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Dr. Rick Mayfield speaks about Olive Oil with Dr. Ben Weitz.

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Podcast Highlights

5:09   Dr. Mayfield got more interested in olive oil when he discovered that olives contain ingredients that help the body to produce glutathione, which is our master anti-oxidant and which helps to sweep our heavy metals and other chemicals out of the body.  We also know that people in the Mediterranean basin who are eating and drinking olive oil have less heart disease and this is really the key to the Mediterranean diet.  While the monounsaturated fatty acids, the omega 9 fats in olive oil are neuroprotective and promote brain health, it is the phytonutrients known as polyphenols in olive oil that provide most of the health benefits. There are 36 different phenols or polyphenols within olives.  The most important one is Oleuropein, which is broken down by our gut bacteria into hydroxytyrosol and tyrosol.

8:09  There are different types of olives and when you look for which ones have higher levels of phenols like hydroxytyrosol, there are 3 or 4 that come up most frequently.  You want to buy an olive oil that lists the type of olive it is made from and the products sold at the grocery store usually do not list this.  Some of the most common are picqual from Spain, koroneiki from Greece, and coratina from Italy.  Dr. Mayfield often buys his olive oil from Amazon or OliveOilLovers.com.  One thing to keep in mind is that olive oils higher in polyphenol content may have a slight bitter, tangy test, rather than the very neutral tasting olive oil that many Americans prefer.

12:53  What is the best way to buy the healthiest olive oil?  Dr. Mayfield mentioned that in the Twin Citires in Minnesota where he is from they have four different olive oil stores that sell olive oil in 3 to 5 gallon bines and they list the phenol content from 300 to 800.  However, where I live in Los Angeles, I’m not sure we have any stores that only sell olive oil. Dr. Mayfield mentioned that one of his favorite olive oils in Hypereleon, which uses the Olympus varietal, and for four years in a row it has the highest recorded phenol content. It is also best to eat organic to avoid pesticides and because organic fruits and vegetables tend to have higher levels of phytonutrients, like polyphenols.

16:38  Some olive oil is sold that is not actually olive oil or is fake or has cheaper oils mixed in.  Dr. Mayfield referenced a study conducted by UC Davis in California in 2011 in which they analyzed olive oil sold in stores and found that 73% did not contain what they claimed. Here is the report about the study with a link to the study: Imported Olive Oil Quality Unreliable, Study Finds.  They found cottonseed oil, soybean oil, and other things that were not on the label mixed in. The California Olive Oil Council has developed a certification process in the last few years, and this does look like this is something that is improving the quality.  Here is a link to the COOC certification process.

21:51  Olive oil much more so than red wine accounts for some of the benefits of the Mediterranean diet.  In fact, some people in Mediterranean countries like Greece will drink a small glass of olive oil and Dr. Mayfield does this as well.

23:29  Cooking with olive oil. 

Dr. Rick Mayfield is a Doctor of Chiropractic and he is double board certified in Functional Medicine, including through the Institute of Functional Medicine.  He is the director of the Center of Well Being in Edina, Minnesota. Here is his office website: CenterForWellBeingpc.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. Our topic for today is olive oil with Dr. Rick Mayfield. Many of us have heard that olive oil is healthy, it has a lot of benefits, it’s good for our heart health. We know that olive oil is an important component in the Mediterranean diet, and the Mediterranean diet has had an impressive amount of scientific studies showing that it’s associated with greater health. It has protection against cardiovascular disease. It’s beneficial for brain health. It even has anticancer properties.   What is it about olive oil? Well, we know that olive oil contains primarily omega-9 oils, also known as oleic acid. There’s a certain amount of scientific data showing that this type of fat is beneficial. Then, depending upon how the olive oil is produced, it may have more or less polyphenols. Much of the recent research is indicating that these polyphenols, or some people refer to them as phenols, are responsible for a lot of the health benefits of the olive oil. Polyphenols are antioxidants, natural phytonutrients that are present in olive oil especially extra virgin olive oil.

                                                We have many questions about olive oil. What is the best olive oil? I’d like to drill down a little more on exactly some of the health benefits and how olive oil promotes cardiovascular health, etc. We’d also like to know about the polyphenols and how do we determine if an olive oil has a lot of polyphenols? Is it okay to cook with olive oil? These are some of the questions we have.

                                                I’ve asked Dr. Rick Mayfield to come on to help give us some additional information about olive oil. Dr. Rick Mayfield is a doctor of chiropractic and he’s double board certified in clinical nutrition. He’s also certified in functional medicine through the Institute of Functional Medicine. He’s currently the Director of The Center for Well Being in Edina, Minnesota. Dr. Mayfield, thank you so much for joining me today.

Dr. Mayfield:                      Thank you so much. It’s an honor to be here Dr. Ben.

Dr. Weitz:                            Great. Maybe you could tell us how olive oil became a topic of interest for you.

Dr. Mayfield:                      Well, it all started about 2009, 2010 when I was asked to join the Institute for Functional Medicine as a faculty member to teach detoxification and biotransformation. They gave me an open book to say, “Create your own deck and we want it to be science-based.” I spent six months creating my major deck. We had three major decks and one of the big decks was on phytonutrients. I’ve always been obsessed or somewhat quite interested in phytonutrients and phytochemicals because they’re the active ingredients in plants. All the research for the previous, I would say, 25 years have been exploding about phytochemicals in terms of what they do, how they benefit our health. We all know we should be eating our vegetables. Grandmother told us-

Dr. Weitz:                            By the way, for those who don’t know, phytochemicals are particular compounds found in plants that have important benefits and they’re beyond vitamins and minerals.

Dr. Mayfield:                      Yes. It’s like when you look at a vegetable and you see green, red, purple, orange, and so forth, those pigments are phytochemicals. When you look at a berry, that dark purple are called anthocyanins. There are different names for these chemicals and these are the active ingredients. We’ve known for centuries, well I’d say decades, that eating your vegetables and your fruits are really healthy for you even though most of us have not done that historically but we know that looking … Beginning in about the 1970s, they started looking at more about these phytochemicals. It’s evolved to the point now where most of the research that I read, which is about five hours a day is involved with phytochemicals because that’s where the action is.  While we need our macronutrients like proteins and fats and carbohydrates and minerals and vitamins, it’s the phytochemicals that really make the cells healthy and anti-disease.

                                           I got involved in olive oil because it kept coming up in my radar in terms of doing the research showing, well, these ingredients in olives are really strong agents to produce a protein called glutathione. Glutathione is our master anti-oxidant in all of our cells that sweeps out free radicals or oxidized agents. It also sweeps out heavy metals and other chemicals out of the body. I started looking at this a little closer and it evolved into a complete database search of everything that I could read about olive oil. Now, I’m definitely an olive oil kind of nut job now. I really love everything about olives because the science is there. Initially, the science came through what’s called epidemiology, looking at population based studies. People in the Mediterranean basin who are eating and drinking olive oil had less heart disease. That’s how it became known as the Mediterranean diet largely because it was cardio protective. It turns out that the chemicals within olives have these phytochemicals. They’re really the smoking gun.

