Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Autoimmune Disease with Palmer Kippola: Rational Wellness Podcast 171
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Palmer Kippola speaks about Autoimmune Diseases with Dr. Ben Weitz.

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Podcast Highlights

4:28  Palmer reports that when she was 19 years old she woke up one day and had tingling in the soles of her feet. This tingling progressed and crept up her legs like a vine. Her parents took her to a neurologist who did a cursory exam and then told her that she has multiple sclerosis and there is nothing that she can do except go home and wait and eventually she would be destined for a life in a wheelchair.  She essentially laid on the couch for 6 weeks since it was difficult to walk, but eventually, with the encouragement of her father, who told her “Honey you’re going to beat this thing,” so she decided to fight it and overcome her health challenge.  But her Dad was also verbally abusive to both her and her mom and she recalls her dad yelling at her mom when they were age 3 or 4 for being overweight. She developed insomnia at around age 11 or 12.  So she lived with chronic stress and this may have been the trigger for her autoimmune disease.  The Adverse Childhood Experiences (ACE) Study shows that traumatic events in childhood can trigger autoimmune diseases later in life. Palmer considers herself cured of her multiple sclerosis and she pointed out that in the dictionary, the word cure means to restore to balance. She recognizes that she still has the genes for MS but she has altered the epigenetic expression of those genes.

13:52  Some of the keys to Palmer improving were developing a yoga and a meditation practice that enabled her to deal with stress better. Prior to that she would get symptoms whenever she felt stress building up. She tried following a low fat, vegetarian diet since this is part of the Roy Swank diet that was recommended for multiple sclerosis, but it did not work for her. She found that she did not do well eating gluten and she also found that it was important for her to include some humanely raised, grass fed, grass finished beef and wild fish and that such animal proteins and amino acids were helpful in her body being able to repair and heal.

19:12  Most patients with autoimmune diseases should give up eating gluten, since Dr. Alessio Fasano in 2015 discovered that gluten creates leaky gut and leaky gut (aka intestinal hyperpermeability) is the pathway to autoimmune disorders.  And 70% of the people sensitive to gluten are also sensitive to dairy.  The casein protein in diary is inflammatory, esp. from A1 cows. Palmer recommends her clients do a 30 or 60 or 90 day food elimination diet in which they avoid gluten and all grains, dairy except for ghee, sugar, eggs, soy, corn, night shades (tomatoes, white potatoes, peppers, eggplant, goji berries), legumes, nuts and seeds, coffee, and alcohol. They essentially do an autoimmune paleo diet until their symptoms resolve and then they test these foods back in one at a time to see if they create a reaction or are tolerated.   

29:25  Gut health is a big factor in autoimmune diseases and if you have leaky gut then large protein molecules like gluten and casein will more likely get into your bloodstream and get attacked by the immune system.  If you have leaky gut, you have genes that predispose you for it, and you have environmental toxins and other factors that create inflammation and cause the immune system to overreact, then you are more likely to end up with an autoimmune disease. In order to stop an autoimmune attack we need to remove the stuff that is breeching the lining of our gut, heal it, and seal it, so that we can arrest that process. Palmer said she likes look at a good stool test like GI Map or a stool test from Genova or Doctor’s Data to assess the gut health and then she will use the 4 R program (Remove, Replace, Reinoculate, and Repair) first pioneered by Dr. Jeffrey Bland, the Father of Functional Medicine, in her treatment approach.

 



 

Palmer Kippola is a Functional Medicine Certified Health Coach who specializes in helping people prevent and reverse autoimmune conditions.  Palmer is the author of the best selling book, Beat Autoimmune: The 6 Keys to Reverse Your Condition and Reclaim Your Health. Her website is PalmerKippola.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. Today our topic is autoimmune diseases with Palmer Kippola. Autoimmune diseases are increasingly common causes of sickness and death in the United States. Autoimmune diseases have been on the rise for at least the last four decades. The immune system which we’ve all been learning a lot more about in recent times, it’s designed to protect us from viruses, sure. Bacteria and parasites and to repair our tissues from damage. Autoimmune diseases are diseases when the immune system, instead of attacking those pathogens, attack our own cells and organs and what this means is that the immune system is out of balance. This is often referred to as immune dysregulation. So there are at least 100 different autoimmune diseases and the list is growing and quite a number of other diseases that are suspected to have an autoimmune base. So if we include diseases that have an autoimmune basis, then autoimmune diseases are now the third leading cause of death in the United States, since most of these diseases are chronic and are often life threatening. So a little more common autoimmune diseases include Alzheimer’s Disease, Parkinson’s, Rheumatoid, Hashimoto’s Hypothyroid, Celiac Disease, Type one diabetes, multiple sclerosis, Crohn’s Disease and what we have recently learned from Dr. Pimentel that Irritable Bowel Disease, the most common GI condition, also has an autoimmune origin in many patients. Conventional medical doctors treat autoimmune diseases either by controlling the symptoms, such as providing thyroid hormone in the case of Hashimoto’s Hypothyroid or by using medications that suppress the immune system such as corticosteroid, chemotherapeutic agents or the newer injectable TNF alpha blocking agents like Humira and Remicade. These drugs block the immune system and unfortunately this is a problem because we do need a properly functioning immune system and they have potential side effects like infections and cancer.

                                But functional medicine treats autoimmune diseases by looking at some of the underlying factors that lead to this immune system getting dysregulated such as leaky gut, food sensitivities, toxins, mold, heavy metals, infections, nutritional deficiency, stress, et cetera. This is very important. If I have a patient with Hashimoto’s Hyperthyroid and most women in the U.S. with Hypothyroid have autoimmune Hashimoto’s and all this patient is treated with is thyroid medication, it doesn’t do anything for the smoldering fire of the autoimmune disease that’s been attacking the thyroid gland and chances are will continue. So this patient may need higher dosages of thyroid or they may end up with another autoimmune disease. So not just regulating the thyroid, but also putting out that smoldering fire of autoimmunity is crucial for this patient’s long term health.

                                Palmer Kippola wrote an awesome book, “Beat Autoimmune The Six Keys to Reverse Your Condition And Reclaim Your Health.” She is a functional medicine certified health coach and she specializes in helping patients reverse and prevent autoimmune diseases and she’s here to bring some clarity to this topic and give us some more detailed ideas about what we can do about preventing and reversing autoimmune diseases. Palmer thank you so much for joining me today.

Palmer:                It’s an honor and a pleasure Dr. Weitz. Thank you so much for having me.

Dr. Weitz:            Absolutely. So, maybe we can start by introducing you to our audience by having you tell us a little bit about your life story, beginning when you were diagnosed with MS at age 19.

Palmer:                Yeah, well I have to take you back a few years in time for that. In fact, I grew up in where you’re practicing right now in Southern California and I was home for the summer after my freshman year of college. I was your average 19 year old hardworking, hard playing young woman. I was home from school and I didn’t have any of the precursor symptoms. So this hit me quite out of the blue. I was working a summer job and one morning I woke up and the soles of my feet were all tingling. That feeling, that pins and needles feeling like when you sit on a limb too long. I shook my feet, but as hard as I shook my feet I couldn’t get the blood flow back to my feet. I headed off to work thinking this will just pass.   But over the course of the morning the tingling progressed and it crept up my legs like a vine. By the time it got to my knees I knew something was wrong. So, I called my parents who called the family doctor who said, “Get her over to the neurologist at UCLA today.” So that afternoon we sat in the neurologist office and it was a woman who had me do the cursory exam which you know heel toe, heel toe. Touch your finger to your nose. That was really about it. Tested my reflexes and after about five minutes she said with what I consider to be a spectacular lack of sensitivity, “I am 99% certain that you have MS, multiple sclerosis.” My family and I had never heard of this. So this is in the mid-80s. I have to take you back a little bit. We didn’t have an internet, but like you said in the introduction, these are on the rise. These autoimmune conditions and when I was growing up and in the mid-80s nobody had heard of MS or multiple sclerosis.    So the doctor continued if I’m right, “There’s nothing you can do except go home and wait. We have these immunosuppressive drugs. These steroids, which you could take and we have something called an NMR, a nuclear magnetic resonance image machine” which was the precursor to the MRI. “But other than that there’s nothing you can do.” So later I would learn that she actually pulled my parents aside and said, “You better get ready because she destined for her life in a wheelchair.”

Dr. Weitz:            Wow.

Palmer:                “So you need to really prepare for that.” I’m telling you like a mack truck just simply quite out of the blue and that day we went home just devastated. We had no idea what to expect. That feeling of uncertainty and the earth has shifted beneath your feet. That was what we felt and that night we got into bed, my mom crawled in with me and all the areas that had been tingling had crept up right underneath my chin, but now every part of my body had gone numb. My body would stay completely numb for a full six weeks that summer, 1984.

Dr. Weitz:            Wow.

Palmer:                A terrifying time. Yeah, so I’ll leap into, I won’t leave you hanging here. We started when I wasn’t despairing about the future, my parents were really rocks. They were really there for me and my dad, who really encouraged my can do attitude, would say to me, “Honey you’re going to beat this thing” which is how I got the title of the book was my dad’s encouragement, “You can beat this thing.”  My mom started to plan for my future in a wheelchair.  Could I got to school? Could I attend UCLA in a wheelchair for example?

Dr. Weitz:            Wow.

Palmer:                That was what we were feeling. So I lay on the couch because there was nothing else I could do that summer. When you’re numb, you can walk, but you don’t have any of that proprioception where you can feel your limbs in space. So it’s this really gangli walk. I would install myself on the couch everyday for six weeks. Friends who weren’t too scared off by this mysterious disease, would come and visit and some friends brought, what do 19 year old friends bring you? Cookies, books, movies, they hand out with you. This one family friend came to visit. She was into things metaphysical. She said, “Palmer why do you think you got this MS? Why do you think you got this?” I was literally stunned. I was really taken aback. I got mad. “Are you insinuating that I brought this on? Do you think that I did something to do this or deserve this?”   She left, but the question wouldn’t leave me. So I sat there on the couch chewing on that question like a dog with a bone. I just lay there, “How did I bring this on?” So I need to take you back a little bit more in time. So I had been adopted as a baby and my parents were very loving. But my dad had been a fighter pilot and his way was invariably the right way. We used to butt heads quite a bit. It was this dichotomy because on the one hand super motivational, encourage my can do attitude all the time. But on the other hand, he was a yeller and he was really judgmental and really critical and he verbally abused my mom and me.

Dr. Weitz:            Wow.

Palmer:                I have to tell you Dr. Weitz that my earliest memory and this is unfortunate, but true.  I’m maybe age three, maybe four my dad’s yelling at my mom who is overweight.  She struggled with her weight perpetually.  So she shut herself behind the bedroom door and she’s crying and my dad is yelling at her.  I am standing up to my dad in the hallway with my little dukes up, “You call my mom names? I’ll sock your lights out” or some words to that effect, right?  I had become a child warrior.  I was going to protect my mom no matter what.  I had become hyper vigilant.  I developed insomnia maybe around age 11 or 12.  I was always scanning my environment for safety, right?  In that moment as I’m lying on the couch at age 19 I had no idea how this came to me.  But I figured that if I didn’t have a real battle to fight my immune system, the concept of Don Quixote?  I came up with that idea years later.  But he didn’t really have a battle.  He was fighting windmills. He was lunging at windmills right?

Dr. Weitz:            Right. Yes.

Palmer:                So there was nothing really to fight. But if I didn’t have a real battle to wage, I would turn those warriors, that immune system, that attack on myself. So that hypothesis, that initial hypothesis at age 19 that it was chronic stress from growing up in that environment where I didn’t feel safe. That still rings true for me today even though I know there’s vastly more to the story. But that was my initial hypothesis and now we have tons of research from the ACES study, the Adverse Childhood Experiences Studies powerful connecting what happens in childhood does not stay in childhood, but is profoundly linked to the advent of autoimmunity even decades later. So just to put a nice period on the story, I had the type of MS which is called relapsing, remitting. Meaning symptoms come and symptoms go.   So that summer just in the nick of time for me to go back to college for my sophomore year, the numbness started to retreat. That would take a full two years for the numbness to completely dissipate, but I got off the couch and went back to school for my sophomore year and there I went off on my 26 year course of relapsing, remitting MS.

Dr. Weitz:            So along this journey what have been some of the biggest keys to helping put your condition in, would you say it’s in remission now?

Palmer:                I don’t like to use that word because remission makes you think that something is lurking in the background, ready to pounce forth.

Dr. Weitz:            Okay.

Palmer:                Okay. So let me step out boldly here and say that the word cure if you look it up in the dictionary, means to restore to balance.

Dr. Weitz:            Okay.

Palmer:                Okay, I believe that the larger forces like the pharmaceutical industry and I’m not a doctor so I’m not constrained by some of those American Medical Association rules that say you cannot say cure. So I believe that I am cured and I will say very, very clearly that I will always have the genes for MS. That’s not what we’re talking about here. We’re talking about the expression of our genes and that is some of the most profound science that I discovered was the science of epigenetics which allows us to control the expression of our genes. That is what’s super empowering and ultimately how I healed.

Dr. Weitz:            So what were some of the real keys that allowed you to overcome the expression of your genes?

Palmer:                So, it just follows that because I intuited that chronic stress was my big root cause, then I needed to address stress head on.

Dr. Weitz:            Right.

Palmer:                I didn’t immediately do this. In fact, I went back to college and I was in denial for quite some time. Let’s call it for the next couple of years and probably for the next three or four years I just went on with my life. When I started having symptoms again I started to realize maybe there was something in fact, that I could do about this. Maybe my dad was right, I could beat this thing. So I noticed that when I was stressed out when I had exams at school or something that I was particularly stressed out about, I would develop symptoms, almost immediately within a day or a week of that stressful event. Conversely, when I started to relax more I noticed a dissipating of symptoms. I mean it really became clear. So in 1987 I started doing yoga and I found that that was a practice that I could actually do and become present. I wasn’t focused on the past. I wasn’t worrying about the future. I was just on the mat and I learned how to breathe in through my nose and man that shavasana of just lying there and letting things go, that was huge for me.  So that practice was the first thing I did and subsequent to that I discovered meditation in the early to mid-90s and as long as I did those practices I noticed a reduction in symptoms. I mean it really became this little experiment that I was doing, not realizing that I was really doing it. But I could tell this cause and effect pretty early on that stress equals symptoms, relaxation equals a diminishment of symptoms. That was certainly number one and that is still true today. That was one of the biggies.

Dr. Weitz:            Great. So if that’s number one, what were number two and three on your journey to health?

Palmer:                So there was a lot of experimentation that went on. Since I had more than two decades with MS and I was really trying to do this and remember there was no internet at the time. So I was just doing things by going to the public library in Santa Monica or intuiting things and following that intuition. I tried diet for awhile. I just want to touch on this because I think it’s also important to pay attention. We try things, right? Our life is a series of experiments. Not all of them are going to work.

Dr. Weitz:            Yeah, so let’s talk about diet. What’s the best diet for somebody with an autoimmune disease?

Palmer:                Yeah, well-

Dr. Weitz:            Or does it depend on the person?

Palmer:                I think it depends. I will say what didn’t work for me was a low fat veterinarian diet. So it became very clear there was this book that was in the mid-80s called the Roy Swank Diet. Multiple sclerosis diet, something like that.

Dr. Weitz:            Yes.

Palmer:                He professed that you got to get rid of fat, that’s your enemy. So we were a super low fat house. Tried that. The advent of the inclusion of more healthy whole grains in my diet, not only didn’t make the MS symptoms better, it actually made things worse and I started experiencing more tummy troubles.  So that for me was a failed experiment and it wasn’t until much later until 2010 that I discovered my biggest root cause or I would call it the linchpin root cause for me happened to be gluten.  So, I have what’s considered to be non-celiac gluten sensitivity meaning I don’t have Celiac Disease, but I am sensitive to the protein in wheat called gluten.

Dr. Weitz:            By the way do you think that that’s the case for most people? Can some people get positive results following a vegetarian diet with an autoimmune disease?

Palmer:                It’s an interesting question and again I need to just convey not only my personal experience, but I’ve done a lot of research since as you’ve seen I have a very large book.

Dr. Weitz:            Right and what have you found?

Palmer:                I have found that not a single person that I have found or interviewed including Dr. Terry Walls, including Linda Clark who is a health educator, including lots of people that I include in my book, Michelle Corey, people who had been vegetarian or vegan could not heal from autoimmune disorders until they began to incorporate meat. We’re not talking about tons of meat, but I found from my studies that what I’ll call a paleo template diet appears to be the best for people with autoimmune disorders. Now that’s not to say that a short term vegetarian or vegan diet is not powerful in helping you to detoxify from things. I think as a cancer healing mechanism that can be helpful for a short term. But when it comes to building and repairing the proteins that we have in our bodies every single cell, we need those amino acids from animal based protein. I would certainly only advise and advocate for humanely raised, grass fed, grass finished, so 100% grass fed animals and wild fish.

Dr. Weitz:            So, in terms of you mentioned gluten, so gluten is a food that you said you were sensitive with. You didn’t necessarily have Celiac Disease and so are there a set of foods that all patients with autoimmune disease should avoid, or should we be testing for food sensitivities or doing an elimination diet? How should we approach that?

Palmer:                So this is huge and I didn’t answer one of your questions which was does everybody need to give up gluten? I want to really address this.

Dr. Weitz:            Okay, yes.

Palmer:                Because this is the elephant in the room. In 2015 Dr. Alessio Fasano who is now at Harvard Medical School, he and his team of researchers discovered that gluten creates a leaky gut in anyone who eats it. I want to be really clear because that sounds like a really big and bold statement and it is. Because we’ve also discovered that a leaky gut that is intestinal hyperpermeability is the pathway to autoimmune disorders. So if you are doing something that is causing your gut to be leaky and you’re continuing to do that thing and you have the proclivity, the genetic predisposition to autoimmune disorders, then you are setting yourself up for a bad path. So, I would say from my research, from the science, if you have an autoimmune condition or if you have the proclivity because you have the genes in your family which we know genes are a part of it. May only be five to 10% of the equation. Your lifestyle matters way more. But gluten happens to be the biggest baddie that I have seen in my practice, in my experience, in my research.

                                To add to that, it turns out that people who are sensitive to gluten, it turns out 70% of the people sensitive to gluten are also sensitive to dairy. So that goes hand in hand. We see a lot of people sensitive to gluten have the same sensitivity to dairy and it’s not the lactose. It’s the casein, especially in these inflammatory cows like A1 cows, these Holsteins. So there are varying degrees of this, but in my research and experience and work with people, the gold standard as they say in functional medicine and in my experience is to do that elimination diet. I call it a 30 day food vacation to make it a little more palatable in the book. But it’s really the same thing. Take the usual suspect foods out for a period of time and when we remove those inflammatory proteins it gives our immune system a chance to calm down so that when you add them back in slowly and one at a time you can really tell if you are reacting to something. That’s super empowering because my-

Dr. Weitz:            So you’re saying essentially anybody with autoimmune disease, you should automatically give up all gluten and all dairy?

Palmer:                I am saying that gluten needs to go for good and I’m saying that dairy most people need to get rid of it, now with the exception of ghee.

Dr. Weitz:            Right, what if they say what about this one form of dairy? What about just yogurt? What about just non-A1 casein?

Palmer:                That might be just fine.

Dr. Weitz:            Right.

Palmer:                So this is where experimentation comes in. I’m not dogmatic about my approach.  You’re asking me for … I’m giving you the 80-20 rule.

Dr. Weitz:            I know. These are some of the controversial areas.

Palmer:                Right, right, right. But gluten isn’t controversial.

Dr. Weitz:            We get really clear about it, you know?

Palmer:                Right, people want clarity. But nothing tastes as good as feeling healthy feels. I like to say that to remind people that look, I can do this. I have been completely gluten free since 2010. So just about 10 years. I have not experienced a single MS symptom, not a tingling baby toe, not anything and we didn’t get into all of the ups and downs that I had over the years. But I had searing pain of optic neuritis. I really felt terrible MS symptoms for a very, very long period of time. So by removing some of these things, it can be a eureka moment for some people, but it’s not the only thing. That’s why I go into a great bit of detail about what the other categories are that we have to address.

Dr. Weitz:            Okay, so when you put somebody on an elimination diet, what are the six, eight or 10 foods that you have them eliminate?

Palmer:                Yeah, so we take out grains. I mean that’s really a starting point. Gluten is a grain, but many grains contain a form of gluten that is highly inflammatory. So we take out all grains. We take out all dairy with the exception with organic, grass fed ghee. We take out sugar. We take out soy. We take out corn, which happens to be a grain. We take out for a period of time night shade vegetables. People with pain or aches often are sensitive to night shades which include tomatoes, white potatoes, eggplants, even goji berries. So those have to go for a period of time. Let’s see what else is on that list? I don’t have them all.

Dr. Weitz:            You take out nuts and seeds?

Palmer:                Take out nuts and seeds and coffee and alcohol.

Dr. Weitz:            You take out legumes?

Palmer:                Yes.

Dr. Weitz:            So essentially you’re saying follow an autoimmune paleo diet?

Palmer:                That’s right. That’s right.

Dr. Weitz:            Okay.

Palmer:                I would say it sounds so restrictive and people are like, “What do I eat? What’s left?” I have that optimal food guide which we can share with people. They can go to my website and get this free download because I really want people to know there is a ton of stuff that you can eat. But the best you can do for this period of time, it might be 30 days, could be 60, might be 90. Some people never want to go back to eating these things. Eggs, oh, we forgot eggs. That’s a big one. It might actually be number three on the list and what people will notice across all of these foods, it’s the protein. These are protein molecules that can often be inflammatory in people with autoimmune susceptibilities, but not everybody is intolerant to eggs for example. So that’s why we call it a paleo template because sometimes there’s variability. You asked about dairy. Could you come back to goat yogurt for example or sheep cheese. I mean there is a world of things that you could try to experiment with. But we know enough now. There is enough data, there is enough research, you don’t have to go and do all this research on your own. I did it because it wasn’t out there. There was no Terry Walls when I was healing from MS, right?

