have to just move very fast.

It’s a perfect example of how we, as a society, we actually stop listening to the government at a certain point, because what the government was telling us, “Well. It’s nothing to worry about. The risk to the American public is low.” Remember Fauci saying that? “The risk to the American public is low.”  Then, the next thing we know is masks don’t work. Don’t waste your time with those. Then, all of a sudden, how are we going to get people to isolate themselves?  In every one of those cases, the American public outperformed the advice of the American health care experts and governmental health care experts. The American public started thinking for themselves and saying, “Hey. Wait a minute. You don’t seem to have a handle on this. You’re telling me that the virus is not going to be able to protect me from getting infected, but you seem to be neglecting the fact that an entire street full of people wearing masks has a different effect altogether. You’re actually now amplifying the effect of the protective thing because not only am I being covered myself. I’m being protected by all the other people.”

Well, that seemed to escape the government at a certain point and they sort of had to play catch-up with that.  So, here you have people now, because of social media, you’ve got a…and here you got an entirely different discussion, which is, “What kind of a fresh hell is social media right now with regard to just all the crazy-ass stuff that people are actually sharing?” The general low quality control of what is going out there.  We had the whole thing we were talking about just before the show started. Elderberry, who’s got a theory on elderberry? It’s going to give you a cytokine storm. It’s like, “Yeah.” If only that were true, we could use elderberry as an anti-cancer agent, because, I mean, if elderberry increased all those cytokines, like turmeric does, you’ve got-

Dr. Weitz:                            Okay. So maybe you should let everybody know. So, certain integrative practitioners had written some articles saying that elderberry can lead to a cytokine storm because it overstimulates the immune system and that when COVID-19, that when the infection becomes severe, you get this severe inflammatory cytokine storm in the lungs, which is why people end up having trouble breathing and end up being ventilated. So, that’s the context for what you’re talking about.

Dr. D’Adamo:                     Yeah. You wind up in a situation where people, again, extrapolate out. It’s easy to take a Petri dish full of a couple of cells and drop a dumpster worth of a chemical on top, after you’ve primed the cells to give you the response you were looking for.  Then, you contrast this with another study that actually used the substance to treat the thing in question. So, you’re comparing a study that says, “Wow! We’ve used this in SARS and MERS,” which are the two coronavirus equivalents, and it had efficacy. Then, you have Joe new epidemiologist molecular biologist telling you that he found a study on PubMed that showed that it did this other thing.

Now, here’s a question that most people don’t realize. It’s also a question of amount. You can produce an increase in some inflammatory chemical in the cell culture. The question’s how much did you produce and how hard did you work to get it?  Now, it turns out that the amount that elderberry produced of interleukins and cytokines was roughly about 6% of the amount that you would have produced if you ran a half-marathon. So, don’t run any half-marathons out there, folks, because your COVID’s going to get worse, especially if you’re on your way to the ICU, you do not want to run a half-marathon.

Dr. Weitz:                            Right. Is this a similar in my mind to this fear among oncologists that taking some vitamin C is going to completely uncouple your chemotherapy because one of the ways that chemotherapy kills cancer cells is by producing free radical reactions and antioxidants block free radical reactions.

Dr. D’Adamo:                     Yeah, except that that all started, strangely enough, not by studies, but rather letters to the editor. I can write a letter to the editor that says, “I think today’s Saturday,” but in fact it’s Tuesday.

Dr. Weitz:                            Yeah. I specifically remember one from Dr. Watson from Watson and Crick and he’s railing about why anybody would take antioxidants, but yet, nobody has any problems with cancer patients eating fruits and vegetables and the amount of antioxidant properties from eating a cup of blueberries is like 50,000 times what a 1,000 milligram vitamin C tablet contains.

Dr. D’Adamo:                     Yeah, but let’s lift the curtain a little bit on the whole Watson thing. He couldn’t stand Linus Pauling because they were working … Pauling had a different model of DNA that they were in a race against.

Dr. Weitz:                          Oh, really?

Dr. D’Adamo:                     If Pauling basically said that vitamin C was bad, I’m sure Watson would have said vitamin C was good.

Dr. Weitz:                          I didn’t know all that.

Dr. D’Adamo:                     But here’s another thing we have to realize is that vitamin C, it’s a redox reaction, so that, given the nature of how it works, vitamin C can certainly be a pro-oxidant a whole lot more than it can be an antioxidant.  Then, the other side of the coin is that looking again at what are your associations? Let’s talk numbers. You have a drug like cisplatin or Taxotere, you want…

Dr. Weitz:                          These are common in chemotherapeutic agents.

Dr. D’Adamo:                     Yeah. Do you honestly think your multivitamin is going to … That’s like saying, “I’m going to put my lunch on the New Haven Line and I’m going to try and derail the next train.” It isn’t going to happen. I mean it’s just the whole …  Now, but let’s even discuss it from an evidence standpoint. It turns out that if you do a reasonably good study, the evidence supports the fact that actually using these very same substances seem to enhance the effect of chemotherapy, not actually blunt it.  So, this all became part of the standard silo-type mentality that you see in most places where this was not part of their curriculum. It’s not part of their water cooler discussions. It’s not part of their seminars. It’s foreign information. Medicine has one outstandingly unimpressive tendency, which is they paraphrase it as, “Don’t be the first and don’t be the last.”

Dr. Weitz:                            So, you mentioned vitamin C…

Dr. D’Adamo:                     So, now you could look at that and say to yourself, “Okay. Just, does that mean that everybody should take vitamin C for this?” No. It just means that this situation is far more complicated than an across-the-board statement.

Dr. Weitz:                            So, since you mention vitamin C, one of your blog posts, you explain why older folks are getting hit so much harder with COVID-19.  Now, typically flus tend to hit the older and the very young. It’s generally thought that’s because they have a weaker immune system, but COVID-19 seems to spare young folks, but hits the older folks harder, but you don’t think that’s really because of a weakness in immune system, right?

Dr. D’Adamo:                     Well, not really. I think what we do see and there’s a gene that’s associated with the activity of … Most people know by now that the coronaviruses have a spike protein called the S protein. This interacts with a common receptor found pretty much throughout the body called ACE2. This is part of the renin system that regulates your blood pressure.  What ACE2 does is it functions as part of a system that’s involved in controlling the vasculature. The fact that it’s found so uniformly all over the body allows the body to control the vasculature in different places without having it impact other places.  So, it’s sort of almost a kind of a set of stoplights on the vasculature. This makes it very attractive, so there’s a lot of anti-hypertensive blood pressure medicines that are made in response to this.

It turns out that actually there is a separate gene that’s related to basically the effectiveness of how well the coronavirus can interact with ACE2. It’s another gene. It’s got a long name, TMPRSS2. With this particular molecule, it shows a massive increase in the capacity of the SARS COVID to activate it and reproduce. It turns out that actually the molecule itself is typically controlled by a system inside the body called antioxidants response elements.  So these are your natural antioxidants that you make. So, we normally think, oh, vitamin E, beta-carotene, selenium. These are external antioxidants, but we make internal antioxidants that are part of our own mechanism of controlling oxidative reactions. These include things like SOD and catalase and those kind of things, but it turns out that one particular thing, which is a chemical that’s called sulforaphane, but that’s known to everybody else as sprouted stuff.

Dr. Weitz:                          Specifically broccoli, sprouts, or broccoli seed extract, right?

Dr. D’Adamo:                     Yes and you can put other kind of cruciferous things in there. Sulforaphane dampens the capacity of this TRMSS2 thing to participate in ACE, but the theory that I had was that if you look at this, you see almost a perfect curve that correlates with age-related functions. These antioxidant functions drop as we get older.  So, in essence, you’re then basically not having the ability to dampen down this thing which then, instead of being able to go and behave itself, it now feeds into the other receptor, the ACE2. That makes the viral replication speed up.  So, as you get older, your antioxidant defenses drop, their ability to tamp the other things down becomes compromised, the virus tends to take off more.  So, sulforaphanes, you can buy these things in supplements, and actually it turns out that sulforaphanes are just fascinating molecules in their own right. I mean, they have big effects in terms of mitigating prostate cancer, they cause your genetic material to compress again so that cancer cells don’t get to read it as well as they could. It’s called a histone deacetylase function. It’s actually epigenetics.  So, you wind up with this kind of stuff. You think to yourself, “Wow. Simple little thing.” Go out and go buy some sprouts and do that. Again, I mean, what’s the downside? There’s no downside to basically increasing your consumption of sulforaphanes.

Dr. Weitz:                          Yeah, because you’re the first person I’ve heard in numerous articles recommending specific nutraceuticals to talk about sulforaphane as being something we ought to consider adding. Obviously, eating it in your food, but for those of us like myself who believe in not only eating as many healthy nutrients from fruits and vegetables and et cetera, but we’d rather top it off with some additional supplemental amounts. This is one to add to the stack, I think.

Dr. D’Adamo:                     I think so. Ultimately, you could take a lot of stuff and not get much done at all other than give yourself a bellyache.

Dr. Weitz:                          I’m somebody who really feels good about taking supplements. I think they’ve helped me. I’m 61 and I feel really good.

Dr. D’Adamo:                     No. I totally agree with you. It’s just, I think, when you’re going to do this kind of stuff, you should work with somebody who has your type of training or my type of training and be able to make sure that you’re taking the stuff that matters.

Dr. Weitz:                          Absolutely. You’ve got to prioritize and take the things that are most important in the most appropriate dosages. Absolutely.

Dr. D’Adamo:                     There’s an interesting thing, too, is that I’ve tried to sprout these things. It’s not easy. I mean, you’ve got some guys who do this for a living and then you can get those amounts that are needed, but some other things are easier to get in the diet.  For instance, one of the things that shows a lot of efficacy as well is green tea. Anybody can drink that. It’s actually a good protease inhibitor, which is kind of interesting.  And so, there’s lots of other things that people can do as part of their own strategies. The blog has a lot of technical stuff about it, but I think what I try to do is take a step back and realize that a lot of times with the average person, they can understand something technical as long as you take a step far enough back to bring them into the story.  The other thing I believe in is that if you’re actually onto something and you’re actually dealing with something that’s logical and science-based and truthful, it’s pretty much going to boil down to a piece of common sense.  Ultimately, at the end of it all, when you distill it down, somebody’s going to be able to say, “So, in other words you mean that,” and you would say, “Yes. Exactly. We took the long way around because I wanted you to understand how it all connected, but in essence, yes. At the end of it all, it means this.”

Dr. Weitz:                          Right. So, since you did a little myth-busting with the idea that elderberry is a potentially beneficial herb to take at a time like this and that fears about creating a cytokine storm are completely unwarranted.

Dr. D’Adamo:                     And you should take some vitamin D, by the way. People get problems with that.

Dr. Weitz:                          There you go. I wanted you to comment on that. I’d seen several blog posts where functional medicine practitioners have cautioned against taking vitamin D or vitamin E because they might have a negative effect in this situation.

Dr. D’Adamo:                     Well, vitamin D and vitamin E we can kind of dispense with because I see no evidence that it’s beneficial. Now, vitamin A.

Dr. Weitz:                          Yeah, vitamin D and A, they mentioned. Yeah.

Dr. D’Adamo:                     Yeah. A might have some slight benefit as far as mucosal immunity, but again, there’s no, as far as I could find, any direct indications that it would play a role in the mechanistic basis or the mechanism behind this whole thing.  Vitamin D, on the other hand, there are things called sins of omission. You know what they are? You made a sin because you left something out. Then, there’s what are called sins of misrepresentation. Now, your sin was that you just got the whole thing wrong. It turns out that if you ask me sins of misrepresentation are worse than sins of omission.  It goes back to what my third grade nun said. “If you can’t say something nice, don’t say anything at all.”  So, the reality here is that you have really the worst of all possible types of things. When people take a hypothetical and use that in a fearful population, a population that’s looking for things to confirm fears, then you’re kind of in a way you’re stunting how we can basically take hold of this.  Vitamin D is a perfect example. It has some indications that, yeah, it possibly might be, I don’t know. What was the counter-argument there, that there was some increase? Well, I mean, I’ve seen it increases vascular endothelial factors and all sorts of-

Dr. Weitz:                            Yeah. They were saying it might increase the expression of the ACE2 receptors.

Dr. D’Adamo:                     Yeah. Well, it turns out that, actually by a factor of fill in the blank, the ACE2 receptor is ubiquitous in the body. So, how are you going to increase this receptor all that much when it’s basically found everywhere to start off with?  The second problem with this is theoretically you’re looking at saying that, but then what does the literature say? It’s clear people who are vitamin D deficient have a much higher rate of progressing to ARDS, acute respiratory distress syndrome. That’s the thing that kills you with COVID-19. So, by being vitamin D deficient, there’s a clear link to the progression of the thing that kills you.

So, here’s the hypothetical. Here’s the actual, and you can’t compare the two. It turns out that what do you define as a vitamin D deficiency? Well, those people might say, “A number that’s maybe below 25,” but I would say, “Vitamin D deficiency to me is the number below 50.”  So, in many respects … Then, look how many people get vitamin D. They put on sunblock like it’s an extra set of clothing. They never go outside. They take [crosstalk 00:28:19]-

Dr. Weitz:                            And they’re taking statin medications to drive their cholesterol lower, which is how your body makes the vitamin D.

Dr. D’Adamo:                     And they take four baths a day. So, there’s never any stuff on the skin to get converted in the first place. So, the reality is that, how do you respond to somebody who’s just made that degree of misrepresentation? You just try it. And this, of course [crosstalk 00:28:46]-

Dr. Weitz:                            Right. The bottom line is vitamin D is a super healthy nutrient to take at all times that we probably ought to strive to get our vitamin D levels up to a range of, say, for example, 50 to 70 nanograms per milliliter, not just above the minimal of, say, 25 or 30 and especially in a situation like this, it actually has absolute beneficial effects in preventing this ARDS, which is how people die.  There’s also quite a bit of data showing that if patients do end up on a ventilator, if they have higher levels of vitamin D, they’ll do much better and survive.

Dr. D’Adamo:                     Right. There’s another study that I’ve put up on the Facebook group that showed that actually high levels of vitamin D were protective against cytokine storms.  So, I mean, what are you going to do? Take somebody who’s been playing with their Legos in their mind and take their word for it or you going to go look at the science and see where the direct connections are?

Dr. Weitz:                            Right. So, I want to come to this blog post you wrote about chloroquine, zinc, and Quercetin.  What do you think about this chloroquine or hydroxychloroquine, which some people are touting, some people are skeptical of?  I’ve seen Functional Medicine doctors recommending it for everybody as part of their protocol or even using quinine water.  What’s the truth about chloroquine or hydroxychloroquine, which traditionally has been used for malaria?

Dr. D’Adamo:                     Right. Well, the drug, which has been around forever, is Plaquenil, which people take for lupus and some autoimmune diseases. It’s cheap as all hell and chloroquine phosphate is one of the WHO essential medicines. It’s considered to be one of a small number of medicines that the production cost is so cheap that it’s considered to be mandatory for all the participants to keep that, because we live in a malarial world.  So, to step back, chloroquine and hydroxychloroquine are what are known as quinine analogues, that they come from the same family as quinine, which is the Jesuit Bark that was found in the cinchona tree that was the first official treatment for malaria.  Yes, people have felt that this was an indication that they should drink lots of tonic water because, since it is a quinine analogue, maybe if I drink tonic water, I’ll have the same effect.  Quinine may very well act in a manner similar to the other drugs because there is some evidence that it does. The difficulty is thinking that you could get anywhere near a dose sufficient by drinking tonic water because, by government law, your tonic water can only have a maximum of 83 milligrams of quinine per liter. To get up at a therapeutic dose, you would need maybe about 600 to 800 milligrams. So, you’d have to drink about 10 liters a day of tonic.

Dr. Weitz:                            What else are you going to do?

Dr. D’Adamo:                     That’s a lot of gin. So, the reality is that would it have somewhat of an effect?  Well, I don’t know, but the mechanism is we understand that there’s a lot of politics caught up in this drug because the administration kind of jumped the gun on it and kind of started promulgating for it, but mechanistically we understand it does work in certain areas that would certainly be interesting and possibly effective. It tends to cause an alkaline reaction in places in the cell where the virus reproduces itself.  They’re like little blebules called endosomes. Inside those endosomes, the virus actually is convincing the cell to make more virus, but those endosomes require very low pH, a very acidic environment.  Most of these chloroquine quinine drugs raise the pH in those endosomes,

Dr. Weitz:                            So, just to clarify for one second. The virus with the spike protein attaches to the ACE2 receptor, then it gets into the cell and it ends up in one of these endosomes first, right?

Dr. D’Adamo:                     Yeah after basically, it … Well, the first thing it does is an RNA virus, so it goes into the body of the cell, the cytoplasm, and convinces the ribosomes, which are the things that make proteins, to make a few virus proteins. Then, those virus proteins set up the next stage, which is to make a new virus. That takes place in the … Well, generally, they have to find a way out of the cell once they get made so they kind of make a bubble. Then, that bubble heads towards the outside and fuses outside and releases the virus.

Dr. Weitz:                            Oh, okay. So, that’s the endosome. Okay.

Dr. D’Adamo:                     So, basically, that has to be very acidic because the virus is going through a finishing school in terms of its protein. It’s getting carbohydrates glommed on and to make what are called glycoproteins and things. As soon as you raise the pH, that comes to a halt. We know that the class of drugs that are the chloroquines, they cause an alkalinization of the endosome.  So, there’s a mechanistic aspect there as well, but there’s another thing there that actually implies that there may be an even second mechanism about why these things work. That has to do with what are known as zinc ionophores.  Generally, zinc is very critical to the cell, but it can cause a lot of disruption so the cell likes to keep the zinc outside. Zinc has an electrical charge that makes it very difficult for it to penetrate the cell.  So, the body has to produce what’s called an ionophore, which is almost like a little gate that causes the zinc to come into the cell. They know that actually when the zinc concentration rises inside the cell, the capacity of the virus to manufacture copies of itself by using the protein machinery, reading its RNA, it goes down to zero.  But we can’t get enough zinc inside the cell by itself because the body has a built-in mechanism to prohibit that.  So, you have other chemicals that actually act to open up those gates. Those are called zinc ionophores and chloroquine is one of those.  So, there’s a second mechanism behind how it could possibly work, but it also points the way to a natural product that does the same exact thing, which is about flavin and Quercetin, which people take for allergies and stuff.

Dr. D’Adamo:                     So, you can look at how you could kind of hot rod. For instance, let’s say, I mean, I was telling somebody the other day that actually, I don’t want to get too into the woods here, but there’s a very famous powerful Chinese herb called Chinese scute, Scutellaria baicalensis it’s called, Chinese skullcap. Use it a lot in cancer management, wonderful plant and well, well studied. You could go into PubMed. There’s hundreds of articles on this plant because two ingredients are really, really, profoundly powerful, baicalin and wogonin. I won’t go there, but it turns out that Chinese scute has the effect of actually doing that same thing to the endosome that chloroquine does.  So, in essence, if you can’t get your hands on any chloroquine or quinine, you could actually make your own cocktail of Quercetin and Chinese scute and you would have both of those functions covered by those two.

Dr. Weitz:                            Wow! Cool! How much zinc do you think we should probably be taking per day?

Dr. D’Adamo:                     Well, it’s a great question because it turns out that you don’t really have to take any extra zinc because most of us have fairly adequate levels of zinc in our bloodstream, but a little background probably wouldn’t be the worst thing in the world. Eat a couple of oysters or take a 15 milligram zinc or whatever, 20 milligram. I don’t like high doses of zinc, because it just starts messing up other stuff.  Also, too, it’s interesting because it’ll stay in your bloodstream for a quite a while, so even if you took it like 50 milligrams of zinc every couple of days, that would be sufficient because, there’s plenty of it out there in most of us, but…

Dr. Weitz:                            Yeah. I know somebody like me, I traditionally have tested low on zinc and genetically, I have a couple of genes that make it difficult for my body to absorb zinc, so I-

Dr. D’Adamo:                     Well, that would be a good reason to basically add a little more.

Dr. Weitz:                            Yeah. I’ve normally been adding zinc and it made a huge difference in several other things going on.

Dr. D’Adamo:                     Yeah, so you have that basically. Again, there’s very little downside to taking the lower end of the spectrum on zinc supplementation, especially in the short term.  So, then, what you’re doing is you’re kind of working the equation. You’re kind of saying, “Okay. I want to control for this variable, too.” In other words, I don’t want to leave that to chance.

Dr. Weitz:                            And what would be a good dosage for the Scutellaria to take?

Dr. D’Adamo:                     Good question. I can tell you, I take a couple of, I think the capsules are 500 milligrams, but they’re just the herb. They’re not anything special. I take a couple of those a day. But it’s an interesting thing, too, because I mean, you can do a whole show on Chinese scute in terms of its biochemistry and applications and things, but again another harmless, good anti-inflammatory herb, very good for cancer stuff, wonderful when given concurrently with chemotherapy because it acts to induce apoptosis. So, it kind of finishes the job that the chemotherapy’s doing.

Dr. Weitz:                            Cool. So, we’ve been talking about how older folks are more vulnerable. You wrote another blog post about melatonin and its potential benefits here. Maybe you can talk about that.

Dr. D’Adamo:                     Sure. Well, melatonin is sometimes a lot of people use to go to sleep. You have to pardon me if we get a little technical here, but that whole process of going down the road of a massive inflammatory consequences in end-stage COVID-19, it’s all due to rampaging inflammation. That’s courtesy of a very primitive part of our immune system that regulates chemicals that are known as inflammasomes.  We think about immune system essentially is basically I get an antibody, I’m protected. That’s called acquired immunity or adaptive immunity, but we also have a very primitive part of our immune system that actually we share with lizards and all sorts of very primitive organisms. In other words, it’s been so good, they keep it around. So, that actually you get to even the higher organisms and they still haven’t found a reliable replacement.

So, we still got this same thing. What it is is it’s called innate immunity. The mechanism behind it is that it’s kind of like, it’s kind of a shoot-first-ask-questions-later-type immunity. Ultimately, the reason being that it’s set up to give you protection because all those other types of adaptive immunity, they require time in order for you to become sensitized, in order for those lymphocytes to promulgate and clone off, in order for them to make antibodies. There’s a temporal element there that sometimes back when you’re running through the jungle and you cut your foot on a rock, you don’t have two and a half weeks to do that. So there’s this primitive immune system that has like circulating battery acid and what happens is when it recognizes certain patterns that tell it that something bad has invaded the body, it activates these clusters of things and then they release all these corrosive enzymes.