                                           Now, when you look at, say, neuroprotective or you mentioned helping your brain health, we know that the olive oil itself, the oil, the oleic acid, the monounsaturated fatty acid, actually stabilized the neuron membranes, your brain cells. That the walls of the cells become more stabilized with omega-9 fatty acids. That, in itself, is neuroprotective. Taking that a step further, it’s about these phytochemicals. There’s 36 different phenols, the polyphenols within olives. The master most important one is called oleuropein. Oleuropein, like most phytochemicals in our foods, is swallowed through our diets and our bacteria. Our flora in our gut then process this oleuropein into the metabolites. Then, we absorb these metabolites. When you eat a berry, for example, you absorb not the berry itself but the metabolites produced by these bacteria that break it down. Same thing with olives. When you ingest an olive oil that has phytochemicals, you’re actually ingesting oleuropein primarily and that’s broken down to what’s called hydroxytyrosol and tyrosol. Hydroxytyrosol-

Dr. Weitz:                           By the way, can you spell oleuropein?

Dr. Mayfield:                      Yeah. Oleuropein is O-L-E-U-R-O-P-E-I-N-

Dr. Weitz:                           Thank you.

Dr. Mayfield:                      Oleuropein. Hydroxytyrosol is H-Y-D-R-O-X-Y-T-Y-R-O-S-O-L. That is one of the key phytochemicals or phenols within olive oil or olives itself. Now, it turns out that hydroxytyrosol and tyrosol is providing most of the benefits. Not all of them, but most of the benefits that we’ll talk about further.

                                           Now, there’s different kinds of olives just like there’s different kinds of grapes that produce different kinds of wines. There’s different kinds of olives that produce different flavors and different tastes and different constituents or content of olive oil. When you look in the database of what’s highest phenol content like hydroxytyrosol, there’s three or four varieties that come up the most frequently in the database. When I choose olive oils, I’m trying to find those olive oil products that have those kind of variety or varietals. Now, there’s well over 150 different olive oil varietals. Most labels will not identify what kind of olive this is coming from. It’s very few products will actually have it on the label.  Except for those coming out of the Mediterranean basin, most of those will … Say from Spain, Spain has a very high concentration of a varietal called picqual. It’s P-I-C-Q-U-A-L, picqual. Picqual is very high in hydroxytyrosol. It’s very high for oleuropein. It’s very high in these highly concentrated active ingredients. I will choose an oil from Spain trying to find an orchard or a mill that will have right on the label 100% picqual or a very high percentage of picqual varietal. If I go to your local Walmart or your local Costco or even to a local health food store, you won’t find this on the label largely. It’s really rare to find this on a label here in the United States. I’ll come back to how we search out these oils.  There’s other varietals as well that are very high in these phenols. One is from Greece. It’s also from Crete, the Island of Crete. Greece has a common oil varietal called koroneiki. That’s with a k. It’s K-O-R-O-N-E-I-K-I, koroneiki. Koroneiki and coratina from Italy, that’s with a c, coratina just like it sounds. Those three, koroneiki, coratina, and picqual from Spain are consistently high in polyphenol content. I’ll primarily look for oils that are coming from those countries that will label their bottle as such. Now, there are many other varietals as I mentioned. There’s another one from Spain that I use that I’ve come into and I’ll come back to that. That’s really exciting for neuron health and brain health. It’s a totally different variety.   When we go to looking for the right kind of olive oil, I can go to a website like OliveOilLovers.com, that’s what it’s called, OliveOilLovers.com, I can even go to Amazon and type in the search words picqual, koroneiki, or coratina extra virgin olive oil and up comes a whole list of different oils that are ready to go for you. You can actually start reading about them. Some of them will not say picqual on the label but many of them do.

Dr. Weitz:                           Picqual is a type of olive, right?

Dr. Mayfield:                      It’s a type of olive, that’s correct. Just like koroneiki is a type of olive from Greece and Crete and the surrounding area.

Dr. Weitz:                           What about Tunisia as a country for olive oil because I know Dr. Gundry sells a high polyphenol olive oil that comes from … I think it’s from Tunisia.

Dr. Mayfield:                      Yes. There’s different countries. I buy one from the West Bank near Israel in Palestine area. It’s really high in phenol content. It’s not a koroneiki. It’s not a picqual. It’s not a coratina. There are different varietals in different Mediterranean basin areas. The strongest research we have are on those three varietals. There’s other countries that are producing like Tunisia. I like the Tunisian oils as well. They taste well. For me, a lot of it’s about taste. Many times the higher the phenol content, the more bitter it’s going to taste. It’s a little more pungent. It’s a little more peppery. You can tell when you put the oil in your mouth and just let it sit there. You can go, “Okay. Yeah. This has got a little bite to it.” That’s the phenols. That’s the chemical content. It’s not because of-

Dr. Weitz:                           I think Americans have a tendency to want their oil not to have any taste. We need to resist that tendency that we need to understand that high polyphenol, healthy olive oil is going to have a little bit of a pungency, a little bit of a kick to it, right?

Dr. Mayfield:                      That’s correct. That’s correct.

Dr. Weitz:                           Perhaps you can continue on how to buy the best olive oil that’s going to give us the most health benefits.

Dr. Mayfield:                      If you have a local store that’s an olive oil specialty store … I’m in the Twin Cities in Minnesota. We have four different olive oil stores. They sell olive oil that’s fresh in a large three to five-gallon bin. There might be 30 to 50 of these bins and you can go and they’ll list them by the number of potency of phenol from 300 to 800. The higher the number, the higher the phenol content. The International Olive Council Society is trying to standardize our olive oils based on the phenol content. That has not happened yet but we hope to see that at some time in the future. When you buy a bottle, it’ll have it right on there.  Check your local area to see if there’s an olive oil store that will sell … They have a variety of olive oils based on their phenol content. Number two…

Dr. Weitz:                           Can you find out about the phenol content if you go to the website? I don’t know if most of these companies have website.

Dr. Mayfield:                      Some do. Yeah. Some will have it. One of my favorite olive oils is Hypereleon. It’s H-Y-P-E-R-E-L-E-O-N. Hypereleon is an award-winning Greek oil right near Mount Olympus. It’s a different variety. It’s called the Olympus varietal. On their website and in their literature, they’ll actually list the number of phenol content. This oil has, for four years in a row, the highest recorded phenol content. It’s extremely robust in flavor and there are three different varieties. They pick their olive early on. Actually, it’s a green olive before it ripens. The olive is maturing just like an apple or a berry. They go through various stages of development of phenol content. They pick their olives at the peak level of certain phenol content. This particular olive is grown at high altitude where it has a natural subsoil drainage. It has a lack of water so it stresses the plant. When the plant becomes stressed, it produces these chemicals. That’s how it is with all food. If you stress, say, a spinach plant, you’re going to create a better chemical content in that plant. 

Dr. Weitz:                           Which is one of the reasons why you want to eat organic because the pesticides actually protect the plant from some of the stress it’ll undergo from being attacked by pests. Therefore, organic fruits and vegetables are more likely to have a higher level of phytonutrients. I’m assuming organic olive oil probably would have a higher level of polyphenols as well?

Dr. Mayfield:                      Very likely. Yes, because they’re under higher environmental stress. Depending upon where the olive is grown, the amount of water, amount of sunlight, and so forth, you’re going to get different levels of phenol content.

Dr. Weitz:                           Is getting organic olive oil important as well to void whatever chemicals might be sprayed on the olive tree?