Dr. Weitz:            So they follow this autoimmune paleo very strict diet.

Palmer:                Yep.

Dr. Weitz:            How do you determine if it’s 30 days or 60 days? You’re waiting for a [inaudible 00:26:09] of symptoms?

Palmer:                That’s right. that’s right. So people typically and I see and other practitioners and integrative and functional doctors agree that people can reverse symptoms of autoimmune conditions between 60 and 100% just by addressing food which is why it’s chapter one in my book, start with food because it’s such a high leverage category.

Dr. Weitz:            Okay so you do that. Let’s say you do it for 30 days, your symptoms go away. Now they start putting foods back in one at a time. What if they put all the foods back in and they don’t notice any difference?

Palmer:                Oh. I have to share with you that this was a story of one practitioner who is a friend of mine who overcame, completely reversed lupus and hashimoto thyroiditis. She had a hefty dose of traumatic stress in childhood. She had a ton of food sensitivities. She developed these autoimmune conditions. She finally discovered that food might be the path out. So she did this elimination phase, but she was so eager to go back to her favorite foods, guess what she had for her first meal after all this? She had a burrito. A burrito. So it’s got flour, there’s gluten in the tortilla. There’s cheese, so we’ve got dairy. There’s beans, so there’s beans and legumes, right? There’s tomatoes for the night shades or other people. Then she developed the symptoms, they came flooding back. So she had lost all this weight, that inflammatory water weight when she was doing the elimination phase, she had the burrito and everything swelled back up again. So she had to go through the whole process again.

                                So that’s one thing that can happen if you decide to introduce things, like you’re going to go have a pizza as your first meal. One at a time. There are other people that try this elimination, they go through it, they put things back in slowly. They do everything right and they still can’t tell their symptoms. This is when as you mentioned, doing food sensitivity testing can be helpful, although I’ve seen it go both ways in my own personal experience and with clients who get these tests done and it turns out that they’re sensitive to cooked pineapple and red dye number 32. Crazy things that they don’t even eat. So it’s less empowering when you get a test done and you don’t resonate with what I find.

Dr. Weitz:            Or the test comes back and says they have no food sensitivities and they spend 800 bucks for it.

Palmer:                That’s right. That’s right. So there’s more than just food and we need to talk about that because there are a number of root causes. I mean even stress can create a leaky gut. So I’m not sure that people are really aware of that. But, you can do everything right. You can get your pristine diet, you can exercise. You can get up in the morning and meditate. But if you’re still wrangling with a lot of stress, I would submit that you can have a really hard time healing or if you decide you’re not going to address that traumatic stressful childhood, it’s a tough road to get fully better.

Dr. Weitz:            So let’s go into gut health next. Gut health is one of the chapters in your book. It’s obviously one of the big factors in autoimmune diseases and you mentioned leaky gut and there’s the term gut dysbiosis. How do we figure out what’s going on and how do we figure out how do address these issues?

Palmer:                Great question. So we know that and I don’t know what your experience is in working with autoimmune patients, but I can say that if you have symptoms, mysterious symptoms or an autoimmune condition, there is almost a one for one correlation with a leaky gut. We can assume that your gut is leaking these large protein particles.  Why?  Because if you have symptoms that means that your immune system is attacking something in your body and it could be dysregulated.  Sometimes it’s called molecular mimicry or mistaken identity.  That gluten fragment if we want to use that inflames the lining of the gut, actually breeches the cut barrier, gets into the bloodstream where it doesn’t belong and that’s what sets off the immune system.  So let’s start there, right? So it gets through the lining of the gut. Then your immune system doing what it does, what it’s supposed to do develops antibodies which are missiles. They’re actually bullets you can think of them to attack the invaders. That’s what the immune system is supposed to do. So it views gluten or that protein, that casing from dairy as an invader. Tags them, begins to shoot at them, right? But it develops so many antibodies in the process of trying to destroy that invader that it’s going around the bloodstream looking for a fight. Your human tissue and I don’t know how in the world this is possible, but our human tissue at a molecular level can resemble that gluten fragment. That gluten molecule looks like the thyroid tissue or in the case of MS, as the myelin sheath, okay? So that’s where the bullets are mistaken. They’re doing their job, but your thyroid or your mile in chief just gets in the way.  So it’s not that your immune system has turned on you in some evil or malicious way. It’s just doing its job. So, in order to stop that autoimmune attack, we therefore need to remove the stuff that is breeching the lining of our gut, heal it and seal it, so that we can arrest that process.  That’s central to the autoimmune equation that Dr. Fasano and his team discovered.  We have an autoimmune equation which are, you have to have the genes for it, right?  So it turns out that my birth father has MS.  So I know that there’s a genetic connection.  Number two, we have to have these inflammatory environmental factors that are either coming from the environment or within us that are toxic and causing our immune system to overreact and then we have the advent of this leaky gut.  So the exciting thing about this autoimmune equation is that if you flip the equation, we can reverse the condition.  Meaning, you find and remove your environmental triggers, remove them and heal and seal the lining of your gut and that is central to arresting that process.  So, I wanted to share that mechanism of how autoimmunity happens so that people can really visualize every time you’re putting something into your gut that is irritating it, inflaming it, there’s a possibility that that autoimmune attack could start or it could be perpetuated until you stop that process of introducing those proteins.

Dr. Weitz:            So how do we assess that’s going on in the gut? Do we assume they have leaky gut? Do we test for leaky gut? Do we do a stool sample? Do we do a SIBO breath test. What is your normal procedure with a patient to figure out what’s going on in the gut?

Palmer:                So typically we can assume that leaky gut is going on and so people don’t necessarily need to spend money to figure this out. They can just do their own experimentation of just taking stuff out. We know what the biggest baddy culprits are for harming our guts and we’ve talked about food.  I will also add that part of the food problem is how it has grown and how it is sprayed with lyphosate and that is one of and commonly known as RoundUp. This is something we know harms the lining of the gut. So people can take this stuff out and do their own experimentation. We know that antibiotics-

Dr. Weitz:            But the container of RoundUp at the store has nice pictures of animals and butterflies and plants.

Palmer:                Don’t be fooled people. Don’t be fooled. This is where it is incumbent upon us as consumers to really become the CEO of our own health and wellbeing. We have to do our job, our research to protect ourselves. The Europeans have or follow what’s called the precautionary principle and in their I forget the name of the body that tests for chemicals and whatnot. But they won’t let chemicals get introduced into the environment until they’re proven safe. Whereas in this country, we release the chemicals and then they’re only taken off the shelf when they’re proven guilty.

Dr. Weitz:            Well because the goal is protection of the profits of big corporations. People’s health? Oh, well.

Palmer:                Right. So I’m somebody, I’m a product of cheerios. I ate gluten with every meal, okay? I have peanut butter and jelly sandwiches for every day of my life growing up. I had pasta or pizza or beer throughout my life. I did not realize, I did not put this together that I was inflaming and harming my gut and perpetuating the MS for more than two decades until I did that experimentation and removed it and voila. Again not to say that that’s going to be the standard that happens for people, you take one thing out and your good. No, no, no there’s a lot more than that. But-

Dr. Weitz:            Okay, assume they have leaky gut. We assume they’ve gotten exposed to pesticides and other chemicals. Do you do a stool analysis? Do you put them through a gut healing protocol 4R, 5R, what’s your normal protocol?

Palmer:                Yes. Yes, I’m a big fan of getting the data. We’ve got fantastic modern lab work that’s getting better all the time and even though nothing is perfect, we do have some good tests that we do and a couple of the tests that I like are the GI map test is fantastic. GI Effects from Genova has been around it’s probably the gold standard gut test. Doctor’s Data, all of these labs have comprehensive stool tests and we can tell not only what’s the state of somebody’s microbiome, but are there any infections present? Because it’s not just foods, they’re infections that could be at play here. They offer I think it’s called a zonulin add on. Zonulin is the marker.

Dr. Weitz:            That’s for leaky gut, yeah.

Palmer:                For the leaky gut, right? So, when you have that it monitors and manages the tight junctions in our gut in that lining. So our gut is supposed to be selectively leaky to let in nutrients, right? But when the doors are left open, that means there’s excess zonulin at play and zonulin gets into the blood stream and so forth. So we can test for leaky gut and I think that’s now considered to be more of a gold standard than the former-

Dr. Weitz:            Lactulose mannitol test.

Palmer:                Yeah, yeah, yeah.

Dr. Weitz:            Yeah. Okay. So, what protocol do you put everybody on besides you’ve already put them through a diet program, right?

Palmer:                Right.

Dr. Weitz:            Do you change their diet again? do you put them on a specialized diet? Do you put everybody on probiotics? Do you use the four or 5R program?

Palmer:                I really like that 5R program. I mean this has been around for decades now.

Dr. Weitz:            Since Dr. Jeffrey Bland.

Palmer:                Yes, yes. There were a lot of people-

Dr. Weitz:            The father of functional medicine.

Palmer:                Right, right. There were a lot of people involved with that and you’ll have to remind me of all the R’s, but the biggest one in a 5R program is the remove. A lot of people are they get a little miffed that, “Well why aren’t we talking about putting more stuff in? I just want to take probiotics and heal.” Well, the best thing, the biggest bang for your buck is taking the stuff out that’s harming you. So the first R of remove is what we’re already doing when we’re in the food phase. So these are often overlapping categories right? The next thing we want to do is maybe oh, my goodness. It’s not replenish, reinoculate. A lot of us are missing digestive enzymes.

Dr. Weitz:            Replace, yeah.

Palmer:                Replace. Thank you. So, we need to replace our digestive secretions and often people feel like if they have an acid tummy or acid reflux that they are experiencing too much acid when in fact it’s often a sign that they’re not producing enough acid. So by supplementing with hydrochloric acid when eating meals can be a game changer for people to be able to actually digest and absorb their food better. Maybe their enzymes that we want to include and a lot of people don’t have a gallbladder. A lot of people are having sluggish bile. So whatever you can do to improve your bile flow by maybe taking digestive bitters before eating, we definitely start to add those. So people can digest and absorb what they’re already eating and that is that phase, replacing those digestive secretions.

Dr. Weitz:            Okay.

Palmer:                Then and only when we address if there’s an infection present, like candida, we want to get rid of it, right? So we’re going to work to get rid of that with as natural a process as possible and other infections that might be present, H. Pylori and so forth.

Dr. Weitz:            So you’re going to use natural antimicrobials in that case?

Palmer:                Exactly. Exactly.

Dr. Weitz:            Okay.

Palmer:                And there are some helpful anti-yeast and anti-mold things that people can do.

Dr. Weitz:            Right, combinations.

Palmer:                Combination therapy is often very, very helpful and-

Dr. Weitz:            How long does that usually take? Two weeks? A month? A few months? Many months?

Palmer:                It can take three to four weeks. Excuse me, three to four months.

Dr. Weitz:            Okay.

Palmer:                I’m doing wishful thinking there. Because sometimes we find parasites too and if people find that on their stool test that parasites are present, there’s actually another test that I really like from Parawellness Research that can be much more specific about the types of parasites that are in there. So oftentimes we got to get that stuff out. I mean this is … We were designed to cohabitate with a lot of these critters that are in us. But I think what happens is that when we have all of these inflammatory foods and the sugar we’re eating and the simple diet, we start to feed those microbes of the pathogenic stuff and it starts to overgrow like the candida, like the parasites. So when we start with a diet, remove stuff, we address those parasites in yeast. It might take three to four months. People need to be patient with the process, right?

Dr. Weitz:            Yep.

Palmer:                And it’s only when we remove all of those pathogens that we want to start replacing with the, and reseeding with probiotics and prebiotics because we don’t want to be feeding the microbes that are out of balance. We want to be introducing probiotics at the right time.

Dr. Weitz:            Right. So, the next chapter in your book is infections and so this is not somebody who currently has a cold or a fever. These are stealth, chronic infections that they often don’t know they have.

Palmer:                That’s right. That’s right. Again, you’ll see the overlap here because a lot of the gut infections that I just talked about are the infections that are driving autoimmune conditions. But people here about Epstein-Barr and they want to point every finger at Epstein-Barr at being the problem. Well I’ll tell you, 96% of us in the United States have Esptein-Barr. So, we have coexisted with viruses for I don’t know how long. As long as we’ve been on earth. It’s when things get reactivated and when things get way out of balance that these things become problematic. So, infections could include viruses. It could include bacteria. We’re seeing much more Lyme Disease. What’s now called Persistent Lyme, I found out only in 2017 that I have Persistent Lyme and in fact, I might have gotten it when I was age 18 when I was romping around in the hills of Vermont. That may have preceded the MS. But I only learned about it recently. So, getting tested for Lyme and there are more and more good tests for Lyme Disease.

Dr. Weitz:            Yeah, yeah.

Palmer:                And many more doctors are recognizing that. I don’t know if you see Lyme frequently in your practice.

Dr. Weitz:            There is a fair amount of Lyme. It’s not necessarily one of my specialties, but we’re learning how common it is. In fact, we have Dr. Darin Ingels speaking at our functional medicine meeting on Thursday who is a Lyme expert. He feels like a large percentage of patients with MS actually are undiscovered Lyme patients.

Palmer:                That’s right. That’s right and not just MS. I mean this is why I didn’t call the book, “Beat MS” because what we’re talking about these healing principles-

Dr. Weitz:            Goes to all autoimmune.

Palmer:                All of them. It’s wholistic. Mind, body, spirit, but you got to look at food. You got to look at infections. You got to fix your gut health. You got to look at toxins in your environment. And you got to balance your hormones and last, but not least is that S for stress that we are all facing and that makes everything worse.

Dr. Weitz:            Right.

Palmer:                So all of it is part in partial of what we do. I’m not collaborating with a naturopathy doctor who specializes in infections and toxins. The other thing that we’re seeing much more of is mold. Mold and mycotoxins are just amplifying the problem. So it’s not just one thing. It’s I call it a toxin bucket. We all have one, right? We carry a certain amount of toxins and if we’re not excreting properly, if we’re not able to handle and let go of the toxins that come into us and it’s all of those things, then things start to build up until finally the leaky gut spills over and you start to have symptoms. Because autoimmunity happens on a spectrum. It goes from silent where you start to build those antibodies, right? That’s happening silently. So when I was 19 and the MS struck, I had been silently building antibodies to my own tissue and the gluten and other things. Not even knowing it and then the next phase is autoimmune expression where you start to feel symptoms. That is exactly where you want to … Well you want, ideally you want to prevent things. But most people are going to pay attention when they start having symptoms.

                                What you don’t want to do is get to the next phase of things which is full blown autoimmune disease where tissue damage starts to happen, right? So you have this window of it could be decades from the first silent autoimmunity all the way to full blown autoimmune disease. But the opportunity to address it is now. It is now.

Dr. Weitz:            So for practitioners who are listening and maybe even patients who are trying to sort through some of this stuff themselves and they are saying to themselves, “Wow, look at all the things that could be affecting my potential autoimmune disease or the autoimmune disease of this patient sitting here in front of me and we could have food. We could have stress. We could have nutritional deficiencies. We talked about infections. We’re talking about gut problems. There’s hormonal problems. Oh, my God where do I start? Then where do I go next and how do I decide what to do?”

Palmer:                Yeah I think the first thing to do is take a big, deep breath. I mean I really do and I’m not being facetious. I mean in through the nose, in the belly a big deep breath. Autoimmune problems did not happen overnight and they’re not going to go away overnight. This is a process and a practice. But now we have people that have gone through this that have a framework or a protocol. Follow people who have healed themselves or who have cured themselves. I mean that would be a really good place to start. There are books out there, not just mine. There are a lot of really good books on the subject. Educate yourself. Empower yourself. I would submit that the very first thing to do is to understand that these are reversible conditions. This is not a death sentence. This is not something that you should take what a conventional doctor tells you that all you can do is manage your disease. That is simply false. There is so much hope and it’s real, find people who have reversed their condition. I profiled 12 of them in my book. I didn’t want to write a memoir, because people would just pat me on the head, “Oh, look at you. You had a spontaneous remission.”

                                No, no, no. This is not a spontaneous remission. This is learning to control what we can control and you let go of the rest. But the people that I profile in there, Dr. Mark Hyman, Terry Walls, Susan Bloom, I mean there are a wealth of practitioners who used to be medical doctors who themselves had some debilitating autoimmune disease or condition. They did the work and then the wounded healer themselves, now they’re helping hundreds, thousands of people. So this is an exponential good news story. It’s not just my story. So my aim is to really help people to know this is possible. So the first step, understand that it’s possible, decide you’re going to reverse your condition and reclaim your life because you can. Then the next step is to get whatever book you’re going to get and then educate yourself. There’s lots of … My website is palmerkippola.com. I have got lots of free information on there. I’ve got this book which is about ten bucks on Amazon. People ask me, “I need more help than a book. I want help implementing this.” Because there’s a lot. As you said, it’s not just one thing, it’s wholistic. So I created this membership called Beat Autoimmune Academy. I’ve got a bunch of people in there who we’re taking step by step because it can be overwhelming. People get overwhelmed.

Dr. Weitz:            I would say to the practitioner out there, the first thing you want to do is take a detailed history like they teach in the Institute of Functional Medicine courses and then you’ll start once you really go deep into someone’s history from birth and find out about their life story, you can start to figure out what direction, “Oh, this person had a lot of early life stress. This person took lots of antibiotics and had multiple ear infections and maybe more liable to have gut and chronic infections.” You’ll get a sense of what direction to go first. If nothing jumps out at you, always consider starting with the gut and then also doing some testing can give you an idea of what direction to go to as well.

Palmer:                Perfectly said. That was beautiful. That history when you’re sitting with somebody and they’re sharing with you how they grew up. Were they breastfed? Were they delivered as a C-section. What kind of home life did they have growing up? What was that like? If they started to develop let’s call it juvenile rheumatoid arthritis, what happened before age seven that you developed rheumatoid arthritis at age eight? What happened when you were 11 years old and you developed lupus when you were 15? We really need to have other people tell us the story so that they can see how powerful it is that when I was asked that question, “Why do you think you got the MS?” I took it as an affront, right? But that question has become my north star for me and for the people that I work with. We always want to find out why. If you haven’t healed, if you’re still experiencing symptoms, those are just messages from your body letting you know that you haven’t dug deeply enough into root causes. You need to keep going.

Dr. Weitz:            That’s great. So, any … I think we should wrap because we both have appointments coming up. Obviously there’s a lot more stuff we could talk about. We really didn’t get to toxins or hormones, but this is a huge topic and we could spend hours talking about it. So for now do you have any final thoughts for our audience?

Palmer:                I do. I do. I want to help you shortcut the suffering because there’s an expression that pain is real, but suffering is optional. I think the faster that you can view what’s happening in your life as a gift, the faster that you can realize that this is happening for you and not happening to you. You move from a victim mode to an empowered mode. The faster you can get to the other side of this. So when I was 19 I didn’t have a crystal ball into the future. I don’t know that I would have had the where with all to think, “Oh, thank goodness this is happening to me.” I’m not trying to be [inaudible 00:52:01]. Of course you’re going to have grief and there’s going to be stress and so forth. But the faster you can realize that these things are actually happening for you to take a more close look at your life mind, body, spirit, the faster you’re going to get to the other side of this. I find it such a privilege to work with people when I do my one on one consulting and they tell me, “I want to get to that side too. I want to work with people who have autoimmune conditions. I want to help people. I know I can reverse my condition and I’m still working on it, but I can see that I’m going to view this as an opportunity and as a gift.”

                                So that’s what I would invite people to consider this as happening for you and not to you.

Dr. Weitz:            That’s a great message, absolutely. It’s easy to play the victim or feel the victim and not see it as an opportunity.

Palmer:                Yeah. I think every moment of every day we all have an opportunity. Health is not static. So I didn’t just beat an autoimmune condition and everything is roses. It takes daily work and practice. That’s why health is a practice. But when we view it in a certain way it can take a lot of that angst and deep level of stress away and when we remove the stress and we get into that relaxation response that’s where healing happens. So, it’s powerful.

Dr. Weitz:            That’s great and you have a special gift for our listeners?

Palmer:                Yes. So I mentioned when we were talking about food that it can be very, very frustrating and difficult to figure this out. So I have a gift. If you go to my website palmerkippola.com/gift, I have created an optimal food guide E-book and you can find out what your optimal foods are by following this process of what I call a 30 day food vacation and that’s just a little 12 page E-book that can be very helpful for people to see that there are a lot of things that you can eat. It’s not just, “Oh, I can’t have any of the foods I love.” No there’s a world of foods for you to explore and maybe many vegetables that you’ve never heard of or tried. So I invite people to take that step.

Dr. Weitz:            And what’s the best place for people to get ahold of you?

Palmer:                Palmerkippola.com is my blog and website and so I have a lot of information there. That would be a great first place to start. I lead people in Beat Autoimmune Academy, so it’s on website beatautoimmuneacademy. People can check out what’s in there. Those are two great places to find me and so thank you.

Dr. Weitz:            That’s great, excellent. Thank you Palmer.

Palmer:                It’s been a pleasure. Thank you so much for having me Dr. Weitz.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Reducing Food Cravings with Dr. Elena Zinkov: Rational Wellness Podcast 170
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Dr. Elena Zinkov speaks about Reducing Food Cravings 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

3:47  Many of us, esp. women, have food cravings such as for sugar or chocolate or for salty, crunchy foods and they can be overpowering.  There are numerous reasons why they may exist, including genetic predisposition, skipping meals, hormones, etc.  If a woman is nearing her cycle and her progesterone is tanked that can trigger food cravings.