So, this is called an inflammasome and a big one is NLRP3, which is the functional inflammasome involved in things like cytokine storms and a lot of the inflammatory stuff.  Well, I mean, it’s a very effective if somewhat unprecise system. It’s one of the ways you can certainly wind up with your immune system going quite recklessly on you.  So, the evidence suggests that melatonin tends to damp this down. It tends to actually keep NLRP3 levels low and that tends to somewhat decrease the odds that you’ll go into any sort of an advanced inflammatory blowout kind of thing. The nice part about it is that … Who was the guy who said, was it Newton? He says, “An object in motion is able to be maintained in motion with a minimal amount of effort”?  It turns out that extraordinarily low doses of melatonin keep this thing happy.  So, it isn’t even like the amounts that anybody would have to take anything, that sometimes the amounts that … The amounts that people take to go to sleep are probably overkill, but it turns out that a couple of milligrams of melatonin, actually again, and I would fit that with vitamin D. These are the things you can do to remove variability and risk out of any progression to anything other than just a bad flu. In other words, you want to stay out of the ICU. That’s the whole strategy. You can be miserable. You can be miserable at home.

Dr. Weitz:                          On the other hand, potentially higher dosages like 20 to 40 milligrams could potentially be beneficial if that cytokine storm had already started and you are in the ICU.  So, it’d be interesting for somebody to do a study of those patients with a higher dose of melatonin.  Obviously that’s not something a person’s going to be doing while they’re on a ventilator, but …

Dr. D’Adamo:                     Right. And of course, there’s that whole hospital culture thing again. I mean, you can’t even get people sometimes to sign off to do some vitamin C and stuff.  It’s a whole rigmarole.

Dr. Weitz:                          Now, aren’t some of the hospitals doing IV vitamin C?

Dr. D’Adamo:                     Yes, and certainly some of the protocols for chloroquine that are being used in a hospital are including zinc.  So, there are little changes here and there. I think it’s kind of like, again, it’s really about being resourceful, being able to make the best possible decisions at the best possible time.  I wrote a blog about another herb called stinging nettle. Some of your listeners probably take stinging nettle because it’s used a lot for allergies and stuff, the leaves.

Dr. Weitz:                          Yeah. I recommend it for men who have elevated levels of sex hormone binding globulin.

Dr. D’Adamo:                     Yeah. That’s precisely why the root is used because ultimately, in the root…

Dr. Weitz:                          That’s what we use.

Dr. D’Adamo:                     … that actually drops your SB …

Dr. Weitz:                            SHBG.

Dr. D’Adamo:                     Yeah. There you go. I’m not good with consonants. I don’t know if you’ve noticed that, but the reality is that there turns out to be a chemical inside the root of stinging nettle known as a lectin.  Lectins are little molecular pieces of Velcro that actually fly around and interact with things. Sometimes they interact with things for the worse, but every occasionally, if you get the condition and the lectin right, they can actually do some good.  It turns out that there’s a lectin in stinging nettle that actually interacts directly with the connection between the ACE2 receptor and the viral spike protein.  There’s studies on this. As a matter of fact, someone told me after reading my blog, “You might be interested to know that NIH is extraordinarily interested in stinging nettle lectin right now.”

Dr. Weitz:                            Wow!

Dr. D’Adamo:                     Which also brings up another interesting thing which will get me to yet another interesting thing.

Dr. Weitz:                            Which, and of course, lectins have been in the functional medicine world by a prominent doctor who’s been telling everybody not to eat grains and beans and seeds and even any fruit or vegetable that has seeds because they contain lectins which are necessarily bad.

Dr. D’Adamo:                     Yeah, but if he would read my book, which I’m sure he did, he could have learned that most of these things are blood type specific.  Of course, we have another conversation there. The interesting thing about stinging nettle, though, is actually you don’t have to have a lot. The root is … People go out and pick it or you can take the supplement.  There’s another interesting lectin as well, which actually is worth also talking about here. It has to do with the lectin found in leeks. Leeks are, I mean, my wife is going to make some leek soup today. They studied all these lectins that had capacity to interact with SARS. They don’t have evidence on COVID-19, so they use MERS and they use the prior SARS or other coronaviruses. The lectin from leek has a fairly profound inhibitory effect, again, on the capacity of the viral spike antigen to actually bond to the ACE2 receptor. It’s very abundant in the part you make the soup from, which is the stock, the ball part.  There’s another thing. Lectins are actually very similar in structure to the area that I spend most of my life studying, which are blood groups. You look at, for instance, remember from bio class, certain blood groups cannot get blood from other people.  So, for instance, I’m blood type A. I can’t get blood from blood type B. Blood type B can’t get blood from blood type A. Blood type O can only get blood from blood type O and blood type AB can get blood from everybody, universal receiver.  Well, it turns out that those antibodies that you make to the other blood types are one of the prime reasons we probably have blood types to this day, why hadn’t they ever kind of merged together? It’s because they convey a sort of built-in protection against pandemics. If you have an antibody against blood type B because you’re blood type A and the pandemic virus looks like blood type B, you’re protected so nature sort of hedged its bets by making these antibodies specific.

It turns out you can’t find an infectious disease that doesn’t have a predilection for one blood type or another. It turns out that the studies that have sort of got widely distributed was that, for instance, blood group A had much more of a tendency to have a severe case of COVID-19.  Again, this has been actually shown again in a separate study in the United States. So, the Chinese observation was duplicated. But one thing that they didn’t pay attention to was that there were prior studies on the earlier versions of coronavirus that actually told us why this was the case.  It turns out that the reason Type O is better protected against coronavirus from consequential type damage and severe ARDS is that they make an antibody to blood type A. It’s the antibody to blood type A that gives them the protection and it’s the inability to make an antibody to blood type A which is what gives the risk to people who are blood type A. You can’t make an antibody to yourself.  So, it turns out that I wrote a blog and I said, “Well, even though you’re blood type A and you can’t make an antibody to A, you can use certain foods that contain anti-A-like lectins.” For instance, soybeans, fava beans, domestic mushrooms. These foods will actually act in a kind of a replacement way for the antibody that you can’t make because your system won’t do it.

Dr. D’Adamo:                     So, again, hypothetical, but all based on very, very sound molecular biology. We know these lectins get passed right through your gut. They do all sorts of interesting things and away we go.  So, you have that. You have the leek leptin. You have the stinging nettle lectin. These are like naturally-occurring, targeted monoclonal antibodies. You just have to know where they go, who they react with, and how to get them in there.

Dr. Weitz:                          What would you think would be a reasonable dose of taking stinging nettle root? I’m thinking it typically is coming in 250 milligrams capsules, what I’ve seen.

Dr. D’Adamo:                     Yeah. It’s hard to say what the actual dose is because I actually ran some numbers on that and came to something like you needed 17 grams.

Dr. Weitz:                          Oh, wow!

Dr. D’Adamo:                     Yeah, but before I totally alienate the audience, it turns out that that’s not the way they calculate. What it was, I was extrapolating out the amount from small animal studies and in vitro studies. It turns out that you just don’t simply multiply the amount by the difference in weight.  So, it turns out that probably along the lines of about maybe a gram a day of the root would be …. But here’s the interesting thing.

Dr. Weitz:                          Which is typically, I’m usually recommending 500 milligrams twice a day so that would …

Dr. D’Adamo:                     Yeah. The other thing about lectins, which makes them so fascinating and actually makes them why they killed that guy with ricin back in the 70s, is the lectins disassociate after they do their damage.  So, for instance, after lectin gloms onto a sugar molecule, it initiates a phenomenon on the cell that’s called camping. It causes all the receptors to move to the north pole of the cell. Once they get all coalesced there, the lectins disassociate and they’re free to do it all over again.  So, actually, it turns out that this is not a straightforward you need this amount in order to do this, because once you get them going, they just keep doing it again. They just attach and release, attach and release, attach and release.

Dr. Weitz:                          Fascinating. Good. So, to kind of sum up what we’ve talked about, we talked about why older folks are more vulnerable. It probably has to do with their weakened antioxidant defenses. So, therefore antioxidants, including sulforaphane potentially would be beneficial.  I definitely think that vitamin C … Do you recommend vitamin C as a preventive for …

Dr. D’Adamo:                     I take four grams a day.

Dr. Weitz:                          Right. Yeah. So, you take 500 or a thousand at a time? Do you think it matters how much to take?

Dr. D’Adamo:                     I take two or three in the morning and two and three in the second dose later in the day.

Dr. Weitz:                          Oh, two to three grams? Okay. Okay.

Dr. D’Adamo:                     Mm-hmm (affirmative). Yeah. I mean, I’m not going to say that these numbers are absolute. I have to say though since I’ve been taking it, my gums have never been happier.

Dr. Weitz:                          Yeah. I normally take two grams of vitamin C a day and now I’ve upped it to six to eight, basically every couple hours. I usually take some vitamin C and then take some of the immune-strengthening herbs like elderberry, echinacea. Then, periodically throughout the day, throw in some zinc and Quercetin and resveratrol. Resveratrol seems to be another nutrient that may have some benefit here.

Dr. D’Adamo:                     It may. Ultimately, it has similar actions in many ways to Quercetin.

Dr. Weitz:                          Right, and also may help to protect the heart and I guess there’s a percentage of patients who end up with myocarditis from coronavirus infection.

Dr. D’Adamo:                     Yeah. Now, if I was an emergency room guy, I would put a little taurine in the bag.

Dr. Weitz:                          Taurine, yeah. Throw some IV glutathione or NAC in there.

Dr. D’Adamo:                     Yeah. Well, certainly taurine, because there’s good literature that taurine basically … What happens is when you goes through myocarditis event, there’s something called a free amino acid pool in heart muscle. It’s like a motor pool in the army. There’s a bunch of cars anybody could use.  It turns out that if you look at the free amino acid pool in cardiac muscle, taurine is number one and number two is a mile and a half away.  So, there’s just so much … Myocardial tissue loves to just have extra levels of taurine. So, if you look at things like enlarged hearts and those kind of things like that, it’s very effective for that kind of stuff.  So, if I was in a situation where I was looking at myocarditis as a possibility, it probably would be something, but again, these are types of things that they’re not going to penetrate hospital culture in the short-term.

Dr. Weitz:                          Right. Probably coenzyme Q10 wouldn’t be a bad idea either, which I understand also helps with zinc transport.

Dr. D’Adamo:                     Yeah and there’s actually one of the clinicaltrials.gov was looking at coenzyme Q10 with a few other things, so we’ll see.

Dr. Weitz:                          Yeah. Interesting and also antioxidant status there. So, sulforaphane, we talked about why elderberry is potentially beneficial and not a problem, zinc with Quercetin, and we talked about melatonin. You talked about maybe a couple of milligrams. I think, typically, a lot of the dosage is at three milligrams. That would probably be fine right before bed.

Dr. D’Adamo:                     That’s what we talked about like my time with Todd, but actually Todd and I were talking about that and David. They were like, “You don’t need a lot of that stuff in order to get this effect.”

Dr. Weitz:                          Right. Yeah. If you’re stressed out and getting a little help with sleep, it wouldn’t be a bad idea either.

Dr. D’Adamo:                     Sure, sure. There are other things that you can use to control inflammasome activity and most of those things are kind of like a little more esoteric.  Another one I think I’m kind of keeping my eye on is arabinogalactan. It actually has some interesting properties as well, larch arabinogalactan. There were some studies that show that people who have gotten that BCG vaccine seemed to have some resistance to advancement of the advanced … It what turns out that if you look at what …  BCG vaccine is a vaccine against tuberculosis. It turns out that what it is is the vaccine is created out of the viral membrane. It turns out that the viral membrane is made out of two chemicals. One of them’s tacoic acid, the other one is arabinogalactan.  Alternately, arabinogalactan may give you an immunological step up that’s very similar to than what they’re seeing in people who get the repeated BCG vaccine.

Dr. Weitz:                            Wow! Interesting. Yeah. I typically take a mixture of herbs that includes that except these days it’s hard to get your hands on supplies of it. Everybody’s sold out.

Dr. D’Adamo:                     I find it these days. I’ll tell you how I got started in larch, because up until the moment that a 50-pound bag of it showed up in my clinic, nobody in our functional medicine group ever heard of this stuff. It was used mostly as a substitute for gum arabic and was manufactured by a paper company who wanted to have it used to glue the back of envelopes.

Dr. Weitz:                            Wow!

Dr. D’Adamo:                     Then, so, at one point, I get a 50-pound bag shows up in my office with a bunch of articles in Japanese that just go like, “Japanese, Japanese, Japanese, echinacea, Japanese, Japanese, Japanese, arabinogalactan,” and a phone number.  So, and it was a guy at the Champion Paper Company. He sends me this bag of stuff. I said, “What did you send me this for?” “Well,” he goes, “We know you do a little bit of stuff with the immune system and you’re kind of well-versed in this kind of stuff.”  I said, “So, it’s good for the immune system?” He goes, “Well, I can’t really say that.” So, what they did is they gave me this huge amount of stuff and I just started passing it out to people. Works great for otitis media and a few other things.

Dr. Weitz:                          Oh, really?

Dr. D’Adamo:                     It’s a real common nutraceutical, but if I didn’t get that 50-pound bag of larch, nobody’d be using it.

Dr. Weitz:                          That’s great. So, I think that’s a wrap for here. That was incredible discussion of some of the interesting mechanisms from an integrated perspective.

Dr. D’Adamo:                     It was very enjoyable and thank you for asking me. I enjoyed our chat very much.

Dr. Weitz:                          I did, too. So, for those listening, watching who’d like to get a hold of you and get your books or contact you for consultations, how would they get a hold of you and your products and your books?

Dr. D’Adamo:                     I think they can go to dadamo.com, which is my mega website. If they want to read the COVID-19 blogs 

Dr. Weitz:                          Yeah. Those are hard to find.

Dr. D’Adamo:                     Yeah. If they go to that main page, there’s an orange bar at the top. It says, “Click here to read Dr. D’Adamo’s COVID posts.”

Dr. Weitz:                          Ah! Okay.

Dr. D’Adamo:                     So, they can go, it’s my last name minus the apostrophe, D-A-D-A-M-O dot com. You can read all things blood type, but then also all the COVID stuff is there. I mean, I’ve since been mostly doing genetic stuff. I’ve written a lot of software now, so I don’t really see that many patients anymore. I’m mostly seeing my old patients, but I do have a telemedicine practice that I do do with other doctors that do use my software and stuff. They can go to, I think it’s dadamohousecall.com.

Dr. Weitz:                          Oh, okay. Excellent.

Dr. D’Adamo:                     All right?

Dr. Weitz:                          Thanks, doc.

Dr. D’Adamo:                     You’re quite welcome. It was nice chatting with you. Be safe and maybe our paths will cross physically one of these days in the new system to come.

Dr. Weitz:                          Sounds good.

Dr. D’Adamo:                     Take care now.

 

We are still here for you!
With all of the stress and disruption happening in our lives now, it is important now more than ever to be focused on our health and overall maintenance. Undergoing all these changes and disruptions at once can put a lot of strain on our bodies.
Now more than ever, it is important to keep positive and know that we will come out of this stronger. One way to do this is to spend less time watching the news, and especially not at night before bed. Best to read a paper book, which will let you avoid thinking about the news and also let you reduce your expopsure to blue light in the evening. This will increase your body’s ability to produce melatonin to help you sleep. BTW, did you know that taking 3 mg of melatonin in the evening can help you recover better if you do get infected from the coronavirus?
We are still here for you to see you for *in person* chiropractic services, which is considered an essential service by the City of Los Angeles and the State of California. We are here to ease your pain and discomfort and there are studies that indicate that chiropractic adjustments may have a beneficial effect on immune system by stimulating the parasympathetics and by normalizing nervous system function.
Also if you’re having trouble getting immune strengthening supplements like vitamin C, D, zinc, elderberry, and andrographis, we do have a variety of supplements in stock. As well, if you’re confused about what to do about immune system health, Dr. Weitz is available for remote video/phone consultation to assess how you are doing and take reasonable, rationale steps to bolster your immune system.
With all of this in mind we are offering a special for immunity consultations. Normally our nutrition consultation is $275 but we are going to do a special discount just for immunity concerns which will be $140 for a 45 minute consult.
And as always we are staying vigilant in the office. We are meticulously and vigorously cleaning all surfaces, common areas, gowns, etc.with high grade disinfectants, wearing masks, as well as taking temperatures, monitoring who is coming into the office, and making sure any one feeling ill is staying home.
Please feel free to give us a call if you have any concerns or need any help.
Stay Safe and Healthy!
Dr. Ben and Staff
Weitz Sports Chiropractic and Nutrition
1448 15th Street Suite 201, Santa Monica, CA 90404
T: 310-395-3111 E: weitzchiro@yahoo.com
www.drweitz.com
Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Rethinking COVID-19: A Conversation with Dr. Nalini Chilkov - Rational Wellness Podcast 152
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Dr. Nalini Chilkov, a Chinese Medicine and Integrative Cancer expert provides a Unique Perspective on COVID-19 and what to do about it with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

3:25  Dr. Chilkov has been studying what has been happening in China and they have been using a lot of traditional Chinese herbal medicine, with over 90% of COVID-19 patients having received herbal medicine. In fact, there were two studies that demonstrated that there were front line clinicians in two different hospitals that did not get sick in the midst of treating patients because of the Chinese herbs they were taking.  Simply giving our caregivers masks and protective equipment is not enough to take care of them.  And we need to think about the arc of the journey that COVID-19 patients go through and how to address them at different phases of that journey, as is often done in Chinese medicine.

5:30  We need to think about how our most vulnerable citizens are protected and it is different in the US as compared to China.  In China the most vulnerable are the elders and men, which is partly because men in China tend to smoke, while women generally do not, so their lungs are vulnerable.  In the US, the age disparity is not as significant and we are seeing more patients in the 30-50 range who are being hospitalized. You are more vulnerable if you are over 80 and somewhat in the 60-80 range but in the US we have such an epidemic of obesity and diabetes and metabolic syndrome that most patients have some risk factors.  Patients with obesity have the worst outcomes.

7:48  The biggest risk to death is not having the infection but when the virus gets into the lungs and stimulates an excessive immune response and creates a cytokine storm that tends to lead to death.  Having diabetes leads to more inflammation, more oxidative stress, and more kidney damage and the kidneys are one of the organs targeted by this disease, along with the lungs and the heart.  The complications of COVID-19 are lung fibrosis, myocardial damage, kidney nephron fibrosis, and disruption of the gastro-enterologic tract.  Patients with autoimmune diseases are more vulnerable since they have upregulated immune systems, so they tend to have ratcheted up levels of inflammatory cytokines.  And we have cancer patients who vulnerable because they either are immunosuppressed due to their chemotherapy treatments and we have leukemia patients who already have elevated levels of white blood cells.  And COVID-19 patients who get hospitalized often have lung fibrosis, many have kidney damage, and possibly myocardial damage and damage to the neurons of the brain, so these recovered patients really can benefit from Functional Medicine to help repair them and restore their full function.

11:34  Fibrosis can result from patients going through a lot of oxidative stress and inflammation once they recover.  One strategy to combat this fibrosis is by taking a nutritional supplement, Modified Citrus Pectin.  Dr. Chilkov talked about certain Chinese herbs that can help with fibrosis, including Chinese red sage, dan shen, salvia miltiorrhiza, white peony, Bai Shao, and peony alba.  N-AcetylCysteine can be helpful since it helps to produce glutathione to quench oxidative stress and NAC can thin mucous secretions in the respiratory tract and it can be nebulized. 

13:43  Intravenous vitamin C is being used in hospitals in China and in some hospitals in New York City to quench the cytokine storm.  Quercetin can also help in this way. Some of the Chinese herbs have large amounts of quercetin, as well as resveratrol, and berberine.

14:41  One herb that is being used a lot in China COVID-19 is scutellaria baicalensis, which is also used widely in cancer treatment.  Scutellaria baicalensis has phytophenols, baicalin and baicalein, which are active in the viral replication, but also they’re in the category of bioflavonoids and so, like quercetin, they actually change the confirmation of the virus at the cell membrane and its ability to bind and enter into the cell and start taking over the machinery of the cell. Stinging Nettle Root (not Nettle Leaf) has antiviral activity against coronavirus and tends to inhibit the acute respiratory syndrome when COVID-19 becomes deadly, as Dr. D’Adamo explained in a recent webinar he participated in with Dr. Brady and Dr. LePine. Here is an article that Dr. D’Adamo wrote about Stinging Nettle Root: COVID-19: Stinging Nettle LectinThere is a brilliant Chinese doctor, Michael McCulloch who put together a list of the herbs being used in China that are available in the US and a Chinese herb company, Health Concerns, has some formulas that we can use, including Clear Heat, which has most of the antiviral herbs being used in China, and Lily Bulb Formula, which for the lung for patients whose lungs have been burned by inflammation. There is also a formula of Chinese herbs that was put together by Dr. Misha Cohen for AIDS patients called Enhance that can also be used here. And probiotics are helpful, esp. for the GI symptoms that some patients get.

19:48  There are western herbs like andrographis, which is an herb traditionally used in Ayurveda and China, echinacea, and elderberry that are effective for coronavirus.  Metagenics makes a product, Andrographis Plus that can be combined with Immucore, which contains Vitamins C, D, zinc, selenium, and medicinal mushrooms. Pure has a product, Innate Immune Support that contains andrographis, astragulus, and reishi mushroom extracts. A basic formula should include vitamin A, C, D, zinc, probiotics, and a Chinese mushroom product, like Clinical Synergy’s Mycoceutics Immune Max or Pure’s M/R/S Mushroom Formula.

21:02  The coronavirus may not flourish in warmer weather, though we do not really know yet.  If you are immunosuppressed, you might want to avoid eating raw food like salads and cook all your food, which kills the virus.

25:40  We need to focus on what changes the cell membranes, what regulates inflammation, what changes immune response, and what changes epithelial barriers.  So this means vitamins C, A, D, zinc probiotics and some immune enhancement, like quality Chinese mushrooms and astragalus, which is a great immune tonic and a lung tonic. This is for prevention.  If a person has been diagnosed, we need to be careful about taking immune enhancing herbs, since we don’t want to increase the cytokine storm.  Elderberry is fairly weak and not much to worry about, but herbs like andrographis, echinacea, and astragalus and Chinese mushrooms might make a cytokine storm worse, so these should be stopped once the patient is sick.  At this point you should focus on using antiviral nutrients like Isatis, which is a Chinese herb that has antiviral properties, as does the yin chiao formula used for colds and flus, which contains honeysuckle, and chrysanthemum may have some antiviral properties as well.  Herbs like feverfew and boswellia are anti-inflammatory that can be helpful in reducing the inflammation in the lungs that can occur with COVID-19.  Also omega 3 fatty acids can make the cell membranes healthier and can help to dial down the inflammation. And it is not a good idea to take NSAIDs like ibuprofen since they seem to make things worse.