Dr. Mayfield:                      Well, I prefer the organics. The only type of oil I buy is organic because I choose to buy organic produce and foods.

Dr. Weitz:                           I do as well.

Dr. Mayfield:                      Yeah. That’s really, to me, important. There’s many non-organic olive oils that are high in phenol content. They are there, I just don’t buy them. If I can avoid chemicals, then why not?

Dr. Weitz:                           We certainly heard reports that there’s olive oil being sold in stores that we go to that are fake or non-authentic or have cheaper oils mixed in. How do we avoid that?

Dr. Mayfield:                      Difficult because we don’t know because there was a study done, I think, in 2011. They went to California grocery stores and pulled 60 some different olive oils off the shelf and analyzed them. They found cottonseed oil, soybean oil. Things that were not olive oil but it wasn’t on the label. You don’t know. I choose not to buy generic non-labeled where this oil is coming from. That’s why I go to the Mediterranean basin to buy my oils. Not to say there’s not good … There’s probably good olive oils coming out of California and other countries but we just don’t know. I know there’s good olives coming out of South America now. There’s very little information on it but it looks interesting. Looks like they have higher phenol content, we just don’t know. 

Dr. Weitz:                           I guess something I read said that in California they have this certification process that they’ll put this certification on the label and that’s something that can provide some trust. Is that true?

Dr. Mayfield:                      That’s true. Yeah. That’s fairly new in the last few years. The industry is stepping up.

Dr. Weitz:                           Where do you get these oils? You buy them through the Internet?

Dr. Mayfield:                      I do. I buy them off the net. I buy them off of Amazon.com. I’ll buy them off of special olive oil websites. I mentioned one, OliveOilLovers-

Dr. Weitz:                           You give your money to the evil empire?

Dr. Mayfield:                      Yeah. I buy quite a few from OliveOilLovers.com because they have great variety. You can buy them by country origin. You can buy them by types of olive oils. They don’t have necessarily by varietal content but they … If you type in the word coratina in that search engine base, up will come a bunch of Italian oils. I gravitate to those. It’s really that simple. If you buy it off Amazon, obviously, you get some free shipping if you have that type of Amazon account.

Dr. Weitz:                           What about some of the brand oils that we see all the time like Spectrum Oil or some of the other popular brands you see at say Whole Foods or I shop at our local co-op?

Dr. Mayfield:                      Well, we don’t know because they’re not labeled. I went to Whole Foods just a couple weeks ago to look at a particular olive oil that a patient told me about. There’s one out of 12 oils, only one had the word koroneiki on it. All the other oils had no source of variety. We didn’t know what kind of oil it was, just that it was organic olive oil. It might be fine as organic olive oil. I prefer to know where it’s coming from.

Dr. Weitz:                           What if it says it’s from a certain country?

Dr. Mayfield:                      Well, we still don’t know. I mean, in Spain, they have dozens of oils, different varietals and species of olives. They probably have very good oils and I’ve tasted many of them. I just prefer ones that are highest in phenol content. We know that the picqual from Spain is an example. It’s readily available. You can do a search. You can find these pretty readily. My patients do it every day off the Internet. We have a handout in our office. We type all this information up. It’s very simple. Type this into a search engine, here’s the websites, they find it.

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.

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                                                Now, back to our discussion.

Dr. Weitz:                             How much of the health content of olive oil’s coming from the omega-9 fats versus the polyphenols?

Dr. Mayfield:                       From what we can see with the science, much of it is coming from the polyphenols. That seems to be where the smoking gun is in the Mediterranean diet. For years, they thought, “Well, it’s because people are drinking wine with their meals. Yes, they eat more vegetables but it’s the wine.” No, no. I’ve actually talked to Mediterranean based scientists out of Spain and so forth, they’re going, “No, no, no. It’s not about the wine.” Many of us don’t even drink wine but we were consuming massive amounts of olive oil. I did a lecture for the Institute of Functional Medicine here about five years ago and I talked about 30 minutes on olive oil. I mentioned about the lifestyle of Grecians, Greek people, and how they eat and what they eat and how much. This doctor came up at the break and said, “You’re the first person that’s ever really described my lifestyle in Greece. We actually drink the olive oil. We actually drink it like a beverage.”   I’ve gotten into the habit myself where in my morning breakfast, I’ll have a little shot glass full of very high phenol content olive oil and I’ll drink it like a drink. That’s how a lot of people in the Mediterranean basis, that’s how they do. When you have a salad, it’s not just drizzled with oil. That’s actually soaked in oil. I was having dinner with somebody at one of these meetings and she actually just ate her salad and then … Maybe it wasn’t very socially nice, but she lifted up the bowl and actually drank all the olive oil right out of the salad bowl. I was like, “Go for it.”

Dr. Weitz:                           What about cooking with olive oil? I’ve heard people say, “No, you should never cook with olive oil. The oil will get damaged. Cook with another oil and then use the olive oil just to put on the food afterwards.” Then, you look at the smoke point of extra virgin olive oil, it’s 375.

Dr. Mayfield:                      Exactly.

Dr. Weitz:                           For a while, I stopped using olive oil for cooking. I would only add it afterwards. Now, I’ll make my eggs in olive oil. When I cook things on the stove top, I try to use a lower or medium heat and I use olive oil. Is that a good thing to do?

Dr. Mayfield:                      Yes. In fact, that’s what I do as well. This information that it shouldn’t be cooked at all is really misinformation. You look at the lifestyle of people living in Greece and Crete and Tunisia and so forth, they are cooking with their olive oil, maybe not at high heat. Anything that’s cooked at high heat is going to be oxidized and damaging. Cooking your eggs with your olive oil at lower to moderate heat is fine. There’s nothing wrong with that at all. People can argue, “Well, I use a saturated fat like ghee from butter or coconut oil, it’s more stable.” Yeah, theoretically. It’s not necessarily necessary to actually cook with that. When I cook our vegetables, they’re not going to be mushed out. They’re going to be crunchy. They’re using olive oil when I cook with it but it’s not going to be high heat. You don’t want your vegetables to be soft because you’re losing the phytochemical content. The longer they cook, the more you lose your nutrients.

Dr. Weitz:                           What is considered high heat?

Dr. Mayfield:                      Well, I’d say anything over beginning above 300 degrees, you’re moving towards high heat.

Dr. Weitz:                           Okay. Olive oil, extra virgin, should be stable till what temperature?

Dr. Mayfield:                      I don’t know if we have an exact number on that but typically a low to moderate heat setting on your stove should be fine. I’m cooking my broccoli, I’ll bring the heat up, put the broccoli on there and I’ll cook it for about two to four minute and that’s it with the olive oil in there because anything beyond that, you’re going to just basically just cooking the heck out of the phytochemical content.

Dr. Weitz:                           Do you ever bake your vegetables?

Dr. Mayfield:                      I have, yes.

Dr. Weitz:                           What temperature do you use for that?

Dr. Mayfield:                      Typically, about 200 to 250. It’s a lower heat.

Dr. Weitz:                           Okay. Yeah. That’s a lot lower than most people use.