5:20  There are various genetic variations including if there is a MTHFR mutation, which controls how our body utilizes vitamin B12 and folate.  This can trigger neurochemical imbalances and mood disorders that can lead to food cravings.  We often need to prescribe methylated B12 and methyl folate to such patients but if you see skin breakouts or feeling a bit more irritable than you were before are signs that you could be over-methylating.

15:28  There is a dopamine receptor gene that can play a role in neurotransmitter balance and in food cravings.  If you are genetically programmed to have fewer dopamine receptors, you need more stimulus to gain the same effect and you may be reaching for more pleasurable things and you need dopamine to reinforce that behavior.  It can be helpful to do urinary neurotransmitter testing.  It can be beneficial to use amino acids therapeutically, like 5-HTP or L-Tyrosine or to use some adrenal support or thyroid support or some B vitamins. GABA, pregnenolone, or progesterone supplementation can also be helpful for the right patient to help with issues with the GABA receptors.

19:45  Dr. Zinkow has found that some patients do really well with pregnenolone, which is one of the main precursors for all of the other female hormones, like estrogen and progesterone and it can have a positive effect on the GABA receptors and can be very soothing to the nervous system.  Similarly, for some women giving DHEA may work better than prescribing testosterone, since it is like a back door way of boosting both estrogen and testosterone levels.

22:58  Diet can be very helpful in controlling food cravings but we should be cautious if we have been eating the standard American diet that if can be too drastic to just jump into intermittent fasting right away and this can trigger more food cravings and they may get irritable, angry, and fall off the track completely.  It is probably better for them to clean up the diet first, get your emotions under control, and then later jump into some time restricted eating. Start by cutting out the crap and processed foods and find healthier ways to satisfy food cravings like having a couple of dates with some almond butter instead of a candy bar.  Getting enough protein and healthy fats is important and getting carbs from starchy vegetables or sweet potato and limiting fruits to one or two per day rather than eating pastas and breads.

27:32  Nutritional deficiencies can promote food cravings, such as a lack of magnesium can lead to more chocolate cravings.  A lack of iron can lead to carving more red meat.  A lack of B vitamins can stimulate sugar cravings.  Or we may have an inability for our mitochondria to produce enough ATP, so we may need mitochondrial support, like CoQ10, L-Carnitine, B vitamins, and magnesium.

29:48  The microbiome can play a role in food cravings.  For example, if you eat more sugar, you are more likely to grow more yeast and then you’re going to crave more sugar, which is going to cause more yeast overgrowth.

31:44  If we eat a higher fat, higher protein diet it is still important to get enough fiber to feed the microbiome, but we just need to avoid foods that we have sensitivities to. Dr. Zinkow said that she tends to stay away from food allergy testing because she does not find it to be very accurate and the gold standard is to do an elimination diet.

 

    



 

Dr. Elena Zinkow is a Naturopathic Doctor in Seattle, Washington who specializes in women’s health, hormones, and gut health utilizing a Functional Medicine approach.  She is also the best selling author of Crave Reset: A breakthrough guide for mastering the psychology and physiology of carvings.  Her website is ProactiveHealthND.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. Those of you who enjoy listening to the Rational Wellness Podcast, please go to Apple Podcasts and give us a ratings and review. If you’d like to see a video version of this podcast, go to my YouTube page, and if you’d like to see detailed show notes and a complete transcript, go to my website, drweitz.com.

                                Today, we will be discussing how to reduce food cravings, which we all have, with Dr. Elena Zincov. How do we reduce food cravings? Is it just by not giving into them? Is it by learning to stop hating our father? No. Food cravings actually have some physiological relationship to various things going on in our physiology, our genetics, our hormones, our microbiome, et cetera, and today we have Dr. Elena Zincov here to discuss those with us. She is a naturopathic doctor in Seattle, Washington. She specializes in women’s health, hormones, and gut health utilizing a functional medicine integrative approach, and she’s also the bestselling author of Crave Reset, a breakthrough guide for mastering the psychology and physiology of cravings. Dr. Zincov, thank you so much for joining me today.

Dr. Zincov:           Hey, thanks for having me. It’s a pleasure.

Dr. Weitz:            Good. So, we can get to know you a little bit. Perhaps you can tell us how you decided to become a naturopathic physician, and for the few who are new to this podcast, what exactly is a naturopathic physician?

Dr. Zincov:           That’s a great question. So, I grew up as a competitive athlete. I played competitive tennis for many years, I played in Voluntary Academy down in Florida, and I got exposed to a healthy lifestyle early on as a teenager, and so having struggled with my own cravings and acne and bloating and gut issues and hormone imbalances, I found my way to naturopathic medicine, and in fact, my mom was actually a medical doctor and I was exposed to naturopathic medicine when I was about 16 years old and I felt great, and so after competitive sports, I wanted to help others, I wanted to help myself, and I found myself at the Steer University applying for the naturopathic doctorate program, and naturopathic medicine, it looks at the whole person.

                                We don’t want to just treat the symptoms, we want to see how all things are interconnected and how they’re working synergistically, and even nowadays when patients come see me and they want to know what’s at the root cause, I always say there could be multiple root causes, right? We sometimes don’t know what came first, the chicken or the egg, and it ends up being this orchestra of things. It’s hormones, it’s gut, it’s brain, it’s inflammation, it’s immunity. So, naturopathic medicine really looks at the whole person, and not just the person, at the the environment, at mental state, at the work situation. So, it’s a total mind-body approach.

Dr. Weitz:            Cool. So, what are food cravings and how should we think about them? It’s a general thought.

Dr. Zincov:           Yeah. Yeah, we need to willpower away through food cravings, no. Food cravings are really interesting. I personally struggle with food cravings, sugar in particular, I’m sure a lot of people-

Dr. Weitz:            Does everybody have food cravings?

Dr. Zincov:           Not necessarily, actually.

Dr. Weitz:            Okay.

Dr. Zincov:           So, from personal professional experience, I feel like, as someone who sees both men and women in my private practice, men tend to have fewer food cravings, from just my observation. I find that women, and this is where I get, even in my book, I go a lot into hormones, women, due to just natural fluctuations in our hormones throughout the month, tend to be a little bit more impulsive around food, tend to have more of the sweet, that salty, crunchy, savory-like cravings, and they can be very overpowering.  But the thing with cravings is that they are multifaceted.  It’s not just, “Oh, I’m craving chocolates because I’m just craving chocolate.” There’s usually many more biochemical things that are happening behind it. You could have a genetic predisposition of why you’re craving sweets. You could be skipping meals and just not eating right, and you’re craving those things, right? For a women, she could be nearing her cycle and her progesterone is tanked, and that’s why she’s craving those things. So, cravings can be multifaceted, we all experienced them differently and there needs to be a unique approach when you’re addressing them.

Dr. Weitz:            Cool. So, in your book, you go through various concepts, and one of the concepts you talk about is genetics. So, perhaps you could talk about some of the genetic factors that might affect our craving for sweet foods or bitter or different types of foods.

Dr. Zincov:           Yeah. That was actually really interesting just in my research, and frequently, I won’t go into too much of scientific detail, but many people have heard of MTHFR mutation, and it’s how our body utilizes B12, well, and B12 is a really important nutrient that if it’s not metabolized properly or used correctly by the body.  And MTHFR prevents us from getting methylated B12 in our system that we can have a lot of neurochemical imbalances, mood disorders that can actually predispose us to craving more junk food, can predispose us to feeling more irritable and really not understand why we’re feeling the way that we do, and of course, Dr. [crosstalk 00:06:23]-

Dr. Weitz:            It’s interesting that you describe MTHFR as primarily about B12 when most people think of it as primarily about folate.

Dr. Zincov:           Yes. Yeah, and I think it’s a fine balance between the two, but predominantly from my experience, I really see B12 being an issue from just clinical or professional background, but I think it needs to be both, right?   Just like we need to talk about methylated B12, we also need to take methylated folate into consideration in this case.  So, that’s a really common one, right?  And that’s the low hanging fruit as far as genetics go. It’s easy to test, it’s easy to address, sometimes supplemental form.

Dr. Weitz:            The tricky part is how much. How do I know how much methyl B12, folate, methyl B vitamins do we need to take, should we take, can we over methylate?

Dr. Zincov:           Yes.

Dr. Weitz:            How do we measure levels?

Dr. Zincov:           Right. Yeah, and you actually bring up a really good point, and I had this conversation with one of my colleagues that I think we’re over methylating people to some extent, because a lot of providers are not testing for MTHFR and they’re just prescribing, let’s say methylated B12, right?    And so I get that many people are actually deficient or they have this mutation, but some of the things that I tell my listeners and my viewers and followers is that if you take methylated B12 and things like skin breakouts or feeling a bit more irritable than you were before, are signs that you could be over methylating.

Dr. Weitz:            What about testing? Because we do a fair amount of testing and I often find serum B12 is high, maybe serum folate is high, but then they could have sky high homocysteine levels, so obviously they don’t have enough folated B12, so testing is tricky and I think it can easily get confused if we run the wrong test.

Dr. Zincov:           Yeah, absolutely. I don’t know what your perspective is. I personally like more white blood cell testing than red blood cell testing, especially for B12. So, this is something when we do like a micronutrient test, I think that can show, I would say, not more optimal levels, but more accurate levels of nutrients.

Dr. Weitz:            Are you still using SpectraCell?

Dr. Zincov:           Every once in a while, I do, but for me, I’m at the point where I am seeing more of how my patients are feeling.  If I see somebody’s B12 are through the roof, but they’re presenting that they’re deficient in B12 and folates, I’m not just going to go for the labs, right?  I think that there’s something more involved, and I’m a conservative lab prescriber just because I’m sensitive sometimes to, when patients come in and they have like a 10 year history of not feeling well, and they’ve had all sorts of lab testing done, functional and nonfunctional, I’m more interested in talking to the patients and hearing how they’re feeling rather than maybe ordering another lab test, right?  Because I do cost-benefit analysis, pros and cons.  What is this lab test really they going to show us? Right? Are labs always 100% accurate? And do they always show the full picture? And so I’m really just sometimes more interested in seeing and hearing what the patient is all about. There’s so many times where we’ll do a serum B12 test and it’s like 2000, right? Whatever. It’s through the roof, but we still supplement, or we do a nutrient shot like a hydroxocobalamin, methylated B12 combination and they feel great. So, who’s to say that they have too much, quote unquote, air quotes-

Dr. Weitz:            So, my argument would be because that’s the wrong test, that serum B12 levels are not indicative of tissue levels, that doing a methylmalonic acid or homocysteine is a more functional test, so my argument would be, you got to run the right test.

Dr. Zincov:           Right. Yeah. No, I agree with you. Mm-hmm (affirmative).

Dr. Weitz:            Okay. So, talk about more, some of these genes that affect our cravings.

Dr. Zincov:           So, there’s definitely a few genes. For example, I talked about MTHFR and the reason why I call it the low hanging fruit, because it’s easier to address. There are-

Dr. Weitz:            So, what cravings does a MTHFR, if somebody… So, MTHFR they could have, there’s at least several different versions of this gene, and then they could have one or two copies of it. So, how many copies of one or both of these variations, and actually there’s 10 more that most people don’t measure, would affect food cravings? And in what particular food cravings would we tend to see with that?

Dr. Zincov:           So, I think just focusing on the MTHFR mutation can actually not be very beneficial because what I don’t want is for people to get hyper-focused that if they have even one or two genetic mutations of this gene, that all of a sudden they’re going to blame all of their life’s problems on MTHFR mutation.  So, I definitely don’t want people to walk away from this thinking, it’s like, “Oh my gosh, well, I have this one mutation, I have two mutations, therefore, all the things that I’m craving or all the things that I’m experiencing are based on this, because-

Dr. Weitz:            You don’t want them walking into your office saying “Dr. Zincov, my life is ruined. I have MTHFR.”

Dr. Zincov:           Exactly. I want to approach this a little bit more from a holistic approach, which is where, when you have just one mutation compared to two, chances are, yes, you could possibly be experiencing fewer food cravings, and particularly sugar, and the reason for that is we need B12 for serotonin synthesis, and serotonin is a really important neurotransmitter that regulates our cravings, regulates our habits.  It’s a desirable, right? Neurotransmitter, and so it causes us to feel pleasure, and food is just such an easy thing. It’s a quick fix these days, and so when someone has one or two mutations, chances are that they’re not producing optimal levels of serotonin, which can lead them to binge more, right? Because they got to get that pleasure from somewhere else.

                                So, the tricky part with the other genes is, some people like bitter foods, some people don’t like bitter foods, some people like fatty foods, some people don’t like fatty foods as much, right? When you talk to your clients, people have different food preferences, and those folks who are genetically predisposed to avoid bitter foods are not going to be eating as many leafy greens because the bitter and the leafy greens is going to be a deterrent for them, but that is to say, right?   I don’t want people to say, “Well, I’m not going to eat my leafy greens because I’m genetically predisposed not to eat them.” Right? One of the things that I talk about in my book is that there are different ways that if you don’t like bitter greens, guess what? There’s an area of other greens that are non bitter, that are neutral to taste that you can have, right? So, let’s not just blame our genes for our poor dietary decisions.

Dr. Weitz:            In fact, maybe if you don’t like bitter greens, maybe that’s a reason why you need them.

Dr. Zincov:           Exactly, right?

Dr. Weitz:            I know chiropractic, right? We get patients all the time, and they spend hours and hours stretching and they can put their leg behind their head and twist it around three times, and they think that taking more yoga classes is going to help them with their back pain, but they love doing things they’re really good at, and that person really needs strength training and is not going to benefit from more yoga classes, whereas the person who is super tight and only does strength training and hates stretching probably needs, or definitely needs stretching more.

Dr. Zincov:           Right. Exactly. So, that’s so funny because I’m actually, I’m a yoga practitioner myself, and I’ve been doing yoga for 20 years, but I learned early on that more stretching is not actually a good thing, and my perspective is that we need to strengthen more than we need to stretch.

Dr. Weitz:            Yes.

Dr. Zincov:           But that’s-

Dr. Weitz:            Let’s talk about some of the other genes. I’m sorry. I’m throwing you off track.

Dr. Zincov:           No, that’s okay. So, I think those are the main ones that I would talk about, not to get lost too much in the weeds. I really think-

Dr. Weitz:            You mentioned a dopamine receptor gene also in your book.

Dr. Zincov:           Yeah. The dopamine receptor gene. So, this is really interesting because serotonin and dopamine are partners in crime. So, if someone has, we talked about MTHFR, we talked about serotonin synthesis and how someone who has, let’s say, deficiency in serotonin just naturally biologically, for whatever reasons, will seek pleasure in other ways.

                                What would happen, so let’s say you do an activity or you eat a food that causes you pleasure, right? Then dopamine comes around and reinforces that behavior, right? Because this is where I always talk about how we live in very urban environments, but we’re very primal in certain ways, and so if there is a dopamine receptor issue, for example, maybe you have fewer dopamine receptors, right?

                                Genetically you’re predisposed to have fewer dopamine receptors, your body’s going to need more stimulus to gain the same effect, right? So, now you’re reaching for more pleasurable things and then you need more dopamine to reinforce that behavior. So, it’s a vicious cycle that people find themselves in, and then, God forbid, then you share that something was pleasurable, then you produce oxytocin, and that reinforces that behavior. So, it ends up being a hot mess.

Dr. Weitz:            So, neurotransmitters, you have a whole chapter devoted to neurotransmitters, like serotonin, dopamine, GABA, and so these are crucial for food cravings?

Dr. Zincov:           Yeah, absolutely. So, a lot of times-

Dr. Weitz:            Do you ever measure neurotransmitter levels? Have you done the urinary neurotransmitter testings?

Dr. Zincov:           Yeah. Yeah, and I find that to be really interesting. There’s simple quiz that people can take online, and maybe I can forward the one that I like, if somebody doesn’t have access to testing, but I think urinary metabolites, really, the breakdown products of a lot of these neurotransmitters can be a good indication of our natural production.  In fact, I think it should be more mainstream to test for this, right? Before we even prescribe something like a SSRI or an antidepressant or anything like that. It’s like, why don’t we test these things first? Right? And spare people a lot of pain and agony.

Dr. Weitz:            Absolutely. Because otherwise we’re just guessing at what we’re doing with neurotransmitters.

Dr. Zincov:           Yeah. Yeah, exactly, and so when it comes to craving-

Dr. Weitz:            In fact, very few studies really directly link low serotonin levels with depression, it’s much more complex than that.

Dr. Zincov:           Right. Right. Absolutely, and so it ends up being like a cocktail of neurotransmitters that are involved in regulating our emotions, our mood, and then in turn, our food cravings, right? It’s not uncommon for someone to say like, “I’m irritable.”   Or let’s say depressed, right? Since we’re talking about serotonin and SSRIs, “I feel depressed, I feel anxious, I’m going to have something sweet.” Right? Because it just provides that immediate release of serotonin to patch that pain for a short term.

Dr. Weitz:            So, can a therapeutic use of amino acids be beneficial in helping to support neurotransmitter production?

Dr. Zincov:           Yeah. Absolutely, and this is one of the things, even in my research and trying this with my patients as well, I’m not the first provider in the history of medicine, right? Who’s saying, hey, how about even just a little bit of supplementation of 5-HTP or L-Tyrosine, or how about a little bit of adrenal support, a little bit of thyroid support?   How about some B vitamins? Like we talked about some precursors for some of these neurotransmitters. I talk about GABA, pregnenolone, progesterone, all those things play with the GABA receptors, right? How about we try those things, right? And see if we can manipulate our physiology or optimize our physiology in that way.

Dr. Weitz:            So, how often do you prescribe pregnenolone?

Dr. Zincov:           I would say actually more nowadays than ever before.

Dr. Weitz:            So, give us an example of when you might prescribe pregnenolone.

Dr. Zincov:           Yeah. I have a couple of women that I’m working with right now where it’s actually made quite a big difference and I actually didn’t really believe in pregnenolone for some time. I just-

Dr. Weitz:            Going back and forth on it?

Dr. Zincov:           Yeah. Yeah. I was like, “Oh, does it really work?” And then I’ll go through phases where I’ll research something a little bit more and then I’ll dose it, and then I’ll just see how my patients react.

Dr. Weitz:            By the way, for people listening to this podcast, if you’re not familiar with pregnenolone, maybe you could just explain what pregnenolone is.

Dr. Zincov:           Yeah. Pregnenolone is one of the main hormones which then gives birth to all the other hormones, right? So, it’s higher up in the chain of command as far as hormones go, and we can’t really test for it because it has a super, super short lifespan in the bloodstream, so it’s not like you can… I don’t like it when I see providers testing for pregnenolone, because I’m like, “What does it give us?” Right? I mean, it doesn’t really give us a lot of information, but anyways, but what can happen, so I’ll give you an example. I have a postmenopausal woman who continues to have really poor sleep and we’ve tested her cortisol, we’ve tested her nutrient levels, we’ve worked on her thyroid, worked on all of the sex hormones.

                                She does exceptionally well with bioidentical progesterone, but terrible with any sort of estrogen, right? And so, one of the things that I wanted to explore with her is because I know pregnenolone has a really positive impact on GABA receptor. So, one of the pregnenolone metabolites can affect GABA receptors and can be very soothing to the nervous system, right? And so I added, I think, like 25 milligrams of pregnenolone to her nighttime routine, because technically, you can take it in the morning. For someone who tends to be anxious, pregnenolone can be really good to dose first thing during the day, but for her, I used it at nighttime and that really did the trick.

                                However, I should also add that I also added DHEA to her routine, and for someone, let’s say, there’s a lot of women who are sensitive to hormones, right? And so we have to go through the back door, and the reason why I like pregnenolone, the reason why I like DHEA is because I’m not giving you exactly estrogen, I’m not giving you exactly testosterone, but those guys get converted, right? DHEA, some of it gets converted to estrogen, some of it gets converted to testosterone, and that could be the back door to boosting someone’s, even estrogen levels. So, that’s one way that I’ve used it in my practice.

Dr. Weitz:            Cool. What is the best diet for controlling food craving? Should we follow a low carb program? What about intermittent fasting?

Dr. Zincov:           Oh, the million dollar question. I get this asked a lot, and I actually, this is where medicine becomes really individual because some people who have a really hard time controlling food cravings, sometimes intermittent fasting or time restricted eating may not be the best thing, right? Because it can cause… Yes, it can help balance blood sugar longterm, but you almost have to clean up the diet first, get your emotions under control, and then later jump into some time restricted eating, right? What happens sometime is somebody eats the SAD diet, the standard American diet, they’re have uncontrollable sugar cravings, and they’re like, “Intermittent fasting or time restricted eating is going to fix all of my dietary problems.” Right?

                                And so they go from doing 0 to 100, and they find themselves really overwhelmed, really irritable, angry, and falling off track really quickly, and so in terms of what’s the most optimal diet, you’ve got to start with the basics, right? Let’s cut out the crap, all the processed food, all the processed junk. I’m okay with people, even initially when they’re battling food cravings, and having gone through this personal experience myself, it’s like, it’s okay to have alternatives, right? But have them healthy. Instead of having a chocolate bar, having a couple of dates with maybe some peanut butter or almond butter, right? So, still satisfying that sweet craving, but in a really more holistic and functional way.

                                And then later, once you have your bearings under you, right? You can start playing with time restricted eating. The other thing I should say is that a lot of times people experience cravings because they didn’t eat enough protein. They didn’t eat enough fat during the day, or they skip meals, not unintentionally. So, it’s different if you’re fasting, right? And you know that you’re skipping meals, versus, I’ll have breakfast, and then six hour later, I have a snack, and then I find myself staring at a refrigerator at six o’clock at night eating everything in sight. That’s, I call, the non-intentional fasting where you lose track of your day, versus time restricted eating, which is intentional fasting.