29:49  If the patient starts showing signs of breathing trouble and may be entering the acute respiratory distress syndrome, this is a medical emergency and the patient needs to be seen by a physician immediately, evaluated for oxygen, and taken to the Emergency Room.   Their airway is being obstructed due to an inflammatory response with cytokines in their lungs.  Curcumin makes sense at this point. The inflammation also leads to hypercoagulability and some of these patients end up with thrombi (blood clots).  These patients can become dehydrated, so fluids and electrolytes can be helpful.  They also need adequate protein so they can repair tissue and make antibodies, so protein or amino acid supplements make sense.  Probiotics and glutamine can help heal the lining of the GI tract.

32:43  Fever is a normal part of the immune response and in naturopathic medicine we don’t try to decrease a fever unless it gets extremely high.

35:24  Melatonin. One of the reasons why older people do more poorly is because they tend to have lower levels of melatonin.  Melatonin is a super antioxidant that can help quench some of the oxidative stress and it also modulates immunity and impacts T cell function.  Dr. Chilkov has experience in using high dosages (20-40 mg) of melatonin for cancer patients. At a higher dosage, it may cause vivid dreams. But melatonin is not a sedative. At a low dosage, even at .5 mg it is a dark signal to the brain, but at higher, therapeutic dosages melatonin is a neuro-hormone and a neuro-antioxidant and a signal to the immune system.

37:50  Vitamin D is very beneficial for immune function in helping to protect against a virus.  During the SARS epidemic Canada instructed their population to take vitamin D, since it has been shown to decrease vulnerability to viral respiratory infections. Therapeutically you could give 50,000 units for three or four days and then drop down to 20,000 and 10,000 a day after that but it’s really the blood level of 25-OH vitamin D being close to 75 nanograms per milliliter when you get this change in immune response. And keep the level below 100 ng/mL.

40:07  When COVID-19 patients are recovering they often have a lot of fatigue because their HPA axis has been on overdrive, so we should think about using adatogens, like rhodiola and ashwagandha. They need to have their microbiome tended to and we should have them get a cardiology check to see if their heart muscle was damaged.

 



Dr. Nalini Chilkov is a licensed Acupuncturist and Doctor of Oriental Medicine and is a respected expert in Collaborative Integrative Cancer Care.  She has been a lecturer at the School of Medicine at UCLA and UC Irvine in California as well as many schools of Traditional Oriental and Naturopathic Medicine. Dr. Chilkov is in private practice in Santa Monica, California and can be reached at 310-453-5700 or through her website at NaliniChilkov.com. As the founder of the American Institute of Integrative Oncology, Dr. Chilkov offers a course for professionals called the Foundations of Integrative Oncology Professional Training Program that can be found at the American Institute of Integrative Oncology website.

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 or go to www.drweitz.comPhone or video consulting with Dr. Weitz is available.



 

Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.  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 give us a ratings and review on Apple Podcasts and if you’d like to see a video version of this interview, you can go onto my YouTube page. If you go to my drweitz.com website, you can see detailed show notes and a complete transcript.

Today, I’ll be speaking with one of the nation’s top integrative experts on cancer, to get her perspective on the current coronavirus pandemic, including how it impacts cancer patients. Dr. Nalini Chilkov is a doctor of oriental medicine and an acupuncturist with more than 30 years in private practice in Santa Monica, California. She’s lectured at both UCLA and UC Irvine Medical Schools as well as ed schools of naturopathic and oriental medicine. Dr. Chilkov is recognized as one of the go-to experts in integrative cancer care and immune enhancement and she runs the American Institute of Integrative Oncology. She offers an incredible Foundations of Integrative Oncology online course for clinicians to learn how to help manage the health of cancer patients while they are ongoing traditional care. Dr. Chilkov, thank you so much for joining me today.

Dr. Chilkov:                         Thank you for having me.

Dr. Weitz:                            So I know you have a little bit different perspective on this COVID-19 coronavirus pandemic, but before we get to that, since we’re in Los Angeles and we’re all on lockdown and stay at home orders, how are you managing to still see some patients, or how are you handling this situation?

Dr. Chilkov:                         Well, my practice is composed of patients from all over the world, and so I’ve been doing telemedicine for a long time and so I’m just doing it from home right now.

Dr. Weitz:                            Oh, okay. You just don’t get to see the in-person acupuncture patients.

Dr. Chilkov:                         Yeah, yeah. So the people who come to see me in Los Angeles are also consultation and cancer management patients, but many of them come in for acupuncture, so that’s the piece that isn’t happening. Those patients have a bit of resistance to doing a telemedicine visit because they’re accustomed to seeing me in person, but I’m just carrying on here.

Dr. Weitz:                            We’re all carrying on.

Dr. Chilkov:                         Right?

Dr. Weitz:                            You can see I have the mark of the mask from wearing an N95 mask all day, tends to rub the skin off across your nose. So tell me about your latest understanding of the coronavirus and what’s going on with this situation.

Dr. Chilkov:                         Well, I’ve invested a considerable amount of time trying to understand this, looking through a slightly different lens because there’s plenty of brilliant people who are teaching us about the physiology of this virus and the standard nutraceutical approach but I think we really need to think about it, about the arc of this experience that patients have, and how we address patients at different phases of that journey, but also, because of my interest in Chinese medicine and Chinese herbal medicine, I have been taking a deep dive into what has been going on in China and over 90% of COVID-19 patients have received Chinese herbal medicine concurrently with Western herbal medicine and this is not very publicized and also, there’s a couple of studies … They’re now publishing what they’ve been doing with these patients and there are some emerging patients of what makes sense and what’s working.

So I’d like that share that but I also want to share that there were two studies that came out of China demonstrating that the caregivers, the frontline, up close and personal caregivers in two hospital settings, were given Chinese herbs to keep them from getting the infection and there was a set of clinicians in two different hospitals that did not get sick in the midst of treating these patients. So I think we need to be thinking about how to care for the caregivers as well, because we have higher exposure, being intimately involved with our patients.

Dr. Weitz:                            That’s a good point, and simply giving them masks and protective equipment is really not enough, yeah.

Dr. Chilkov:                         It’s not sufficient, no. It’s not sufficient, the masks don’t protect you 100% and I think we also need to think about who are our more vulnerable patients. Now, the demographic of the patient population in China is different than in the United States, so we’re actually seeing different trends here. So although in China, the elders and the men are more vulnerable, our population is different.  In China, most men smoke and most women don’t, so puts a disparity in lung vulnerability in that population.  What we’re seeing in the United States is that it’s not so dramatic in terms of age. Once you get over 80 you’re highly more vulnerable in the United States and certainly between 60 and 80 is a slightly more vulnerable but we have a significant number of patients who are between 30 and 50 who are being hospitalized here as well.  We also have more obesity.

Dr. Weitz:                            Do you think that’s because we do such a good job with getting chronic diseases, that we don’t wait till we’re older to get them.  We end up with diabetes and heart disease much younger.

Dr. Chilkov:                         Yeah, that’s the problem, we have an epidemic of obesity and metabolic syndrome and diabetes that is driving high risk in all age groups. It turns out United States, the worst outcomes are in obese patients, if you take the age factor out.

Dr. Weitz:                            Not a shock.

Dr. Chilkov:                         Right, because of the high inflammation. If you have diabetics of any age, these people already have more inflammation, more oxidative stress and more kidney damage, so we know that one of the vulnerable organs in this syndrome are the kidneys, so if you lose kidney function. So the complications of this disease are lung fibrosis, myocardial damage, kidney nephron fibrosis, disruption of the gastro-enterologic tract because we know the virus is found in the gut. In fact, David Brady, his company Diagnostic Solutions, is developing a stool test to look at the virus in the stool.

Dr. Weitz:                            Yeah, it’s already available.

Dr. Chilkov:                         Right, and so we have this bigger picture to consider and there’s a sub-population of people who contract this, who develop this cytokine storm, this hyper up-regulation of the immune system, so patients who have autoimmune disease are more vulnerable, but also we have a lot of cancer patients who’ve had immunotherapies who have ratcheted up their inflammatory cytokine titers and who now have autoimmune disease on top of having cancer and these are highly vulnerable patients. We have cancer patients who are myelosuppressed due to their chemotherapy treatments and we have cancer patients who have leukemias who already have elevated levels of white cells. So we need to think a little bit differently about patients in terms of age demographics and risk factors in the United States versus the information we’ve gotten out of China. We’re a different population here.

Dr. Weitz:                            It’s still fairly predominant in men over women though, right?

Dr. Chilkov:                         It is, it’s interesting and women do have different immune patterns that start evolutionarily in order to carry a baby that has different DNA than you have, to be able to do that, your immune system has to be able to adjust, right?

Dr. Weitz:                            Right and isn’t it the case that estrogen leads to a stronger immune system and that during pregnancy, the estrogen drops so the mother doesn’t react and that’s why-

Dr. Chilkov:                         Exactly.

Dr. Weitz:                            … women have a higher risk of autoimmune disease?

Dr. Chilkov:                         Yes, yes. So we want to look at where a woman who’s diagnosed with the disease in her hormonal life cycle, if she’s on hormone replacement therapy and if she gets sick, do we want to withdraw some of her estrogen so that she doesn’t have a cytokine storm? I mean, these are questions.

Dr. Weitz:                            Or maybe the estrogen is immunoprotective.

Dr. Chilkov:                         It might be, it might be but the real risk that we’re learning is not from the virus itself but how it hijacks the immune system and in those patients whose immune system goes into overdrive, that’s where the damage and the mortality is being seen. These are the patients that get the most into trouble breathing. These are the patients who, if they don’t die from the syndrome, they come out of it with a high level of lung fibrosis, possibly myocardial damage, most of these patients have nephron damage too and so we’re looking at a population of survivors that need our help. They need functional medicine. They need what we do because we know how to repair people and restore function and I think we need to be really thinking about all this fibrosis that this disease causes as well. So we can have a big impact on the prevention and we can have an impact with the survivors and if we have patients that are staying at home with this illness, then we have a lot of antivirals in the [inaudible 00:11:14].

Dr. Weitz:                            Is the fibrosis mainly in the lungs, or is it in the other organs as well?

Dr. Chilkov:                         Well the fibrosis is being seen in the lungs and the nephron and the nature of the damage is to the myocardium, it’s not expressly fibrotic but whatever tissue dies, it gets more fibrotic.

Dr. Weitz:                            As soon as I think of fibrosis, I immediately think of modified citrus pectin and galectin-3 and Isaac.

Dr. Chilkov:                         Yes, I think we need to think about that. Where I actually think about is Chinese herbs have a lot of research on their impact on fibrosis and one of the herbs I use the most in cancer patients for fibrosis, which is very common in cancer patients, is Chinese red sage, dan shen, salvia miltiorrhiza. There are studies on that and lung fibrosis. I’ve seen studies on white peony, Bai Shao, peony alba and fibrosis. So there’s a number of botanicals which do have research in their impact on fibrosis and these are botanicals that change the amount of development of fibrotic tissue and activity of the fibroblasts-

Dr. Weitz:                            So these could be taken ahead of time to reduce the potential for fibrosis, or would they be taken afterwards?

Dr. Chilkov:                         No, I think of using them-

Dr. Weitz:                            After care.

Dr. Chilkov:                         … for the recovery period but if you have a patient who you can see is in a physiologic state where fibrosis is going to happen, I would think about using them then. Remember, the fibrosis is the sequelae of extraordinarily amounts of inflammation and oxidative stress. So those patients also need to take N-acetylcysteine because that, of course, is producing glutathione and quenching a large amount of the oxidative stress. But remember that N-acetylcysteine is also used in medicine to thin secretions in the respiratory tract and it can actually be nebulized. So we can think about putting people on nebulized-

Dr. Weitz:                            Yeah, they’re using IV vitamin C and that seems to be having some effect, so that may be one of the ways that vitamin C plays a role as well.

Dr. Chilkov:                         I knew vitamin C is being used in China in hospitals and we can certainly use that here, I think that-

Dr. Weitz:                            It is being used in some hospitals in New York.

Dr. Chilkov:                         Oh, is it?

Dr. Weitz:                            Yes.

Dr. Chilkov:                         Oh, that’s fabulous. So I think that that is intervening with the cytokine storm, I think that’s what that’s doing. And quercetin, quercetin also acts in that way. A lot of the formulas in China, the herbs that are in them, have high amounts of quercetin and high amounts of resveratrol and high amounts of berberine. So if you just look at the phytochemicals that are in a lot of the formulas that are the dominant formulas being used, that’s one thing I’m seeing.  Then, the Chinese Materia Medica has a large number of antivirals, very large number. Another herb that you see in a lot of the formulas coming out of China is scutellaria baicalensis, which is used widely in cancer treatment but scutellaria baicalensis has phytophenols in it, baicalin and baicalein, which are active in the viral replication, but also they’re in the category of bioflavonoids and so, like quercetin, they actually change the confirmation of the virus at the cell membrane and its ability to bind and enter into the cell and start taking over the machinery of the cell. We also, David Brady and Peter D’Adamo talked recently about nettles. Now, there’s some confusion, I’ve had people ask me, nettle leaf and nettle root are two different medicinals.

Dr. Weitz:                            Yeah, they were talking about nettle root, which I use on some of the male patients who have high levels of binding protein, whatever it is, the one that binds testosterone.

Dr. Chilkov:                         Yeah, it’s an aromatase inhibitor basically. Yeah, so nettle root is used also in estrogen-dominant cancers, where there’s estrogen receptor positive. Again, you could do that in testosterone receptor positive syndromes also to deal with the aromatase enzyme, transforms androgens into estrogens in the tissue. So that’s helpful but nettle leaf is also used as an antihistamine and so some people, I think are confused about which is being used in COVID, I think that clarification needs to be made.

Dr. Weitz:                            Right, so it’s the nettle root that you want to use for COVID, right?

Dr. Chilkov:                         Yes, yes, yeah, because we’re not having high histamine, we’re having high cytokines.

Dr. Weitz:                            Right, right, okay.

Dr. Chilkov:                         We have this virus that specifically binds. So there is a very, very brilliant Chinese doctor named Michael McCulloch who practices in the Pine Street clinic up in San Anselmo in Northern California, who’s a long-term friend and colleague of mine and he is a PhD epidemiologist as well as a doctor of Chinese medicine and he speaks Chinese and he’s been tracking all this research. What he did is he took all the herbs that are currently being used in China and he looked at which ones can we get in the United States and then he looked at which ones are actually active with this virus and he made a list of those because a shortlist of things we can get here.  So I looked at that list and there is a Chinese herb company that I like very much called Health Concerns that has some formulas that already exist that I think we can use. In my clinic, I do compound custom formulas so I can replicate the formulas that are used in China but just for the clinician who isn’t doing that, Health Concerns has a formula called Clear Heat, which has most of the antiviral herbs in it that are being used in China, not all of them, but most of them. There’s also a formulas that’s called Enhance, that was developed by Dr. Misha Cohen during the AIDS epidemic in San Francisco in the early days and it’s a combination of Chinese medicinal mushrooms, antivirals and also tonic herbs. What was found in China is that these patients need to have digestive tonics given to them. The patients who have digestive tonics given to them, and I’m using probiotics as well, do better. Isn’t that interesting? Their nutritional status is maintained, right?

Dr. Weitz:                            Yeah, a significant percentage of patients who are hospitalized have GI symptoms.

Dr. Chilkov:                         Yes, yes. There are Chinese traditional herbal formulas that support what we call digestive chi and so that’s in this Enhance formula. So that’s a really nice formula, I think for recovery also and it can be used for the person who also just doesn’t want to get sick with this, it’s a nice formula for that, whereas the Clear Heat is for if you have a viral infection. So those are two formulas that are available. There’s a traditional Chinese formula called Lily Bulb Formula that is available from Health Concerns and it’s available from a lot of companies that make Chinese herbs, granules and things. That is for the lung and that’s for the patient whose lungs have been burned by inflammation and that would be a really nice formula for people for recovery.

Dr. Weitz:                            What about some of the Western herbs you hear a lot of people talk about, like andrographis, echinacea and elderberry?

Dr. Chilkov:                         So andrographis is actually an herb traditionally used in Ayurveda and China, it’s actually of Asian origin and it has a lot of studies on it, Metagenics makes a formula called Andrographis Plus, which could absolutely be used. You could combine that with the Metagenics formula ImmuCore, you could put those two together, that’s a nice combination. That has Chinese mushrooms and the A and the C and then you could add some vitamin D and zinc. If someone wants to just put together a basic protocol, vitamin A, vitamin C, vitamin D, zinc, some probiotics and some kind of Chinese mushroom product, Clinic Synergy, Isaac’s formula, Isaac Eliaz’ formula. I like their Mycoceutics Immune Max, is a very nice formula. For these patients who are super inflamed as you mentioned, the PectaSol-C could also be used. I think that’s a thought.

Dr. Weitz:                            Yeah, there seems to be a fair amount of research showing it reduces fibrosis, so-

Dr. Chilkov:                         Yes, it does, it absolutely does. So when there’s traditional, old time naturopathic medicine where you do hot castor oil packs, hot castor oil fomentations over fibrotic areas. It does penetration all that deeply so I don’t think it’s going to get into the lungs or into the kidneys, however. So you can use it over pelvis certainly, but that’s not where we’re seeing fibrosis in these patients.

Dr. Weitz:                            It seems to be data that heat is beneficial in helping to reduce the ability of the virus to grow and to flourish?

Dr. Chilkov:                         Well that’s in Petri dish, so I don’t think we really know what … I just read a comment yesterday, there’s some people are hoping that this is going to behave like the influenza virus and decrease in the summer, but there’s evidence that that is not a factor, that this virus is very happy in warm weather also. So certainly in terms of our food safety, if we’re concerned about that, the virus is killed by cooking. You have to get your food heated. So people are particularly vulnerable and immunosuppressed, they might want to not eat raw food right now and cook all their food if they’re really, really concerned. That’s something any immunosuppressed person might think about, not having more exposure to bacterial pathogens in food and the lipopolysaccharide’s immune triggers, inflammatory triggers, that come with that. So it just depends where someone is on the spectrum and that’s why patients also need us because we really treat so individually.

 



 

Dr. Weitz:                            I’ve really been enjoying this discussion, but now, I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements. Pure products are meticulously formulated using pure scientifically-tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives.

Among other things, one of the great things about Pure Encapsulations is not just the quality products but the fact that they often provide a range of different dosages and sizes, which makes it easy to find the right product for the right patient, especially since we do a lot of testing and we figure out exactly what the patients need. For example, with DHEA, they offer five, 10 and 25-milligram dosages in both 60 and 180 capsules per bottle size, which is extremely convenient.

                                                Now, back to our discussion.

 



 

Dr. Weitz:                             Well, are there any natural products that work similar to the way hydroxychloroquine works? Which has been talked about as one of the preventative drugs that may have some benefit?

Dr. Chilkov:                         Well, I think this is all conjecture. I think this is all conjecture.  Not to my knowledge. I mean, you can use quinine, but-

Dr. Weitz:                            Yeah, people are talking about artemesia.

Dr. Chilkov:                         … the problem with hydroxycloroquine is that it should be assessed patient by patient because it does have cardiac toxicity.  It also seems that you have to give it with zinc to get a really good effect because of the entry into the cell.  So I think we just don’t know enough and I think it’s really dangerous to be having intellectual exercises around this until we have more data too, because these patients are vulnerable and so we certainly don’t want to experiment on them. But for our, relatively well, population-

Dr. Weitz:                            But Donald Trump says it’s the game changer.

Dr. Chilkov:                         Donald Trump knows nothing about science.  I am fairly conservative and was a cell biologist and I think we have to go with data.  I think that this particular virus is an animal we don’t understand completely and of course will be mutating and changing and that we just need to go with what we know will be of benefit to our patients for sure.  So what changes that cell membrane, what changes inflammation, what changes immune response, what changes epithelial barriers.  These things, we know what to do.  So again, then you can go back, vitamin C, vitamin A, vitamin D, zinc, probiotics and then some immune enhancement.

So if you want to think the immune enhancement part, I like the high quality Chinese mushrooms plus astragalus, which is a great immune tonic and a lung tonic. But a caveat here is, as soon as a person is diagnosed with it … So those go in the prevention box.  As soon as a person is diagnosed with, or obviously has the viral exposure and infection, I withhold those because we don’t know which patients are going to have cytokine storms and patients who continue to use astragalus and Chinese mushrooms will have exaggerated cytokine storms.  This is the elderberry question as well.  Now, elderberry is very mild so I’m not so worried about it if people use it but echinacea falls into that category as well, that can increase and make worse a cytokine storm.  So I always like to err on the side of safety, so I pull out those things which potentially will make the inflammatory response bigger.  I take those out and then put in the antivirals in a much more aggressive way. So andrographis falls into that category.  Another category is Isatis, is another Chinese herb which is a potent antiviral. The very well-known yin chiao formula used for colds and flus has honeysuckle in it and that has been shown to be active against this virus and that’s lonicera, you’ll see that in many formulas. Chrysanthemum has been shown to have some activity.  I think about an herb like feverfew, tanacetum parthenium, which is super anti-inflammatory, so I think about putting that into these formulas.

Think about other herbs that we know act on inflammation in the lungs, like boswellia, boswellia is very powerful for inflammation in the lungs, it not only interacts with the Cox enzymes, but with the LOX-5 enzyme, which is more active in the lungs and with asthmatics, for example. So I’m using that, the boswellia’s also active in the gut. I’m thinking about using lots of Omega-3 fatty acids in these patients to make the cell membrane healthier and to dial down inflammation and these are very safe things that don’t have a lot of drug interactions. Also, we know that the over-the-counter NSAIDs, the non-steroidal anti-inflammatory drugs seem to make this worse and so, although people are having inflammation and might want to reach for those, it’s been advice that people not take Advil and Aleve, or even aspirin when they have this syndrome. So I think again, we’re just all really learning and we have to also learn on our American patient population, which is … The average patient’s taking 10 to 20 pharmaceuticals at the time they’re diagnosed also.

Dr. Weitz:                            What about when the patient’s … If they’re sick and they start having breathing problems? Is there anything you think about using then?