Dr. Mayfield:                      Yes, that’s true. You’re going to get a much more healthy vegetable content as far as chemical content when you eat your food raw. Some vegetables are not really tasty or people don’t like eating certain raw vegetables. They bake them or saute them. You can still taste … They bake or saute at a lower temperature, it retains the healthiness of that food. If you want to be hardcore, you can be a raw vegan, sure but it’s a little challenging for most people to comply with that. They just get tired of chewing, chewing, chewing.

Dr. Weitz:                           Let’s talk about the health benefits of olive oil. Why don’t we start with cardiovascular health?

Dr. Mayfield:                      Sure. Well, we know that it helps inhibit our platelet cells from aggregating or clumping. Our platelets are our cells that create clotting. When you inhibit to make your blood more thin, there’s less tendency towards stroke in [inaudible 00:27:08] or clogging of the arteries. It helps reduce the cholesterol itself. It does reduce cholesterol. More importantly, there’s a bad cholesterol called LDL, low-density lipoprotein. It reduces the oxidation of LDL, that’s the key thing. If you can reduce LDL oxidation inhibiting the platelets from aggregating or clumping, it also helps inhibit oxidation as … These phenols act as anti-oxidants. What they do is they go around and they scavenge free radicals like superoxide and hydroxyl radicals. There’s also a type of [inaudible 00:27:47] called induced nitric oxide. Nitric oxide has a two-edged sword. It could be really healthy but unless it’s induced by oxidizing agents, that creates more inflammation in the vessels of the circulatory system. The phenol content in olive oil reduces this oxidation or peroxidation of fats and also free radicals themselves.  When you look at a lab test and you can measure these oxidized molecules, you go by the abbreviations of MDA and TBARS, you can actually measure these in your blood. People who are ingesting higher levels of olive oil have lower levels of these oxidizing agents. That creates a better cardio protective effect.

Dr. Weitz:                            Same thing if we measure oxidized LDL on our cardiovascular panel?

Dr. Mayfield:                      Yeah. Correct. That’s right. We also know that extra virgin olive oil has an antihypertensive antiblood pressure effect. There’s many studies showing us that if consumed say 1,000 milligrams of this oleuropein or these phytochemicals for six weeks, you can beat your blood pressure by 10 points or 10 millimeters or mercury.

Dr. Weitz:                            Wow, that’s pretty impressive.

Dr. Mayfield:                      That’s very impressive within six weeks. There’s been other studies that go as long as two years showing the same benefits. One of the other benefits of olive oil is that actually it acts as an anti-inflammatory. There is an enzyme inside all of our cells called NRF2. The enzyme creates a gene expression to create anti-inflammatory proteins. Things that fight inflammation throughout the whole body. It turns out the phenol content in olive oil, specifically hydroxytyrosol, activates NRF2. It also inhibits an enzyme called LOX or lipoxygenase. This LOX enzyme is … If you have arthritis, your LOX enzyme is quite active and quite high. There should be things in plants, including olive oil, that inhibit that enzyme. There isn’t any other kind of molecules like that but I’ll stop there.   We know that with the disease called atherosclerosis, or hardening of the arteries, olive oil has been shown to be antiatherogenic. It prevents clogging of the arteries with plaques. Those are the key primary current effective benefits of olive oil for heart disease.

Dr. Weitz:                            I understand it raises HDL as well.

Dr. Mayfield:                      It does to a certain degree. Yes. It’s got that benefit. It definitely does.

Dr. Weitz:                            Good. What about cancer prevention? Is olive oil play a role in reducing our risk of cancer or helpful as part of a healthy diet to somebody who’s dealing with cancer?

Dr. Mayfield:                      I could answer that by looking at … We have cell culture studies that shows it helps reduce what’s called cell apoptosis or program cell theft. We know they’re in animal studies it does the same thing. A [inaudible 00:30:54] mix of cancer cells die off faster if they’re elevating too high. We know that the olive oil phenol content from an epidemiology or population-based studies, has been correlated with less cancer incidents. That doesn’t necessarily show that’s the reason why there’s less cancer but it’s a strong correlation just like with heart disease. We have fewer studies with humans with olive oil showing anticancer as far as direct human studies. Most of it’s with animals. Cell culture studies and epidemiology but there is a strong evidence-based, the answer to your question is yes.

Dr. Weitz:                            Right. Certainly, olive oil should be part of health promoting diet including one that is designed to help reduce cancer risk.

Dr. Mayfield:                      Definitely so. What I’m most excited about is the neuron effect on the brain. It’s very neuroprotective. It’s anti-Alzheimer’s. There’s a study done here called the Seven Countries Study. They looked at different countries and looked at what their disease patterns were. They found, “Oh, these people have fewer levels of Alzheimer’s disease and neurodegenerative diseases. They are consuming higher levels of olive oil.” When we look into the science of it, we find that there is a protein in our nerve cells that if it becomes too high, it creates problems and it’s called amyloid beta or AB. When it becomes high amyloid beta, it gets stuck together and it inhibits the nerves from working correctly because they can’t transmit neurotransmitters properly, the cells degenerate. Then, the cells become tangled. There’s little fibers called neurofibrons that become tangled. Well, it turns out that the phenol content of olive oil inhibits amyloid beta and these neurofibral tangles from happening. That’s not only true for olive oil, it’s true for a lot of different vegetables and fruit contents like in berries. We know with olive oils, it’s really very specific.    There are some benefits, as I mentioned earlier, is that the olive oil fatty acids, the monounsaturated fatty acids, oleic acids, does stabilize the neuron membranes. There’s some other benefits that we don’t understand. The reduced risk of age-related cognitive decline is one of the things that I’m most curious about in those cultures that are ingesting higher olive oil content. Those are primarily the biggest factors. There’s some other [crosstalk 00:33:29].

Dr. Weitz:                           You mentioned that famous Seven Countries Study of Ancel Keys which has been highly criticized by some of the functional medicine world.

Dr. Mayfield:                      I know. They all have an opinion. That’s okay. There’s a road to every pile of information so I look for the benefits. I can take apart the most highly acclaimed study and I can critique it. A study just came out here about four weeks ago on fish oil called the Strength Study showing, “Oh, this shows that high doses of three fatty acids, EPA, ghee and fish oil, actually create higher levels of cardiovascular risk.” Well, if you dig into the study, there’s actually some really good positive things out of the study they didn’t talk about in the media. There’s actually some issues with the study itself. The problem with these studies, the media gets hold of it and they twist it [inaudible 00:34:26]. The authors tend to [inaudible 00:34:28] the significance in a certain way to meet their definition of what they’re trying to show. That’s going to go on forever probably with research studies.

                                                Another area that I’m pretty excited about with extra virgin olive oil is the antiaging effect and we call it cellular senescence. Cellular senescence is where the cells age too fast. Well, we’re early on in the science but there’s an enzyme in all of our cells called AMPK. This AMPK, it delays the aging of the cells. Turns out the hydroxytyrosol and its phenol content activates this AMPK. We need more data on this but it’s an up-and-coming new area of science.

