Reducing Food Cravings with Dr. Elena Zinkov: Rational Wellness Podcast 170

Dr. Elena Zinkov speaks about Reducing Food Cravings with Dr. Ben Weitz.

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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.


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