Dr. Chilkov:                         I think that anyone who is showing respiratory distress of any kind should be seen by a physician.

Dr. Weitz:                            Sure.

Dr. Chilkov:                         And be evaluated for oxygen. These people basically are having airway constriction due to constriction, so think what happens to an asthmatic lung, that the airway is obstructed due to an inflammatory response. In this case, it’s not eosinophils, it’s inflammatory cytokines like IL-6 and IL-8 and IL1B1, so we do know we have lots of botanicals that interact with those. Those happen to be the cytokines most ramped up in cancer as well, so curcumin is available and the other thing that’s happening with these patients, this extra inflammation leads to hyper-coagulation and so some of these patients are forming a lot of thrombi and so if you have a patient that’s having pain in their lower legs, or suddenly gets short of breath, they may have developed a dangerous thrombus. So these are medical emergencies and we should not be messing around. We should be getting them to urgent care, basically.

Dr. Weitz:                            Sure.

Dr. Chilkov:                         But what we can think about, do you have a patient who has a higher risk of thrombus formation, like a diabetic or an obese patient, a hypertensive patient, their blood vessels are too constricted. So these patients should stay hydrated also. Even a low grade fever can disrupt your electrolytes so making sure patients are not only replacing fluids but electrolytes and I’ve seen people become both sodium and potassium depleted going through this syndrome. So very important.  Then how do we repair tissue and hold onto fluids and make antibodies? You need to have adequate protein repletion. So we have good functional foods that can assist people. I think about the digestive issues that are going on, so not only probiotics, but perhaps glutamine will help the epithelial lining of the GI tract. So I think about things like that. If patients really can’t eat, maybe we should be giving them full spectrum amino acids just so that they have the building blocks that they need, right?

Dr. Weitz:                            Right.

Dr. Chilkov:                         Nobody’s going to use that as their diet but therapeutically, patients can quickly become depleted in essential nutrients.

Dr. Weitz:                            Right and some of these patients do have a loss of appetite.

Dr. Chilkov:                         Yes, well fever does yeah, fever does that.

Dr. Weitz:                            Now, what’s your perspective on fever?

Dr. Chilkov:                         Well fever is a normal part of an immune response and so in naturopathic medicine we don’t try to decrease a fever, we know that a high fever’s really only dangerous to the young brain for seizure but typically, adults don’t have anything dangerous happen to them, and so it’s part of the body’s solution to make the environment inhospitable to the organism and so I don’t have a problem with a person having a fever but as soon as a person has a low grade fever, we should be moving them in our mind into the category of active infection and being concerned about cytokine storms. We should be concerned about that.

Dr. Weitz:                            Right, so one of the tricky things is, there’s a percentage of patients who don’t have any symptoms at all, they’re outside spreading the disease.

Dr. Chilkov:                         Well, probably a lot of kids are in that category, you know?

Dr. Weitz:                            Yes.

Dr. Chilkov:                         Probably a lot of kids are getting it and sharing it with other children and with their adult caretakers and-

Dr. Weitz:                            Now young kids are typically very vulnerable to the flu and don’t do that well. Why do you think young kids do well with this virus?

Dr. Chilkov:                         Everyone has that question right now, we actually don’t know the answer to it but it might teach us something about the immune system. Maybe it’s because they have an active thymus, I mean, who knows?  Todd LePine posited to use peptides, thymic peptides in these patients, which we also do in cancer patients, to mobilize immunity. I just had a hip surgery and I took thymic peptides and I could see my blood cell counts change from doing that. I had much more robust immunity after using those but we don’t know enough. I really think it’s important not to experiment and conjecture because we don’t really know if that also might ramp up more inflammation. We don’t know that because elevating white blood cells has the potential to increase inflammation and clotting risk as well.  So again, I’m just very conservative. I do not experiment unduly, even if it sounds like a good idea, because the border between low risk and high risk can change in a day in these patients and we should not experiment on them. That’s my comfort zone.

Dr. Weitz:                            There’s been some discussion about melatonin and one of the reasons why older people are not doing as well because they have lower levels of melatonin.

Dr. Chilkov:                         Well I think the studies on melatonin are pretty good and melatonin is widely used in cancer as well, at high doses. So, I think that melatonin has a couple of functions here. Of course it’s a super antioxidant, it can help quench some of the oxidative stress but it also modulates immunity and impacts T cell function and so because I have experience using melatonin in high doses, which most clinicians don’t unless they’re working with cancer patients, I am comfortable giving 20 to 40 milligrams of melatonin to patients. Some patients in the cancer setting get up to 180 milligrams of melatonin over a 24 hour period and patients who are particularly sensitive to melatonin, the early sign is you get really vivid dreams. Now, melatonin is not a sedative, people think it’s a sedative, it’s a dark signal to the brain at half a milligram.  Once you start getting into these super doses, you’re not using it to modulate sleep cycle any more. You’re using it as a neuro-hormone and a neuro-antioxidant and a signal to the immune system. So that’s very different. So I think also clinicians need to remember there are nutritional doses of nutraceuticals and botanicals and phytochemicals and there are therapeutic doses and we have to really understand the difference.  So some clinicians are suggesting for example, at early signs of viral exposure, that patients take up to 50 to 100,000 units of vitamin A for a few days. Although in all our educations, our textbooks tell us that that’s liver toxic, I have never seen that in clinical practice. Never once have I ever seen that.

Dr. Weitz:                            Yeah, you know the World Health Organization actually recommends for children to protect them from a vaccine, to take 300,000 units?

Dr. Chilkov:                         Yes, yes, yes. Yes, that’s done in developing countries when they give children multiple vaccines at once. During the SARS epidemic, that was a coronavirus, during the SARS epidemic, the entire country of Canada instructed their population to utilize vitamin D because we know vitamin D decreases vulnerability to viral respiratory infections. Again, a lot of physicians aren’t well educated in the therapeutic use of vitamin D, and so you can give 50,000 units for three or four days and then drop down to 20,000 and 10,000 a day after that but it’s really the blood level of 25-OH vitamin D being close to 75 nanograms per milliliter when you get this change in immune response. So you can measure your patients, vitamin D goes up very slowly, even if you give high oral doses. It’s only dangerous where it gets near 100 nanograms per milliliter and then you start to change the compartment where calcium is found, but up to that, it’s pretty safe. So I think that using … with the general public, I feel safe saying you can take 10,000 a day.

Dr. Weitz:                            Yeah, I’ve seen that as well, there’s the occasional patient, where you give them a modest dosage and it shoots up to a hundred but it seems like 80% of them, it’s really difficult to get that level up, especially if you’re trying to get to a therapeutic range of … you mentioned 75 but somewhere’s 50 to 70, 60. It’s really hard to get up to that range and keep it there.

Dr. Chilkov:                         Well, in patients where you’re having that experience, you’re giving them fairly aggressive oral dosaging and you see the OH-25 vitamin D doesn’t budge a lot-

Dr. Weitz:                            Oh, I check the 125 also,…

Dr. Chilkov:                         … you have to check the 125 because you want to see the rate of turnover. So we know that autoimmune patients and cancer patients utilize vitamin D at a much higher rate and so we don’t know that about these patients but we could measure, we could find out.

Dr. Weitz:                            Yeah, good. Okay, and let’s see. I think that’s about the thoughts that I had. Anything else you wanted to cover?

Dr. Chilkov:                         Well I think that we should all really be thinking about how we are going to help these patients recover. So let’s think about what happens for the patients who’ve had hospitalization or patients who’ve had aggressive bouts at home. I’m seeing patients being sick for two to three weeks beginning to end and then at that end, where the virus and the sequelae of the acute symptoms has dropped off, there are patients who are experiencing a lot of fatigue because their HPA axis has been on overdrive, so we need to help people with resilience and think about our adaptogens.

Dr. Weitz:                            Adrenal support.

Dr. Chilkov:                         Well not only adrenal support, but the category of adaptogens, things like rhodiola and ashwagandha also speak to the parasympathetic balance. These patients have faced death, a lot of them, so they’ve really been in extreme physiology. A lot of them have been alone and away from family and really sick and not having someone there to down-regulate them.

Dr. Weitz:                            And it makes it even worse when they’re in the intensive care and not only don’t they have their friends or family there, but the people caring for them are covered with masks so they don’t even get to see their faces.

Dr. Chilkov:                         Right, they’ll get that. Yeah, get that and if you’re intubated, you can’t speak for yourself either. So there are people who have some large or small version of PTSD and so that’s vagal nerve, parasympathetic balance, that’s very important. I think all these people need their microbiome and GI tracts tended to and then we have to look at what sub-population they were in. Did they go into this with cardiovascular disease, then are we concerned? Do we want them maybe to get an ejection fraction test when they come out to see if their heart muscle was damaged or not?

Dr. Weitz:                            Sure.

Dr. Chilkov:                         We want to monitor if their hypertension is still well managed, or now it’s not well controlled. The diabetic, what has happened to them as a result of this? I think we don’t know enough but since we are looking for health. We are looking for health, not marginalized good enough, which is the standard of care in medicine today. But if we really want to get these people back to robust health, that’s one category of things we need to do. Then we need to also think about repairing damage and so how do we make the heart muscle more efficient? How do we protect the kidneys and the lungs?  So for example in cancer, these organs are also damaged by the inflammatory nature of cancer but also the pro-oxidative therapies they receive damage all these organs as well and so we use milk thistle a lot for these patients. So I don’t have all the answers yet because I don’t have enough experience with a large enough population of these survivors but these are the things I’m thinking about, certainly acupuncture is a restorative therapy that also helps you regulate, helps you regulate.  So we need to think about hormesis and all of the self-regulating functions that are disrupted by trauma, really, by emotional and physical trauma that these patients have gone through and-

Dr. Weitz:                            And also the trauma that some of the healthcare workers are going through when they care for these very sick patients.

Dr. Chilkov:                         Yeah, I’m thinking about also putting together some ideas for caring for the caregivers, because we have a whole traumatized, highly stressed population of heroes and heroines on the front lines and I think there’s a fair amount of anxiety, whatever end you’re on, the patient end or the caregiver, or the, “Am I going to get it,” end. So we need to help our patients have better coping skills also.

Dr. Weitz:                            Right, great. Awesome. Well, thank you so much for spending some time with us, Dr. Chilkov.

Dr. Chilkov:                         You’re welcome.

Dr. Weitz:                            How can people get a hold of you and find out about your programs and seeing you if they want to?

Dr. Chilkov:                         My clinic website is just my name, NaliniChilkov.com, N-A-L-I-N-I C-H-I-L-K-O-V and my professional training for primary care frontline clinicians who want to care for the health of cancer patients and survivors is aiiore.com and if you opt in to my list on that site, you’ll get a series of videos, very short videos, in which I talk about how we can begin to make a difference in the lives of these patients in primary care settings.

Dr. Weitz:                            Awesome, thank you so much.

Dr. Chilkov:                         Thank you.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Men's Health Approach to the COVID-19 pandemic with Dr. Geo Espinosa: Rational Wellness Podcast 151
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Dr. Geo Espinosa provides a Men’s Health Approach to the COVID-19 pandemic with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

2:24  Dr. Espinosa provides a men’s health perspective on how to protect oneself from the Coronavirus.  Men are twice as likely as women to die from the corona virus.  Men were two to three times more likely to die from the 1918 influenza.  Men were also more likely to die from SARS and MERS. If someone is male, over 60, and smokes, they’re in trouble.  Men are more likely than women to smoke and less likely to wash their hands. Testosterone has an immuno-weakening component to it compared to estrogen.  While there is a tendency for men to want to have as high a testosterone level and as low an estrogen level as possible, Dr. Espinosa likes his male clients to have an estrogen level of between 20 and 30 and not less.  Estrogen has immune stimulating benefits, which is why women are less likely to succumb to infections and more likely to suffer with autoimmune diseases. 

9:05  One other reason that men are more prone to infections is because the X chromosome is involved in the processing of T cells and B cells while men have one X chromosome, women have two.

13:23  The coronavirus tends to target certain organs, including the lungs, the heart, and the kidneys.  Some patients end up with a myocarditis, which is why they may succumb. A percentage of patients get GI symptoms. Some of the symptoms are typical cold and flu symptoms. Some patients have a loss of smell and taste. They may get a rash around their eyes. Most patients get a fever.  Since testing is not widely available, if you have the symptoms, you should assume that you have it until proven otherwise.

20:20  Some of the most important things we can do to strengthen our immune system include making sure that we get

  1.  Quality sleep
  2.  Melatonin has both antioxidant and anti-inflammatory properties
  3.  Vitamin C–500 mg every 2 waking hours, which works out to a total of 4-5,000 mg per day.  The importance of vitamin C is often under appreciated.  IV vitamin C should be used in the more critical phase of the viral infection.
  4.  Water
  5.  Spray botanical mixtures with echinacea and other herbs that you spray into your throat throughout the day
  6.  Moderate levels of exercise
  7.  Eating healthy, which means avoiding refined carbohydrates and sugar, which which weaken your immunity.
  8.  Intermittent fasting and the fasting mimicking diet both stimulate immunity.

44:00  The World Health Organization (the WHO later reversed its position on this) and the French health minister have both recommended that we avoid using nonsteroidal anti-inflammatory medications (NSAIDs) because they may increase the ACE2 receptors where the coronavirus attach to the cells.  And NSAIDs are often used to lower fever, but we should really let the fever stay, since this is how the body is fighting the virus, unless the fever gets dangerously high.  It is recommended that if a medication is needed to lower the fever that acetaminophen (Tylenol) is recommended. And of course the downside to taking acetaminophen is that it inhibits glutathione production, which is super important for immune function and acetaminophen can also be liver toxic.

50:40  Other nutraceuticals to consider taking to strengthen our immunity include the following:

  1.  Selenium is immunomodulatory and has antiviral properties. 200 mcg per day is recommended. Selenized yeast is preferred.
  2.  Zinc up to 60 mg per day, though he usually recommends 30 mg per day.  If you take 60 mg per day you need one mg of copper per day.
  3.  Vitamin D 4000-5000 IU per day to start with along with vitamins K1 and K2.
  4.  N-Acetyl Cysteine or liposomal glutathione.
  5.  Glycyrrhizic acid from licorice.
  6.  Andrographis, echinacea, and astragalus are herbs that are very helpful in fighting viral infections.
  7.  Larch arabinogalactan
  8.  Quercetin–300-500 mg once or twice per day
  9.  Resveratrol–200 mg twice per day. It may have anti-coronavirus properties and it helps with male sexual health through nitric oxide production in the endothelial cells of the blood vessels.

 

 



Dr. Geo Espinosa is a Naturopathic Doctor, licensed Acupuncturist and Certified Functional Medicine practitioner recognized as an authority in holistic urology and men’s health. He is a professor and holistic clinician in Urology at New York University Langone Medical Center and faculty for the Institute for Functional Medicine. As an avid researcher and writer, Dr. Geo has authored numerous scientific papers and books including co-editing the Integrative Sexual Health book, and author of the best selling prostate cancer book: Thrive, Don’t Only Survive. Dr. Geo is the Chief Medical Officer (CMO) and formulator at XY Wellness, LLC and lectures internationally on the application of science-based holistic treatments in urological clinics. His website is DrGeo.com.

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



 

Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.  Hello, Rational Wellness podcasters. Thank you so much for joining me again today. For those of you who enjoy the podcast, please go to Apple Podcasts and give us a ratings and review. If you’d like to see a video version of this interview, you can go to my YouTube page. If you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Today, I will be talking to the go-to expert on men’s health in the functional medicine world, and my friend, Dr. Espinosa. Today, we are not going to be talking about prostate or men’s health. We are recording this while we’re in the midst of the COVID-19, coronavirus pandemic, and Dr. Geo will be giving us his perspective on the situation, what steps we can take from a preventative perspective to help strengthen our immune system, and to increase the likelihood that we will have a positive response if we do get infected.

Dr. Geo Espinosa is a naturopathic doctor, licensed acupuncturist, and certified functional medicine practitioner, recognized as an authority in holistic urology and men’s health. He’s a professor and holistic clinician in urology at New York University Langone Medical Center and faculty for the Institute for Functional Medicine. As an avid researcher and writer, Dr. Geo has authored numerous scientific papers and books, including co-editing the Integrative Sexual Health book and author of the bestselling prostate cancer book, Thrive Don’t Only Survive. Dr. Geo is also the Chief Medical Officer and Formulator at XY Wellness, and he lectures internationally on the application of science-based, holistic treatments in urology clinics. Geo, thank you for joining me today.

Dr. Espinosa:             Ben, it’s such a pleasure, such a pleasure. We may have to start this conversation from a men’s health perspective.

Dr. Weitz:                  Oh, that sounds good.

Dr. Espinosa:             And we need to take-

Dr. Weitz:                  Yeah, why don’t we do that?

Dr. Espinosa:             … preventative action. There is a connection.

Dr. Weitz:                  Okay, cool. Let’s do that. Tell me how the present coronavirus pandemic has impacted men’s health and how it’s affected your practice. What’s your perspective on that?

Dr. Espinosa:             It turns out that men are more prone to getting the coronavirus. They’re more prone to dying from it than women about almost twice as much. That’s the data that came from China, and the data that’s coming from certainly Italy, and even South Korea. Historically, men are always more prone to dying from viral infections including the 1918 influenza, which that affected younger people between the ages of 20 to 40.  Most that succumbed to dying from the Spanish flu, they were men. Two to three times as much. SARS in China a couple of years or several years ago mostly affected men. MERS mostly affected men. Even the human papillomavirus in terms of when it converts into different cancers, even like lymphoma, affects men more times than or at least the mortality rate is higher in men more so than it is in women. I find that to be very interesting.  If someone is a male patient, 60 years old or over, who smokes, they’re in trouble. They’re in trouble. That particular population is in trouble.  I guess it begs a question why is that.  Why are men more prone to infections and viral infections? Why do they succumb to it more so than women?

Dr. Weitz:                  Is that because estrogen helps stimulate our immune system?

Dr. Espinosa:             There are several theories.  Most of these theories have been looked at by scientists involved in looking at behavioral changes in populations. One of the reasons is that men tend to do more things that affect their health negatively than women around the world.  About 50% of men in China smoke contrasted to about 5% of women who smoke in China.

Dr. Weitz:                  Really? Wow. That’s a big drastic difference.

Dr. Espinosa:             That’s right. In Italy, about 40% of men smoke. Men tend to wash their hands less and do all kinds of less hygienic things than women on average.  That’s one version.  Some of it is behavioral.  Some of it is just lifestyle. Some of it is-

Dr. Weitz:                  When you talk about smoking now, we’ve got vaping is the new version of it, especially among younger people.

Dr. Espinosa:             Right. When you talk about the fact that coronavirus affect mostly aging people. I have 80-year-olds that are in better shape than 40-year-olds. It’s not so much that. It’s that, on average, those who age are less strong, more feeble than those who don’t.  But when you see the cases coming out now, some of these younger people, it’s not affecting so much as much kids yet. I mean it is, but the percentage is much less than 1%.  Once it gets to 40 years old, it’s really affecting mostly people that are between their 40s and 80s and, again, mostly men.

The other reason why that you alluded to, Ben, is that the hormone that makes us men, and that we love, and is dear and near to our hearts, and our… literally near and dear to our hearts because its cardiovascular benefit, and makes us strong and healthy is testosterone.  However, testosterone does have an immuno-weakening component to it compared to estrogen.  So that’s how when I’m reading estrogenic levels in men, I really like them to be about between 20 and 30 nanograms per milliliter, not less. And so sometimes in our world, treating men’s health, many people think less is more.  Less estrogen is more. Well, there’s an important benefit, osteoporosis prevention in men as well as much as in women. Estrogen plays an important role in men as well.  So, yes, estrogen, the predominant hormone in women, they have more of that, so then they succumb to these viral infections and even bacterial infections a lot less than men.

Dr. Weitz:                  Yeah, I’ve had-

Dr. Espinosa:             Of course, that’s why women-

Dr. Weitz:                  Yeah, I’ve had-

Dr. Espinosa:             I’m sorry. One more thing. That’s why women are more predisposed to autoimmune diseases as well.

Dr. Weitz:                  Right, right. Yeah, I’ve had a few patients who were going to see anti-aging doctors come in. They were on testosterone, and they put them on these anti-estrogen drugs, and sometimes their estrogen gets driven down so low. So now, we see one example of why that’s problematic.

Dr. Espinosa:             Yeah, I like my ratios to be 10 or 12:1, testosterone to estrogen and/or roughly, the estrogenic level to be around a 20 to 30 nanograms per milliliter.

Dr. Weitz:                  Is that for total estrogen or estradiol?

Dr. Espinosa:             Total estrogen.

Dr. Weitz:                  Okay.

Dr. Espinosa:             Total estrogen. That shouldn’t be a problem if they’re converting properly. Life is good with total testosterone being high because then all things kind of normally take care of themselves. You don’t want to produce too much DHT, but DHT is also important.  So there’s no thing as bad hormones in people in general. It’s all about ratios. If total testosterone is a good number, then everything else normally takes care of itself. There more be more 5 alpha reductase activity in some places, more aromatase activity, but all in all, everything takes care of itself including the conversion of testosterone to estrogen.

One other reason that it seems that more men are prone to infectious diseases is because the X chromosome is involved in the processing of immune cells, T cells, and B cells, and so forth. Women have two of those. Men have one. Men have XY, right? So the X chromosome is involved in that process. Again, these are all the theories. I read about this phenomenon around three years ago. I have actually the book here. I’m always reading male books, as you can imagine. This is a great book called How Men Age by Richard Bribiescas right here. I read this book about two years ago. It was the first time I was drawn to the idea that men, they succumb to infectious diseases more and things like that. I really didn’t know that information, and this concept about testosterone being not great for immunity, and things like that.

Dr. Espinosa:             Then now, we’re seeing a lot more cases. There was a article published in The New York Times, The Guardian as to this connection of men being more vulnerable to COVID-19 than women. There’s the connection there.

Dr. Weitz:                  Interesting. Other than making sure men don’t have their estrogen level too low, are there any strategies around that concept?