                                                Just like with bone loss, there’s very good data in animals and now in humans showing that ingesting adequate levels of extra virgin olive oil helps prevent the loss of bone mass. It does this by activating our cells called osteoblasts. Osteoblasts create new bone. They do this through a variety of gene expression pathways and a variety of enzymes and creating new proteins. Bones are not just hard calcium. It’s actually active enzymes and proteins and collagen and content. It turns out that extra virgin olive oil activates this whole process. There was a study done for 24 months where they ingested 50 mls or extra virgin olive oil. That’s about three and a half tablespoons of olive oil. They followed the different levels of these compounds called osteocalcin and pro-collagen type one. Things that you can measure in the blood. In urine, they found that the levels are much more higher than the group that was ingesting extra virgin olive oil. They actually had lower loss of bone mass.  People who are having osteopenia or osteoporosis, they should be ingesting high olive oil in their diets as one component. It’s not just about taking your calcium. It’s much more as you know than just calcium.

Dr. Weitz:                            Yeah. Interesting you mentioned antiaging, we just did a podcast about a new way to measure aging using a methylation clock.

Dr. Mayfield:                      Yes.

Dr. Weitz:                            Yeah. That’s some of the newest cutting edge way to try to figure out how well we’re aging is by looking at the extent to which our DNA is methylated or not.

Dr. Mayfield:                      Right. That’s correct.

Dr. Weitz:                            Cool. I also saw some information that olive oil maybe beneficial for autoimmune diseases like rheumatoid arthritis as well.

Dr. Mayfield:                      Yeah. Some early on information that’s still … We don’t have hard data but as with most plant chemicals in our food, it modifies our microbiome. If our microbiome is healthy, there’s going to be a reduced autoimmune response. Largely, autoimmunity partially is about modifying your microbiota. We know that extra virgin olive oil, people ingesting that on human levels but for sure in animals, you can actually improve our microbial diversity in a healthier way. We know that these hydroxytyrosol and other phytochemicals in extra virgin olive oil has a direct effect upon our immune cells itself. There are various types of immune cells in the gut. I won’t go into that, it’s a long discussion. Basically, you can improve the healthy proportion of, say, natural killer cells versus dendritic cells how this immune system is communicating with the rest of the body. I’d like to say if you could just drink olive oil and your Hashimoto thyroiditis would go away. No, we don’t have that kind of data yet but it’s going to come. We’ll see it in time if we keep doing research.

Dr. Weitz:                            Cool. Good. I think those are most of the questions that I had on my mind. Any other topics you’d like to mention?

Dr. Mayfield:                      Probably the last one would be something I use quite a bit in my practice is we focus quite extensively on the microbiome in our functional medicine practice. We use a lot of antimicrobial agents that are plant-based whether it’s berberine or oregano and so forth. The extra virgin olive oil polyphenols are very antibacterial against bacteria like H pylori or helicobacter pylori which is correlated with acid reflux and GERD. We know that certain other bacteria lower downstream called [inaudible 00:39:16], salmonella, e coli and so forth. These unhealthy bacteria can be inhibited by extra virgin olive oil ingestion. No, I should also say you can get some of this oleuropein content through olive leaf extract.

Dr. Weitz:                            I was just going to mention that. Exactly. I’ve seen that recommended for immune support.

Dr. Mayfield:                      Exactly. Olive leaf extract is quite high in oleuropein so that’s another option for people who rather take a pill than eat their olive oil. I always recommend food first, supplements second but it’s an option. We don’t know the dosage but there was one study showing that about 1,200 milligrams of oleuropein per day was very antibacterial in the gut. We know it even kills staphylococcus or staph MRSA, this antibiotic-resistant strain of the bacteria that can be quite [inaudible 00:40:10]. It has super benefits. The olive leaf extract which has been known for years to be antiviral because of its oleuropein content. The oleuropein with an olive leaf and olive oil, they will go against say hepatitis or herpes or mononucleosis and a whole bunch of other strains of viruses. It has other immune system benefits. I use a lot of extra virgin olive oil and actually olive leaf extract just from an immune system component.

Dr. Weitz:                            Which product do you like for olive leaf extract and what dosage?

Dr. Mayfield:                      I use a brand from Bio-Botanical Research called Olivirex. Typically, it’s going to be-

Dr. Weitz:                            That’s the company that makes the Biocidin, right?

Dr. Mayfield:                      That’s right. I think their brand is nothing special. I use Biocidin, I also buy other products from their company. It’s convenient to buy that. I’ve used other brands. There’s a brand called N-O-W, Now, very inexpensive. Their oleuropein product works good too. There’s olive leaf extract. There’s other 500 milligram capsule like six percent oleuropein content. I tell people taking four of them three times a day is therapeutic when there’s a virus infection.

Dr. Weitz:                            2,000 milligrams three times a day?

Dr. Mayfield:                      Correct, for therapeutic [crosstalk 00:41:37].

Dr. Weitz:                            That sounds like fairly high dosage.

Dr. Mayfield:                      It is but you need to really go after this. If you got an infection, you can’t be half stepping it in through it. You need to be more therapeutic.

Dr. Weitz:                            You use that along with other antimicrobials like you mentioned berberine and oregano or will you use one product at a time?

Dr. Mayfield:                      No, I always use at least two, if not three, products at the same time because I found over the years that many of these bacteria and other microbial strains where there’s yeast or viruses, they seem to become somewhat resistant after a few days to a few weeks of taking the same ingredients. You need to up the dosage even higher. If we added multiple different ingredients whether it’s berberine or a [inaudible 00:42:22] leaf or some other product, that’ll give you more clinical benefit as a double and triple bang all taken together. I tell people just remind this is short-term. This is not for months and months and months.

Dr. Weitz:                            What is short-term? How long do you-

Dr. Mayfield:                      Between two to six weeks depending on how bad they … What’s going on. If [crosstalk 00:42:42]-

Dr. Weitz:                            What if they still have symptoms after that? Will you rotate different herbs or what will you do?

Dr. Mayfield:                      Well, usually I’m seeing my patients every three to four weeks for a consultation for functional medicine so I’m going to be checking in. They often will tell me, “Oh, I still got all this bloating” or “I’ve still got all this discomfort.” I say, “Okay. Get some garlic or get some high-end oregano oil type stuff.” Rotate to a different product to see if that makes a difference because everybody’s got a different microbiome so we’re finding we do often need to rotate consistently just like in the pharmaceutical world if you just use the same antibiotic all the time with the same patient, you’re going to find antibiotic resistance. You’re going to rotate to a different antibiotic. Same thing in the plant world, same thing.

Dr. Weitz:                            Cool. Great. How can listeners and viewers find out more information about you or get a hold of you?

Dr. Mayfield:                      They can go to our website. It’s called Center for Well Being PC, centerforwellbeingpc.com.

Dr. Weitz:                            Great. Thank you, Rick.

Dr. Mayfield:                      You [crosstalk 00:43:49].

Dr. Weitz:                            I appreciate you giving us quite a bit of detailed content about olive oil in a reasonable period of time. Thank you.

Dr. Mayfield:                      You’re welcome.

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Dr. Marvin Singh speaks about Gut Health and Autoimmune Diseases with Dr. Ben Weitz.

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Podcast Highlights

5:38   Dr.  Singh has both an integrative and a conventional Gastroenterological practice and in his conventional practice he still offers lifestyle modifications and natural treatments if patients prefer that approach.

7:28  The gut and the immune system are intimately connected and 70% of our immune system is located in our gut, which is how gut health plays an important role in autoimmunity.  The gut immune connection centers on the microbiome, which is this ecosystem of micro-organisms that live inside of our digestive tract. The microbiome runs our metabolism, makes vitamins for us, releases chemical metabolites and hormones and neurotransmitters, which is how these microbes regulate our immune system.