Dr. Weitz:            So, if not getting enough protein and not getting enough fat is important, should we follow a high protein, high fat, low carb diet?

Dr. Zincov:           I’m a huge proponent of a lower carb diet, but not necessarily keto. I think that I’m not a carbophobe, I think carbs are important. I think, obviously, a lot of carbs are not created equal. When I talk about carbs, I want people to get most of their carbs from vegetables, from starchy vegetables, maybe like squash, right? Or sweet potato. Maybe just limiting fruit to one to two servings per day. When I say carbs, I really am talking about the vegetable group of carbs, right? Not necessarily the pastas and the breads. I want people to avoid those things.

Dr. Weitz:            What about legumes?

Dr. Zincov:           Sensitive topic.

Dr. Weitz:            Watch out for the deadly lectins.

Dr. Zincov:           I know. Oh my gosh, I am fine with legumes. I think that they have lots of good nutrients, they can actually help people balance their blood sugar, they can be-

Dr. Weitz:            Lots of fiber to feed your microbiome.

Dr. Zincov:           Absolutely. The whole thing with-

Dr. Weitz:            Low in the glycemic index.

Dr. Zincov:           Yeah. There’s just so many benefits to legumes, and it’s more about the source, how you prepare them. I mean, there’s so many ways that you can optimize their digestion and breakdown and absorption. I’m just not 100% in the whole lectin theory that that’s at the root problem of our diets, like what do we eat? Just meat and kale? I mean, I’m all about moderation when it comes to diet.

Dr. Weitz:            It could be the new diet, the meat and kale diet.

Dr. Zincov:           God forbid.

Dr. Weitz:            The Carni-Kale diet.

Dr. Zincov:           Yeah, exactly. You never know, right?

Dr. Weitz:            So, how do nutrient deficiencies promote food cravings?

Dr. Zincov:           Yeah, absolutely. So, a key example, like we talked about B12, right? And MTHFR deficiency, and that can predispose people to have more sugar cravings. Magnesium is a really common example. It’s like the poster child for food deficiencies or nutrient deficiencies that can lead to food cravings, so if someone, let’s say, is low in magnesium, they can have more chocolate cravings, and so that’s the poster child for that.  If you have low iron levels, that can cause, especially a lot of women, it can cause them to crave more red meat, right? We just run into a problem. Do you really need to eat more red meat? So, that’s where we need to individualize our medicine a bit more. So, those are really the common examples. The thing is that, what I’ve seen is a lot of deficiencies in B vitamins. Deficiency-

Dr. Weitz:            So, if I had a sugar craving right now, if I popped a couple of mag citrate caps, that would take care of it?

Dr. Zincov:           No. I think in that situation, when someone is like, “Oh, I really need sugar right now.” Chances are, maybe they didn’t get enough B vitamins, right? Because here’s the situation, is that, how do we get our energy? ATP? When we talk about, “I need more energy.” We need more ATP. That’s the unit of energy, right? Where’s your energy produced? In the mitochondria. What does your mitochondria need?  It needs, for the electron transport chain, right? How do we get the ATPs? We need CoQ10, we need, L-Carnitine, lots and lots of B vitamins, we need magnesium, we need B12, which is part of the B-vitamin family. So, there’s all of these nutrients that are involved in energy production, that if we’re deficient in those things, guess what? We’re going to crave more sugar because we can’t make those ATPs. Now, we’re getting into mitochondrial dysfunction.

Dr. Weitz:            Absolutely.

Dr. Zincov:           Yeah.

Dr. Weitz:            Functional medicine discussion without mentioning the mitochondria.

Dr. Zincov:           Or MTHFR.

Dr. Weitz:            What part does the microbiome play in food cravings?

Dr. Zincov:           Well, we’ve got more bacteria in our gut than we have the total amount of cells, right? In our body, and people talk about the microbiome as something like super cozy, working for us, but the reality is that the microbiome is there to serve itself, right? So, it’s us versus the microbiome, and the more certain foods you eat, let’s say you eat more meat. You’re going to create more microbiome that’s going to thrive on meat, right?   So, you’re going to produce that type of bacteria that’s going to make you crave more of those foods. Same thing with carbohydrates. I don’t remember off the top of my head, there are certain bacteria that when you do eat a higher starch diet, higher carb diet, those are the things that you’re going to crave, right? So, you create the microbiome by what you eat. The cool thing is that there’s a lot of research that shows that we can simply turn that around 24, 48 hours, right?  Which is pretty cool, and so I tell people, if you slip off your diet, don’t worry about it. You have the next day, or even the next moment to start making the change. So, certainly there’s a link between what we eat and the type of microbiome that we shape, and when I talk about microbiome, even I used to think that microbiome just talks about bacteria. Microbiome is viruses, microbiome is bacteria, it’s yeast, it’s parasites.  So, it’s a whole ecology that we’re dealing with. If you eat more sugar, chances are you’re going to grow more yeast, right? You’re going to crave more sugar, which is going to cause more yeast overgrowth, and it’s not just candida, right? There’s like 20 plus, some sort of yeast species that we can get exposed to or create.

Dr. Weitz:            Now, if we have a higher fat, higher protein diet, lower carbs, are we going to risk not having the fiber that a lot of the bacteria that are in a microbiome need?

Dr. Zincov:           Yeah. Well, and this is going back to what you were talking about, even legumes, right? I have no problem with people eating legumes or whole grains, things that they’re not sensitive to.  It’s really, the only foods that I want people to avoid are the ones that they’re sensitive to, right? Or that can be inflammatory, or that possibly can cause allergies or blood sugar dysregulation-

Dr. Weitz:            How do you determine which foods those are?

Dr. Zincov:           Ah, another sensitive topic. So really, I stay away from food allergy testing because I don’t think that it’s very accurate. Really, the gold standard of food allergy testing is, take a food out for an extended period of time, bring it back in to see if that’s something that you get a reaction to, and-

Dr. Weitz:            The elimination diet?

Dr. Zincov:           Elimination diet, exactly, is really the gold standard. There’s just way too many false positives and false negatives with food allergy testing, and don’t get me wrong. I’ve seen great success with those tests, right? But I think there’s few individuals who really benefit from it, and I think that it can be useful when we’ve exhausted all our options, and we have no clue where to begin, right? I’ve seen something like asparagus being a really big sensitivity for someone, and we didn’t know that until we did the food allergy testing. So, it’s not-

Dr. Weitz:            And there’s better and worse food sensitivity testing too.

Dr. Zincov:           Yeah, exactly. But when it comes to, going back to the question of, are we risking people eating lower fiber diets by choosing higher protein, higher fats? Yeah. We are. And that’s why I’m not afraid to prescribe, right?   Legumes and squash and the tubers, right? I’m not afraid to prescribe those things, and I encourage those things because fiber is super important and prevents against colon cancer and it supports the microbiome growth, and so it’s-

Dr. Weitz:            Yeah. I interviewed Kiran Krishnan a few weeks ago, he spoke at our functional medicine meeting and he was talking about how, if you have a higher meat diet, you have a higher level of Prevotella, and you throw off your Prevotella to Bacteroides ratio.

Dr. Zincov:           Yeah, yeah. And-

Dr. Weitz:            Yeah. And how that’s a negative and that affects blood sugar, so that could play into this whole thing too.

Dr. Zincov:           Yeah. And I’ve studied Bacteroidedes and Firmicutes species and some of those other proteobacterium like E. coli pretty extensively, and that can affect your estrogen, especially for women. This is really important.  Actually for men too, because sometimes when people think about estrogen, it’s like, “Oh, that’s a woman’s hormone.” Well, guess what guys? You don’t want your estrogen to be through the roof, right? And when I-

Dr. Weitz:            And you don’t want it to be too low either. Men need a certain amount of estrogen also.

Dr. Zincov:           Absolutely. Yeah, absolutely, and so when I look, let’s say I do somebody’s hormone panel and I see that their estrogen is through the roof-

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

Dr. Zincov:           So, I do a combination. I like urine testing, and I also like blood testing.

Dr. Weitz:            You like Dutch?

Dr. Zincov:           I like Meridian.

Dr. Weitz:            Oh. I don’t know them.

Dr. Zincov:           Yeah. Yeah. I-

Dr. Weitz:            Just like a 24 hour urine?

Dr. Zincov:           It is. So, it’s actually both Dutch and Meridian and I’m pretty vocal about my preference between the two.  I’m a Meridian fan for my reasons, but they’re similar in the technology-

Dr. Weitz:            You got to carry around the jug of urine, though.

Dr. Zincov:           No, that one, so it’s different. So, they’ve moved away from doing the jug of urine test, which is really inconvenient for people, to doing the dry urine strip testing.

Dr. Weitz:            Oh, okay.

Dr. Zincov:           So, a bit more convenient. I’m sure it’s not as maybe accurate as doing an actual jug of urine, but it’s a lot more convenience, the compliance rate is obviously a lot higher, and it gives us great data. I mean, everything from estrogens to estrogen metabolites to, right?  Progesterone, to androgen breakdown, cortisol curve, super essential to know, and so there’s just minor differences that I like in Meridian compared to Dutch. I don’t think we should go off of just urine testing alone, I think it’s important to also do blood testing, get a snapshot of the, actually, bioavailable levels, but when it comes to once someone is doing-

Dr. Weitz:            You often see discrepancies between serum and urine on hormones?

Dr. Zincov:           It’s not comparing apples to apples. So, there is, every once in a while, and I’ll tell you what it is. I’ll give you an example of testosterone, for example, right? So, someone can test really high on testosterone in the morning when they go get their blood drawn, right? But the benefit of doing something like a 24 hour hormone test is that-

Dr. Weitz:            It could drop later in the day.

Dr. Zincov:           Precisely, and I’ve had women who would say, “Well, my testosterone is high. Why do I need more testosterone?” And then I show them their test on the 24 hour, and I’m like, “Yeah. You could have been high at 8:00 AM, but then starting at 10:00 AM, it could significantly or exponentially drop, for whatever reason.   Maybe there’s an adrenal dysfunction, right? And so for whatever reason, and then they ended up feeling better, right? Once they’re in a little bit of testosterone, for example, or MOC or whatever we decide what the route of treatment is going to be, but that’s the benefit of using both tests, urine and blood, because the blood is great if we just get a snapshot, right?    And if you’re low, well, then you’re low, right? But someone could be low at one point and super high at another point, and this is where even the thing with estrogens we want to be really careful with, is that we want to make sure that we are understanding what are the total levels of hormones? I think that’s really the point, that, what are the total levels of hormones, given that they can cycle throughout the day, not just a month?

Dr. Weitz:            And also, how does your body process those hormones?

Dr. Zincov:           Oh, man.

Dr. Weitz:            Are you clearing your estrogens? Are you clearing them in a way that puts you at less risk of breast cancer?

Dr. Zincov:           I work with so many women who are post breast cancer, who have a high risk of breast cancer, I have a lot of women who don’t have breast cancer, but their mom, their aunt, their sister have all had had breast cancer, and so I’m such an advocate for women getting their estrogen metabolites tested, getting their estrogen tested.  I think there’s a misconception that when women hit, let’s say, perimenopause or menopause, that our estrogen declines. It does, but actually some women are still estrogen dominant even in menopause, and that’s a scary thing, giving what estrogen can do in terms of cancer.

Dr. Weitz:            So, what do you do about that?

Dr. Zincov:           So, we definitely want to offset estrogen. Estrogen, I see it more as a bully hormone. It’s an important hormone, but it can be nasty, right? When it’s I high amounts.

Dr. Weitz:            So, you give them progesterone?

Dr. Zincov:           We give them progesterone. That’s one of the best ways to offset estrogen. The other thing we can is-

Dr. Weitz:            And you like oral or cream for progesterone?

Dr. Zincov:           I like oral. Yeah. I like oral. Again, lots of benefits, especially if we’re dealing with estrogen dominance, I say, just go for the oral form. Every once in a while, and literature is really mixed on this as phytoestrogens, right? Phytoestrogens much more mild in terms of binding estrogen receptor sites, bu you got to be careful.

Dr. Weitz:            Like soy, black cohosh, things like that?

Dr. Zincov:           Yeah. Black cohosh, dong quai, all those things are great. Flaxseeds, ground flaxseeds are actually natural phytoestrogens, and of course soy, just making sure that it’s organic soy, but it’s really, again, it’s like people are so scared of soy. Well, it’s actually just maybe a couple of times a week as a phytoestrogen source, it might not be a bad option. Yeah. So, those are the two ways that I would offset estrogen, and of course we can get into some liver optimization, right?  Like DIM and NAC and glutathione and dandelion root and burdock root. Anytime there’s estrogen dominance, you actually got to work on the liver, but then you actually, like we were talking about, gut health and Bacteroidede species, it’s really interesting. I started my own case study research in my clinic, because I’m like, if someone is estrogen dominant, I bet if I test their stool, they’re going to be dominant in certain types of bacteria, and sure enough, right? And they’ll be high in Bacteroidedes, they’ll be high sometimes on Firmicutes or even E. coli, and people are scared E. coli.

                                It’s like, well, we have certain strains E. coli in us, right? It’s just, it’s when they outgrow their welcome, then it becomes a problem, and so when it comes to even estrogen dominance and people are like, “Well, how’s this related to food cravings? Well, if you’re estrogen dominant, you’re going to be an irritable mess, which is going to force you to make really poor food decisions, in a nutshell.

Dr. Weitz:            What’s your favorite stool test?

Dr. Zincov:           I liked Genova. The GI Effects. And again, some people prefer the GI-MAP. I really like Genova, I think they do a really great job of breaking down the different categories. It’s visually more pleasant to look at, it’s easier to explain, wrap your mind around it. I think they do a great job of showing the protein breakdown, the fat breakdown, if there’s missing short chain fatty acids, right? Which are important for the microbiome as fuel. So, I think they do a really great job of just putting things in their place.

Dr. Weitz:            So, you mentioned estrogen and progesterone and testosterone. What about adrenal hormones and thyroid?

Dr. Zincov:           Yeah. Yeah, absolutely, and I think those are the ones that people think about more frequently than the other hormones, the sex hormones. The thing is that, especially in times of stress, and a lot of people are under a lot of stress right now, right? Times of uncertainty. That’s an understatement. “What stress?”

Dr. Weitz:            “What stress? There’s no problem.”

Dr. Zincov:           “I don’t know what you’re talking about.”

Dr. Weitz:            “I don’t know what you’re talking about. Everything’s great.”

Dr. Zincov:           I know. Yeah, right? A little bit of denial can’t hurt us, right?

Dr. Weitz:            Just another pandemic. No big deal.

Dr. Zincov:           Yeah. Exactly.

Dr. Weitz:            “Our economy’s locked down.”

Dr. Zincov:           Oh, man. Don’t even get me started on that. So, the two really main organs, or not organs, glands that are really taking a beating is our thyroid and our adrenals. We’re not sleeping enough, we’re eating bad food, we’re angry, we’re frustrated, we’re stressed. We are dealing with things that are out of our control, right? And so your thyroid and your adrenal gland, the things that really keep your metabolism going, the things that keep your adrenaline pumping like your adrenal glands, they’re stressed. They’re also stressed.

                                And so what happens is that when your thyroid tanks, people tend to crave more sugar, and one of the reasons is because your thyroid regulates your insulin, it regulates your blood sugar, and when that system is broken, you’re going to get your sugar from elsewhere, right? Not from your innate reserves, for example. And then because your adrenal gland, which is actually located right on top of your kidneys, it helps your kidney. It helps your kidneys function, right?

                                It keeps your pH, keeps your concentration of your blood at a certain level and people crave salt. And it’s a synergistic relationship, right? Between the thyroid and adrenals and people are like, “Well, what if I create both sugar and salt?” Well, that’s a double whammy. We gotta address both, but that’s, again, from a functional medicine perspective, a lot of people are walking around with under functioning thyroid glands, and I just don’t understand, given the research that TSH is not the most optimal marker to test the thyroid gland, we’re still not feeling well.

Dr. Weitz:            So, what do you look at? What’s the most important thing to look at, and what are the key ranges?

Dr. Zincov:           Yeah. Yeah. So, I hope people have a piece of paper and a pen or their notes on their iPhone ready. So, I still like to test for TSH, but I like to test for total T4, total T3, free T4, free T3, always fired antibodies, sometimes reverse T3, mostly used for cancer monitoring or inflammation, but not really relevant, at least from my… I have not seen it professionally or in research that it’s relevant in terms of diagnosing thyroid dysfunction.  So, you want to test all of those thyroid markers and what’s the optimal range? There’s a lot of even research that shows that TSH below 2.2 has linked to less depression and fewer mood disorders. So, I like the TSH to be at least closer to 1. 1 is that optimal range. I like to look at free T4 and free T3 because those are the more bioavailable active hormones.   For free T4, I like for it to be at least between 1.2, 1.4, and a lot of people are walking around with like 0.9, 0.8, right? “Just because it’s not tanked doesn’t mean that I need to treat it.” And four free T3, some providers just look at free T3, what it’s doing, because that’s really the most active of thyroid hormones. Free T3, I like for it to be at least 3.3.

Dr. Weitz:            Oh, wow.

Dr. Zincov:           3.3, 3.5. Men actually do really well with at least like a 3.7.

Dr. Weitz:            Wow.

Dr. Zincov:           Yeah.

Dr. Weitz:            That’s that’s a high level.

Dr. Zincov:           Yeah. Well, I mean-

Dr. Weitz:            I mean, compared to the normal range, right?

Dr. Zincov:           Oh, yeah. Well, it’s really frequent that someone will, like during my initial consult with a patient, people will say, “Well, my thyroid is normal.” And I’m like, “Well, what is normal?” Because they’re coming to me from, let’s say conventional medicine, or even a naturopath, right?   I do a lot of second opinions on hormone testing and they’ll say, “Well, my thyroid is normal and they’re free T3.” So, the free T3 range, let’s say, is 2.0 to 4.4, and they’ll say, “Well, my free T3… let’s say, “… is 2.4.” “Wow, you’re low.” Right?

Dr. Weitz:            Yeah.

Dr. Zincov:           And so-

Dr. Weitz:            Oh, even though it’s in that range, because it’s at the lower end of that range, that’s something to look at, so don’t just pay attention to the things that come up in red, you’re saying?

Dr. Zincov:           Exactly, exactly, and my patients, they’ve become really educated about that. They know that I’m not just looking for something in the middle, right? I’m really looking at what’s the upper ends, but even though, we talked about B12, doesn’t matter. If you’re through the roof on B12, but you are feeling crappy, chances are, it’s either the wrong test, right? Or something else.

Dr. Weitz:            Now, some of the functional medicine labs will include the free T3 and a free T4, but not the total T3 and a total T4, so a lot of times I don’t do those. Am I really missing something?

Dr. Zincov:           I don’t think so.

Dr. Weitz:            Okay.

Dr. Zincov:           I think it’s really more essential to understand what the free T4 and the free T3.

Dr. Weitz:            Okay. Because those are the active forms?

Dr. Zincov:           Exactly, and that’s where you’re getting the real benefit, and the real result.

Dr. Weitz:            Yeah. Okay. Great. Any final thoughts for our listeners and viewers?

Dr. Zincov:           I think one of the things I’d want them to know is just pay attention to how you feel. So much we’re in a reactive mode, right? We just don’t take the time to pause and check in with ourselves, and whether it’s food cravings, whether it’s fatigue, whatever you’re feeling, we go from feeling something, to reaction, and so nowadays, I think it’s just really important to just take pause, right? You’re going to get a lot out of that 10 second pause. That’s where the change happens. That’s where the magic happens. That’s where you change your behavior and your habits for the best.

Dr. Weitz:            Cool. How can listeners get a hold of you and find out about your book and seeing you for a consult?

Dr. Zincov:           Yeah. People can go to my website, proactivehealthnd.com. There’s a lot of information there on the programs, on some educational things that we’re doing, and then I’m big on the Instagram. It’s Dr. Elena Zincov, really easy to find me. Try to basically share the knowledge of health with everyone.

Dr. Weitz:            Cool. Thank you so much for joining us today.

Dr. Zincov:           Thanks for having me.

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Gut Parasites with Dr Jason Hawrelak: Rational Wellness Podcast 169
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Dr. Jason Hawrelak speaks about Parasites 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

6:49  Gut parasites used to be considered a more common cause of gut infections 20 years ago, whereas in the last 5 or 10 years in Functional Medicine circles we have come to focus more on conditions like Small Intestinal Bacterial Overgrowth, H. pylori, dysbiosis and fungal overgrowth. What should make us suspect that a patient with digestive symptoms might have a parasite?  The symptoms do overlap with symptoms from conditions like IBS, SIBO, functional dyspepsia, and inflammatory bowel disease.  We have to distinguish between parasites like Giardia and Entamoeba Histolytica that clearly cause serious gut infections from more debatable ones like Blastocystis Hominis and Dientomoeba Fragilis. You might get some history like they have recently travelled overseas and then got a case of traveler’s diarrhea.  We have to do some testing to see what is causing the symptoms and not just stool testing for parasites. If you find Giardia, you can be fairly confident that this is responsible for that patient’s symptoms. But if it is Blastocystis Hominis or Dientomoeba Fragilis we can’t make that assumption, because of the prevalence of these microbes in healthy populations.  Dr. Hawrelak recommends doing a suite of tests to determine what causes these symptoms including not only a PCR stool test but a microbiome analysis stool test, fecal calprotectin or lactoferrin for inflammatory bowel diseases, a fecal occult blood, and SIBO breath testing.