Dr. Espinosa:             I don’t know, right? We cannot undo our genes, and we wouldn’t want to. Again, testosterone’s a very good hormone, does a lot of really good things for us. If our total is in normal to optimal, then everything takes care of itself including estrogen. Testosterone’s a very important hormone. We want to optimize that for sure. What I would say one of the takeaways is, in my opinion, thus far is, look, we know that immuno-compromised patients are succumbing to COVID-19, right? Even the younger population, they have sometimes comorbidities. There’s only very few cases that people are saying, “Well, this person was healthy, and they are on a ventilator.” There’s very few of those cases. Sometimes you hear it in the news, you hear it on CNN or Fox. First of all, how we describe or define healthy, it’s… right? It’s-

Dr. Weitz:                  Exactly. I was listening to one of those discussions. It was talking about some gentleman who’s in the news. I guess he’s a friend of Biden’s. He said, “Oh, he was perfectly healthy.” He had a big gut on him. Right away, my first thought is from my perspective is, “That guy’s not healthy. He’s got metabolic syndrome without even doing any testing.”

Dr. Espinosa:             I would assume so.  I don’t know these people, but I would assume so.  Everybody’s definition of healthy is very subjective.  I think the takeaway for men is, first of all, knowledge is half the battle.  So knowing that we succumb to all these things more than women is something that should be a driver for us, take better care of ourselves. The other is that we need to do some things.  We need to work to keep our immune system up.  We do the right things, it’s very unlikely that we’ll succumb to things like viral infections of any kind, even new ones, newer strains because I think one of the lessons here is that it’s not only viral infections in general.  It’s that you don’t know when a new strain is going to come about, right?

Dr. Weitz:                  Correct.

Dr. Espinosa:             And then our bodies are just not immune to this new strain. That’s part of what’s happening now with COVID-19. It behooves us to do the right things. The right things is not gender-specific. We can discuss some of those things when you’re ready.

Dr. Weitz:                  Sure. Let’s see. What else do we want to talk about? The latest research on the coronavirus, I guess we know that it tends to target the lungs. Then there’s some literature that it tends to target other organs like the heart seems to be a prominent factor. Some patients end up with a myocarditis. That seems to be one of the reasons why people end up succumbing to it.

Dr. Espinosa:             Yeah, yeah.

Dr. Weitz:                  We’ve also seen a percentage of patients now who get GI symptoms.

Dr. Espinosa:             That’s right. That’s right. The novelty of this virus is what makes it a challenge, right?  Some of the symptoms, mild symptoms can include things like cold-like symptoms or flu-like symptoms. Other symptoms that are more associated with COVID-19 includes things like loss of smell and taste. I am monitoring a few patients actually with COVID-19, although, again, it’s not my specialty, but some of my male patients, I’m monitoring with this case. So far, they’re doing well, thank goodness. Some fair-skinned people get a little rash around their eyes that is like a red rash around their eyes. It’s patchy and so-

Dr. Weitz:                  What are you thinking-

Dr. Espinosa:             … it looks like anything, and it could feel like anything. The fever, 101 fever, that my daughter had three weeks ago could have been COVID-19.  I wrote on drgeo.com this article that I wish my prostate articles gain as much popularity as this COVID-19 one.  It did spend a good time.  It’s kind of very simple way of knowing what it is and what one can do naturally, but I wrote that one should assume they have it or had it until proven otherwise, I think. It will be prudent to do so.

Dr. Weitz:                  Well, we know the test that the CDC has, came out with, which is the most common test, still I think has about only a 60% sensitivity rate. So there’s a lot of false negatives.

Dr. Espinosa:             That’s if you have access to testing.

Dr. Weitz:                  If you can even get it, exactly.

Dr. Espinosa:             Yeah. If you have access, then you’re right. It’s only 60%. I saw something online. I don’t know. I didn’t verify it. I didn’t fact-check it. There’s a lot of confusion with this whole thing, as I continue to touch my face. The other thing that I wrote about is how are we supposed to do everything? It behooves us to do everything possible to keep our body strong and our immune system strong because I’m not going to turn every doorknob with my elbows. I touch my face. I don’t even know when I’m doing this. Wasn’t there a politician talking about what we should not do and touch our face, and then she licks our hand?

Dr. Weitz:                  Yeah. Oh, yeah.

Dr. Espinosa:             These are just habitual things that we do.

Dr. Weitz:                  And once-

Dr. Espinosa:             We aren’t going to be-

Dr. Weitz:                  Once you have a mask on, there’s even more of a tendency to want to move it, and touch your face.

Dr. Espinosa:             All these things. Now, yes, I am washing my hands a whole lot more than… I’m one of those natural doctors that believes that I want to be one with bacteria, and I think bacteria makes us stronger, and we need some exposure, and things like that. So other than after using the bathroom or going from exam room to exam room, and, yes, I wash my hands after every prostate exam. I just want to make that clear. Other than that, I wasn’t that obsessed about washing my hands. Now, I am, for example, but a bunch of other things. People say, “Well, do this.” That’s just impossible. It goes back to the point of make your body strong. We are going to be exposed. We’re going to be all exposed to COVID at some point.

Dr. Weitz:                  Yes, 100%. I know I am because I’m still interacting with patients. There’s no way we can perform a chiropractic adjustment and keep six feet of distance.

Dr. Espinosa:             If you can figure that out, my friend, you’re onto something. You’re onto something. The other thing is there’s nothing like… I mean there’s healing aspects through touching a patient. I teach all my students to do a physical exam even beyond prostate like check for the glands and a pelvic exam around the lower abdominal area, look for things. Look, 99% of the times, you’re not going to find anything, but the healing component of touching patients, I think is critical. I think it’s part of the art, I think, that many have lost.

Dr. Weitz:                  Yes, absolutely. It’s really super important, one of the lost arts of doing a really detailed, physical exam in which you really touch the patient. You hear about some of these doctors who’ve been doing those kinds of detailed physical exams and similar remarkable results. I know there’s a prominent doctor in town. He’s always done a very thorough exam. He was just palpating his patient’s abdomen. He said, “There’s something funny I feel around your kidney.” And turns out, they had a kidney tumor and were able to remove it. Yeah, I think-

Dr. Espinosa:             After thousands of patients… And we’re bouncing a little bit. I’m sorry. I tend to do that, but we’ll bring it back to COVID and everything else.

Dr. Weitz:                  Yeah, I do too.

Dr. Espinosa:             Out of thousands of patients that I’ve had in my life, I had one case where one person was having an aortic aneurism. He didn’t even know.

Dr. Weitz:                  Wow.

Dr. Espinosa:             I send them right to the ER, and they were able to treat it successfully. I think it was a lifesaver for him. Just one case. That’s all that’s needed. So going back to touching and everything like that, so both-

Dr. Weitz:                  And did you detect that from listening to his heart?

Dr. Espinosa:             Yeah.

Dr. Weitz:                  Okay.

Dr. Espinosa:             Yeah, and his abdominal area actually, listening to his abdominal area.

Dr. Weitz:                  Okay.

Dr. Espinosa:             Yeah, yeah. There some abnormal sounds there that were clear or at least to me, I had to think back to when I was in school, but I was like, “Well, this is abnormal. This is very abnormal. As best as I can tell as a non-cardiologist, I think you should get this checked.” No symptoms. No symptoms.

Dr. Weitz:                  Right.

Dr. Espinosa:             Yeah. We’re always doing these things. Just to kind of hit on that point and kind of strengthen, highlight the point of it behooves us to take care of ourselves and our immune systems, and for us to keep doing what we do as functional medicine and integrative doctors to help our patients build their bodies up.

Dr. Weitz:                  Right. And so what is some of the most important things we can do to strengthen our immune systems?

Dr. Espinosa:             All right. We are also at risk of recommending too many things for patients and where we set them up for failure. Just like we’re recommending them to wash your hands, and turn the knob with something other than your hands, and keep six feet away, don’t touch your face,… We’re also as, sometimes I feel as functional medicine doctors, setting them up for failure.  I take a lot of supplements, so my bias is-

Dr. Weitz:                  I take about 30 pills twice a day, and now, I’ve just added 20 more to it.

Dr. Espinosa:             Right. That’s my bias. Everything I do with science, based all on experimenting.  Before I start giving things out to people, I experiment, and I try things, make sure that I don’t grow an extra scrotum or something, but-

Dr. Weitz:                  Well, I do a lot of testing, so I’m constantly manipulating variables and trying to hit targets.  For me, it’s a fun exercise in trying to optimize health.

Dr. Espinosa:             Correct, but I understand that many patients are not going to do what I do, and I don’t know that they actually have to. So I have to prioritize what to do, but before we talk about supplements, I got to say if I have to prioritize… That’s the other thing is prioritizing all the right things to do is almost like asking me which one of your three kids you love the most.  It’s like, “Well, I don’t know.  One day, I may love one more than the other.  The next day, it may change depending on how they were behaving, so I don’t know.”  But I would say sleep is very important.  Certainly, in the patient population that I see, as a male population, type A personality, these are successful people, and sleeping is a waste of time.  You want to keep grinding, right?  You want to keep working.  I understand that as a man, right?  I understand making things happening, and accomplishing things, and being productive.  Sleeping takes away from that, at least we think.  Of course, it doesn’t.  You’re more productive when you get good sleep and all these things.  So I think that teaching men to sleep well, it’s pivotal for this.  We know now that there’s antiviral aspects to melatonin, right?  I believe it has some anti-coronavirus activity.  I don’t know about COVID-19, but certainly others, SARS, and MERS, and things like that.  Melatonin is a really important hormone for building immunity.  I think it behooves us to sleep better, but if-

Dr. Weitz:                  Yeah, melatonin also has antioxidant and anti-inflammatory properties. When you get into that inflammatory cascade that can happen in the lungs, having better melatonin levels can only help.

Dr. Espinosa:             Correct. And has anti-cancer properties as well. Melatonin, that’s a monster hormone that I still… I know in our world is something we talk about often. I think it’s undervalued.

Dr. Weitz:                  By the way, I’ve been recommending melatonin lately, and I had several patients say, “Well, isn’t this going to be a problem? Aren’t my natural melatonin levels going to go down?”

Dr. Espinosa:             Right, the answer is no. Even from my cancer patients, I give them 20 milligrams of melatonin. You’re going to think, “Well, is that too much? Am I going to sleep too much? Am I going to be narcoleptic or anything?” The answer is no, but there seems to be some anti-cancer properties or activity in that dosage, and that’s why we do it. In any of them, melatonin is important. Sleep is very important. Look, I have patients that sleep four, five hours a night. I’m just trying to get them to do one more hour a night. That’s it. One more hour. Of course, I have patients that pee at night and so they wake up couple of times to pee at night, so we try to address that. Whatever one needs to do to have them sleep better and longer at night. One of the things with quarantining is that I am sleeping more at night. Things just start later including getting my kids up for school, which school is in my house right now. So-

Dr. Weitz:                  Do you monitor sleep to see how much time you spend in REM and deep?

Dr. Espinosa:             I do. I have a Fitbit. I use Fitbit to do that. I think it’s pretty accurate. At least, it’s giving me some idea of my patterns. It tells you deep sleep. I know some people have the Oura Ring, which is very good too. I think any good gadget to help you as objectively as possible. This is what happened with my Fitbit when I first got it. Of course, I’m thinking, “I sleep seven hours a night.” Well, it was showing me that I sleep really five and a half hours a night. That other hour and a half, I don’t know exactly what I was doing. Hopefully, I was doing interesting things, but you don’t really know how much you sleep unless you get it measured.  That’s a good point. Then it tells you deep sleep, and REM sleep, and things like that. Then you can see what it is that you do. For example, when I started introducing magnesium and some mitochondrial things that I started taking, my deep sleep got improved, and my REM sleep improved. I saw that. It was pretty obvious to me. It was very linear kind of how I measured that.

Dr. Weitz:                  Yeah, magnesium’s a wonderful nutrient, and very few people have enough.

Dr. Espinosa:             Yeah, yeah. So sleep is very important. Now, sleep and exercise. Sleep, exercise, eat right, supplements. Wow. So do everything perfectly. Well, that’s impossible. Which one do you love most? God, that’s very difficult because they’re all so important. If you put a gun at my head, and you asked me to prioritize, I would say exercise, sleep, food including some fasting, and then the right nutraceuticals in that order. That’s the way I would put it. Now, again, the right nutraceuticals as fourth, and I’m one to take 25 pills twice a day. So I’m just trying to optimize what I do and taking that many pills is easy for me. For many patients, it’s just not. So for many-

Dr. Weitz:                  Yeah, same thing with me. I can swallow-

Dr. Espinosa:             Right?

Dr. Weitz:                  Yeah.

Dr. Espinosa:             No problem.

Dr. Weitz:                  Six, eight, 10 at a time.

Dr. Espinosa:             Let’s jump to vitamin C because I have this little gadget here. I keep only vitamin C, 500 milligrams. I’m taking about 500 milligrams of vitamin C every two hours, every two waking hours actually as I take one right now. We’ll go into the other life stuff, but just since we’re talking about vitamin C, I find that vitamin C undervalued as well. Now, there’s a lot of talk on vitamin C right now with COVID as there should be. I can’t believe-

Dr. Weitz:                  And there’s-

Dr. Espinosa:             … that it take… Now, us crazy, natural doctors are actually getting notoriety of some sort because we’ve been talking about this for decades. I mean Linus Pauling was a genius. We’ve been talking about vitamin C for decades in terms of its use and, oh, poo-poo it. Now, in many hospitals, certainly, here in New York, they’re giving IV vitamin C as they should.

Dr. Weitz:                  Yes, 20 grams a day. Yeah.

Dr. Espinosa:             20 grams. Well, they’re doing one to six grams a day here so far because they need… They’re being [crosstalk 00:28:10] vitamin C.

Dr. Weitz:                            Well, the reports I’ve heard is, I think, in China, they’ve been doing 20 grams, and I think some of the hospitals here are starting to do 20 grams as well.

Dr. Espinosa:             That’s amazing, right? That’s a huge step. IV vitamin C and oral vitamin C works a little differently, but here’s the deal. The way I prescribe vitamin C is the following. Based on my studies, Ben, some people taking 1,000, 2,000 milligrams a day.  The body cannot absorb more than 500 milligrams at one time. So when people talk about, “Hey, isn’t vitamin C just expensive urine?”  Yes, it is unless it’s not.  Your body is saturated, and then the kidneys with its innate ability, innate, wonderful abilities, it kinds of removes the amount that you don’t need once your plasma’s saturated with vitamin C.  So then it comes out in your urine.  That’s why I recommend if you are infected, to take 500 milligrams every two to three waking hours.  I am doing that just to optimize my situation as I’m still trying to do things and interact with some people when I go to work or anything like that.

Dr. Weitz:                  By the way, just because you’re urinating out… You’ve got vitamin C in your urine doesn’t mean on its way out of the system, it’s not scavenging free radicals and having a beneficial effect. If you were-

Dr. Espinosa:             Exactly.

Dr. Weitz:                  If you were going to conclude because there’s vitamin C in your urine that you shouldn’t take vitamin C, then as long as you’re pooping, we might as well stop eating because it’s just coming out in poop.

Dr. Espinosa:             How about this? Let’s talk drinking water.

Dr. Weitz:                  Exactly.

Dr. Espinosa:             Why drink water?

Dr. Weitz:                  Exactly.

Dr. Espinosa:             You’re peeing it all out.

Dr. Weitz:                  Exactly.

Dr. Espinosa:             Right. Vitamin C is oral and IV. There are two phases with viral infections. You have the initial phase and you have the more critical phase. The initial phase is when the virus is somewhere on your nasal cavity, going down your trachea, and heading down to the bronchi, to the bronchioles. Your body needs to do a good job before it gets to the air sacs, right?  Before this virus gets to the air sacs, your body needs to get this thing, get rid of this thing.  So that’s the initial phase.  That initial phase, you have sneezing and coughing, all good things because all your body’s trying to do is take the irritants out of its respiratory system, right?  All good things. That’s great. That’s perfect.  During the initial phase, you want to take 500 milligrams of ascorbic acid. I mean I don’t know. I’m not that fancy with my vitamin C.  Ascorbic acid is great. I know that people use buffered and things like that, which is fine too. 500 milligrams every two to three waking hours. It comes up to 4,000 to 5,000 milligrams a data by the time it’s all said and done. There is no softening in the stool in many patients that I’ve done this with with up to 5,000 milligrams a day. I think it’s about 10,000 that you start seeing softening in the stool, which is just a sign to back up a little bit.

Dr. Weitz:                  Right.

Dr. Espinosa:             Right. IV vitamin C, whole different story other than you can use it for prevention. You can use it during its initial phase. Certainly, it’s the main thing I would use during the more critical phase of an infection, which everybody is realizing that now, that you can use IV vitamin C in the more critical stage of a viral infection like COVID-19.

Dr. Weitz:                  When you talk about the fact that initially, the virus ends up in our respiratory passageways, and our nose, our month, et cetera, I’ve seen that you’ve recommended some of these spray, herbal products. That’s one of the reasons why you like those, these sprays with the-

Dr. Espinosa:             Man, I practice what I preach, brother. I practice what I preach. Here you go. This is one of them. I’m spraying every couple hours.

Dr. Weitz:                  Yeah, I’m doing the same thing. I wasn’t actually doing it until I read your article. Now, I’ve got some of those products on backorder. Should be coming soon, but I got the Wise Herbals, Wise Herbal women one that has echinacea and a few other herbs.

Dr. Espinosa:             It has a-

Dr. Weitz:                  And I’m using that.

Dr. Espinosa:             It has several botanicals that just… The reason why I’m not out of stock is because I order about 10 of these bottles or 10 and the Wise Women every year right around late September, getting ready for flu season. I have a flu season protocol for my own personal use and my family’s that I order. That’s the only reason because all these things are out of stock.

Dr. Weitz:                  Yeah. No, I know.

Dr. Espinosa:             Yeah.

Dr. Weitz:                  Yeah. We’ve been trying to order some of those. I do have some Immunitone, and I got some ImmuCore® coming from Metagenics, which is kind of nice combo product.

Dr. Espinosa:             Awesome, awesome, awesome.

Dr. Weitz:                  Yeah. We’ve been recommending those quite a bit.

Dr. Espinosa:             So going back to lifestyle, and we’ll hit nutraceuticals again, but going back to lifestyle.

Dr. Weitz:                  Yeah, so exercise.

Dr. Espinosa:             First of all, if you’re not exercising right now, you are going insane, right? You’re going insane.

Dr. Weitz:                  You can’t go to movies.

Dr. Espinosa:             I mean-

Dr. Weitz:                  You can’t go to the beach.

Dr. Espinosa:             What-

Dr. Weitz:                  There’s a million things you can’t do. Can’t go anywhere.

Dr. Espinosa:             Can’t go anywhere, can’t do anything. This is your time to figure out how are you going to make… I don’t care what kind of a space you live in. This is a time to create something in your home so that you become a no excuse person with regard to exercise. There is absolutely no excuse. The physical benefits are extraordinary. The psychological benefits might be even better than the physical benefits, believe it or not. So we were talking about this, Ben, before we started recording. I’m exercising every day, sometimes twice a day just because… Nothing to do with aesthetics. Anything that I get physically from an aesthetic perspective is great, but just from my mental well being as I’m here in my home office, and I have three kids. They’re going crazy, right? So they go out in the back. They go out on the trampoline. They come back. They even know, “Hey, I need to get some movement in,” right? So the kids go to the trampoline. They go to my garage. We make something happen. They go for a quick run or something. So exercise is access for the immune system.  Running marathons or anything extreme actually weakens the immune system. Okay. Not that you should not do it. I mean I’ve done those things. I’ve done obstacle courses. A lot of fun and there’s other benefits that is not related to the immune system, but as it relates to physical health and the immune system, ultra marathons, and marathons, and these extreme exercises actually weakens the immune system.

Dr. Weitz:                  So the key for now is really moderate levels of exercise.

Dr. Espinosa:             Moderate and, again, that’s subjective, right? So what does that really mean? Moderate exercise for anybody is five minutes. Now, five minutes is even fine in between, I don’t know, work. Every 90 minutes or so, I stop working, and I do something for five or 10 minutes, whether it’s burpees or something. Here’s what I’ll say. The intensity should be high, but the amount of time should be not exceeding 30 or 40 minutes, 45 minutes. Sometimes I am in the gym for an hour. I take longer between sets. I work on strength training. When you work on strength training, you want a bigger gap between sets and things. It depends what you’re trying to accomplish.

Let’s not make it too difficult for people because then it’s just an excuse to not do it. Get to exercising. Figure out how you can create a gym in your… I had a gym in my apartment where I lived in a two-bedroom apartment with two kids, a family of four. I had a pull-up thing, and I had some kettlebells, and some bands, and some things that didn’t even take a lot of space. I really wanted to make a Ninja Warrior type of facility in my house, but my wife knocked that down. She was not trying to hear that, rings and everything, but, no. That didn’t fly. She said, “You have the garage. You can do whatever you want in there in the one-car garage, the other garage for the other car. you can do whatever you want there.”

Dr. Weitz:                  Yeah. I was never able to turn the backyard into a putting green either.

Dr. Espinosa:             I wanted to, man. I still want to. We’ll see. We’ll see. Exercise very important, then food. Now, this is debatable. Somebody may say to me, “Geo, you’re crazy. You mean to tell me eat like crap, but exercise and sleep, and you’re fine?” Look, again, it’s very difficult, but people need to… We, as practitioners, need to set up our patients for success, not failure. Sometimes we just add too many things to the mix, and I think that becomes challenging. So that’s that.  From a food perspective, intermittent fasting is a good thing, intermittent fasting. The more and more I read on this, the better it is, certainly from a longevity perspective. Whether it has immuno benefits, I’m not exactly sure. I know that when we have a viral infection, we want to eat less, right? So that’s the less taxing to our system so that the body could do its work and get rid of the infection.

Dr. Weitz:                  Yeah. Essentially, the body has so much energy, and if it’s not spending that energy on breaking down, digesting, assimilating, absorbing your food, it can use that energy for immune function.

Dr. Espinosa:             Correct, and just healing in general. So intermittent fasting is good. Now, I probably said how I use my supplements, and I do my sprays, and I exercise. I do intermittent fasting, but definitely the biggest challenge for me is… I’m just being transparent. The beginning challenge for me is not eating. I love to eat. I love to eat. When I’m doing intermittent fasting, I have to be super, super mindful of doing it. I actually like the ProLon approach, doing the five days, they send your meals per day, make it easy. Fasting Mimicking Diet, I actually like that approach as well. I have no financial connection with FMD or ProLon. I wish I did, but I don’t. I like their program because it just… For people like me, which that is my biggest challenge, it just makes it a little bit easier. That’s that.