9:05  Leaky gut or increased intestinal permeability means that the tight junctions in our one layer thick lining of our digestive tract is damaged in some way that allows bacteria or food particles or toxins to get into our bloodstream, where the immune cells may launch an attack on them.  Once you have this immune reaction to what gets into our system through the leaky gut, either it will resolve or it won’t resolve and cause a chronic problem and there may be chronic inflammation.

14:34  Dysbiosis is a medical term for an imbalance in our microbiome. Unfortunately, there is still a lot that we don’t know about what the ideal microbiome looks like, but there has been a tremendous amount of research on this in the last few years. And we are getting a lot closer to understanding what creates such imbalances in our guts and how to fix it.

16:32  There is a section on the GI Map stool test that lists bacteria that if overgrown are potential autoimmune triggers.  Dr. Singh believes that we don’t need to respond to one microbe or another. Let’s say there is elevated Klebsiella, which can be an autoimmune trigger for ankylosing spondylitis, but you don’t necessarily want to try to treat the Klebsiella.  There may be 10 excellent microbes who are beating up the Klebsiella every day and the Klebsiella may not be doing a lot.  Another classic example is Claustridium Difficile (aka, C. Diff.), which shows up on many stool and microbiome tests but many of these don’t have an infection and they don’t need Flagyl or Vancomycin. In this case, the C. Diff is a commensal and when we see bad bacteria, we don’t have to go around killing them all the time if they are not causing a problem.  We need eventually to focus not just on the microbes but at the metabolites that they produce or release.  So if you have Klebsiella in there producing a lot of bad metabolites, this can drive inflammation and inflammatory processes and they can call other bad microbes to the table so they do their bad stuff as well.

19:26  If a patient has C. diff and they have diarrhea and a fever, then you know you have an acute infection that needs to be treated with antibiotics and this can be a very serious, even life threatening infection.  On the other hand, if there is no fever and chronic diarrhea or even constipation, this may be IBS or SIBO and they may just happen to have C. diff as a commensal. Dr. Singh recommends testing for C. diff toxin via PCR and if that is present, then you should treat. And if antibiotics don’t work, then the treatment is a fecal transplant, which a ginormous probiotic enema.  Sometimes you can have a patient with a C. diff infection and severe diarrhea, fever, and classic symptoms and you teat them with Vancomycin or Flagyl and their symptoms go away and they are fine. Then a year later they do a GI-Map to look at their gut health and C. diff is still sitting there. What does that mean? What did we do when we treated the C. diff?  Are we just shutting down the genetic mechanisms that make the toxin? Are we just impacting the functions of the organism? The other thing to consider is that you can have C. diff, get treated and be fine and 6 months you could end up with ulcerative colitis that was triggered by the C. diff. and this happens not just from C. diff but from any infection of bacterial, viral, or fungal origin.

23.54  From an Integrative perspective, in addition to reducing the level of the pathogenic bacteria that shouldn’t be there, or at least not at that level, we also want to restore gut health and the microbiome with proper diet, exercise, and supplements like probiotics, serum-derived immunoglobulin, colostrum, L-glutamine, etc.

26:55  While supplements like colostrum and serum derived immunoglobulins can support the immune system, they don’t really rev it up or put it into overdrive, which you might no want to do with a patient with an autoimmune disease.  In fact, there are published case reports where bovine immunoglobulins have been helpful with C. diff and in inflammatory bowel disease, which is autoimmune in nature.  On the other hand, some of the immune stimulating herbs like ashwaganda should be used with caution because they could in certain situations and in certain patients could overstimulate the immune system, so they should be used at the right time.

33:04  Gluten from wheat and glyphosate, which is the main ingredient in the herbicide RoundUp, which is often sprayed on GMO wheat, can cause leaky gut and play a role in the development of autoimmune diseases.  This is especially the case if you eat wheat frequently or every day, then you may get chronic leaky gut, which loosens the tight junctions, which allows toxins and chemicals and pathogens to get into your bloodstream and can trigger autoimmune diseases.  Antibiotics can save your life in certain situations, such as if you get bacterial pneumonia, but if you take a Z-pak every time you get a runny nose, you are messing up your gut and creating leakiness of your gut barrier by doing that.  And glyphosate is designed to kill weeds and when we ingest it, it can kill the bacteria that make up your microbiome.  If we eat wheat we directly ingesting glyphosate and we may be exposed to it inhalationally and traces of it are found in common foods like sugar, corn, and soy as well.  And now we have seen cases of folks, like a groundskeeper at a school who got cancer from spraying RoundUp.  Dr. Singh said that he will either put patients on an elimination diet and take them off wheat, eggs, soy, dairy, shell fish, tree nuts, and corn, etc. or he may order food sensitivity testing from Cyrex Labs, who he feels have the highest quality testing.  If they don’t want to do the testing, then he will take patients off these foods for 4-6 weeks to let things calm down and then reintroduce them in 2 week intervals.  The problem is that there can be some negative effects of eating some of these foods, like damage to the microbiome, that may not be felt right away. Dr. Singh always recommends eating non-GMO, organic whenever possible.

40:54  TMAO is a marker developed by Cleveland Heart Lab that is a marker for increased risk of heart attack and stroke, but it is very controversial and it has a lot to do with diet and microbiome.  But fish contain a lot of TMAO and we know that fish reduces the risk for heart disease, so this TMAO concept is controversial.  TMAO is a metabolite that can be produced by certain microbes in the microbiome, which make TMA (Trimethylamine), which can then be converted into TMAO in the liver.  TMAO also comes from foods that contain choline or L-carnitine like eggs, dairy, and red meat, which has been used by those advocating a vegan or vegetarian diet to demonstrate another reason why eating animal foods promote heart disease.  But Dr. Singh regards this as a marker for the health of the microbiome more than a marker for an unhealthy diet.

Dr. Marvin Singh is an Integrative Gastroenterologist in San Diego, California, and a Diplomate of the American Board of Integrative Medicine. He is also board certified in Internal Medicine and Gastroenterology/Hepatology. Dr. Singh is currently the Director of Integrative Gastroenterology at the Susan Samueli Integrative Health Institute at UC Irvine. He is also an Assistant Clinical Professor at UCSD in the Department of Family Medicine and Public Health. Dr. Singh is one of the editors of the Textbook of Integrative Gastroenterology, 2nd edition and he has written several book chapters and articles. His website is DrMarvinSingh.com.  Dr. Singh’s Precisione Clinic website is Precisioneclinic.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 a 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 gut health and autoimmune diseases with integrative gastroenterologist Dr. Marvin Singh. Autoimmune diseases are becomingly increasingly common causes of sickness and death in the U.S. Autoimmune diseases have been on the rise for at least the last four decades. Our immune system is designed to protect us from bacteria and viruses and parasites, and to repair our tissues from damage. Autoimmune diseases are diseases where the immune system attacks our own cells and organs instead of fighting these outside pathogens. Our immune system, therefore, is out of balance.   And there are over a hundred different autoimmune diseases, and at least 40 others diseases are suspected as having an autoimmune basis. Autoimmune diseases are one of the leading causes of death in the United States, and to just name a few of the more common autoimmune diseases, we have Alzheimer’s disease, Parkinson’s, rheumatoid arthritis, psoriasis, alopecia, which is hair loss, Crohn’s disease, Hashimoto’s, hyperthyroid, M.S., type-1 diabetes.