12:00  If you have a patient who has digestive symptoms like gas, bloating, diarrhea or constipation, and they have a positive SIBO breath test and they also have a protozoan organism like Blastocystis and/or Dientomoeba that shows up on a stool test, you should treat the SIBO.  Such protozoans are extremely common and are generally irrelevant to that person’s symptoms.  15-20 years ago SIBO wasn’t that well known and we used to treat such patients for Blastocystis and we would get some results but it would generally not resolve completely. He talked about one patient who he treated for Blastocystis and got somewhat better and then 12 months later was diagnosed with fructose intolerance and went on a low fructose diet and all her symptoms completely resolved and Dr. Hawrelak was upset that he missed that diagnosis.

15:15  It is interesting to consider whether there could be SIPO or Small Intestinal Protozoan Overgrowth as a cause of IBS.  We should probably think of certain protozoans like Blastocystis and Dientomoeba as commensal, as a normal part of a healthy gut.  In fact, Dr. Hawrelak noted that he personally has elevated levels of Blastocystis Hominis on a stool test and no gut symptoms.  Perhaps we’ll be taking protozoan probiotic supplements one day.  On the other hand, taking certain antibiotics like Metronidazole, Flagyl, the most common antibiotic used to kill protozoal organisms, it tends to awaken the pathogenic potential of Blastocystis and increases its capacity to actually cause gut damage and to interact negatively with precancerous cells and become much more virulent. 

20:54  There are 17 different subtypes of Blastocystis Hominis but only 9 have been found in humans and the rest in other animals, like chickens, pigs, cows, etc..  For humans the most common subtypes are 1, 2, 3, and 4, esp. 1 and 3. There is no consistency in the data around which of these subtypes may be more pathological than the others.  Dr. Hawrelak wants to emphasize that when he has a patient who shows elevated Blastocystis or Dientomoeba he used to think that these were primary parasites that needed to be killed to help his patients feel better and now he generally regards these as a normal part of the microbiome in healthy patients. There have been a lot of good studies done in western Europe that have found that 7 out of 10 healthy kids have Dientomoeba in their guts and kids with functional abdominal pain are less likely to have Dientomoeba in their guts than those who are actually healthy.

25:33  In rare cases where he has a patient with significant GI symptoms and who has elevated Blastocystis and no other findings on gut testing, Dr. Hawrelak will treat the protozoan.  Blastocystis Hominis flourishes in an alkaline environment, so he will have patients eat more fiber, prebiotics, and a more plant based whole food diet.  More fiber will lead to more production of short chain fatty acids like butyrate and acetate, which will lower the colonic pH.  That in itself can lower Blastocystis levels.  Dr. Hawrelak will use agents like pomegranate husks and garlic along with saccharomyces cerevisiae boulardii probiotic.

29:57  Of the more clearly pathological parasites, Giardia is the one that Dr. Hawrelak sees most commonly, though less common than when he was practicing in a more rural area of Australia. He said that Giardia will often resolve without the need for specific treatment, but when it is required, he will use raw garlic and have patients press a couple of cloves into capsules or a glass of water and consume it twice per day. One study in Eqypt showed 100% erradication in only 3 days with raw garlic. He will also use pomegranate husk and plantago major ribwort. Dr. Hawrelak used to use berberine containing herbs like coptis, but he is concerned that berberine may have a damaging effect on the microbiome since it reduces bifidobacteria levels.  He will also give saccharomyces cerevisiae boulardii again as a probiotic, since it has been shown to help erradicate Giardia.  The Giardia is an amazing protozoal organism that forms a cyst and when you get one or two of them in the gut, they can cover the entire small bowel with the Giardia trophozote and they can damage the intestinal villi so necessary for absorbing nutrients from our food and damage the brush border and affect the brush border enzymes that are necessary to absorb foods like fructose and lactose.  Saccharomyces boulardii are wonderful for helping to regrow those villi and the brush border and you might do that during, then for at least six to 12 weeks afterwards to speed up healing. 

36:18  When treating worms, especially bigger worms like pinworms, it may be necessary to treat for 10 days, wait 10 days and then treat again for 10 days since eggs laid by the worms will not germinate until the antibiotics or antimicrobials are stopped. But this approach is not necessary with Giardia, which has a short treatment period and does not require using some of the stronger antimicrobial herbs.  For pinworms, Dr. Hawrelak used to use various herbs, including megadoses of wormwood and pomegranate husks and mix some garlic and peppermint essential oil with Vaseline and inserting it around or up the anus. Now he tends to use the prescription anti-parasitic taken once and then again in 10 days and that turns out to be both effective and cost effective and less labor intensive, esp. if it occurs in an entire family. 

41:02  H. Pylori is another type of infection that has been famously shown to be the cause of gastric ulcers in a percentage of patients.  What should Functional Medicine practitioners think about seeing an elevation of H. pylori show up on a stool test?  Dr. Hawrelak said that if he had a patients with GI symptoms and H. Pylori showed up on a stool test, he would look to see if there are any virulence factors and then he would follow up with an antibody blood test and a breath test.  If the antibodies and breath test were negative and a small amount of H. pylori showing on a PCR stool test, then its probably benign and not there in large enough amounts to cause any issues. If there are antibody levels and they have symptoms consistent with ulcers or gastritis, then it is important to treat H. pylori.  We know that certain strains of H. Pylori can cause peptic ulcer disease, we know they can cause increased risk of stomach cancer.  But there is also concern about eradicating H. pylori, since if you wipe out this species, what other microbe might start growing there that might be more virulent. Also there are quite benign strains of H. Pylori that might even have some healthful effects for us over time.  We should be especially concerned it we are considering using a triple or quadruple antibiotic cocktail that can cause permanent damage to the microbiome.  On the other hand, we can use some common nutritional products that have very little risk of harm and that can be very effective, like a mixture of the following natural agents: cranberry juice, broccoli sprouts, Lactobacillis reuteri DSM17938 probiotic strain, green tea extract, turkey rhubarb, and pomegranate husks have about a 90-95% eradication rate.  Dr. Harwelak noted that he rarely uses potent antimicrobial herbs like high dose berberine or eregano, clove, or thyme oil, since these can cause damage to the microbiome. 

                               



 

Dr. Jason Hawrelak is a Naturopathic Doctor, a PhD, and a master herbalist. He has been in practice in Australia for more than 20 years. Dr. Hawrelak is one of the leading experts in the treatment of gastrointestinal conditions with natural medicines and he has written extensively in Australia and International textbooks and journals on digestive topics. He continues to see patients in person and remotely. Dr. Hawrelak has developed an incredible subscription based resource to keep track of all the research on probiotics, called ProbioticAdvisor.

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 Doctor 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.

Today, I’m very happy to be speaking with Doctor Jason Hawrelak all the way from Australia about parasites. Parasites is a topic in gut health that seems to have fallen out of favor among functional medicine practitioners who deal with patients with gastrointestinal symptoms in the last five or 10 years. The focus seems to have shifted towards focusing for patients who are negative for having Crohn’s and ulcerative colitis, the focus seems to be towards SIBO and IBS.   Certain parasites are referred to as protozoans. Protozoans are actually single cell microorganisms and they include a large variety including amoeba, flagellates, ciliates, protozoans. Protozoans are common in fresh, brackish, or salt water. As well as in other moist environments including in an extreme environments like hot springs, hypersaline lakes. The protozoans can also form cysts to survive in dry environments in a dormant state. Some protozoans live in our guts without causing harm and may even provide some benefits while other protozoans may be a significant cause of disease such as [inaudible 00:01:54], malaria, giardiasis, et cetera. Protozoans are not infrequently found in the stool of patients when undergoing stool testing, especially some of the very sensitive molecular PCR tests. Parasites can take the form of worms or protozoans, of which, Blastocystis Hominis, dientamoeba fragilis, and Giardia are some of the more common parasites. Blastocystis Hominis is often considered by Functional Medicine practitioners to be a particularly difficult microorganism to eradicate and is often associated with a host of gastrointestinal symptoms including diarrhea and it’s also sometimes thought to be associated with Hashimoto’s hypothyroid disease. Some of these protozoans may not always be pathological as many of us think, as Doctor Hawrelak will explain today. One other topic I would like to ask Doctor Hawrelak about is H. Pylori infection, which at one time was considered an obvious problem when discovered on a stool panel, but is now understood to have a much more complex relationship with our gut.

                                                Doctor Jason Hawrelak is a naturopathic doctor. He’s a PhD, he’s a master herbalist, and he’s been in practice for more than 20 years in Australia. He’s one of the leading experts in the treatment of gastrointestinal conditions with natural medicines. He’s written extensively in Australia and international textbooks and journals on digestive topics. He both sees patients in person and remotely, he also teachers other healthcare practitioners. He’s currently coordinates and teaches the evidence based complimentary medicine program in the School of Medicine at the University of Tasmania. He’s the gastrointestinal imbalances lecturer in the master of science and human nutrition, and functional medicine program at the University of Western States in Portland, Oregon. Doctor Hawrelak started and runs an incredible resource to keep track of all the research on the latest probiotic strains called Probiotic Advisor, which I have used and is an extremely valuable resource. Doctor Hawrelak, thank you so much for joining me today.

Dr. Hawrelak:                     You’re very welcome, Ben. Nice to speak to you again. It’s been a while.

Dr. Weitz:                            Absolutely. Before we get started, I don’t know if you saw 60 minutes on Sunday, but I have bad news for you. You’ll have to close down your Probiotic Advisor because 60 minutes reported that there’s absolutely no benefit to any probiotic.

Dr. Hawrelak:                     Great. What can I tell my patients for the last 20 years? I can say it was all placebo perhaps. I haven’t seen that actually. I should put it on my agenda as something to watch to see what the mainstream media is actually reporting there. I think that comes from really misunderstanding some of the nuances around probiotics. Rather than taking them to change the ecosystem or to repopulate, which I think is the more popular idea, with knowing that they actually have specific effects and actions when ingested which creates physiological change, so we can use it for helping to eradicate H. Pylori for example, for decreasing obesity, or for moderating mood. There’s a whole bunch of positive clinical trials that it’s I think pretty mind blowing to come to that viewpoint that probiotics don’t work for anything based on what data has been published for the last 30, 40 years, particularly the last 20 years.

Dr. Weitz:                            Amazing amount of studies. Of course, that was one of their complaints. We’re not going to spend the whole time talking about 60 minutes, but that was one of their complaints that the probiotics that you ingest don’t actually find themselves to populate the gut. We know that.

Dr. Hawrelak:                     That’s not surprising, that’s now why we should be taking them. At least, what the research has shown us is that if that’s why you’re doing it, you’re not really taking it for the right reasons because you’re not really going to achieve that with the current generation that we have. It’s pretty rare to have any sort of longterm colonization, but that’s not to say that won’t be something we generate with future probiotics if we start making probiotics from things like Akkermansia, [inaudible 00:06:24]. Novel species that might actually have that capacity to stick around for longer periods of time or if not permanently. Reality is that they have therapeutic effects when we take them, some of them do anyway if we select them well and make sure they’ve got the right traits and qualities. When we stop taking them, that will stop having that effect just like any pharmacological agent whether that be pharmaceutical or herbal medicine that they’ve got an action while you take it. You cease taking it, it stops having that action.

Dr. Weitz:                            One of the reasons I really have been looking forward to this discussion is that I really wanted to dive into some information about parasites. When I first got into Functional Medicine 20, 30 years ago, it was a lot of talk about parasites. In the last five or 10 years, we’ve lost that focus, but I think it’s an important topic to talk about. When you’re consulting with a patient, are there any particular symptoms that come up during a consultation that will make you suspect this could be somebody who’s having a problem with parasites?

Dr. Hawrelak:                     I mean, the challenge with most symptoms that we’d associate with gut parasites like Giardia, which is undoubtedly a cause of gut infections, gut damage, Entamoeba Histolytica for example that are in that camp, versus ones that are much more debatable like Blastocystis and Dientomoeba is that the symptoms overlap with irritable bowel syndrome in some degrees with inflammatory bowel disease, functional dyspepsia, post infectious IBS with SIBO. It’s a whole cluster. If someone presents with these symptoms, you really need to do testing to ascertain what’s going on. You might get some clues from history in that they’ve just traveled overseas. They went to developing nations and they got a case of traveler’s diarrhea. That to me is a red flag that there may well be something staying in their gut from that.  That time of ingestion and that acute flair.  Sometimes, your body will fight that off.  Most of the time, it’s a bacterial agent anyway that causes traveler’s diarrhea, but we do get protozoa as part of components of or as contributors to that overall traveler’s diarrhea load.

                                                We might get that flag on the history, but we really need to do testing to ascertain what’s going on. For me, that wouldn’t mean just doing stool testing for parasites because I think we all get the potential of getting quite lost and missing what’s going on if that’s all that we do just because some microbes like Blastocystis and Dientomoeba are so common in healthy everyday people that if they’ve got some runny stool and some abdominal pain, you do one test, you do a stool test. It shows that, I think there’s a decent chance you’re going to miss what’s really causing that person’s issue in that instance. If it happens to be Giardia, fair enough, that’s a different scenario. If it’s Dientomoeba or Blastocystis, we can’t make that assumption that this is the cause of their symptoms because of the prevalence of these microbes in healthy populations. Essentially, to me it means we’ve got to do a suite of tests that if they present with that symptom picture that overlaps with so many other conditions, we actually have to test to rule out those conditions.   That would be things like fecal Calprotectin or Lactoferrin for inflammatory bowel diseases, a fecal occult blood for example also looking for more pathological changes and damage to the small or large bowel. For me, it would mean SIBO breath testing would be a component of that.  As well as doing a stool PCR looking for the presence of potential bacterial and protozoal parasites that may have been picked up from overseas.

Dr. Weitz:                            What is your favorite stool test these days?

Dr. Hawrelak:                     I would actually use a number in practice. I’m based in Australia, so we have the conventional pathology labs that do a stool based multiplex PCR that looks for the most common protozoal parasites, the most common bacterial causes of diarrhea. I might run that, but then also do a microbiome assessment as well that tells about the bacterial ecosystem, as well as doing breath testing. Then, the other tests looking for inflammatory markers.  In the colon, that might indicate that it’s more likely to be inflammatory bowel disease.  Even some of the more rare ones like lymphocytic colitis or collagenous colitis for example.

Dr. Weitz:                            Which microbiome tests will you use?

Dr. Hawrelak:                     Good question. These days, I’m using one of mostly between two different labs. One lab here in Australia called Microbiome that does metagenomic sequencing, which means we get very good detail and data from a species level perspective as well as from genus and higher up the hierarchy up to phylum. It also gives us the markers around levels of LPS production, levels of hydrogen sulfite gas production for example that I find can be clinically useful. Then, I’m also using Thrive as well particularly for my US patients where we get that nice snapshot of the bacterial components of the ecosystem.

Dr. Weitz:                            Yes, you might check out this biome FX test that Microbiome Labs is promoting now that Kiran Krishnan helped fine tune. It looks pretty interesting.

Dr. Hawrelak:                     I haven’t had a chance to look at that yet.

Dr. Weitz:                            Yes, check that out. If you had a patient who came in your office and they’re having some of these symptoms like gas, bloating, maybe diarrhea or constipation, they had a positive SIBO breath test, and you also saw a parasite, which would you treat first?

Dr. Hawrelak:                     For me if it showed up a very clear positive on SIBO breath testing and it had Blastocystis and/or Dientomoeba in the stool, I would treat the SIBO. I do this all the time. The presence of Blastocystis and Dientomoeba is generally completely irrelevant to that person’s symptoms. That’s something I’ve come to from 20 years of practice and reading more the recent literature around the prevalence of these parasites or in parasites. Protozoal and protozoal like organisms in people’s guts is extremely common. What I found is that most patients who present to me with, they go I’ve got a positive stool test for Blasto or Dientomoeba and they haven’t done a breath test yet, we’ll do a breath test for SIBO and it will actually show up positive. We treat the SIBO, their symptoms get better, they still have Blasto in their gut afterwards. That is so common. For me, it really showed clearly … I go back to how I treated patients 15, 20 years ago. If they showed up with a positive Blasto or Dientomoeba, I was like let’s try to kill this. Let’s focus in on that.

                                                Sometimes, you’d get symptomatic improvement for sure, but I think at least temporarily. I still think we were often inadvertently treating the SIBO in these patients, which was the cause of their symptoms because I wasn’t really aware of SIBO 15, 20 years ago. It wasn’t well known as a diagnostic label. Testing wasn’t really promoted, discussed, and talked about very much. I think I’ve seen that major shift in focus. I mean, one patient also illustrated to me very clearly that they came to see me. Classic symptoms of bloating, distention, some runnier stools.  Positive stool test for Blastocystis. I just made the assumption that was the cause. I said let’s treat that. Yes, there was symptomatic improvement while they were taking the herbs. Then, I hadn’t seen them for a while. Then, she came back. I think it was probably 12 months later. She said, “I was actually diagnosed with fructose intolerance. I reduced my level fructose and all my symptoms went away.” I just really was like, how could I miss that? I really let this patient down by not doing a proper diagnostic workup.

                                                I got fixated on this thing and that wasn’t the cause of her symptoms, she still has Blastocystis in her gut, but no symptoms if she goes on a low fructose diet. That patient really taught me a major lesson that we can’t … We’re often guilty of this premature diagnostic closure. I try to be less guilty of that now than I was in the past where we wouldn’t do a proper suite of tests to really see what’s going on. We’d get really fixated on that one and actually miss it. I’ve had other patients that I’d subsequently diagnosed with celiac disease that were by other practitioners diagnosed with Blastocystis and not followed up. You think, what’s the consequence of that missed celiac disease because we got so fixated on that Blastocystis on a stool test? Huge.

Dr. Weitz:                            Right. I want to go into some more detail on those two protozoans. I wonder if it’s possible that we have SIBO, which is bacterial overgrowth in the small intestine, I wonder if there’s a SIPO, if there could be a protozoan overgrowth in the small intestine that could be creating some of these problems. I asked Doctor Pimentel that when he was speaking at our meeting last month. He said, “We’re still going through all the samples. We’re going to look at that as a possibility.”

Dr. Hawrelak:                     Yes, because I think really with the evolution of technology I’ve used in metagenomics, we can actually take samples and see things that exist that we didn’t know existed before. It is interesting. I think because we’ve changed that technology or evolved into using technology that is far more accurate in its capacity to tell us what’s there, we’re seeing now that we all have protozoal organisms in our gut. That’s totally normal for humans. If you go back 20 years ago, people weren’t thinking that.  We were thinking if there’s a protozoal there, we must need to kill it because it shouldn’t be there.  It’s like, no.  We’re supposed to have fungi in our guts, we’re supposed to have bacteria, and we’re supposed to have protozoal.  They live in this usually beautiful harmonious ecosystem where they’re all interacting in ways that ensure our state of health until we upset that balance in different ways.

Dr. Weitz:                            Are you proposing that we should really think of protozoans in some cases as commensal?

Dr. Hawrelak:                     Definitely. I think certainly in the camp with microbes like Blastocystis and Dientomoeba, I will generally put them into the commensal camp in vast majority of my patients. Personally, I had a stool test done just because I was testing a bunch of different labs. It turns out I’ve got Blastocystis and Dientomoeba in my gut and I’ve got no gut symptoms. Managed to work 60 plus hours a week for the last 10, 15 years. No fatigue issues like the things that people see as symptomatic with these things, I don’t have. Here’s this one clear example of a case of a healthy person that has these microbes there, no symptoms whatsoever. You look at the literature, we find that’s actually fairly common with Blastocystis and Dientomoeba. They are extremely common in healthy people. The more recent research for the last few years have suggested particularly for microbes like Blastocystis that they actually play a pivotal role in keeping our ecosystem healthier verses the loss of our protozoal species that we’ve evolved with over millions of years some scientists and researchers are suggesting is having negative repercussions on our state of health that we see around us. Just like we’ve had that loss of bacterial diversity and loss of arguable fungal diversity that we are just finding out about now, but the repercussions of which I think we see all around us with the Western disease states that we see in practice all the time.

Dr. Weitz:                           Yes. Maybe we’ll be taking protozoan supplements at some point.

Dr. Hawrelak:                     It’s possible, I reckon. Yes.

Dr. Weitz:                           Maybe, it’s a question of balance. Maybe, it’s a question of you’re supposed to have a certain amount, but maybe if the Blastocystis is too high, it’s not a question of it shouldn’t be there, but it shouldn’t be there at that level.

Dr. Hawrelak:                     Yes. I mean, I do think there might be a part of that. Part of that is around environment. I always go back to that, the train is really immensely important for most organisms whether they can be infectious or not. The train is important and I’d dare say it’s similar with some of these microbes too that if we’re eating the right things and living the right lifestyle, then their presence is probably fairly irrelevant. You throw those things way out of balance and you throw other things in the gut out of balance, then maybe their populations or their behaviors change. I think that’s something we can see with microbes. There is some research around that with Blastocystis for example, research published very recently showing that exposure to Metronidazole, Flagyl, the most common antibiotic used to kill protozoal organisms. Well when it doesn’t kill Blastocystis it seems to actually awaken it’s more pathogenic potential that was lying dormant beforehand, exposed to antibiotics, and it increases capacity to actually cause gut damage to interact negatively with precancerous cells and become much more virulent. I think that there is an argument around how we eat, what our lifestyles are like, and potential functionality and behavior of these organisms within our gut that can be different if we ate a completely different diet, different lifestyles, exposed to low levels of antibiotics in our food chain. Maybe we’re bringing up more of the pathogenic potential.

Dr. Weitz:                            I was listening to an interview that Michael Ruscio did with Ilana Gurevich. She was talking about a study that found that species like Blasto and Dientomoeba fragilis, what they do is they change the microbiome enough to make the bacterial neighborhood more pathogenic and predisposed to negative changes either in the small or large bowels. Therefore, they’re maybe setting up things like SIBO.