Refined carbohydrates, and sugars, and things like that, those are your immune weakening foods. There’s no other way around that. Now, holistic, but realistic. Everybody’s at home. Where are you doing to counter the anxiety and distress from being at home? Many people are just eating a lot, anxiety eating, and many people are eating crap. Look, my 15-year-old daughter comes back with a bag of Pepperidge Farm chocolate chip cookies the other day. She’s like, “Dad, don’t even try it. Just leave me alone.” Guess what? I left her alone.  I get it.  I’m like, “Honey, I get it. Pass me one of those cookies.  I get it.  Just pass me one and take it away from me.”  I get it.  I get it.

What I would say is everybody has, I don’t know, four things that are important, the four things that they’re able to do, they’re willing to do. Have at least two things that you are on it, that you are, “I don’t even have to think about exercise.  I’m going to do it.  I don’t even have to think about sleeping at least seven hours. I know I’m going to do it.”  Then the other two, you work on it.  You don’t have to be perfect, but you work on it.  Likely what would happen is that all the right things that you do counteract the things that you don’t do right.  Look, Ben, in our field, I’m behind the stage with many people giving talks and everything. Let’s just be real here.  We have the guy that eats perfectly and plant-based, but drinks like a fish, right?  Or the other guy that does… and smokes pot like a maniac. I don’t care what you think about pot, its medicinal values of cannabis, you do too much of it, it’s not a good thing.

Dr. Weitz:                  Absolutely.

Dr. Espinosa:             We all have our vices, and so it’s very important to be aware of the vice.  Look, when I have a 73-year-old person that smokes cigarettes, I can’t tell them to stop smoking. I mean how-

Dr. Weitz:                  Why can’t you?

Dr. Espinosa:             Well, I don’t, and here’s why. 73 years old.  This is actually a real case.  He smokes a half a pack to a pack a day.  That’s a hard sell.  He’s been smoking for 50, 55 years.  I cannot guarantee that at that age, I will prevent him from lung cancer, emphysema or any… even if he stops smoking right now.  I understand what the smoking does and the instant gratification that it provides.  Now, 53 years old, different story.  Young, different story.  You have to stop smoking, but a 73-year-old, this is my opinion, I just don’t want to set them up for failure.  What’s going to happen in that situation is the one-

Dr. Weitz:                  Maybe the coronavirus though is an excuse to recommend not smoking because even if he’s already setting himself up for cancer, for smoking for 30 or 40 years, he might increase his ability to recover from the coronavirus if he’s not actively smoking.

Dr. Espinosa:             Oh, recover from the coronavirus, 100%, but that’s exactly right. You’re already diagnosed with something. When they come in, he’s 73 years old, relatively healthy, “I smoke a half a pack day.” There’s no real incentive. Plus the cigarette smoking brings him so much pleasure and relief. So I have him take vitamin C. Those that smoke have less vitamin C, lower vitamin C levels in their bodies relative to those that don’t smoke. So selenium and all those things that we can talk about. I have him do that, and I do have him be mindful so that he does not smoke.  I think the poison is in the dose.  The poisonous dose may be anything, but certainly, the more you do, the better.  I’m just bringing a scenario where I think it’s very important for us not to… be real with ourselves as practitioners who practice lifestyle functional medicine, integrative medicine.  Let’s be real with ourselves.  Then let’s be real with our patients to not set them up for failure.  I do believe in the power of nutraceuticals even though they’re fourth on my list.  I do believe that between two or three things that you do really well, it counteracts a little bit of the other stuff that you don’t do perfectly well.

Dr. Weitz:                  Sure. That’s a reasonable approach and then-

Dr. Espinosa:             I think so.  I think so.  It’s worked out, and my patients do amazing, amazingly well.  Whether it’s prostate cancer or prostate issues, they just do really well.  I guess with the food component, I don’t want to harp on because that could be a podcast all in its own. The main thing is what you stay away from is refined carbohydrates as much as possible. Intermittent fasting is a good thing. General recommendations are plant-based diet that includes some sort of high-quality animal products, primarily fish. That’s just general immune-boosting, immune-enhancing protocol in general.

Dr. Weitz:                  Yeah.

Dr. Espinosa:             Then we could dive right into nutraceuticals if you want.

Dr. Weitz:                  Okay. Hey, just before we do that, I know there’s been some discussion, and I know you’ve written about the issue, about some of the blood pressure meds and ibuprofen and whether or not those increase or decrease your likelihood of getting infected or your response. It seems to be going back and forth. What’s your latest perspective on that?

Dr. Espinosa:             All right. We know that the virus gets into our system. It attaches to the ACE2 receptor in our lungs. That’s how it gets into the cell, right? We know that. There’s certain things that increases ACE2. There are other things that decrease ACE2 receptors. Then a few weeks ago, French government said, “No more ibuprofen.” Then so did-

Dr. Weitz:                  World Health Organization.

Dr. Espinosa:             … World Health Organization. Then they kind of, a day later or so, “I take that back. We jumped the gun. There’s no evidence to support that.” The truth of the matter is that just if you have more ACE2 receptors does not mean that you’re more prone to a COVID-19 infection relative to having lower ACE2 receptors. There’s nothing to prove that. More ACE2 actually can be protective in another, different mechanism where there’s less inflammatory response by having more ACE2 than not having as much ACE2 receptors. That’s that.  What the French government said is, “No more ibuprofen,” because ibuprofen was shown in The Lancet to increase ACE2 receptors in The Lancet. My overall takeaway is this with NSAIDs in general. It’s not a good idea to… First of all, let the fever ride. Let the fever ride. Lord, are you seeing this?

Dr. Weitz:                  Our society has such a problem with that. I talk to mothers all the time, and they’re freaked out. Their kid has a fever. What is the fever? 101. That’s okay.

Dr. Espinosa:             What I tell parents, and I don’t see kids, but friends and things. “Geo, my kid… Oh, god. He looks horrible, 102.” I said, “Well, give him Tylenol. When you’re giving them Tylenol, you’re giving it to yourself. You’re not giving it to him. I just want you to be aware of that. You’re giving it for you to feel better, not for the kid to feel better. As long as you understand that because they’re going to look better once they take Tylenol, okay? I’m prescribing it to you, not to the kid, but you give it to the kid.” You got to let the fever ride. That’s number one, and the aches and things.  I had a patient with COVID who was taking Tylenol and excessively. I said, “Look, there’s no way of us to know if you’re doing better or not because you’re disguising what’s really happening. The fever actually tells you that you’re still fighting something, and it’s actually helping you fight the infection.” He was taking it too much. I said, “Well, look, just take it at night before going to bed so you can sleep better. That’s it. You’ll be able to sleep better by taking Tylenol at night, acetaminophen.” He did. He took it once a night. Then he stopped taking it, and he’s doing much better. Now, we know that he’s doing better from COVID. So take-

Dr. Weitz:                  Of course, the potential downside is acetaminophen can inhibit glutathione production and that’s super important for immune function.

Dr. Espinosa:             100% and not to mention in higher dosages, above 3,000 milligrams per day, liver hepatotoxicity. Look, let the fever ride. Look, I’m agnostic. I am agnostic. I only care for what works. It just so happens that in my, yeah, biased opinion and even unbiased opinion, natural therapeutics work very well before you need the stronger guns. I’m very agnostic as it relates to what is it the patient needs and how can we provide them with whatever it is they need that has the least amount of side effects. That being said, but I don’t recommend NSAIDs in patients who have fevers because that does weaken the immune system. It weakens immunity. NSAIDs do, so I do not recommend NSAIDs for that purpose. I recommend, if anything, acetaminophen, but even then, let the fever ride, the certain nutrients, hydration, and just sleep, and rest. That takes care of its own right there. Yeah, that’s the ACE2, ibuprofen response then.

Dr. Weitz:                  Then I guess we’re also going back and forth on whether taking ACE inhibitors and ARBs, angiotensin response blockers, which are blood pressure medications, whether they also play a role, positive or negative.

Dr. Espinosa:             Well, I’ve had that scenario. Again, we don’t know. Some would argue that having ACE inhibitors actually helps.

Dr. Weitz:                  Yes.

Dr. Espinosa:             So that’s beyond my pay rate. In that scenario, I said, “Don’t get off your ACE inhibitors since we don’t know, number one. Number two, your body may be very dependent on it. Just talk to your cardiologist. Apply the other things that I know they help with blood pressure of the [crosstalk 00:49:31].”

Dr. Weitz:                  Right. The last thing you want to do is survive COVID and die from a stroke or something.

Dr. Espinosa:             That would be horrible. That would be horrible. You don’t want to be liable as a practitioner. That’s a scenario. Yeah, I don’t know whether ACE inhibitors help or hinder the process and at this point. I just have them talk to their… Again, what we do for blood pressure is amazing, Ben. I mean we can really treat blood pressure. I’ve done it.

Dr. Weitz:                  Absolutely.

Dr. Espinosa:             I come from a family history of high blood pressure, everybody, brother, sisters, parents. My blood pressure has been roughly 120/85 for a long time. I measure it all the time. I drink a decent amount of coffee, so this is not affecting my blood pressure much. I think it’s because many reasons. Other things that I do that’s beyond what we’re talking about now, but we can bring down blood pressure very effectively and efficiently with natural therapeutics. Other nutraceuticals?

Dr. Weitz:                  Okay.

Dr. Espinosa:             My go-to so mineral-wise is selenium and zinc. Selenium actually has antiviral properties as well. So it’s not only immunomodulatory. It also has antiviral properties. There’s a lot of research on selenium, some of which I highlighted on my article on drgeo.com, and I have links to papers. I have actually a book that I wrote several years ago on selenium that I never published, kind of put it on the shelf. So I’m pretty versed on selenium. Bottom line is this. You could do 200 micrograms a day. That’s plenty. If you go up to 400 micrograms, that’s fine. It’s very difficult to get the disease called selenosis from too much selenium. The symptoms are brittle nails, and very flaky skin, and sort of extreme fatigue. Very difficult to get to that point, but more than 400 micrograms a day is just not necessary. There might be no return on that investment. So 200 micrograms a day is perfect of selenium.

Dr. Weitz:                  Good.

Dr. Espinosa:             Zinc, very important. You could do zinc lozenges are good. You could go up to about 60 milligrams a day. Some would say maybe even up to 100 milligrams a day without needing extra copper. Once you go up beyond, in my opinion, 60 milligrams a day, you need about one milligram of copper just so that there’s no copper deficiency. I only do about 30 milligrams of zinc a day actually. I don’t do more than that.

Dr. Weitz:                  Yeah. For example, I have a gene that it makes it difficult for me to absorb zinc.

Dr. Espinosa:             There you go.

Dr. Weitz:                  So typically, if I do a micronutrient or I do a NutrEval, a lot of times, zinc’ll be one of my biggest deficiencies, so I have to hit the zinc a little harder.

Dr. Espinosa:             Thank you for sharing that. Everybody has their own individuality as it relates to… How did you find out about your genetic ability to not absorb zinc?

Dr. Weitz:                  I took my raw data from 23andMe, which I did a few years ago, and I put it through that PureGenomics® analysis. If you have an account with Pure, they have that software. That works pretty well.

Dr. Espinosa:             Yeah, yeah. Good, good, good. Vitamin D, particularly during this time of the year, I know that over there in California, it’s so beautiful and sunny. Over here, it’s not as much. Even if it was beautiful and sunny, we still need some vitamin… We spend too much time indoors.

Dr. Weitz:                  I got to tell you. Despite being in Southern California where we have lots of sun, we’re seeing 60% of people have either borderline or moderately low levels of vitamin D. It’s weird. They should be high, but they’re not. Then you often hear doctors make these modest recommendations to take 500 or 1,000. There are a few patients who the levels’ll shoot up, but for the most part, I find it’s really difficult to get into that what I consider the ideal, optimal range. Depending upon the person, somewhere is between 50 and 70.

Dr. Espinosa:             Yeah, yeah. Modest between 40 and 60, but I think doesn’t really matter. Let’s say between 40 and 70, let’s just say. As long as they’re-

Dr. Weitz:                  I know for women, there was that paper that showed that women who had their vitamin D level above 60 had a lower risk of breast cancer, and that made me kind of want to push it.

Dr. Espinosa:             There you go. Maybe I just missed that paper because I don’t see many women at all actually in my practice. I just kind of stay in my lane and try to get the-

Dr. Weitz:                  Absolutely. Well, that’s why you’re a genius about men’s health. You got to-

Dr. Espinosa:             Thank you. Thank you.

Dr. Weitz:                  There’s so much data. It’s hard to keep track of it all.

Dr. Espinosa:             That’s right. That’s right. I start everybody between 4,000 and 5,000 units a day, period. I don’t care how much you weigh.

Dr. Weitz:                  I-

Dr. Espinosa:             I don’t care anything. 4,000, 5,000 a day.

Dr. Weitz:                  And always include vitamin K with that to prevent the arterial calcification.

Dr. Espinosa:             Yeah. I include K1 and K2 with vitamin D. Yeah, that’s right. Super important for immunity. If we’re looking for prevention, then vitamin C… I’m sorry to go back, but it just does so many things. It actually helps with stress. Vitamin C helps with stress. It’s a precursor to certain endorphins and certain hormones that are really important to help us modulate stress, so vitamin C. I’ve always been a big fan, and I’m glad that this is getting the notoriety that it deserves because I think that everybody should have vitamin C a day. I think just normal, it’s 1,000 milligrams a day. Maybe 500 twice a day. If I had to prioritize the nutraceutical list, I would do something that contains… A good formula contains all the minerals you need, selenium. I like selenium from selenized yeast as I touch my face again. You’re not supposed to do any of that, right? I mean come on. I’m about to take another vitamin C. You can’t. You just can’t stop. Man, all right.

Dr. Weitz:                  On the other hand, it’s kind of fun. I’m good now pushing the elevator buttons with my knee. It’s kind of an exercise. Get up to that up level.

Dr. Espinosa:             Right, exactly. It’s a challenge, right? I got to open that slim doorknob with my elbow. Let’s see if you can do this. We all have more time in our day now to figure things out and make things interesting. We use a lot of the different formulas that have your selenium. Oh, selenium. I use selenized yeast, high selenized yeast as my favorite form of selenium. Again, mostly because 1996, the was a JAMA paper that showed that this particular form of selenium reduced the risk of prostate cancer by up to 60% in a group of patients. They were looking at other things, but they saw a reduction risk of different cancers including prostate cancer by about 60%. At least the prostate cancer arm, that was the conclusion. So this is the type of form that I use. I don’t use a lot of selenomethionine in and by itself. High selenized yeast has a couple of different types of selenium, selenomethionine, and things, and Selenocysteine that kind of work together. It’s more food-like in the sense that it’s not just one type. They work synergistically together. So that’s the form that I like best, and I use formulas for that. That includes zinc. That includes vitamin C and the biggies for immuno support.

Dr. Weitz:                  You include vitamin A in your immune support?

Dr. Espinosa:             I don’t. But it is good. It was one that I was going to mention. Vitamin A, I don’t include it. I think it’s just bias. No real good reason, right? Back in the day when I was studying nutrition, too much vitamin A does this, that, and the other. I was like, “Yeah, I’m not going to use it. Hopefully-“

Dr. Weitz:                  Well, they say the same thing about vitamin D too.

Dr. Espinosa:             Yeah, exactly. Correct. I don’t use vitamin A unless there is some in a multi that I would use, and I don’t use more than that. I can’t even say that I am that versed. I know a lot of our colleagues have written about it, and it’s one of the things that I use. It hasn’t been mine. Yeah, yeah. I don’t have a good reason. I don’t have a good scientific, unbiased reason for not using vitamin A actually.

Dr. Weitz:                  Right, okay. So-

Dr. Espinosa:             I have to say. Plus I also look at everything, including viral infections from a prostate perspective. So specializing is a good thing, but your lens tend to be everything looking at it from that perspective, either a prostrate or a penis perspective. If we could take care of the prostate and the penis, we know we can take care of the whole body. Sometimes it just gets a little bit silly, that form of thinking. That’s why zinc and prostate, strong connection. Other than thymus, in a man’s body, it’s mostly… The other place where you’ll find a lot of zinc is in the prostate. Selenium for selenized yeast, anti-cancer properties and things like that. So botanicals-

Dr. Weitz:                  What about NAC for immune support?

Dr. Espinosa:             Good. Optimizing glutathione levels are good. I use actual glutathione like-

Dr. Weitz:                  Liposomal, yeah.

Dr. Espinosa:             Yeah, yeah. Then NAC actually can reduce the fluid accumulation in the respiratory system in the lungs. Yeah, NAC is actually very good for that specific purpose actually, so I would use it. I have not had to, but in cases where some patients, you can hear that they’re very phlegmy and very congested, I use NAC for sure. Yeah, that’s very good. Yeah.

Dr. Weitz:                  There seems to be some data showing that glycyrrhizic acid from licorice fruit has some benefit in cases like this, right?

Dr. Espinosa:             Yeah. Moving onto botanicals, yeah. Glycyrrhizic acid is… and it seems to be helpful. However, glycyrrhizic acid can increase blood pressure as well, so [crosstalk 01:00:55] of that.

Dr. Weitz:                  I think the benefit can be because it could support cortisol levels. So you get that anti-inflammatory effect.

Dr. Espinosa:             Right, right. Correct, correct. What I prescribe from botanical perspective is, uh oh, get ready for this, elderberry. Oh my god. Elderberry. Wait a minute. Cytokine storm, cytokine storm, no, no.

Dr. Weitz:                  Well, what’s the-

Dr. Espinosa:             Unbelievable how bad information can get-

Dr. Weitz:                  Yes.

Dr. Espinosa:             Can get so much attention. It’s unbelievable. I can’t tell you the amount of emails and texts I got once that… having to answer elderberry. So much so that I just had a copy and paste little thing for email and texts. I was like, okay, just copy. Paste it, paste it, paste it. Unbelievable. Unbelievable.

Dr. Weitz:                  Yeah. Fortunately, our friend, David Brady, did a webinar that was posted on Facebook where he really, I think, set things straight on that. He along with Todd LePine and Dr. D’Adamo.

Dr. Espinosa:             Yeah, I saw it. Very good. These are brilliant guys, and it was very, very good. Also, Donny Yance, he’s a herbalist out in Oregon.

Dr. Weitz:                  Yeah, I’ve heard of him. I’ve heard him speak.

Dr. Espinosa:             He wrote something very good on this whole thing. I just wrote one or two sentences because my intention is not to focus just on that. The bottom line is this, it does not do that. First of all, no botanical can induce a cytokine storm. It doesn’t do that. First of all, it has great antiviral benefits. Whether it has good COVID-19, we don’t know. We don’t know what works, so we just trying to build the body. I do use elderberry because it may indeed have anti-COVID-19. If it doesn’t, it’s doing other things that are fine. It can induce some cytokine scenario in the body, but it does it during its initial phase. Cytokines is a very important situation. Cytokine production is very important across draw in more immune cells to fight the infection, so cytokine is a good thing until it’s not in its later phases and stages. The production of cytokines during its later stages, it’s like 1,000 times more than during its initial phase, which elderberry does not do. So it’s a little bit silly to… I use elderberry.   A couple of other herbs that I use is botanical is Andrographis. Great. It’s been around for a long time. Certainly, in our pharmacopeia, we’ve used it for a long time during flu season and things like that. So Andrographis is one that one should consider. Astragalus, excellent. Excellent immunostimulatory antiviral benefits. Echinacea’s very good. I like larch arabinogalactan as an antiviral. It’s been around. Good research on that too. I have a couple of links on drgeo.com with regards to larch arabinogalactan as well. Actually, the person who introduced me to larch arabinogalactan back in the day was Peter D’Adamo. Before I went into naturopathic school, I actually worked with Dr. D’Adamo with his-

Dr. Weitz:                  Oh, cool.

Dr. Espinosa:             His book had just come out in 1997, and he hired me around 1998 as I was taking pre-requisite to go to naturopathic medical school.

Dr. Weitz:                  Interesting.

Dr. Espinosa:             He’s the one that put me onto larch arabinogalactan back in the day.

Dr. Weitz:                  Cool.

Dr. Espinosa:             He wrote a lot of papers on it. Yeah, I’m surprised he didn’t mention it during that… Actually, I have to ping him. I say, “You are the larch arabinogalactan guy. Why didn’t you mention it?” Actually, I’m actually going to ping him and ask him about that. That’s another one that I find useful. I use formulas, Immunocore or Immunitone Plus by the good companies. Daily Immunity by Pure Encapsulations I find to be helpful. Biotics Research has a couple of good ones. ViraCon by Vital Nutrients is actually very good. By the way, I have no connection with any of these companies financially. I just mention them because I use them quite a bit. Those are good-

Dr. Weitz:                  Quercetin has gotten some attention for its potential ability to fight viruses. I think it’s been shown to help fight some other coronaviruses.

Dr. Espinosa:             And it’s good for prostatitis.

Dr. Weitz:                  Okay. There you go.

Dr. Espinosa:             I’m working on a benign prostate formula to help men who have prostate issues that include urinary, and quercetin is a major component of that formulation. Yes. Quercetin, there again, you look at quercetin, and you don’t acknowledge it for its antiviral benefits, but it’s… First of all, I haven’t looked into antiviral botanicals specifically. Yeah, I knew astragalus, but specifically in a long time because we have not had this issue. Now, people are like, “Wait a minute.” I have old textbooks, and I’m looking at this. So quercetin.  Resveratrol, which I use for male sexual health because it helps with nitric oxide production in the endothelial cells of the blood vessels. Resveratrol actually may have anti-coronavirus properties.

Dr. Weitz:                  Absolutely, absolutely. It’s actually used in some botanical antimicrobial, anti-Lyme formulas. I know Stephen Buhner uses it in his protocol for Lyme.

Dr. Espinosa:             Right, right. Again-

Dr. Weitz:                  It’s usually referred to as Japanese knotweed.

Dr. Espinosa:             Japanese knotweed, right. Or it’s usually referred to as red wine except that you need a couple of bottles to get enough resveratrol. Some people say, “That’s no problem. You bottle the [crosstalk 01:07:13]. Awesome. I can do that.”

Dr. Weitz:                  There you go.

Dr. Espinosa:             I can do that. I have had to look. Really, I had to go back. I wrote about how viruses work, and I forgot a little bit. I’m not an infectious disease doctor, right? So I had to go back and think because that’s how my… How do these things or how do they get in in general? Okay, how does this particular virus gets in? Then we learned about ACE2, and ACE2 receptors, and so forth. Fascinating. So I had to look at everything that’s possible from a natural, a materia medic perspective, and resveratrol came up, quercetin. I know there’s a link there. Quercetin, very good. About 300 to 500 milligrams once or twice a day is what I use there. Resveratrol, I use attribute 200 milligrams a day or 200 milligrams once or twice a day. I don’t know what’s a dosage for antiviral benefits, by the way. This is just, in general, what I would use.