                                One of the first researchers to explain one of the mechanisms by which the gut is related to the autoimmune disease was Harvard researcher Dr. Alessio Fasano, who, in his 2009 Scientific American article, laid out how leaky gut is an important contributor to autoimmune disease in combination with certain generic tendencies, along with gluten sensitivity. Dr. Aristo Vojdani, Dr. David Brady are two of the more prominent functional medicine practitioners who’ve explained how, I should say, functional medicine researchers and doctors who’ve explained how immune reactions to various infections, including gut infections, food sensitivities, and toxins can lead to an autoimmune disease through the mechanism of cross-reactivity. And 75% of our immune system is centered around our digestive tract, so it certainly makes sense that our gut would play an essential role in regulating that immune system.

                                Dr. Marvin Singh is an integrative gastroenterologist in San Diego, California, and a diplomat of the American Board of the Integrative Medicine. He’s also board-certified in internal medicine and gastroenterology-slash-hepatology. Dr. Singh is currently the director of integrative gastroenterology at the Susan Samueli Integrative Health Institute at UC Irvine, he’s also currently a voluntary assistant clinical professor at UCSD in the department of family medicine and public health. And Dr. Singh is one of the editors of the Textbook of the Integrative Gastroenterology.  Dr. Singh, thank you so much for joining me today.

Dr. Singh:            Thanks for having me, appreciate it.

Dr. Weitz:            Good, good, good. So I’ve been looking forward to this discussion, there are precious few integrative gastroenterologists in the entire country, actually. In fact, Dr. Rahbar in L.A. is the only one I know in the L.A. area, and so you are a rare breed, Marvin.

Dr. Singh:            I am, thank you.

Dr. Weitz:            Not everybody is aware … actually, why don’t we touch on that for a second? It’s actually quite challenging to be a integrative gastroenterologist, because to embrace all the conventional gastroenterology strategies and thinking and also combine it with an integrative functional medicine approach is quite challenging. How did you come to meld those two?

Dr. Singh:             Well, it is definitely challenging. As you were reading my bio, you can kind of see all the different things that I’m doing. I guess it just ended up that I ended up doing a lot of different things, I have three jobs, basically. I still like doing endoscopy and colonoscopy and taking care of sick people in the hospital and things like that, so I have a conventional GI practice where I do all that stuff. I have my integrative GI practice, specifically it’s a university one at the UC Irvine, where I’m the director of integrative GI over there.  And then within this whole field, I really became passionate about precision medicine, and so I created another practice called Precisione Clinic, which is where I have a lot of fun doing these very deep, integrative and functional medicine evaluations and developing personalized protocols for people. So I guess I work all the time, that’s how I figured it out.

Dr. Weitz:            You know, I wonder how, when you’re doing your conventional gastroenterology and you’re doing these scopes, and maybe you’re seeing in the patients who have limited income on insurance, how do you … it must be difficult sometimes to just give them, when it comes to treatment, the cookbook, conventional medical strategies when you have all this integrative stuff in your head, but you know that to really go into would require a lot of time delving into a deep history and everything else that you don’t really have time for in a conventional office visit that’s covered by health insurance.

Dr. Singh:             Mm-hmm (affirmative), yeah. So that’s the thing, I can’t necessarily shut my head off whether the practice is different or not. So sometimes, oftentimes I’ll feel the person out, I’ll talk about, let’s just pick heartburn as a general topic, because it’s pretty common. And we’ll talk about heartburn, we’ll talk about lifestyle things, which is most people would do, lifestyle modifications, and then I’ll say, “Well, you know, I can give you some treatments that are more natural that are not prescription medications, they’re more like herbs or supplements, would you prefer that or would you just prefer to take a medication?”   I don’t force it on anybody if they’re not really into it or tuned into it, but I offer it. I would say nine times out of 10, they’ll just say, oh, I want the natural treatment, because most people don’t want to take medication.

Dr. Weitz:            Right.

Dr. Singh:             And then that opens up the discussion, because I always will offer integrative approach to a common GI problem. Even in my general GI practice, I am handing out a lot of herbs and stuff instead of medications.

Dr. Weitz:            Cool. So let’s get into the topic here: not everybody’s aware why the gut plays an important role in the immune system. Can you explain some of this important connection?

Dr. Singh:             Yeah, well, it comes down to the microbiome. So the microbiome is really this ecosystem of microbes, there are micro-organisms that live inside of our digestive tract, or that’s what we call the gut. And these are predominantly bacteria, but we also want to remember and acknowledge that there are other members of the community, like viruses and fungi. So there are more than just bacteria there-

Dr. Weitz:            Protozoans and sometimes worms and primitive archaea.

Dr. Singh:            Hopefully not too many worms, I think. So 70% or so of our immune system is located in the gut, and it’s not just the digestive tract itself, the elementary digestive tract, it’s the microbiome and its role that it plays in the gut. So oftentimes, when we say gut health, we’re really referring to the microbiome and its interactions with everything else in the digestive tract, which is the gut.  This digestive tract runs our metabolism, makes vitamins for us, they release chemicals called metabolites and hormones and neurotransmitters and all kinds of stuff that communicates with all the other cells in our body, so this is why the gut or the digestive tract is so important. It’s because of the functions that these microbes play in regulating our immune system.

Dr. Weitz:            Now, what is leaky gut and why is it important?

Dr. Singh:             So leaky gut, otherwise known as intestinal permeability, is basically exactly what it sounds like. To explain to people, our gut or our digestive tract is not, like, 10 cell layers thick. It’s not like a big fortress that you have to penetrate in order to create an injury. It’s only one cell layer thick. So if you imagine just a bunch of rectangles kind of standing up next to each other, boom-boom-boom across the straight line, and then in between these rectangles there’s a little drawbridge or a little connection. These connections are called tight junctions, and they kind of regulate what can pass through that gut barrier and into the bloodstream.   Leaky gut means when there’s an injury or a problem with this tight junction, which are just protein complexes. So it’s nothing too crazy, they’re just complexes of protein. And when there’s an injury to this tight junction, then stuff that shouldn’t be coming through the digestive tract into bloodstream can get into the bloodstream. These could be particles of bacteria, they could be food particles, they could be toxins. So then when that happens, these things get into the bloodstream, and now the immune system, the immune cells in the blood are like, what is all this stuff going on? So they launch an immune response.   And when they launch an immune response, you know inflammatory chemicals are released, macrophages, neutrophils, all these immune cells are kind of being called into play because they think there’s an enemy in your system and they want to clean it up. And they go through this whole process of clearing out the problem or reacting to the problem, and depending on what the actual problem is, it’ll either resolve or it won’t resolve. If it’s food, for example, like a carrot or something, your immune system now may be cued in to reacting to carrots because it saw it in that manner.  The problem with leaky gut is that chronically, we do things that we may not know are creating this leakiness of the gut, and then chronically the immune system is revved up against it. And then we have chronic inflammation as a result of that.