Dr. Hawrelak:                     Interesting. I haven’t seen any research around that. I’d be happy to be posted some so I can read it. There is certainly some data. There was one study done in 2019 in vitro data getting a subtype seven from a symptomatic isolate subtype seven Blastocystis and giving it to mice. Finding that in in vitro, that it was able to shift the ecosystem. Maybe that’s what she’s referring to. She might be referring to some other study that I’m unaware of. That was interesting in that it did seem to increase levels of more pro inflammatory bacteria like E coli and [inaudible 00:20:51] for example, and decrease levels of bifidobacteria.

Dr. Weitz:                            We need to discuss the subtypes. There’s 17 different subtypes of Blastocystis, right?

Dr. Hawrelak:                     There is and there’s nine that are found in humans. The rest are found in other animals. That said, it’s not like these are only exclusively found in humans. The ones we find in humans, we also find in chickens, primates, pigs, cows, horses, rhinoceroses, zebras, and any animal you can name generally has a Blastocystis that can be in its gut or a number of them. For humans, the most common subtypes are one, two, three, and four. Prominently, types one and three. Extremely common.

Dr. Weitz:                            Is one of those subtypes more pathological potentially than the other?

Dr. Hawrelak:                     Well, there’s been a lot of research trying to tease that out and I would say the research has been generally … has not shown any clarity around that at all. The only small pivot I’d say there is subtype seven is very rare in humans. It’s mostly found in animals, birds. Chickens particularly, they sometimes carry seven. That study that looked at those shifts in bacterial ecosystems was associated with symptomatic type seven isolates. If I had a patient and it did show up a subtype seven Blasto and all the other tests came up negative as in normal, then I might be inclined to go let’s see about eradicating this organism because it could likely be a cause of their symptoms in your case. I certainly don’t think the data is consistent enough because you’ll find one study that goes subtype three is more common with IBS patients. Another study will go subtype three was totally not and it’s subtype one. Another study will show subtype four. There’s no consistency around the findings.

Dr. Weitz:                            Right. I just want to highlight the fact that what you’re discussing is that Blastocystis Hominis, which I still think a lot of functional medicine practitioners if they see that on a stool test are going to say you’ve got this parasite and this parasite is pathological. This is probably the cause of your symptoms. You’re saying that in a majority of cases, it’s probably not the cause of their symptoms and you may be missing another important underlying cause of their symptoms and you may be going up the wrong path focusing on eradicating the Blastocystis Hominis.

Dr. Hawrelak:                     Yes, that is definitely my viewpoint for sure.

Dr. Weitz:                            I just want to make sure that everybody understands that.

Dr. Hawrelak:                     Fair enough, yes. It’s something that for me has evolved over 20 years of practice, of dealing with patients who present with gut symptoms and Blastocystis on stool test from what I used to do, to what the research is saying, and to what I do now and the results you actually see. I generally will see something else. When we do a suite of tests and make sure we don’t stop our diagnostic procedures so early, we’ll find something else that actually explains it. You treat that something else, their symptoms go away, Blastocystis or Dientomoeba are still there. There’s that component of it, but it’s also just the fact it’s so common. I mean, Dientomoeba in Western Europe where a lot of good studies have been done, it’s found in up to seven out of 10 healthy kids have got Dientomoeba in their guts. What’s normal, what’s not normal? Kids with functional abdominal pain are less likely to have Dientomoeba in their guts than those who are actually healthy.  I still have practitioners here, integrated practitioners who wanted to use antibiotics or a suite of antibiotics to try to kill that Dientamoeba because it shows up on the stool test. Yet, the data tells us that it’s actually immensely common in kids. It’s more common in healthier guts and it’s unlikely to be a common cause of the gut symptoms when you look at the research in totality. Yes, if you’re going to be selective and not look at the broader literature, find a study going look we gave them antibiotics and the case study’s showing they improved, will quote that study rather than looking at the totality of data or looking at only one to date, randomized placebo controlled trial that looked at kids with chronic gut symptoms and had Dientamoeba present and that seemed to be the only … everything else had been essentially ruled out. They said they’ve got these kids with chronic gut pain, they’ve got Dientomoeba, let’s give them antibiotics or placebo. Let’s see the response.   Do you know what the response was? Placebo was equally effective as antibiotics for reducing these kids’ symptoms. There was no difference between them. There was no correlation between eradication in Dientomoeba and any change in symptoms. I think the really good quality data is not suggesting that particularly things like Dientomoeba when we’re talking about now is a cause in symptoms in kids and that it is immensely common in health population.

Dr. Weitz:                           In those rare cases when you have a patient with elevated levels of Blastocystis Hominis and you don’t find any other pathology, what natural treatments have you found to be the most effective?

Dr. Hawrelak:                     It’s been years since I’ve found a patient like that, Ben.

Dr. Weitz:                           Really? Okay.

Dr. Hawrelak:                     I can tell you it’s actually really rare that I don’t find something else that’s going on. The biggest challenge can be teasing out the post infectious IBS from a case of Blastocystis induced infection, gut symptoms because you’ll have a similar picture where someone will travel overseas, they’ll get traveler’s diarrhea, their gut’s never well since. You do a stool test, only thing that shows up is Blastocystis. Now, that Blastocystis could have been present in their gut for the last 10 years, 20 years, or 30 years and not be remotely relevant to what’s going on because we know that post infectious IBS happens where two things once post infectious SIBO develops, that’s pretty common. Then, you have more the colonic inflammation that persists after the infection is gone. You might have traveler’s diarrhea caused by E Coli.  It causes colonic inflammation and visceral hypersensitivity that persists for weeks, to months, to years after that infection.  There’s no more infecting agent present, you just have this residual inflammation that impacts.  Causes bloating, distension, may alter transit time a wee bit. Certainly, holds a sensation in the gut, so you feel a small amount of gas being produced. We know that’s common in literature. Yet if you do a stool test and you found Blasto in that case, you might go I want to kill the Blasto. That’s the cause, but it may not be because it may just be post infectious IBS. That’s I think the area that can be the most tricky to navigate because you’ll have normal tests come back. They may not have SIBO, but they can still have post infectious IBS and there’s no test for that. It’s based on history and their symptom pattern.

Dr. Weitz:                           Not to kick a dead horse, but one more attempt.  What if the stool test shows a really high level of Blasto? Does that raise any suspicions or not?

Dr. Hawrelak:                     I think …

Dr. Weitz:                           No.

Dr. Hawrelak:                     It would depend on the overall path from the history side.  It wouldn’t rely solely on that.  Looking at their symptom picture, looking at their history.  Let’s assume if there was someone, now it’s been years since I’ve had one of those patients that I think Blastocystis is the cause of their symptoms. Then, there are certainly some herbal preparations, et cetera, that I would use to try to help reduce levels, but you’re also focusing on trying to optimize the microbiome as well, heal up inflammation in the gut, and improve their overall vitality and health anyway.  I think for me those are always the core aspects.  What can I do to improve this person’s state of health?  What can I do to make the ecosystem a more healthy environment that’s less conducive to bringing out the bad behavior in things like Blastocystis?

                                                We know that Blastocystis likes living at a more neutral or alkaline PH. It doesn’t like living in an acidic environment in the colon or levels can be certainly reduced that way. The focus is on having a lot more fiber, using prebiotics, eating predominantly plant based whole food diet as ways of actually shifting the ecosystem in the colon, so it’s actually one more healthy, but two there’s more production of short chain fatty acids like butyrate acetate for example that then will lower the PH. That in itself can be effective in decreasing levels of Blastocystis just by changing the environment. Then, I might compliment that with some herbs. These days because of my concerns of causing collateral damage to the colonic ecosystem, I try to avoid as much as I can when I can. I’ll use agents like pomegranate husks and garlic, which we know that can be effective against Blastocystis. The best data that we really have at this juncture of time is in vitro studies or animal studies for example. Mostly, in vitro. I do use that alongside saccharomyces cerevisiae boulardii, which we know has got the positive research for eradicating Blastocystis in the human trial alongside the other agents I talked about that they’re focusing on improving the ecosystem balance in the colon. That will generally one sometimes eradicate the Blastocystis, but two certainly improve their symptoms and importantly their overall state of health and well being.

Dr. Weitz:                            Let’s go on to some of the more pathological parasites. Which ones do you see most commonly?

Dr. Hawrelak:                     I would say Giardia would definitely be top of my list. I work in an inner city environment that is a colder climate, so I don’t see Giardia as often as I once did. My first number of years in practice, I was living in the subtropics where people drank creek water and rain water for most of their … it was rural and people were often bush walking, hiking and drinking the water from creeks, et cetera. Giardia was much more common back then, so I had a lot of chance to hone my practice on Giardia treatment over the years. Now, I tend to see it more in the odd returning traveler or I see the odd person who’s got a chronic infection of Giardia that they weren’t able to get rid of with their previous course of antibiotics.

Dr. Weitz:                            What is some of your favorite natural agents for treating Giardia? Also, do you cycle your use of these?

Dr. Hawrelak:                     Generally, there’s no need. My experience with Giardia is it’s immensely responsible to the right treatments and target treatment with natural medicines. I would use raw garlic ideally and if they’re very sensitive, we might use an allicin based product, but most of my patients have tolerated raw garlic. A couple cloves pressed into either little capsules or a little glass of water and swig it down a couple times a day. There’s one study out of Egypt that showed I think a hundred percent eradication rate by day three on having essentially blended raw garlic.

Dr. Weitz:                            Wow, three days.

Dr. Hawrelak:                     That’s impressive. A hundred percent reduction of symptoms or essentially elimination of symptoms by 36 hours into the treatment protocol. That’s very quick. Garlic’s definitely on my list. These days, I would be using pomegranate husk and usually plantain, plantago major ribwort, which is one of those herbs that grows as a weed almost everywhere in North America and here in Australia.  It’s got some lovely potent anti-Giardia activity, but it actually has some healing anti-inflammatory effects on the gut as well. It doesn’t taste too bad and it doesn’t have that broad killing effect that I might get with something that was more berberine containing herbs.  Years ago when I first started practicing, I used more berberine containing herbs and it’s certainly effective for Giardia, no doubt.  I would be using coptis chinensis, which contains more berberine than goldenseal or other berberine containing herbs like Mahonia aquifolium or Berberis vulgaris a lot more. It’s undoubtedly effective, but I also know from research I did as part of my PhD that it reduces levels of bifidobacteria. It’s not such a big deal for 10 days, which is a usual treatment period for Giardia, but given I can get the same results without having to worry about any collateral damage to my bifidobacteria populations in patients if I use pomegranate husk, ribwort, and garlic, I’ll choose that.  Then, I would give saccharomyces cerevisiae boulardii again as my probiotic of choice because there’s good data on that in Giardia both for helping to eradicate, but I think this is the important aspect too. A number of people have symptoms that persist long term post Giardia. It’s because Giardia, amazing little protozoal organism that when it exits from it’s little cyst, you often get one or two little guys that come out of that, but they can cover up every single little bit of your proximal small bowel, every little millimeter of space will be covered with Giardia trophozoite. They can actually cause a lot of damage as part of that. They can cause nutritional issues in the short term in that most things you eat are going to be malabsorbed because they’re just covering that entire area, they’re going to eat those foods, you don’t get much if any. They’ll also cause a fair bit of damage to the small bowel. This can sometimes mean that there’s a bunch of symptoms that persist even after eradications.  You might kill off the Giardia with antibiotics or with herbal medicines in my case in probiotics and nutritional supplements, but they might still have some persistent diarrhea, persistent lactose intolerance, persistent fructose intolerance that comes from afterwards because when you flatten those villi and you damage the brush border, you don’t have lactates on those brush enzymes anymore. The fructose transporter is very much impacted by inflammation. If we inflame the small bowel, we really limit the capacity of that fructose transported to pull up the fructose and take it in. We can often get this secondary lactose and fructose intolerance. The saccharomyces boulardii is wonderful for helping to regrow those villi and the brush border. You might do that during, then for at least six to 12 weeks afterwards to speed up healing.

Dr. Weitz:                            Interesting. The villi are damaged by the parasite.

Dr. Hawrelak:                     Yes, by the Giardia because they’ve got this little ventral disc that sucks onto it and actually causes tissue damage, inflammation. It’s a crazy little guy.

Dr. Weitz:                            Do you have to have Giardia for a long time for that to happen?

Dr. Hawrelak:                     One would say the longer you’ve got it, the more severe the level of inflammation would be. There’s a caveat there because we know that most people will throw off Giardia in three weeks with no treatment at all. I think from memory, it’s around 90 percent of people who get Giardia, you do nothing. In three weeks, it’ll be gone in 90 percent of people. It’s going to be an uncomfortable three weeks. There’ll be lots of diarrhea, lots of bloating, lots of nausea. I don’t recommend it, but we know that the immune system can generally deal with it, except for people that have IgA insufficiencies tend to be the biggest issue where they will have it … it’s impossible for them to throw off Giardia if they don’t produce enough secretory IGA in the gut. There’s some people that it tends to be a chronic infection. Even a week to two weeks is still enough to actually cause a degree of malabsorption. Depending on how severe the infection was and how much of the small bowel was covered will dictate how much of that post infectious symptomatology we have to deal with and post infectious damage we need to heal up to get patients’ function back to a good level and absorbing food again the way that they should be.

Dr. Weitz:                            Interesting. Have you heard this concept that when trying to kill a parasite because parasites are laying eggs, that you want to use the antimicrobials for 10 days, then wait 10 days because supposedly in the presence of the antimicrobials, the eggs won’t germinate, they’ll wait until the antimicrobials are gone, then the eggs will germinate and you’ll have more Giardia or other parasite? Then, you’ll have a reinfection, so therefore there’s this thought that you treat for 10 days, you wait 10 days, and then you treat again for 10 days.

Dr. Hawrelak:                     Yes. I mean, I certainly will do that with helminth, actual bigger worms, pinworms, et cetera. I will follow that approach. I don’t with Giardia and I haven’t seen any cases where that particular approach has been problematic in that instance. I think if we’re choosing agents that are not going to cause collateral damage to the ecosystem, then I got no qualms with that approach at all to err on the safety side. I’ve never seen it necessary with Giardia. That’s by far the most common one I would be treating in practice.

Dr. Weitz:                            What’s your protocol for pinworms?

Dr. Hawrelak:                     It’s a tricky one. I’ve tried lots of different things. To be honest these days, I actually recommend the pharmaceutical ones from the pharmacy because they work. Yes, I can give you herbs that taste absolutely ghastly, garlic [inaudible 00:37:55], and essential oil put in a little bit of Vaseline around the anus at night, you can do all that for weeks at a time and will get okay results, or I can give one little dose of that chocolate, 10 days later another dose of that thing, and they’re gone. It’s far less costly. You’re often treating a whole family. I’ve trialed and error-ed lots of different things. Maybe some people have got much better results with herbs than I ever had, but we’re using megadoses of wormwood and pomegranate husks which has got anti worming activity too. Listen, it’s certainly brought worms down. Oiling up a tiny a tiny clove of garlic that’s been peeled and inserting up the anus, that helps break the cycle of bit.

                                                Same way with putting some peppermint essential oil around, a little Vaseline around the anus. The worms come out to lay their eggs and are like I don’t like that oil, so they go back in and it’ll help break the cycle. It’s labor intensive. To do herbs for a family of four for a month, that whole process, is costly. I still don’t find the results as effective as just doing the pharmaceutical twice. In this case, I’m not worried about the collateral damage to the gut ecosystem because the data to date doesn’t suggest this much in the way of collateral damage because worms are actually more related to us than they are to bacteria. The agents that are targeting those worms actually have more capacity to cause us side effects than they do kill bacteria directly. I’m not so concerned and that’s my approach now, which is not so exciting as you got to use this fantastic herb, but I just didn’t find the result with the herbs as what I’ve got with the pharmaceutical. The cost differential didn’t make it worthwhile.

Dr. Weitz:                            Speaking of worms, have you looked into helminth therapy, the therapeutic use of worms? A couple of worms that are used is the pig whipworm or the human hookworm. I’ve read some articles where they’re being used for allergies, autoimmune conditions, inflammatory gut disorders like Crohn’s and ulcerative colitis.

Dr. Hawrelak:                     I’m not super familiar with the literature around that. I’m a little bit around the uses of [inaudible 00:40:05] for celiac disease.

Dr. Weitz:                            Yes, that’s the hookworm.

Dr. Hawrelak:                     That’s right. When I looked at the results, they were very underwhelming in terms of [inaudible 00:40:18]. It was like, okay. They gave them these worms, they had a bought of severe enteritis, and they got a lot of pain from the worms. Then, it slightly diminished the degree of inflammation caused by subsequent gluten exposure. To me, that was underwhelming. Okay. Yes, you made the gluten, you got less gut damage than if you didn’t, but it still didn’t completely stop the gut damage and it didn’t completely stop the pain from ingesting the gluten. Plus, you had the pain and discomfort from ingesting the hookworm in the first place. I thought the worm results were very underwhelming for celiac disease. That doesn’t mean that they might be more useful for inflammatory bowel disease and other conditions. I’m not so familiar with the literature there, not enough to make any judgment calls on their efficacy or not.

Dr. Weitz:                            I like to ask you about one more topic about H. Pylori. H. Pylori is another infection in the gut. Often, occurs in the stomach. There’s a whole story everybody’s probably familiar with that it could be related to ulcers and we have that whole story about Doctor Marshal giving himself H. Pylori causing ulcers. Anyway, H. Pylori is another thing that comes up on stool tests a lot. We’ve learned more and more how H. Pylori’s an important part of the gut. It may not necessarily be pathological.  What’s your take on H. Pylori?  When is it pathological?  How do we know?

Dr. Hawrelak:                     That’s another great thread of questions. I think we’ll answer this question differently in five years’ time than what we can now.

Dr. Weitz:                            I mean, we do have the virulence factors that give us an idea of whether we’re reacting or not.

Dr. Hawrelak:                     That’s right, we’ve got some of them. I think that’s a step in the right direction. For me if I had H. Pylori show up on the stool test for example, I would look at the presence of the virulence factors. That’s the first thing I would do because that’s usually in that same test that might pick up the H. Pylori and tell me those things are present. I would always follow that up with doing a antibody test like a blood test or a breath test because for me I want to see, is the body reacting to that H. Pylori? Is it increasing antibodies to the H. Pylori? Is it high enough of a count that it’s actually showing up on a more conventional test rather than using these genetic markers? Those to me really tell me the data that I’m after as well as, do they have symptoms that coincide with gastritis, gastric ulcer or peptic ulcers? If they do, then I would go H. Pylori’s probably related to what’s going on there.  If I have a patient where they have it negative, no antibodies in the blood, nothing on the breath test, and a small amount in the stool that showed up on a PCR based test that didn’t show any markers of virulence, then I wouldn’t worry about its presence at all because I would be thinking it’s probably benign, it’s probably there in tiny amounts, not enough to cause any issues. Conversely if it actually showed up with antibody levels, they’ve got symptoms that are consistent with peptic ulcers or gastritis, then I would generally treat H. Pylori in that case. For me, it’s always this balance. We know that certain strains of H. Pylori can cause peptic ulcer disease, we know they can cause increased risk of stomach cancer. That is clear. There’s also some concerns about the eradication of that species. One, leaving an ecological vacuum and what will grow in there. What’s next if we take that species out? Some other microbe might start growing in there. That might be more virulent than that. Second point is there are quite benign strains of H. Pylori that might even have some healthful effects for us over time.

                                                It’s just we don’t necessarily have the technology yet and this is where I would say five or 10 years’ time where we know a good chunk of virulence factors now, but we’re still discovering new things. We might discover more, we might be able to get down to strain subtype. [inaudible 00:44:30], look at the genes of this specific strain. Beyond that, and yes. There’s a greater risk of it being a problem, let’s get rid of it. For me if I’m using natural agents that don’t have the capacity to cause widespread damage to the colon ecosystem, I’m not that worried. If I’m going let’s eat some broccoli sprouts for two weeks, have some cranberry concentrate, and take this herb, et cetera, that can be in my experience very effective at getting rid of H. Pylori. I’m not worried about treatment so much. If there’s patients taking triple or quadruple antibiotic cocktail, then we’re talking about big life … essentially, it’s life altering in the respect that colonic ecosystem that will inadvertently be smashed by that antibiotic cocktail will be permanently changed. It will never go back to the way it was before. When we’re talking about those bigger interventions, then I think we need to consider much more about the risk/benefit ratio that are different when we’re looking at using natural medicines to treat the H. Pylori. That the risk is far less, so it’s quite a different way of considering it.

Dr. Weitz:                            The natural agents you would use would be mastic gum and maybe something else?

Dr. Hawrelak:                     I would usually use a combination of things. You look at the data about natural medicine, there’ll be ones today showing a 16 percent eradication with cranberry juice. 16 percent, not fantastic, but it’s better than none. There’s one study that used the Lactobacillis reuteri DSM17938 strain. I think it had over 50 percent eradication rate just with that single strain. You combine that and I might combine broccoli sprouts, which I think at a 78 percent eradication rate from memory.  You’re going let’s add a few of these things together and nigellis sativa, so black seed again had over 60 percent eradication rate on its own. You’re doing a few of those things together. Then, I might use some herbs like green tea, rhubarb, pomegranate husks for example, turkey rhubarb, and in my experience we follow a protocol that’s for most of my patients around six weeks. It’s around a 90 percent eradication rate, which is really I would argue better than what we’re getting with antibiotics these days. At the first time they started using antibiotic cocktails like triple therapy, they were looking at 90, 95 percent eradication rate. Now, some of the recent studies are like 50, 60, 40 percent eradication rate because of antibiotic resistance.

                                                I’ve been impressed at how well a combination of herbal agents and natural supplements work versus using them just on their own, much more [inaudible 00:47:14] to get the occasional time just getting one of those things to work for a patient. My experience has been again through a fair bit of trial and error with patients, it actually makes more sense and I get the best results with doing a much more intense protocol for a six week stint. Then, do follow up testing, and go, yes. It’s gone. Generally, that combination of things works well. You get synergy between those agents.