Dr. Weitz:                  Right, cool.

Dr. Espinosa:             Yeah.

Dr. Weitz:                  Well, that’s been great. Dr. Geo, we’ve covered a lot of really good, useful information. Hopefully, some information help people calm down a little bit and feel a little more secure about strengthening their bodies to deal with whatever might come their way including coronavirus.

Dr. Espinosa:             I think that’s the biggest takeaway, Ben. I believe this is the biggest takeaway. Starting now and certainly, once this is over, hopefully over, whatever that means, we need to take better care of ourselves. We need to strengthen our bodies. The more we do that, we would reduce our risk of almost anything. Whenever we are affected by anything, our bodies will be able to fight it, and even if we need a surgical procedure or something, our bodies will be best able to manage that. So it behooves us to sleep well, eat well. I don’t even talk much about stress because if you sleep well, exercise, and eat well, and take the right nutrients, you don’t stress as much because your perspective changes.

Dr. Weitz:                  Right. By the way, just one more thing, another role that I think functional integrative medicine’s going to be really important is the data seems to be showing that a percentage of these patients who recovered from the coronavirus actually have some damage to their lungs. That’s a natural approach could potentially be beneficial in helping to get them back to full health.

Dr. Espinosa:             That’s right. We’ll wait and see what the data shows years from now, but so far, we’re seeing there is continuous damage to the lungs even after they recover from the coronavirus. I think that this is prime time for our field, and all the wonderful things, and all the tools we have in our toolboxes to help our patients and to help ourselves too. I’m pretty excited about that. By default, I’m becoming a little bit of a COVID-19 expert. Everyone is, I think. I’m going to stay in my lane. I’m going to do prostates and men’s health, but again, there is a connection just because men are just more predisposed to all infectious diseases, and they die from almost all of them more so than women. That’s my next piece that I’m writing, the connection between viral infections, COVID-19, and men. So stay tuned for that.

Dr. Weitz:                  Oh, excellent, excellent. For patients and viewers who want to get a hold of you, seek you out for men’s healthcare, how would they get a hold of you?

Dr. Espinosa:             Drgeo.com is the best contact and the best page from me. It’s D-R-G-E-O dot come, drgeo.com.

Dr. Weitz:                  Great. Thank you so much, Geo.

Dr. Espinosa:             Hey, Ben, thanks so much. It was a pleasure.

Dr. Weitz:                  It was fun. Be safe.

Dr. Espinosa:             You too.

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

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Small Intestinal Bacterial Overgrowth Clinical Guidelines: Functional Medicine Discussion Group of Santa Monica
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Dr. Allison Siebecker discusses clinical guidelines for treating patients with Small Intestinal Bacterial Overgrowth with Dr. Ben Weitz as part of the Functional Medicine Discussion Group meeting.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, 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

 



Dr. Allison Siebecker is a Naturopathic Doctor and Acupuncturist and she is very passionate about education.  She specializes in the treatment of Small Intestinal Bacterial Overgrowth (SIBO) and she teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO on her website, siboinfo.com. Dr. Siebecker has an excellent course for practitioners to learn more how to treat patients with SIBO, the SIBO Pro Course.  If you use the discount code “ben” you can save $700.

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 or go to www.drweitz.com. Dr. Weitz is available for consultations via video or phone.



 

Podcast Transcript

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Dry Eyes with Dr. Jenna Zigler: Rational Wellness Podcast 150
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Dr. Jenna Zigler talks about having problems with Dry Eyes and what to do about it with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on YouTube at https://www.youtube.com/user/weitzchiro/]

 

Podcast Highlights

3:12  The most common symptoms of dry eyes are burning, irritation, that feeling that you have something in your eyes, redness of the eyes, redness of the eyelid margin, and blurred vision.  There are two common forms of dry eye: Evaporative and Aqueous deficiency.  Evaporative dry eye means that the front of your eyes are evaporating more quickly than they should, so you might have tears but they’re gone within seconds.  This is due to dysfunction of your Miebomian glands, of which you have 31 on the top and 31 on the bottom of your eyelids. These meibomian glands are supposed to secrete an oil into your eyes, but these glands can become clogged or dysfunctional.  Bacteria tends to build up on our eyelids and if we don’t control it and don’t maintain the good bacteria and get rid of the bad bacteria, that bacteria can start building a biofilm.  And this biofilm can affect the Meibomian glands and block the oil from coming out. The oil can harden and stagnate and then those glands stop working and eventually they atrophy.  Another factor is that we should be blinking frequently and when we spend too much time watching a computer screen, an ipad, or an iphone, you’re blinking a lot less. If you are working on a screen for a while, you should take a break every 20 minutes and get up from your desk or at least look 20 feet away and let your eyes rest and consciously blink.

10:50  Ultraviolet light has a negative effect on the eyes.  Heat applied directly to the eyelids can help the oil to flow from the Meibomian glands, along with gently massaging the eyelids. There are devices that can be used in optometrist offices like LipiFlow that clamp around your eyelids and heat them up and then perform a pulsating massage to pump out the oil. You can apply a warm compress and then do a gentle massage from the crease just above your eyeball down toward your eyelashes and then do the opposite on the bottom of the eye upwards.

15:02  The second form of dry eye that many people have is called aqueous deficiency. This stems from the lachrymal gland. We have a lachrymal gland for each eye, up in your eyelids there. Basically, that secretes the watery portion of your tears. Anything that affects the lachrymal gland can affect that watery portion of your tears, and aging is one factor.  Lasik surgery or any type of surgery on the eyes that disrupts the corneal nerves on the front of the eye. When those corneal nerves are disrupted, then your lachrymal glands don’t get a signal that your eyes are dry, and so they stop producing the tears that your eyes need.  Before patients get Lasik surgery they should have a good eyelid hygiene regimen in place.  That means at the end of the night, you’re removing all of your makeup and washing your face. You should also use an eyelid cleanser.  Dr. Zigler recommends a hypochlorous acid cleanser, because it’s naturally made by your body and so it’s gentle on your eyes and gentle on your skin. [Dr. Zigler sells such a cleanser, Heyedrate on her website: Heyedrate].  You should make sure that you drink plenty of water, half your body weight in ounces of water per day.  You should also have a healthy diet and avoid processed foods, excess sugar, pesticides, etc. One way is to start your day with a green smoothie instead of having some cereal or donuts.  You need to exercise regularly.

24:16  Demodex mites are mites that live on your eyelashes and burrow into your eyelash follicles.  They are normal and they actually eat bacteria, but it becomes an issue if they become overpopulated.  They can cause inflammation and cause a blepharitis.  They may burrow under your Mebomian glands and clog them up.  Tea tree oil soap can be be used to help control them.

 

 

 



Dr. Jenna Zigler is the co-owner of Eye Love, whose mission is to heal 1,000,000 dry eye sufferers naturally. Dr. Jenna and her husband use the profits from Eye Love to fund free and low cost clinics in Jamaica and in the US. They also started a charity called the Eye Love Cares Foundation, which provides exams, glasses and sunglasses for those in need, free education, and scholarships for students that align with their mission. Their website is Eyelovethesun.com where you can order their products, including the Heyedrate Lid and Lens Cleanser.

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 Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to leading health and nutrition experts and researchers in the field, to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.  Hello, Rational Wellness podcasters. Thank you so much for joining me again today. Please go to Apple Podcasts or wherever you listen to your podcasts and give us a ratings and review. We really appreciate that. If you would like to see a video version, go to the YouTube page, and if you go to my website, drweitz.com, you can find detailed show notes and a complete transcript.

Today, we will be speaking about eye problems, with a focus on dry eye. As we record this, we’re in the midst of the coronavirus pandemic right now, and a number of other interviews I’ve had recently have shifted the discussion to make it relevant for immune strengthening.  I admit that today, it’s difficult to focus on almost anything else other than the coronavirus.  It seems to dominate all the health news right now, and understandably so.  But we are not going to change this discussion to make it relevant for this current crisis.  You can think of this discussion as a distraction from the nonstop COVID-19 news, and let’s not forget that constantly washing our hands and worrying about not being able to get face masks or gloves or paper towels or toilet paper or thermometers.  We all have other health concerns besides getting the coronavirus, and dry eyes is one of those.  In fact, if you’re trying not to touch your face to avoid allowing the virus from getting into your system through your eyes, having dry eyes makes this more difficult.

Today we are going to interview Dr. Jenna Zigler, and she previously owned and operated two optometry practices. But she sold them in 2017 to focus on her company Eye Love, whose mission is to heal one million dry eye sufferers naturally. Dr. Jenna and her husband use the profits from Eye Love to fund free and low-cost clinics in Jamaica and the US, and there are increasingly more people in poverty in the US right now.

Dr. Zigler:             Yeah.

Dr. Weitz:            They also … With the approaching 30% unemployment rate right now. They also started a charity called the Eye Love Cares Foundation, which provides exams, glasses, and sunglasses for those in need, free education and scholarships for students that align with their mission, so that’s a great thing. Dr. Zigler, thank you so much for joining me today.

Dr. Zigler:             Yeah, thanks for having me today.

Dr. Weitz:            What are some of the most common symptoms people with dry eye struggle from? And maybe you could explain what dry eye is.

Dr. Zigler:             Yeah. The most common symptoms that people with dry eye will notice are burning, irritation, that feeling that you have something in your eyes, redness of the eyes, sometimes redness of the eyelid margin so right around the eyes. Sometimes they might notice crustiness on their eyelashes. Blurred vision. There are so many things that somebody with dry eyes might notice. It’s really … It can be devastating for some people, because if you can’t see or can’t keep your eyes open, you have a hard time working and functioning in daily life. Dry eye disease is really a multifactorial disease. There are so many things that play into dry eye or have the potential to be a contributor for dry eye disease.

There are really two different forms. The first one is the more common form of dry eye, and this is evaporative dry eye. What this means is that basically, the tears on the front of your eyes are just evaporating way more quickly than they should, so you might have tears but they’re gone within seconds. This is due to a dysfunction in your Meibomian gland. You have these little glands in your eyelids. There are roughly 31 on the top of each eyelid, and 31 on the bottom eyelids. People will lose those glands over time if they don’t take proper care of their eyelids, and there are certain other things that can cause it as well.

But basically, when you have Meibomian gland issues, the oil that those Meibomian glands are supposed to secrete, that’s what keeps those tears intact. When the oil is not functioning or it’s not high quality, then it causes those tears to evaporate really quickly. The second form of dry eye that many people have is called aqueous deficiency. This stems from the lachrymal gland. We have a lachrymal gland for each eye, up in your eyelids there. Basically, that secretes the watery portion of your tears. Anything that affects the lachrymal gland can affect that watery portion of your tears. It might be, aging is a big one. Just aging plays into almost the atrophy of that lachrymal grand.

Then also medications is huge. People don’t realize that a lot of the medications that they’re taking for other different conditions can contribute to dry eyes in that way.

Dr. Weitz:            What are some of those?

Dr. Zigler:             Yeah, so some of those are high blood pressure medications, especially your beta blockers, your … The ones that pull the water out, and all of that.

Dr. Weitz:            Like the diuretics, yeah.

Dr. Zigler:             Exactly. Those diuretics are just pulling all the water out of you, and so that includes your lachrymal glands. Anxiety medications and SSRIs and things like that have a really big effect on the eyes. Then of course antihistamines. If you’ve got allergies and you’ve got dry eyes, it can be really hard to balance that because antihistamines can … They work to dry you out, so they’re going to work to dry out your eyes as well.

Dr. Weitz:            Interesting. Let’s start with the Meibomian gland. These are glands that secrete an oil into the eye, essentially?

Dr. Zigler:             Yeah. Absolutely. They secrete that oil, and they do that every time you blink. You blink your eyes, and that oil is secreted out onto the front of your eye. It becomes a layer of your tear film. It’s the layer that keeps those tears from evaporating.

Dr. Weitz:            What causes that to malfunction? Or for these Meibomian glands to … Do they die, or stop working?

Dr. Zigler:             Yeah. They can. In some people, they can atrophy and completely stop working. Most people don’t lose all of them, so they’ll still have some functioning glands. But there are people out there that don’t have functioning glands.

Dr. Weitz:            What makes them atrophy or stop working?

Dr. Zigler:             Basically, what happens is bacteria on the eyelids, this is the most common cause. Is that bacteria on the eyelids, it builds up. We have natural bacteria on our eyelids, but if we don’t control it and don’t maintain the good bacteria and get rid of the bad bacteria, that bacteria can start building a biofilm. This biofilm is very hard to penetrate. It can start inflicting on those Meibomian glands. It goes down into those Meibomian glands, it blocks the oil from coming out. It causes the oil to harden and stagnate, and then those glands just stop working. That’s how that atrophy occurs.

Dr. Weitz:            Wow, so it’s kind of like a dysbiosis of the microbiome of the eyelids, right?

Dr. Zigler:             Exactly. Yeah. You know, there are a lot of different factors, but that’s definitely-

Dr. Weitz:            Is there some sort of microbiome of the eyelids?

Dr. Zigler:             Yeah.

Dr. Weitz:            Is that something that-

Dr. Zigler:             Yeah.

Dr. Weitz:            Can actually be determined or measured?

Dr. Zigler:             You know, I don’t know if it’s something that can be measured right now. But it is something that, we know that the eye has natural bacteria, and that’s a good thing. It’s all over our body, so it’s all in our eyes and on our eyes. But yeah, keeping that maintained and keeping it at a good level instead of a pathological level is really important for those Meibomian glands. Also things like screen time, for example. We know that when we’re on a screen like a computer, or an iPhone or iPad, or even when you’re reading a book, truthfully. You’re blinking a lot less. So when you’re staring at a screen, you’re not blinking and letting those Meibomian glands release oil. We’re thinking that we’re starting to see Meibomian gland dysfunction in very young patients. Kids and teenagers, because they’re on these devices all day long. Sometimes the average is seven hours a day.

Dr. Weitz:            Interesting. So not blinking.

Dr. Zigler:             Mm-hmm (affirmative). Yeah.

Dr. Weitz:            Wow, so when my wife is telling me something and I keep blinking and she says, “You’re not really listening to me,” my excuse can be that I’m just making sure that my Meibomian glands are working properly.

Dr. Zigler:             Exactly. You’re making sure that you’re getting those full blinks in. It’s really important. Yeah. I mean, one of the things we recommend for people is actually when you’re on your computer all day … Many of us work in front of a laptop or in front of a computer now. Take a break every 20 minutes. Either get up from your desk or at least look 20 feet away and let your eyes rest, blink. Consciously blink. Because we’re blinking all day long, but we’re not consciously doing it all the time. It’s important to get those blinks in and take those breaks from your computer screen.

Dr. Weitz:            What about heat that’s emitted from electronic devices, or even heat that you get exposed to if you’re out in the sun? Or a lot of people are doing red light therapy or a sauna. Can that have a positive or a negative effect?

Dr. Zigler:             There are a couple different things here. I mean, we know that UV has in general a negative effect on the eyes, just because it can cause cataracts and contribute to macular degeneration and things like that. But we know that heat, for the eyelids and for the Meibomian glands, can actually be a good thing, especially when it’s applied directly to them. There are devices out there that kind of clamp your eyelids. There’s one called LipiFlow, and it kind of clamps around your eyelids, and it heats your eyelids up, as well as pulses them. It kind of works that oil out of your glands. That is one treatment for Meibomian gland dysfunction, and it’s a great one.

Dr. Weitz:            But when you say it pulses it, it provides some kind of manual sort of massage or pressure to pump the glands? Is that what’s happening?

Dr. Zigler:             Exactly, yeah, exactly. It’s kind of pumping those glands out as it’s heating up, and the thought is that we want the oil that’s coming out of our Meibomian glands to be the consistency of olive oil. A lot of the time, it kind of becomes the consistency of hardened butter or of toothpaste, and that’s not what we want. The thought is, if you heat up those Meibomian glands, you heat up that oil. It kind of starts to become a better consistency, and then that pulsation can release that oil onto your eyes.

Dr. Weitz:            Interesting. Could you apply hot compresses, and sort of do a manual massage in place of that?

Dr. Zigler:             Yeah, absolutely. That’s something that we recommend. You can do it, I would say no more than once a day, but if you suffer from dry eyes this is something that can help with symptom relief. Use a warm compress. You can buy them on Amazon or in most stores. Put it in the microwave for about 20 seconds, and then just lay it over your eyes for about 10 minutes. Then what you can do is kind of just do a massage of your eyelids. You can just kind of work those oils out.  It’s not going to be as effective as the machines that are on the market, of course. But it’s going to provide relief for many people.

Dr. Weitz:            Those machines, are they for home use, or you go to a clinic to have it done?

Dr. Zigler:             These are mostly clinic, yep. A lot of eye doctors, optometrists and ophthalmologists have devices like that.

Dr. Weitz:            Now, my wife does the opposite. She has this eye patch thing that she puts in the refrigerator, and then she puts it over her eyes to try to decrease wrinkles. Does that have a negative or a positive effect?

Dr. Zigler:             No, you know, I think really it’s all about symptom relief. If she has puffy eyes in the morning, or wrinkling that she’s noticing, absolutely use that cool compress. That’s something that we recommend for people with allergies, because they get a lot of swelling. Then even people that have ocular rosacea, or rosacea in general, can benefit from a cold compress versus a warm compress. Because we know that kind of heat can kind of exacerbate those rosacea symptoms some of the time.

Dr. Weitz:            When you say they do the massage, you’re talking about pushing down on this part, down. What about the part about the eyelids? Are there glands in there too, or none?

Dr. Zigler:            There’s no glands up here.

Dr. Weitz:            Okay.

Dr. Zigler:            But down towards your eyelashes, yeah. Kind of from the crease down to the end is where you want to work.

Dr. Weitz:            And you should push down gently?

Dr. Zigler:            Yep, exactly. Then you do the opposite on the bottom. It’s a little harder on the bottom, but you can kind of push it upward, or just kind of massage down there with it.

Dr. Weitz:            Is that fairly safe for everybody to do?

Dr. Zigler:            It is. Make sure that you keep your fingers clean, of course. Wash your hands. We’re talking about that all the time now, so hopefully you guys don’t have to worry about that too much.

Dr. Weitz:            For 20 seconds.

Dr. Zigler:            Exactly. Be careful of fingernails, of course. If you do have long fingernails, don’t scratch the front of your eye, because that will be the worst experience you’ve ever had. But other than that, yeah, it’s pretty safe.

Dr. Weitz:            Right, okay. Tell us about … Oh, and then we have the other, besides the Meibomian glands we have the lachrymal glands, is that what you said?

Dr. Zigler:            Yeah. The lachrymal glands.

Dr. Weitz:            Okay. What do we know about that, and what causes those to diminish or decrease? Is it the same, or different factors?

Dr. Zigler:             Yeah, so there are a couple of different major factors that can play in. Aging is the first one, and that’s just going to happen no matter what. I think some people are just going to be more susceptible to that than others, just like they are to other disease. But other big ones out there that you might be able to control, the first one is LASIK surgery or surgery on the front of your eyes. Any type of refractive surgery disrupts the corneal nerves on the front of your eye. When those corneal nerves are disrupted, then your lachrymal glands don’t get a signal that your eyes are dry, and so they stop producing the tears that your eyes need. They usually say that this is temporary, and it will resolve itself within six months or so. I will say for the majority of people, that is absolutely the case. They might have dry eyes for a couple of months, and then it’ll resolve itself.

Dr. Zigler:             But for many people that we know, it’s been devastating for them. There, right now, are not a ton of things that we can do for those people. I mean, we can teach them how to live an anti-inflammatory lifestyle, but that will only go so far for people who have dry eye after LASIK surgery.

Dr. Weitz:            Well, what if people were thinking about going into LASIK surgery now? Is there an approach to decrease the likelihood that they’ll have this negative outcome?

Dr. Zigler:             There are. One of the things that I would recommend is the same thing I recommend for people right before cataract surgery, because that’s still cutting into the front of your eye. I would recommend getting a good eyelid hygiene regimen in place. That means at the end of the night, you’re removing all of your makeup really well. You’re washing your face. You’re using an eyelid cleanser. We like a hypochlorous acid cleanser, because it’s naturally made by your body and so it’s gentle on your eyes and gentle on your skin. Just really making sure that you’re keeping that ocular flora in balance, because when it gets off balance is when you’re more likely to have issues afterwards. That’s really the big thing that you can do.

Dr. Weitz:            A hypochlorous acid solution?

Dr. Zigler:             Yep, hypochlorous acid. We have one, and it works really well for people. There are lots of other brands on the market too, and they work really well for most people. Most people don’t have sensitivities to it or anything like that, which is nice.

Dr. Weitz:            Okay. Because acid sounds a little scary around the eye.

Dr. Zigler:             It does, doesn’t it? I know. It’s very, very gentle, so yeah.

Dr. Weitz:            Okay. Tell us about your approach to dry eye treatment.

Dr. Zigler:             Yeah. We really, with every dry eye patient, we start out with the basics. This is going to be stuff that you’ve probably heard before. But we have to start here because so many Americans are living such a horrible lifestyle as far as taking care of themselves. They just don’t take care of themselves. We start out, and we talk about hydration being a huge one. Especially for your eyes, and those that have dry eyes, because when your body’s not hydrated, your eyes, your glands, aren’t going to make the proper tears. We recommend that everybody be drinking … Of course work with your doctor on this, but half your body weight in ounces of water per day. Start there, and you will feel better if you are not drinking any water during the day, I promise.

Then we move into diet changes that you can make. An easy way to make a good diet change is to replace whatever you’re having for breakfast, which is normally eggs, bacon, toast, dairy yogurt, you name it. Donuts, I don’t know. Cereal. Replace that with a green smoothie. Right in the morning you’re getting not only hydration, but you’re packing your body full of greens, full of antioxidants, full of all those nutrients that your body is craving and that your eyes are craving. That really helps a lot of people.

Then we get into talking about processed foods and excess sugar, and things like that. Pesticides. We’re surrounded by that in the grocery store. You go to the grocery store, and all of those middle aisles are full of processed food. It’s hard to stay away from that, especially in times like these. We go to the grocery store, and there’s only so much on the shelves sometimes. There’s not everything that you want to buy. You just have to try to make good decisions in what you’re purchasing. Read the labels. I know nobody wants to read the labels, but it is important.  We talk about exercise, because so many people are sedentary. We talk about just starting out with a walk-

Dr. Weitz:            And now all the gyms are closed, so it’s even more challenging to get your exercise in.