Dr. Weitz:                            You think natural agents like oregano, berberine, and maybe some of these other antimicrobials could potentially have negative effects on the microbiome.

Dr. Hawrelak:                     I would say from both of some of the in vitro research I did as part of my PhD and from clinical work with patients doing pre and post testing, yes. That berberine I think clearly can diminish overall diversity of an ecosystem and reduce levels of bifidobacteria specifically. Some of those species may be fine with it. I’ve even seen one patient who managed to essentially result in the extinction of bifidobacteria population from taking high dose berberine for longer periods of times, so I’ve got some caution around that. Again, some plant essential oils, so oregano essential oil, thyme essential oil, clove essential oil that are potent antibacterial agents. They totally are, anti protozoal, and anti fungal agents. They’ve got a wide set of actions, but I do think they have come collateral damaging effects in the gut too. I think there can be times and places for more potent agents. I try to follow that, the naturopathic therapeutic order where we use the agents that are less likely to cause harm first. Then, we move along that order to those that have greater capacity of causing harm if the other ones don’t do the job. I’ll rarely use berberine when I’m treating Giardia these days, I’ll rarely use berberine or oregano essential oil for treating SIBO these days because I think there are other herbs that are effective that don’t have the collateral damaging effect that those herbs have.

Dr. Weitz:                            That’s interesting because I haven’t seen that sort of negative effect on a microbiome from berberine. I also treat diabetics. We very regularly use a pretty decent dosage of berberine on a regular basis. I have seen no increased gut problems coming from that.

Dr. Hawrelak:                     I wouldn’t say [inaudible 00:49:36]. Obviously, it’s got issues. Although, sometimes longer term I think that can manifest. In terms of populations of bifidobacteria, I would suggest if you haven’t yet, using the test that uses either [inaudible 00:49:48] looking at proportions of bifidobacteria or metagenomic sequencing for bifidobacteria pre and post, you might get a slightly different picture with that rather than some of the previous tests that use two plus four ways of measuring things, which are far less clear what’s going on. You may see that.

Dr. Weitz:                            We’ve been using the GI map with quantitative PCR.

Dr. Hawrelak:                     Okay.

Dr. Weitz:                            Good. Excellent. Thank you for sharing some fascinating information with us.

Dr. Hawrelak:                     You’re very welcome. I’m glad I could come back and chat to you, Ben. It was good.

Dr. Weitz:                            Good. I’m glad we could make this happen across the world even in the midst of the coronavirus pandemic. How can listeners and viewers get ahold of you and find out about some of your … I know you have a number of courses that are available?

Dr. Hawrelak:                     Yes, we’ve got one on Dientomoeba and Blastocystis because I’m trying to get that information out there about that. That change in conception that research has actually made manifest. Also, ones on Giardia too as it turns out. The microbiome, probably more broadly lactose intolerance, fructose intolerance, we’ve got a few different lecture out there on the Probiotic Advisor site. My passion is really around the gut microbiome, probiotics, and prebiotics. I’ve been in this area for 20 years when I first started my honors and my PhD research, so I love this area and I love being a clinician still so you get a chance to actually work with patients and see what works. Sometimes, what works in research doesn’t always manifest in clinical change in any beneficial way or it just doesn’t work in reality. It’s been nice to go, what does? What doesn’t? Over years of working with patients too.

Dr. Weitz:                            What’s the website for the Probiotic Advisor? That’s where they can find new courses, right?

Dr. Hawrelak:                     Yes. Www.ProbioticAdvisor.com. Then, we’ve got a teachable courses page too. I think we’ve got 12 or 13 courses up there now around microbiome and gut health more broadly.

Dr. Weitz:                            Great. Thank you so much.

Dr. Hawrelak:                     You’re welcome, Ben. Nice chatting again.

Dr. Weitz:                            Nice chatting with you too. I’ll talk to you soon.

 

 

Weitz Sports Chiropractic and Nutrition
Weitz Sports Chiropractic and Nutrition
Preventing Cognitive Decline with Dr. Tom O'Bryan: Rational Wellness Podcast 168
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Dr. Tom O’Bryan discusses Preventing Cognitive Decline 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

17:28  When a patient presents with Mild Cognitive Impairment (MCI), such as forgetting where their keys are, where they parked their car, etc.  Dr. O’Bryan explained that his website, TheDr.com is a platform that provides the roadmap that helps to make it easy to take the journey back to health.  Brain deterioration is a condition of inflammation.

22:15   While we can use questionaires to assess the level of cognitive function, the first thing to recognize is that brain deterioration is a state of brain inflammation.  Then we can run some testing to help us identify some of the triggers for this inflammation, including the Neural Zoomer Plus from Vibrant Labs that looks at 48 different antibodies in your brain.  The second test Dr. O’Bryan recommends is the Wheat Zoomer, which is the most sensitive marker for intestinal permeability.  The intestinal microbiome modulates your brain function, so having good balance in the microbiome is important for brain health. 

29:41  Dr. O’Bryan likes using the BiomeFx stool test to assess the microbiome health.  So the basics of reducing mild cognitive impairment is to heal leaky gut, create intestinal microbiome balance, and avoid environmental toxins.

 

                         



 

Dr. Tom O’Bryan is a Doctor of Chiropractic, a best-selling author, a professor for the Institute of Functional Medicine and an internationally recognized speaker focusing on gluten and other food sensitivities, environmental toxins, and the development of autoimmune diseases. His 2016 book, The Autoimmune Fix won the National Book Award and the docuseries he released the same year, Betrayal: The Autoimmune Disease Solution They’re Not Telling You  has been seen by over 500,000 people worldwide. He also organized the highly successful The Gluten Summit – A Grain of Truth. His website is www.theDr.com  His second book You Can Fix Your Brain: One Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had was released in 2018 and it is another huge hit.

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 and 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.

Today, we have a very special discussion with Dr. Tom O’Bryan, and we’re going to be talking about how we can prevent and reverse cognitive decline which as we know is a precursor to some of the degenerative brain diseases like Alzheimer’s.  Alzheimer’s disease is the most common form of dementia and we currently have close to six million Americans age 65 and older living with dementia, and 80% of these patients are age 75 or older. 1 in 10 people over the age of 65 has Alzheimer’s and dementia and almost two-thirds of those with Alzheimer’s are women. We predict by the year 2050, we’ll have 13.8 million with Alzheimer’s.  So, this is now one of the leading causes of death for seniors and a major burden on our healthcare system. And of course, the best time for intervention is prevention and during the beginning stages of when you start to see what we call mild cognitive decline. The current medical model provides very few treatment approaches that can help and not even any of that help with symptoms, never mind preventing the disease progression.

                                                Dr. Tom O’Bryan is going to be discussing with us an approach using a functional medicine model that has been pioneered by Dr. Dale Bredesen that looks at a number of underlying risk factors, triggers, and causes using a network-based approach that looks at functional and lifestyle factors, looks at metabolic parameters, everything from hormones to food sensitivities, to infections, to toxins, to sleep, to insulin sensitivities and a bunch of other factors that we can reasonably intervene on and get some improvement.  Dr. Tom O’Bryan is a doctor of chiropractic, a best-selling author, a professor for the Institute of Functional Medicine. Dr. Tom is an internationally recognized speaker focusing on gluten and other food sensitivities, environmental toxins and its development of autoimmune diseases. His 2016 book, The Autoimmune Fix, won the National Book Award and the docuseries released the same year, Betrayal: The Autoimmune Disease Solution They’re Not Telling You, has been seen by over 500,000 people worldwide.  He’s also organized the highly successful, The Gluten Summit: A Grain of Truth. His website, TheDr.com, is a very popularly visited website and his second book, You Can Fix Your Brain: One Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had, was released in 2018 and it’s another huge hit. Thank you so much for joining me, Dr. O’Bryan.

Dr. O’Bryan:                        Thanks, Dr. Weitz. Always a pleasure to be with you.

Dr. Weitz:                            So, before we get into the topic at hand, how are you feeling about life in the midst of the continuing coronavirus pandemic? And you can take that question whatever direction you want.

Dr. O’Bryan:                        Oh, man. It’s really difficult in this world of polar opposites that we’re in now for the last 10 years. Democrats and Republicans don’t agree on anything. They’ll fight to the death on every topic. You’re either red or you’re white. You’re black or you’re white, and not only in that race-wise but in terms of opinions. There’s-

Dr. Weitz:                            And unfortunately all these health factors like wearing a mask or whether or not hydroxychloroquine works is now political and it should just be scientific.

Dr. O’Bryan:                        A paper came out just last week, one of my mentors is Professor Yehuda Shoenfeld from Tel Aviv, Israel. And when I interviewed him for Betrayal, at that time, 28 of the PhD students who received their PhDs in immunology under him, there are many more, but at that time, 28 of them shared Departments of Immunology in med schools and hospitals around the world. This guy is the godfather.   And he just published a paper last week with nine other world famous immunologists. Six of them shared Departments of Immunology somewhere in the world. So, these are the cream of the crop in terms of experts on your immune system, cream of the crop, very best. And in the first paragraph of the paper, they say about this current viral epidemic, pandemic, is that worldwide the death rate is between 0.02% and 2% of the population depending on whether you’re an elder, do you have high blood pressure, do you have diabetes.

                                                But the top end is 2%, and that’s not what we’re hearing in the news, that the numbers are being manipulated. I’m not going to go into why. I don’t know why I have some ideas. But if somebody dies in a motorcycle accident and a family member said, “Well, they had some sniffles.” The death certificate said trauma and SARS-COV2, COVID-19, that they’re manipulating the numbers.   And if somebody gets an antibody test to see if they developed immunity for this thing, they inflate the numbers to say, “Oh, he’s got the virus.” And so, millions of people have, “Well, if you’ve got the antibodies, you’ve got immunity. That’s a good thing,” but they’re representing it as more people are sick with this thing. So, there’s a whole world of things going on and it’s really difficult to understand what to do. It’s really difficult.

                                                And my wife has been so patient with me over the last few years to understand this whole thing about news, and news broadcast because she’s from Poland. And she told me early on in our relationship, US news stations and newspapers don’t say the whole story. And I’m like, “What? You’re challenging The New York Times? Oh, my gosh, I think you’re a pretty cool lady but don’t challenge The Times,” because I read the Sunday times. Every Sunday, I have some coffee, relaxed and just update.   Now, I see because I started … First, I’d read The New York Times, then I’d read the London Telegraph. Then I’d read the French Le Monde in English and I’d see and then I’d read something from Argentina about world events and the whole world is consistent on reporting an event except in the US, that the US story was consistently different. And I was just startled.  I was born and raised in Detroit, raised my family in Chicago, I’m red, white and blue. I just was startled by this. And it was hard to hold. It was hard to accept. I mean, wait a minute … And that’s what’s going on now for people with this whole viral pandemic. It’s when you look, when you really look and say, “Wait a minute. That keeps happening again and again, because it doesn’t make sense.”

Dr. Weitz:                            I think there’s one thing that we should take from this whole pandemic is when they talk about the risk factors, I was talking to somebody and they say, “Well, it’s only people who are high risk are really a problem.” “Oh, really, just a few people?” Well, let’s see. What are the risk factors? One of them is being overweight, 70% of Americans. You got people with hypertension, people with cholesterol. You got people with fatty liver. You got people … You started listing all these chronic conditions and you think, “Wait a minute, maybe in some other country, there’s a small amount in a population.”    But this is like 80% of our population. This should be a wake-up call for us to get more healthy because if we were, we wouldn’t have to worry about having the worst outcome with situations like this.

Dr. O’Bryan:                        Well, you’re exactly right, Dr. Weitz. That’s why it’s important for people to realize that this pandemic is a lifestyle disease, meaning how we’ve lived our lives up to now determines whether or not we get sick, period. No discussion, that every single person that they looked at who has a reaction here, lifestyle, and whether they’ve got deficiencies of vitamin D which over 96% of the people or 5,700 people in New York who died in the hospital from this, 97% of them had low vitamin D levels.

Dr. Weitz:                            Absolutely.

Dr. O’Bryan:                        So in the words of Roseanne Roseannadanna, you think? You just want to check your vitamin D to make sure you’ve got adequate levels. Now, I’m not saying vitamin D cures viral infections, but I’m saying when you have low vitamin D levels, your immune system can’t work the way it’s designed to work.

Dr. Weitz:                            There was another huge study in New York City where they had two groups that both took hydroxychloroquine and azithromycin and one group also took 100 milligrams of zinc. The group that just took the hydroxychloroquine and azithromycin, they got really no benefit. The group that took the zinc in addition had a 49% reduced risk of death.

Dr. O’Bryan:                        Well, I’ll tell you why that is-

Dr. Weitz:                            And so this is the reason why some of the hydroxychloroquine studies have shown a huge benefit is because it’s the zinc transporter.

Dr. O’Bryan:                        That’s exactly right. I’ve done the research on that one. It came from India, the fever tree, the cinchona tree. They take the bark of that tree and they extract quinine from it. And quinine has been an antimalarial drug in India for a couple of hundred years. And what they found was that what the quinine does and that’s where hydroxychloroquine came from was to make a drug that copied what quinine did.  And hydroxychloroquine has been around for over 60 years, really relatively safe as drugs go. Well, what happens is the quinine, it’s called an ionophore and that’s a geek word, but it means as you said, a zinc carrier that if you have enough zinc inside your cells, the only way this virus can grow is it sheds. It’s kind of like dandruff. Viruses have dandruff inside your cells. It’s called shedding. And then that dandruff gets inside some of your DNA and then more virus grows from that.   So, the virus doesn’t reproduce, it sheds. But it only sheds inside your cell. A virus in your lung or in your bloodstream won’t shed. It won’t develop more. It has to get inside your cell to do that. Well, when you enough zinc inside your cell, it can’t shed. That’s why zinc is so important. Zinc of the bloodstream, it doesn’t help very much. It’s necessary to have adequate levels in your bloodstream, but you got to get it inside the cell.   So, to get it inside the cell, you need a carrier, and in the natural world, the most prevalent carrier, number five of all ionophores is called quercetin, which is part of vitamin C.  That’s why quercetin is good to take.  It helps to get zinc inside your cell.  So, when you’re exposed to viruses, the viruses can’t shed. There’s no dandruff.

Dr. Weitz:                            Exactly.

Dr. O’Bryan:                        … the viruses inside your cell. Well, quinine is a zinc ionophore. It carries zinc inside the cell. And in the late 1800s, it was the British who were occupying India and their soldiers were given quinine to prevent malaria but that stuff is really bitter. I mean, it is bad news taste.   And so, they took a little fruit water and added sugar to it with their quinine. That’s where the song came from just a little bit of sugar helps the medicine go down. It came from the Brits from the late 1890s. And the British soldiers and that was the formation of tonic water, which is quinine, a little bit of fruit, a little bit of water, a little bit of sugar.      The British soldiers got permission to put a spoonful of gin with it. Thus was born the gin and tonic. That’s where the gin and tonic came from. It was a medicine.

Dr. Weitz:                            Who knows what you’re going to learn when you talk to Dr. Tom O’Bryan?

Dr. O’Bryan:                        Well, I really like that kind of geek stuff. So, once I learned that, my wife and I started drinking a little bit of tonic water every day. I don’t know that it’s going to help but it sure is not going to hurt. But you just have to make sure of two things if you do this, that there’s commercial tonic waters that are chemical copies and don’t have quinine in them.   So, you have to look on the label and make sure there’s quinine. That’s the first thing. And the second thing is most of the companies add a whole lot of sugar to that bottle of bitter-tasting quinine tonic water. But there’s one–the company’s called Fever Tree, like the tree in India where quinine comes from. And they have five different tonic waters, one of them is India Light.   And so there’s an India tonic water but the India Light has, I think it’s six grams of sugar in the bottle. So, it’s not much at all. So, what we do is we do about a … They’re small bottles so we do like half a bottle and then put sparkling water in there and then a little slice of lime. And it’s a nice pleasant little afternoon drink, but I’m taking a zinc ionophore to help carry the zinc inside the cell.   It may help. It’s not going to hurt. It doesn’t cure viral infections, but it may help a little bit.

 



 

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:                            Now, let’s get into our topic. This one got off topic, my fault. So, how would you … Now, your brain book I know was kind of a self-help book but in this discussion, I’d like you to play the role of the clinician and let’s say you have a patient who comes in your office with symptoms of mild cognitive impairment, how would you assess the patient? How would you set up your consultation and then how would you work that patient up and go about making some recommendations?

Dr. O’Bryan:                        Really good, really good question, thank you. And it’s a really tough topic and I’m going to explain why. When someone is suffering from mild cognitive impairment, which means they’re forgetting where their keys are, where did I park the car in the parking lot, things like that. They’re forgetting things that happened yesterday. “What did you have for breakfast yesterday?” “I don’t know.”  When people notice that kind of thing, it scares the hell out of people. And when we get scared, we tend to avoid the topic. That’s human nature especially in the US. We like everything to be convenient and easy. What pill can I take so that this doesn’t happen anymore? So, one of the platforms at TheDr.com, my website, is that our goal is to make it easy to do the right thing. So, what does that mean?   Well, in order to do the right thing, you have to understand what’s going on and what the goal is of every step you take, so the journey to health. When your body is not functioning the way you want it to, it’s a journey to get back to health again. And if you can take a journey to go from New York to Miami, you need a map. And so we have to teach you how to read the map of your journey to health. But people often don’t want to hear that. What they want to hear is what pill do I take that gets rid of this?

                                                So, the first thing is it’s a wake-up call. And the geek term is you have to change your paradigm. You have to be receptive to thinking a different way, obviously, and I don’t mean that in a pun but you have to think differently. So, first, reality check. The Alzheimer’s Association of America which is the number one group. They have hundreds of thousands of people. They get lots of good education programs they have and all of that.  They told us last year, one out of three elders dies with Alzheimer’s or another dementia, one out of three. We’re hearing numbers all the time. You started the show with some numbers about Alzheimer’s. People don’t know how to hold the numbers. So, here’s how you hold that number from the Alzheimer’s Association. Dr. Ben, you’re interviewing me right now, and then there’s that person listening. So, between you Dr. Ben, you the listener and me, one of the three of us will die with dementia and it sure as hell ain’t going to be me.

                                                That’s the goal here. But that’s the reality check. That’s how common this thing is now. And people don’t get it. It’s not going to happen, because everybody knows someone that had a heart attack and survived and changed their diets, started exercising, they looked better than they’ve looked at years. Most of us know someone diagnosed with cancer that went through the protocols, whatever they were, who’s in remission and they feel great.  No one knows anyone diagnosed with a brain deterioration, mild cognitive impairment that’s doing great.  It scares the hell out of us.  So, we avoid the topic. You can’t avoid this topic that you have to learn how to read the map.  And it’s a day by day journey to learn how to read the map. Critically important, or else people are going to feel a little bit better for a while but they continue to go downhill.  And as a doctor, you say, “Well, we told him what to eat and then told him what to take, and they did it most of the time.  But that really didn’t help very much.” So-

Dr. Weitz:                            How do you … Let’s say the patient comes in your office and maybe they recognize their memory is off or maybe their spouse, how do you assess what their level of cognitive impairment is?

Dr. O’Bryan:                        Yeah. Well, so you’re saying let’s get to the meat of the matter?

Dr. Weitz:                            Yeah. Do you use a questionnaire or-

Dr. O’Bryan:                        I understand. Well, the first thing to understand is-

Dr. Weitz:                            I didn’t mean to cut you off.

Dr. O’Bryan:                        It’s all right. I understand. It’s your podcast. The first thing to understand is that your brain deterioration condition is a condition of inflammation. It’s always inflammation without exception and I’ll challenge anyone to show me that it’s not inflammation because there are so many studies that show your brain is on fire. And when your brain is on fire, you’re killing off brain cells.  So, the question is, is it the frontal lobes or the occipital lobes in your brain that’s on fire? Is it gasoline or kerosene? Where is the fire coming from?  But your brain is on fire. And you say, “Well, I feel fine. I don’t have a problem going on.” You don’t feel when you lose a hundred or a thousand brain cells because you got so many.  But every time you pump gas, every time you pump gas, you fill your gas tank, if you can smell the gas, you’re smelling benzene.  And benzene goes right up to your brain, killing brain cells. It causes inflammation killing brain cells every single time you smell gas.   “Well, I have to pump gas.” I understand.  But when you put it on there, if you’re smelling gas, you’re downwind.  Walk around to the other side of the hose, now you’re upwind.  We just have to start thinking differently about this. We need a paradigm shift, and that’s really difficult for people because they want the magic fix right now.  So, what type of test do you do to identify?

Dr. Weitz:                            Do you use a questionnaire to assess cognitive function? I know there are some good online ones.

Dr. O’Bryan:                        There are some really good questionnaires and I don’t, because if someone comes to me and said, “I’ve got mild cognitive … Doc, I’m not remembering the way I used to. There’s something going on.” I don’t need to document it. I get it already. But they’re very valuable to do and you can compare them six months later. We do multiple symptom questionnaires, so we have a number of questionnaires we use specific memory questions.   I think it’s a good idea to use it, and I just don’t in my practice.

Dr. Weitz:                            And then how do you conduct your consultation to get an idea of what some of the underlying triggers might be for this particular person?

Dr. O’Bryan:                        We have to read the map. So, in order to read the map, you have to have a map. So, to have a map, you have to do some testing to identify where is this coming from? What are the triggers setting it off? So, the number one test … There are two tests we do on every single person, two tests that come in with these complaints. The first one is called the Neural Zoomer Plus.  The Neural Zoomer Plus is a blood test that looks at 48 different antibodies in your brain. If you have elevated antibodies, you’re killing off brain cells. And so, it’s the most comprehensive test I’ve ever seen on this. And we use this at the beginning to see how many different tissues are on fire right now, how many are there?

And the second test is the Wheat Zoomer.  And we do the Wheat Zoomer for two reasons. The first is that it’s the most sensitive marker for intestinal permeability or leaky gut. And when you read the science out there, inflammatory diseases whether it’s brain inflammation diseases, kidney inflammation diseases, skin inflammation diseases; inflammatory chronic, inflammatory diseases, there are five factors required or five pillars as Professor Fasano talks about, the five pillars in a development of chronic inflammatory disease.

                                                The first one is you’ve got the gene that says you’re vulnerable to that. It doesn’t mean you’re going to get it. It just means you’ve got the vulnerability. The second one is an environmental trigger that sets it off. And that can be benzene you’re breathing when you pump gas, or wheat if you have a sensitivity to wheat. The third one is the environmental trigger alters your microbiome, the intestinal microbiome which the geek word is modulates your brain function.   Now, what does that mean? It means it had its hands on the steering wheel, that the bacteria in your gut have their hands on the steering wheel of how your brain functions. For every one message from the brain going down telling the gut what to do, there are nine messages in the gut going up telling the brain what to do. So, when your gut is out of balance, the term is dysbiosis. But when your gut is out of balance, you’re sending the wrong messages to your brain.   So, just imagine you’re driving down the road, if the bacteria has got its hands on the steering wheel of your brain function and you just turn the steering wheel 10 degrees to the right, a hundred yards down the road, you’re off the road. And in your brain that means the hormones that your brain makes called neurotransmitters that they’re way out of balance when your gut is out of balance. And that sets up brain dysfunction. So, that’s the third one, is the microbiome in the gut.   The fourth pillar is intestinal permeability or leaky gut. And when you come back positive for leaky gut, you’ve got leaky brain and we’ll talk about that in a minute. And the fifth one is chronic inflammatory immune response. Whether it’s going into your brain or into your kidneys or your joints or your skin or your heart, but this chronic inflammation is determined by your genes where it’s going to manifest.

                                                So, there are five different parts to this, but the ones that we got complete control over without exception, we’ve got our hands on the steering wheel ourselves is the environment that you expose yourself to, what’s on the end of your fork is the most common environmental trigger, changing the microbiome to a healthier more balanced microbiome, and focusing on healing intestinal permeability. And those three, you’ve got complete control over.  So the baseline, the very baseline of dealing with mild cognitive decline is those three, what’s on the end of your fork, what foods are you sensitive to, what’s your microbiome like, let’s rebuild the healthier microbiome which helps to heal the inflamed gut causing the leaky gut or intestinal permeability. That’s the key, those three.

Dr. Weitz:                            So, how are you going to assess the microbiome?

Dr. O’Bryan:                        There’s a number of gut tests, stool tests that you can do that look at the microbiome. Currently, we’re working with one called BiomeFX that I’m seeing as the most sophisticated one out there right now. But there’s a number of good ones that different doctors will use. And some focus on one piece of information, some focus on others.

Dr. Weitz:                            The BiomeFX is the one that Microbiome Labs is involved with, right?

Dr. O’Bryan:                        That’s correct.

Dr. Weitz:                            Yeah. We just had Kiran Krishnan on our monthly meeting, talking through Zoom. And he was talking about the microbiome and gave us some information about that full molecular analysis stool test.

Dr. O’Bryan:                        Right. It’s a great test. I’m really impressed by it. But that’s the three. That’s the three things that everybody has control over. Now, you don’t fix them in a day. You have to first be able to read the map and then start heading in the direction from New York to Miami. You have to be on the right road to eventually get to health, to better health.

Dr. Weitz:                            What are some of the things that you might see on that Neural Zoomer panel?

Dr. O’Bryan:                        Oh, man, we’ve never had one come back negative yet. Of all the ones we do, every … And I tell people. I tell them this when they first come. And I say, “Mrs. Patient, my favorite patients are the ones that have been to Mayo Clinic and they’re told that they don’t know what’s wrong.” I said, “That’s great. That’s really great.” And they looked at me like I’m a little weird which I am.  But I say, “That means that you don’t have a disease because if you had a disease, Mayo Clinic would find it. You’ve got dysfunction. Something is not functioning right, so the tests we’re going to do are going to look at functional problems, not disease markers.” And they’d say, “Oh, okay. That kind of made sense.”    Then they come back in the next visit, everybody is nervous with test results. They always are. And I look at the test results and I say, “Well, this is really good news. You’re a mess. Look at all these problems on here. These are great because this one will take two months to fix. This one might be six months. This one, somewhere of six months to a year. But every single one of these markers can be turned around and we’ll show you how to turn them around. But this is what we have to focus on, is get the inflammation down in your brain.” So, what’s it going to take? Whatever it takes to get the inflammation down.

                                                I’ll give you an example. The number one type of Alzheimer’s, you mentioned Dr. Bredesen, the real pioneer here. And Dale says that of the five types of Alzheimer’s, the number one most common type is inhalation Alzheimer’s. It’s what you’re breathing that goes right up to your brain. That’s the gasoline on the fire causing the inflammation, killing off brain cells.   And you learn that indoor air pollution is much worse than outdoor air pollution. Molds are huge problem in our country today, huge. “Well, there’s just a little bit of mold on the shower curtain. It’s not too bad.” Yes, it is. If you see it, it’s way too much. It’s way too much, right?   And NASA came out with a study and they showed these common houseplants. You put two six-inch houseplants in every room and you suck up formaldehyde, trichloroethylenes, molds, spores by depending on the chemical for anywhere from 42% to 76% of what’s in the air. The plants suck it in, take it down into the roots of the plant. The microbiome in the dirt converts that stuff, breaks it down and then the plant produces more oxygen in the air.   So, it’s really simple things. You get houseplants in every room. “Well, I don’t have a green thumb.” So if they die, you buy more. You don’t have to have a green thumb, and you’ll learn how often to water them and when not to water them. But the idea is-

Dr. Weitz:                            What about air purifier or plants that are-

Dr. O’Bryan:                        Exactly, much better if you can’t afford an air purifier or in addition to an air purifier, houseplants in every room. And people don’t know that your air … If you can see the sunshine coming through the window, sometimes the rays of the sun and you see kind of the dust in the air, you’re sucking all that stuff in all day every day. And what’s in that dust? Formaldehydes from pressboard, cabinets like your kitchen cabinets or your bathroom cabinets. They outgas formaldehyde into the air. You just can’t smell it.

                                                Scotchgard on your sofas outgases into you and this stuff causes cancer. These chemicals cause cancer. Now, there is no evidence that the amount of Scotchgard that reaches out into the air is toxic to humans. And that’s true, there is no evidence because it’s a minor amount. But this stuff accumulates in the body over years and years and years. Now, you got a problem. And that’s how the chemical industry got away with this crap, excuse me, but they had the legislation passed that you have to prove the amount of toxic stuff in the air is dangerous to humans. It’s not.

Dr. Weitz:                            Yeah, it turns out they actually stopped regulating PFOS and PFO recently. They said, “No, we’re not going to regulate it.”

Dr. O’Bryan:                        Yeah. And when Trump came to the office, I’m not getting political here, but in his first month in office, he removed the regulations for filters on coal burning power plants to filter the mercury, so that mercury doesn’t spew into the air. For the last seven years, there’s been a whole lot more mercury spewing into the air because of our government regulations or lack of regulations.

Dr. Weitz:                            Actually when they remove the controls on the PFOS, it was right after two scientists from his own organization published some studies showing that these chemicals and these are like the chemicals that are found in Scotchgard and Teflon pans and stuff that they’re actually way more toxic at much lower levels. And we’ve already got reports that they’re in the drinking water throughout most of the country including in California.

Dr. O’Bryan:                        Right. See, that’s why all these stuff is overwhelming.

Dr. Weitz:                            And all these chemicals build up in the body like you’re saying.

Dr. O’Bryan:                        Exactly. That’s the danger, is the accumulative aspect. That’s why part of the roadmap to better brain health is teaching people how important it is to detox and that we have to be thinking a little bit every day about helping our detoxification pathways, break down these chemicals we’re exposed to.

Dr. Weitz:                            How do we detox? That word is thrown around a lot.

Dr. O’Bryan:                        Yeah. The first and most important thing is the highway of detox needs to be open and clear. If you’ve got a four-lane highway that’s narrowed down to one lane, everything backs up. You back your car into a snow bank, the exhaust pipe is full of snow, the exhaust comes back into the engine. What does all that mean? You have to drink a half ounce of water per pound body weight.  A half ounce per pound body weight. You just have to have the highway available to flush this stuff out.  “Oh, my god. Well, let’s see, I weigh 140 pounds, that’s 70 ounces. So that’s a half a gallon of water. Oh, my god. I’ll be peeing all day.” That’s the idea. You got to get this stuff out of you. I mean if your brain is on fire, where are the triggers coming from? And there are many, many triggers. And once again, it’s an overwhelming thing to deal with. That’s why you have to understand the paradigm, I’m learning how to read the map to get to Miami.

Dr. Weitz:                            What else can we do to promote detox of chemicals?

Dr. O’Bryan:                        Number one most important is be well-hydrated with the purest water that you can get your hands on.

Dr. Weitz:                            Is there a particular type of water you like?

Dr. O’Bryan:                        Yeah, tap water through a really good filtration system.

Dr. Weitz:                            Okay.

Dr. O’Bryan:                        Yeah. That’s the only time you’re safe. If you can afford it, to spend 400 to a thousand dollars and get a really good water filter … The best one would be a couple of thousand dollars for the water coming into the house [crosstalk 00:38:36] to the kitchen sink because you brush your teeth in the bathroom. You take a shower and you get water in your mouth in the shower. So, having a whole house water filtration system is the best.  But if you can’t afford that, whatever you can afford is better than nothing. Even if it’s just a little countertop Brita that you put the tap water into and it goes through a little filter in the top and it drips down into the container. That’s better than nothing.

Dr. Weitz:                            You can get one of those systems that goes onto the sink that does reverse osmosis and a bunch of filters. And there’s a number of companies that will actually do it for a monthly rental fee. You pay 30, 40 bucks a month or something like that.

Dr. O’Bryan:                        So, that’s the important component on the map of getting to Miami, of getting to better brain function. You have to understand you’ve got lots of cities to drive through, lots of states to drive through to get from New York to Miami.   So, with detox, what else is critically important after water, the next in my opinion most important thing is what’s on the end of your fork. That is the most common trigger, fueling inflammation in the body. And so, the first concept is always get organic whenever you can. And when you go shopping at your local supermarket and they don’t have organic potatoes or sweet potatoes, you ask for the produce manager. There’s always some guy putting out more fruit or something. And say, “Hi, is the produce manager in?” “Yeah.” “Could you get him please?”

                                                And the guy comes out and he’s really happy, he’s the produce manager. Say, “Hi. I’m wondering how come you guys don’t have organic sweet potatoes?” “Oh, well, there’s really not … We just … There’s not that much to manage.” “Oh, my friends and I, we know how important organic is and if you carry organic, we’ll buy it. I promise.”   And then he walks away, “Oh, okay.” he walks away and he might blow you off. But what if 20 people a week do that? It won’t take long before he goes to the store manager and says, “I’m having people every day asking for more organic produce.” That’s the only way you’re going to get a change in the supermarket, is that everybody takes five minutes and ask for the produce manager and does your own due diligence to tell them you want organic carrots. You want organic apples.

                                                And you tell him and a hundred people a month do that, you think they’re not going to get organic? Of course, they’ll get it. They’ll start with a little bit and you say, “Oh, it’s there.” And you ask for the produce manager again six months later and say, “Hey, I see you got some organic rhubarb here. That’s really great. Thanks so much. Now, what about avocados?” And then they’ll have regular avocados and the organic ones that are a little bit more usually. And you just start building it up.

                                                But anyway, when you go shopping, always think of the rainbow diet. Most important concept in your food selection is the rainbow diet. The deeper the colors of the rainbow, the more polyphenols and antioxidants in the fruits and vegetables – blueberries, purple cabbage, red tomatoes, green broccoli, chard. The list goes on and on.   But you think of the colors of the rainbow, critically important. Because the more of the polyphenols you get in your diet every day, every meal, even breakfast, every meal … The more polyphenols you get, the more you support your detoxification pathways so that your liver is better at breaking down the chemicals you’re exposed to. Your lungs are better at breaking down the chemicals you’re exposed to. Your microbiome is better at breaking down the chemicals you’re exposed to.

                                                So, of course you want to reduce exposures of the bad stuff but you can’t in our world today. So you want to enhance your detoxification pathways. One is water, two is food. It’s critically important. And then your doctors can check you for compromised detox pathways and there are some geek terms like methylation, others that you may need more extra support and certain vitamins to help. But your doctor can find that out for you.

                                                But the simple things, you can do it every day and it should be just your new paradigm, is always a rainbow diet and always hydrating really well. You want to be at the point just from those two things, just from that where you wake up in the morning and your spouse wakes up. And you say, “Honey, I just had the best bowel movement I’ve had in three weeks. Holy cow, I feel great.” We think that intimacy and sex is great, but I’ll tell you what man, good bowel movements, you’re a happy man.  And we don’t talk about that stuff, but those functional abilities are critically important to get your brain working better because the ratio is nine to one. The message is coming from your gut nine times more of them going up to your brain. You want a gut that’s working really well.

Dr. Weitz:                            And most of the toxins are being put into the stool and pooped out. So, that’s a major route for detoxification.

Dr. O’Bryan:                        Right. And I could talk about vitamins and take this one or take that one. And those are valuable. Those are really valuable. But if you don’t do the basics, if you don’t learn how to read the math, you can temporarily feel a little better because you’re taking vitamin and caffeine. You’re taking things that jack up your brain to work better, so it’s going to work better for a little while but you keep throwing gasoline on the fire, what do you think is going to happen?

Dr. Weitz:                            So, you’re saying even if you use a specialized detox program, take a detox powder, certain capsules, glutathione, binders, things like that, all those things need to be added on top of having a healthy diet, drinking a lot of water, getting sleep. You’ve got to have those fundamentals first before those specialized detox protocols are going to be beneficial.

Dr. O’Bryan:                        That’s exactly right. When you get out of New York, you need to get … You have to go through the city of New York to get on the highway to get down to Florida. And now, it’s a straight shot on the highway once you’re there. But you’ve got to do all those maneuvering to get on the highway. And the maneuvering … What people have to understand, and people don’t like to hear this. But what they need to understand is that if you have cognitive decline, if you’re forgetting things, if your memory is not working very well, what you’re doing, the way you’re living your life ain’t working. If you’re lucky, you’re going to be one out of the three, you’re at risk of that. So, what you’re doing ain’t working, period.  And you have to understand first because if you keep doing those same lifestyle, you got mold in your house but now you’re going to take some smoothie combination and put this brain powder in there and with 18 different ingredients for your brain and you take the smoothie and your brain is working really good and you’re fired up for a while but you’re still sucking the mold air into your brain, killing off your brain cells, what do you think is going to happen?

                                                It’s like we have to change our paradigm first. I never talk to people about a bunch of supplements to start with ever because you have to change the way … You have to realize the way you’ve been living your life has created the problems you got right now.   So, the definition of crazy is doing the same thing and expecting different results. “So, I’m going to do the same thing but now I’m going to take some brain powder with my smoothie. Oh, I feel better. My brain is working better,” for a short period of time but your lifestyle is the same. You’re breathing the same air. You’re eating the same foods that you’re sensitive to. “Well, I don’t get gut pain when I eat wheat. I don’t have a problem with wheat.” Really? Just do the Wheat Zoomer test and find out.

Dr. Weitz:                            Should everybody stop eating wheat?

Dr. O’Bryan:                        Say it again.

Dr. Weitz:                            Should everybody stop eating wheat?

Dr. O’Bryan:                        I never say that, ever. I’ve never ever said that. But I’m misinterpreted that way because what I do say is that if your immune system is fighting wheat, you can’t eat wheat, period. So, you just have to have an accurate test to see, is my body fighting wheat right now? Because the ratio is eight to one, for every one person that get gut complaints from eating wheat, eight people don’t have gut complaints. They’ve got brain complaints or joint complaints or skin complaints. They don’t have gut complaints.

                                                So, you think I eat wheat, I feel fine, it doesn’t matter how you feel if your brain is fried because it may be your genetics the wheat is causing gasoline on the fire in your brain. So, what I always say, if you’re not happy with your current health and how your body is functioning, do the test to see, does my immune system say I have a problem with wheat? If it says yes, you do, you don’t eat wheat anymore, period. So that’s what I always say.

Dr. Weitz:                            Right. What about just doing an elimination diet and taking wheat out and see if you feel better?

Dr. O’Bryan:                        The concept of … I have to plug my power in here on my phone, there we go … The concept of an elimination diet, the danger of that, it’s a good concept but the danger of that is that you’re looking for how you feel to determine whether or not wheat is a problem. And quite honestly, most people that eliminate wheat, they feel better pretty quickly. But some don’t or they feel better, and if they have a little wheat once in a while, they’d still feel fine. They can’t tell.

                                                So, by the time you’ve got symptoms, it’s the end stage of that organ or that tissue and its ability to function normally. You can’t function normally anymore? You got symptoms. So, there’s a long degenerative process that goes on before you ever have a symptom. That’s the whole world of predictive autoimmunity. That’s what my book The Autoimmune Fix is about.

                                                So, it’s a good idea to do an elimination diet but it’s not comprehensive. Let me see if I can come up with the analogy for that. It’s kind of like saying if you’re driving on the highway through the city and everything is fine, you’re just driving along, everything is fine. You may not know there’s a riot going on four blocks over and there’s lots of chaos and lots of police and maybe the National Guard has been called out. But you’re on the highway and everything is fine.   So, you eat a little wheat once in a while and you can’t tell your brain is on fire. You can’t tell. Sometimes you can, but most of the time you can’t.

Dr. Weitz:                            Your immune system could be reacting to wheat. You could be having some clinical inflammatory reaction that hasn’t created symptoms yet and it could be a period of time before symptoms occur and by then you may be risking organ damage, so better to know early.

Dr. O’Bryan:                        That’s exactly right. You say it much clearer. And there’s only one test, though there are two tests that are really good tests now compared to the ones that almost every doctor does. The ones that most doctors do, the tests have been around for 25, 30 years and they’re good tests but they’re not comprehensive. Then in 2010, a laboratory opened up called Cyrex Labs and they looked at 10 different components of wheat instead of just one. So that’s better. But then a lab opened in 2015 called Vibrant Wellness that looks at 26 different components of wheat, and not just one. Most doctors look at one or maybe two components.

                                                So, if you test for that one component, gluten, and it comes back negative, your doctor says, “Oh, wheat is fine for you. See, the test is negative.” But you may not be reacting to gluten, you may be reacting to what’s called the wheat amylase trypsin inhibitors, that’s in wheat, and that’s causing your brain inflammation or that’s causing the thrombosis, the clots that you’re forming in your blood stream. And wheat does that a lot and you don’t feel any of that. So, you have to test comprehensively. So, those two labs are the only labs that are in the ballpark of being comprehensive.

Dr. Weitz:                            Great. So, I think we have to wrap because I have a patient coming up. As usual, it’s always fun to talk to you.

Dr. O’Bryan:                        I’d like to say one more thing if I may.

Dr. Weitz:                            Oh, yeah, absolutely. I was going to give you an opportunity to give some final thoughts.

Dr. O’Bryan:                        The subtitle of this book, You Can Fix Your Brain, the subtitle is Just 1 Hour a Week to the Best Memory, Productivity, and Sleep You’ve Ever Had. And it’s not a cutesy subtitle. It’s the only way to be successful with mild cognitive impairment, is that you don’t think you’re going to do it all immediately today. You just allocate a little bit of time if you have impairment every day one hour a day or one hour every two days, every Tuesday night after dinner or every Tuesday and Thursday or every night after dinner, I’m going to spend one hour. And I’m just going to review a little bit more.

                                                So, what’s the name of those plants that I need to buy? You go back to the book and you write down the name of the plants or you write down the URLs to look for glass storage containers to get rid of the Tupperware. The only thing Tupperware should be used for is out in the garage for your husband to store nails or for your kids to store crayons, but not around food. But you have to order glass storage containers, that’s going to take an hour, you’re done for the day. But you do this regularly, consistently.  And that’s how you start to change your lifestyle, is a little bit every day, a little bit every week, depending on how severe your symptoms are. In the book, I said one hour a week. But if you’ve got mild cognitive impairments, one hour a day.

Dr. Weitz:                            Yeah, absolutely. We all need to take steps to get as healthy as possible and mild cognitive impairment is one of the more important conditions that we want to do all these things, optimize our lifestyle and once again using a functional medicine approach. This is something that could be prevented and reversed. And just relying on the blockbuster drug that’s going to fix that is not the way to go. And that drug doesn’t exist with this condition anyway.

Dr. O’Bryan:                        Well, you know I know of two, there may be more, pharmaceutical companies that closed down their Alzheimer’s research departments. They closed them down and laid off the scientist after spending literally billions of dollars over the years trying to find the drug because they now know there is no drug and Dr. Bredesen taught us there’s 36 different things that have to be looked at and fixed. It’s a step by step progression. You have to fix this, fix this, fix this, and fix this.   That means there’s a map. To get from here to there, there’s a map and you have to learn how to read the map, which is every step along the way. That’s where the one hour a day or one hour a week comes into play. Be patient, be consistent and you will make it to Miami.

Dr. Weitz:                            Excellent. On that thought, we’ll bid adieu and listeners can find out more about you through TheDr.com website, correct?

Dr. O’Bryan:                        Yes. That’s TheDr.com. Don’t spell the word “doctor” out, TheDr.com.

Dr. Weitz:                            Okay, excellent. Thank you Dr. O’Bryan.

Dr. O’Bryan:                        Thank you, Dr. Weitz.