Dr. Zigler:            Exactly. Yeah, it’s amazing. I see way more people out now. We go out every day, a couple of times a day for a walk or a run or whatever, and you see so many people out now, and it’s so refreshing to see. I wish we saw that every other normal day of our lives, you know.

Dr. Weitz:            Of course, that started happening in LA and parks started being packed, and then the mayor said, “That’s it, parks are closed now too.”

Dr. Zigler:            I know, that’s horrible.

Dr. Weitz:            Hiking trails are closed. Beaches are closed.

Dr. Zigler:            That’s horrible. I saw pictures, it was horrible.

Dr. Weitz:            Golf courses now.

Dr. Zigler:            I know. My brother works at a golf course and yeah, they’re closed now. Although you can still go out and play, so that might be …

Dr. Weitz:            How’s that?

Dr. Zigler:            You can go play, but there are no services. You can go out and bring your clubs and play.

Dr. Weitz:            Not in LA.

Dr. Zigler:            Maybe not anymore.

Dr. Weitz:            Not in LA, no.

Dr. Zigler:            Yeah. It’s a little crazy, but do what you can to get some movement in during your day. Then the last big one that we talk about is mindfulness and practicing different techniques that can help you manage stress in your life. There are so many things that you can do to do that.

Dr. Weitz:            What do we mean by mindfulness? Everybody throws that term around, everybody thinks they know what it means.

Dr. Zigler:            Yeah.

Dr. Weitz:            What does it really mean, and how do you apply it?

Dr. Zigler:            What it really means is just being aware of how you’re reacting to things, in my mind. That’s how I kind of define it. If I’m having a crazy day and I find myself getting angry, I know that I need to step away from the situation, and maybe I need to go do a meditation or do some reading or journaling for a while. A gratitude journal is an absolutely great way to think about all of the amazing wonderful things in your life, instead of thinking about the horrible dry eyes that you have.  That’s a way to kind of be mindful about the good things in your life, and it can help to decrease that stress. Other things like yoga, that can be really. We really like yin yoga before bedtime, because it helps to kind of calm the mind, calm the body. It’s mostly stretching, so that’s also good for you.

 



Dr. Weitz:            We’ve been having an excellent discussion, but I’d like to pause for a minute to tell you about our sponsor for this episode of the Rational Wellness podcast. Our sponsor for today is Metagenics, which is a leading practitioner-exclusive nutritional therapy company offering physicians evidence-based formulas to improve their patients’ quality of life. Metagenics provides functional nutrition support to allopathic, integrated, and holistic practitioners alike. Metagenics offers a number of products that support eye health, which is our topic for today on the podcast, including their new fish oil product, OmegaGenics Neuro 1000, which features a concentrated purified source of Omega 3 fats, with 1000 milligrams in each capsule of EPA and DHA. Which makes it easy to get the therapeutic dosage, which a lot of times is 1 to 2000 milligrams a day.

This product is concentrated with 750 milligrams of DHA and 250 milligrams of EPA. It’s also in a natural triglyceride form. Beyond that, Metagenics adds specific antioxidants. Rosemary, mixed tocopherols, and ascorbyl palmitate which is an oil-soluble form of Vitamin C, are added as antioxidants to make sure that the Omega-3 oils stay fresh. This is an awesome product for eye health, and now back to our discussion.

 



 

Dr. Weitz:            Can you tell us what demodex are, and what part do they play in eye health?

Dr. Zigler:            Yeah, absolutely. Demodex, they are an eyelash mite. Exactly, if you’re not itchy yet, you’re going to be itchy soon. Demodex, there are two different types that live on humans and in our eyelashes. These types of eyelash mites basically burrow into your eyelash follicles, and they cause problems, if you can imagine. They feed on bacteria, they feed on-

Dr. Weitz:            I can’t help but have an image of bedbugs in my mind.

Dr. Zigler:            I know.

Dr. Weitz:            These little creatures on my eyelids.

Dr. Zigler:            It’s horrible, and when you start thinking about it … I don’t want people to think about it so much that it freaks them out and that’s all they’re thinking about, because that does happen sometimes. But just think how you have … It’s a normal part of being a human being. We all have bacteria and mites and everything that live on us, and that’s normal. But it’s when they become overpopulated that it becomes a real issue.

They burrow under your Meibomian glands, they clog up those Meibomian glands with … And they go into your hair follicles, that’s where they primarily live. They start to reproduce. They really feed on that bacteria, and they really rely on the bacteria and dead skin cells to live and thrive. By them being there, it’s thought that they cause a lot more inflammation of the eyelids in particular. This can actually lead to different forms of blepharitis, which is eyelid inflammation, and Meibomian gland dysfunction, and then ultimately lead to dry eyes.

It’s devastating for some people. There aren’t a lot of things that we know, as far as controlling demodex. The one thing that we know is tea tree essential oil, is something that you can use to control demodex. Now, tea tree, you do have to be careful with. You can’t just slather tea tree oil on your eyelids, because it’s going to burn like crazy and it is toxic, so you have to be careful with that. We recommend that you just purchase a product that contains tea tree oil, and is made to be used around the eyes.

Dr. Weitz:            Then what do you do with that, exactly?

Dr. Zigler:            There are eyelid scrubs that are out on the market, that contain that tea tree oil. You would just close your eyes, rub in those scrubs, or if it’s a face wash that’s good to use too, that contains tea tree oil. Just kind of rub it into your eyelashes, rinse it off. That can help control the population. If nothing else, it’s definitely going to help control all that bacteria that they feed on, so it will help decrease that population and hopefully help you feel a little bit better too.

Dr. Weitz:            Okay. This blepharitis creates what exactly?

Dr. Zigler:            Blepharitis is an inflammation of the eyelids, and technically Meibomian gland dysfunction. We talked about the Meibomian glands earlier. Technically that is a part of blepharitis. It’s kind of a blanket term for all eyelid inflammation. The eyelids really play a big role in dry eye. People don’t realize how important the eyelids are, but they not only allow us to secrete that oil and secrete the tears that we need, but they’re the main source of the problem a lot of the time. That increase of bacteria, that thrown-off flora, that’s what leads to a lot of the dry eye that we see today.

Dr. Weitz:            Do people cry a lot? Is that beneficial for the eyes?

Dr. Zigler:            That is actually, the tears that you cry because you’re sad are actually a different composition than the tears that your eyes make naturally to lubricate your eyes. They’re a little bit more watery, and so they don’t provide quite the lubrication that your eyes really need. Some people actually find that it’s worse for them if they cry.

Dr. Weitz:            What part does stress play on eye health?

Dr. Zigler:            Yeah. Stress can be really big. I joke that I know that I’m really stressed when I get a sty, because I feel like every time I’m stressed out-

Dr. Weitz:            Can you explain what a sty is?

Dr. Zigler:            Yeah. A sty is basically a bump that forms on your eyelid. It’s kind of like a pimple on your eyelid. It happens when the Meibomian glands get plugged up, and they plug up because of stagnated oil and bacteria, and they start to form this bump on your eyelid. Stress can definitely play a role in this. Stress increases cortisol in your body, which throws off everything else. Throws off your hormones, it can increase inflammation in your body, and so that can absolutely have an effect on your eyes, as well as other parts of your body. Many people will notice, especially with what’s going on right now, that their eyes feel a little bit worse because they are so stressed out from what’s in the media and everything there.

Dr. Weitz:            Why should we be stressed out? The whole world is ending.

Dr. Zigler:            I know, I know. Don’t be stressed out, you get to spend all the time with your family, except then that causes more stress. Like having a toddler in the house.

Dr. Weitz:            You mentioned macular degeneration, and that’s one of the most common problems with aging. What can we do about that?

Dr. Zigler:            Macular degeneration can really be … There are studies that have looked at different-

Dr. Weitz:            First of all, can you describe what it is?

Dr. Zigler:            Yeah. Macular degeneration is just a deterioration of the macula in the back of the eye. The macula is responsible for your central vision. It’s responsible for seeing people’s faces, for seeing road signs, for reading, for all of those things that you use that specific center of your vision for. It’s not going to really affect the vision out to the side, your peripheral vision, as much. Which is a good thing, but it still means that it’s going to make it difficult for you to live your daily life and to do those normal daily activities of living, basically.

This happens mostly due to aging, and it happens because the cells that are in the central macula just start to deteriorate. There’s pigment there that can start to deteriorate. Our macula needs pigment to be healthy, and when that happens, it can lead to inflammation, it can lead to further vision loss. What we know now is that a healthy diet can really help. Those green leafy vegetables, those colored vegetables. Antioxidants and other nutrients are very beneficial. There’s a study out, the AREDS study and the AREDS2 study looked at specific vitamins and minerals that potentially, or they were looking at if they could help in the progression of macular degeneration. It was found that a certain formulation called the AREDS2 formulation now, that certain formulation is beneficial in stopping the progression or halting the progression of those that have moderate macular degeneration.  We don’t know much about preventing it in general, but we know that a healthy diet can absolutely play a huge role in that.

Dr. Weitz:            Can you describe what are the key nutrients in that AREDS2 formula?

Dr. Zigler:            Yeah. It started out with a lot of it is carotenoids.

Dr. Weitz:            Right.

Dr. Zigler:            Lutein, zeaxanthin. You can get those separately if you want to, but they also come in an AREDS2 formulation. Zinc is in there-

Dr. Weitz:            Now, on the carotenoids, I’ve heard some discrepancy. One of them is, let’s see, is it zeaxanthin or cryptoxanthin that comes from corn, is that right?

Dr. Zigler:            Maybe it’s cryptoxanthin.

Dr. Weitz:            Okay.

Dr. Zigler:            Which is … I mean, I don’t know much about that one, but it does scare me a little bit. Just because if it comes from corn, I’m not big on that.

Dr. Weitz:            Right. I’ve heard people say, “Well, I’m using astaxanthin.” That has the same benefits as the zeaxanthin, and lutein. Is that true? Do we know? What do we really know?

Dr. Zigler:            Yeah, I mean, that can be a great benefit. That is a great one, and one that I recommend to all macular degeneration patients.

Dr. Weitz:            Astaxanthin, yeah.

Dr. Zigler:            Yes, definitely, yeah. Then there’s one that’s meso-xanthin too. I believe we don’t know as much about that, but it’s definitely something that-

Dr. Weitz:            I hadn’t heard of that. Where does that come from?

Dr. Zigler:            You know, I’m not sure. I just know it’s one of the other ones that isn’t talked about too much.

Dr. Weitz:            We’ve got these carotenoids, right. Then we also have … is beta carotene part of that, or not?

Dr. Zigler:            It used to be. In the AREDS, regular original AREDS study, beta carotene was a huge part of it. But then they started finding out that in smokers it can contribute … Or even people that smoked in the past, it can contribute-

Dr. Weitz:            The Finnish smokers study.

Dr. Zigler:            Lung cancer, exactly. They kind of, in the AREDS2 study, they looked at if they could take that out, and they did take that out. It’s not longer in any AREDS2 formulation, which is fine. I totally get that.

Dr. Weitz:            Of course, you know, there’s no way that you’re serious about your eye health if you’re smoking.

Dr. Zigler:            Yes, exactly. That’s actually number one.

Dr. Weitz:            And that goes for cigarettes or vaping, and all these people who are vaping who think that it’s better for you-

Dr. Zigler:            No.

Dr. Weitz:            Just give that up right now.

Dr. Zigler:            It’s horrible, yeah. And smoking is … I want to say it’s the number one cause. If not aging, then smoking is the number one contributor to macular degeneration, so stay away from those cigarettes.

Dr. Weitz:            The number one contributor to-

Dr. Zigler:            To everything.

Dr. Weitz:            Everything. Yeah. Huge numbers of cancer, heart disease, on and on and on.

Dr. Zigler:            Yeah.

Dr. Weitz:            What other nutrients are in there? Is vitamin A and D in there?

Dr. Zigler:            So C and E.

Dr. Weitz:            C and E, okay.

Dr. Zigler:            Yeah, those are the big ones. Really, it’s that combination.

Dr. Weitz:            I think there’s a few B vitamins, right? Is biotin one of them?

Dr. Zigler:            That isn’t one of them, I don’t believe.

Dr. Weitz:            No. One of the B vitamins I think is in there.

Dr. Zigler:            B6? I wish I had it in front of me, but yeah.  [The AREDS 2 formula includes vitamins C, E, zinc, copper, lutein, and Zeaxanthin]

Dr. Weitz:            Okay. Okay.

Dr. Zigler:            But I know that B6 and a lot of those B vitamins can be very helpful for the eyes, so yeah.

Dr. Weitz:            Then we have fish oil, is an important supplement for eye health, right?

Dr. Zigler:            Exactly. Fish oil is a very important supplement, and there have been a couple of studies out on fish oil and dry eyes. We’re specifically talking here about triglyceride-based fish oil, so a higher quality fish oil, medical grade fish oil.

Dr. Weitz:            By the way, for those who don’t know. And to be honest with you, over the years the research has gone back and forth and back and forth, and fish oil or fish in the natural form, the fish oil would be in a triglyceride form.

Dr. Zigler:            Yeah.

Dr. Weitz:            But then when they purify it to get out all the PCBs and mercury and all the other things, it ends up in the ethyl ester form, and then if you want to get it into the triglyceride form, you have to go through another process to process it back into the triglyceride form. The controversy is, which is the better form, the ethyl ester form or the triglyceride form? You’re talking about the fact that the triglyceride form may be the better utilized form.

Dr. Zigler:             Yeah. Better absorbed. Most of the studies are done on triglycerides because we know that it’s better absorbed by the body. We found that basically, there was one study that was done with fish oil compared to, the placebo was olive oil. It showed that comparing those two, there was no difference in fish oil for dry eye being better than olive oil. But I have a problem with that study, because olive oil is a very healthy oil.

Dr. Weitz:            Right.

Dr. Zigler:             To compare it to olive oil is, in my mind, just not fair sort of. I mean, it showed that both of them actually improved dry eye symptoms, in different measures that they looked at. That tells me that fish oil is beneficial.

Dr. Weitz:            Yeah. Why don’t we do this? Why don’t we take a McDonald’s cheeseburger and squeeze that out, and compare that oil to fish oil?

Dr. Zigler:             Exactly. That’s what we should do, and that’s what some of the newer studies are actually doing. I mean, they’re not taking the burger, but they’re taking an unhealthy Omega 6 fatty acid, and they’re comparing it to those healthy triglyceride-based Omega 3s. Those are starting to find that absolutely there’s a benefit to increasing [crosstalk 00:37:32]

Dr. Weitz:            You’re talking about something like corn oil. Despite what the American Heart Association says about polyunsaturated corn oil.

Dr. Zigler:             Yep, exactly. Despite what they say, really, the only healthy oils in my mind, there’s fish oil of course. But then avocado oil, extra virgin olive oil, coconut oil. Those are pretty much it. I mean, that’s what we use in our house and that’s what we recommend for our patients.

Dr. Weitz:            Yep, yep. Plus the fats that come from nuts and seeds, and avocado. Yeah.

Dr. Zigler:             Yep.

Dr. Weitz:            Let’s see what else. I know it’s not exactly part of the topic, but I’ve had several patients in the last couple of weeks have these floaters. They see something in the corner of their eye, and it kind of moves around and comes back. What exactly are floaters?

Dr. Zigler:             Yeah. Floaters are … They actually occur inside your eyeball, so they’re in the back of your eye in your vitreous. Those floaters are just strands of different proteins and things like that, that start to accumulate. Because the vitreous inside our eye, as we age, just starts to liquefy, and it starts to form these clumps. Floaters are what you see as those little clumps in your vision. You’re kind of seeing the shadow of what’s in the back of your eye. The majority of the time, they’re absolutely nothing to worry about. But we do occasionally see someone that has a big floater right in the middle of your vision. If you’ve experienced this, you absolutely know, and you won’t be able to see through it. It can be very hard to see through.

Those are the people that we want to see, for sure, in our office, because that’s called a posterior vitreal detachment. Which sounds worse than it is. But it just means that that vitreous is kind of pulling away from the back of the eye, and it’s a normal aging process. Happens in tons of people, and it’s very common. But it can potentially lead to other issues, such as tears in your retina in the back of your eye and things like that. We would just want to monitor you if you have a floater that [crosstalk 00:39:48]

Dr. Weitz:            Is there a treatment for floaters?

Dr. Zigler:             You know, there hasn’t been for a really long time. Now they’re starting to do some laser for floaters. But really, whether it’s incredibly beneficial or not, it’s all patient-dependent. Some people will find benefit from it, other people won’t. It’s not something that’s regularly done. Optometrists usually don’t do it, an ophthalmologist would. But yeah, so that’s out there.

Dr. Weitz:            What percentage of patients of floaters … Will they go away and stay away permanently, and in what period of time?

Dr. Zigler:             Yeah. I mean, normally we want to see you back. If you have a big floater and you have a posterior vitreal detachment, we would want to see you back in about six weeks, because during that time is usually when if you were going to have a further issue like a retinal tear, that’s when that would happen. For the majority of people, usually within six months or so, those floaters are just going to kind of go out of your vision. Your brain is going to kind of get used to it too, so that helps a little bit because your brain will just turn off to that floater. Some people will just have more issues than others with noticing it and things like that. Probably if you’re more analytical, you’ll notice it more than other people. Yeah.

Dr. Weitz:            If somebody goes for an annual eye exam, will they learn about some of these issues you’re talking about, like the problems with the eyelids and stuff?

Dr. Zigler:             Yeah, absolutely. When we do an exam on your eyes, we start out by looking at the front of your eyes. We examine your eyelids, we examine your eyelashes and your cornea on the front of your eye.

Dr. Weitz:            Is that something that most optometrists do?

Dr. Zigler:             Yeah, absolutely. Most optometrists should be doing that in your comprehensive exam. You put your little chin in there-

Dr. Weitz:            Should be? Are they?

Dr. Zigler:             Yeah. Yeah, they should be. You put your chin in this little cup, and they look at the front of your eyes, you know. That’s when you know that they’re looking. Then they also look in the back of your eyes. They may do that a couple of different ways. They can look at the back of your eyes with a BIO, which is something they put on their head, and then look at you with a lens. Or they can look with the slit lamp in the back of your eye, which is the same machine they use to look at the front of your eyes as well.  They should be educating you, especially if you have any of these symptoms. If you’re noticing dry eye symptoms or blurred vision or anything like that, and you make it known to your doctor, they should be looking for those things.

Dr. Weitz:            Okay. To wrap this discussion up, how about if I ask you to give us top five foods to eat that improve eye healths, and top five nutritional supplements?

Dr. Zigler:             All right, so. The top five foods that you should eat. First of all, you should be drinking water, plain filtered water, throughout your day. Get rid of all the sodas and all that stuff. Number two is green leafy vegetables. Make sure that you’re filling your plate with green leafy vegetables, or you’re putting it in a smoothie, however you want to get it into your body, that’s totally fine with me. The next is, I want you to be either eating fatty fish, wild-caught salmon, mackerel, things like that, or eating lots of avocado is another one. I’ll say fish and avocado. Then the fifth one, let’s see here. The fifth one, I’m a really big fan of nuts as well. Organic nuts can be really great, like almonds, macadamia nuts, those can be really wonderful. I know a lot of those seem like a lot of healthy fats, and that’s because it’s a huge deal. You need to be filling your body with healthy fats, green vegetables and water for sure.

Dr. Weitz:            Okay, cool.

Dr. Zigler:             As far as supplements go, the number one thing that I recommend is a fish oil supplement. A good quality fish oil supplement. Then I would move on to a lutein. If you don’t have macular degeneration or a family history of it, then there’s really not … There hasn’t been a benefit shown of taking an AREDS2. Now, lutein is good for everyone, and so I would take a lutein supplement. Then let’s see here, vitamin D. Because most people are vitamin D deficient, and that is going to play a role or has the potential to play a role in all parts of your health. The next one, let’s see here. Probiotic.

Dr. Weitz:            Okay.

Dr. Zigler:             Good probiotic is going to help that gut flora.

Dr. Weitz:            What’s a good probiotic? I know we could spend an hour on what’s a good probiotic, but-

Dr. Zigler:             Yeah, we could spend an hour. Of course there are ones out there … I believe it’s lysate based probiotics that have been shown to be beneficial for the eyes. There are some-

Dr. Weitz:            What was that term?

Dr. Zigler:             It’s lysate probiotics. There’s one by, it’s VSL, and it’s medical-grade, it’s-

Dr. Weitz:            Oh yeah, everybody’s heard of VSL.

Dr. Zigler:             Yeah, it’s super expensive, so that’s hard for a lot of people. We use one from doTERRA that works really well for us in our lives, so that’s the one that we like to recommend. But probiotics are really going to help to keep that gut flora in check. Gut health is really huge as far as dry eye goes as well. Absolutely take your probiotics. Then you know, the fourth one isn’t really a supplement but it’s something that I recommend every day. The fourth one is an eyelid cleanser, because if you keep your eyelids clean and you do it when you brush your teeth … You brush your teeth twice a day to prevent all that tartar buildup and cavities. If you do the same for your eyes, if you’re cleaning your eyelids twice a day, then you can prevent blepharitis and Meibomian gland issues and dry eyes. Absolutely, those are my five.

Dr. Weitz:            Is that your Eye Heyedrate product?

Dr. Zigler:             Yeah. We have a product that’s called Heyedrate Lid and Lash Cleanser, and it’s a really great product that … It’s super easy to use, you just spray it on your closed eyelids and then rub it in, just let it dry, and you go. My husband just sprays it on, and he’s out the door. It’s really easy to use. It couldn’t be simpler.

Dr. Weitz:            Great. Can you tell us about your contacts, for people who would like to get ahold of some of your eyelid and other eye products?

Dr. Zigler:             Yeah, definitely. We do have an offer that you can try, a bottle of our Heyedrate Lid and Lash Cleanser for free. It’s a month’s supply. You just go to freeheyedrate and you’ll … You can purchase it there, you just have to pay shipping. That’s definitely what I recommend. Then if you want to find us, we’re on YouTube on The Dry Eye Show. We put out lots of videos and content all about dry eyes, all about eye health in general, all about health in general really. You can watch some of our videos there. Then we also have a dry eye syndrome support community on Facebook. There are about a little over 10000 people in there that suffer from dry eyes, and we’re in there every day helping out.

Dr. Weitz:            That’s great, awesome. Thank you, Dr. Zigler.

Dr. Zigler:             Yeah, thank you.