Dr. Weitz:            Now, leaky gut is a concept, or increased intestinal permeability is a concept that’s been around in the functional medicine world for quite a while, and I know for a significant period of time it wasn’t really accepted as a real thing by the conventional medical world. Where are we in terms of that?

Dr. Singh:            You know what’s funny, though, if you look back in the literature, the scientists who are doing the research, they’ve been talking about intestinal permeability for a long time.

Dr. Weitz:            Right.

Dr. Singh:            So I don’t really [crosstalk 00:12:14]-

Dr. Weitz:            But you know on the average it takes 17 years for a new concept that’s actually been proven in the literature to get into conventional practice.

Dr. Singh:            Yeah, and even … actually, it was a few years ago, I was reading Dr. Bland’s book, and he was talking about the stethoscope. I think he said in his book that it took 50 years for the stethoscope to be accepted as an actual tool that a physician could use in examining a patient.

Dr. Weitz:            Wow.

Dr. Singh:            Now what happens?  If a doctor walks in the room without his stethoscope around his neck, you think, what is this guy?  Doesn’t even have a stethoscope.  So I still think the conventional group of docs are still a little slow coming around to this intestinal permeability concept. There are some that are seemingly trying to be more tuned in and, I think, as different studies come out suggesting this kind of concept, that they’re more accepting. But I wouldn’t say it’s widespread still at this point; even some of my GI colleagues will still just kind of poo-poo it, no pun intended, and just blow it off.

Dr. Weitz:            Right. Plus, there’s no drug on the market to cure your leaky gut.

Dr. Weitz:            This podcast episode is sponsored by Quicksilver Scientific. Quicksilver Scientific is a leading manufacturer of nutritional supplements, featuring enhanced nanoparticle delivery systems, specializing in detoxification protocols, fast acting immune formulas, and next generation longevity products. To learn more or to sign up for a professional account, visit quicksilverscientific.com. Listeners of this podcast can receive 15% off their order by using the promo code Weitz, WEITZ2020 at checkout. And I definitely utilize Quicksilver products in our office and some of their products are just absolutely amazing and there’s nothing like it on the market, so thank you to Quicksilver.

Dr. Weitz:             So let’s talk about the gut microbiome and autoimmune disease. What is dysbiosis?

Dr. Singh:             Great question. Dysbiosis is just really a medical term for imbalance, so you can just kind of think of it as an imbalance of the microbes in the gut. And some of the key concepts, now there’s a lot of stuff about the microbiome we don’t yet know. This is a very, very active part of science and research. Actually, interestingly enough, if you got to Pub Med and you type in just gut microbiome, I think I did this recently, I think it’s like, 25,000-some hits you get, just by typing in that.  But they default to a 20-year time span. If you narrow that down to three years, 2018 to 2020, it’s 15 or 16,000. So you can see that a majority of the research has been done in the last few years, actually. So this is very growing area of science and research. And so we’re learning more and more about what happens when the gut gets imbalanced or when there’s this dysbiosis. We know some common things that can actually cause the imbalances, and I’m sure we’ll talk about some of that.  And we know that there are a lot of diseases associated with it. Exactly what mechanisms or what actually happens or what the reasons are and how to get the therapeutics to intervene in that manner, this is an ever-growing field of medicine and science. I’m super-excited about this kind of stuff, so this is going to be cool when we figure out that, oh, you have too much of this bacteria and too little of this bacteria, so in order to fix this problem, we’re going to have to do this. And voila, your Parkinson’s tremor is better now, you know? That’s going to be cool. I’m sure we’re going to get there, but we’re not there yet.

Dr. Weitz:            Have you run the GI-MAP stool test and you see that section, that list of potential autoimmune triggers? There has been a certain amount of literature showing that various bacteria are related to specific autoimmune disease, for example, Klebsiella. I recently had a patient I’m treating who has ankylosing spondylitis, we did a GI stool test, bam, he’s got all this Klebsiella. And that can be a potential trigger for ankylosing spondylitis. But then the question is, if we treat that Klebsiella, how does that impact the ankylosing spondylitis?

Dr. Singh:             There you go, yeah. So I am a big believer, and this is my philosophy, in that we don’t necessarily need to respond to one microbe or the other, because there are trillions of microbes in there, and everybody is so different. So it’s not like a blueprint, you’re not going to be able to open up the textbook of the gut microbiome and see exactly what to do for a Klebsiella, and it’s going to be the same for everybody. Because for all you know, there could be 10 excellent microbes in there who are beating up the Klebsiella every day, and the Klebsiella’s actually not doing a whole lot. Or the Klebsiella, in proportion, relative proportions to the other microbes, is very small, it may be there.

                                I mean, another classic example is C. diff, Clostridioides difficile. Oh man, I see that in so many people’s microbiome tests these days, but they don’t have an infection, they don’t need Flagyl or Vancomycin or any kind of treatment for it. It’s a commensal. Another way of looking at it is that we have criminals, right? We have jails, we have prisons, and those criminals are in jail. Just because there are present doesn’t mean we have to go around trying to figure out a way to kill them. I mean, they’re fine. They’re being rehabilitated. Just because the bad guys are there doesn’t mean that it’s actually something bad is happening.

                                So what we’re going to see happening, as the years go by, is perhaps shifting our view from just looking at the microbiome itself and trying to focus on the metabolites, because the metabolites are the things that the microbes make or produce or release. And these are the things that really make the things happen, so if you have Klebsiella in there producing a lot of bad metabolites and that’s driving inflammation and inflammatory processes, and it’s calling other bad microbes to the table so they can do their bad stuff as well, then we have a problem.  So yes, the Klebsiella may be where the problem came from, but the real problem is what the Klebsiella is doing, what it’s making, and how that’s impacting you.

Dr. Weitz:            Well, then, how do you address that?  Let’s say you see somebody with C. diff infection, and the levels of C. diff are elevated over whatever is supposedly the normal, which is a very small amount, right?

Dr. Singh:             Mm-hmm (affirmative). We can use C. diff as the example, since we’re talking about it. So you do-

Dr. Weitz:            Let’s say you have one case where it seems to directly correlate with their symptoms, and this can be a very serious, even life-threatening condition where they have severe diarrhea. I had a patient in the office a couple of days ago who I’m working with, and she’s got severe constipation and it doesn’t really seem to relate to her symptoms.

Dr. Singh:             Mm-hmm (affirmative). So we want to know whether somebody clinically has signs of infection, and then we want to usually confirm, if we have a suspicion, that oh, there was a GI-MAP or some other test that C. diff is showing up on, and this person has diarrhea. I mean, if they have diarrhea and a fever, then I think you pretty much have your answer there. But if they just have chronic diarrhea, you don’t know, is this really C. diff, or is this just IBS? Because they could have that, or is this SIBO and they just happen to have C. diff as a commensal?  I would always confirm by doing a test of toxin PCR, see whether or not there is detection of C. diff toxin in the stool. And if you do see that, then I would go ahead and treat, because it is a contagious infection that can really make people sick, especially immune-compromised people. People could even lose their colon if the infection gets out of control.  But interestingly, if you look at, you’re starting from the conventional standpoint, looking at this kind of infection, it’s like, okay, I give the antibiotic. Okay, give the antibiotic. And then if the antibiotics don’t work, then what’s the solution? Fecal transplant, which is not an antibiotic, it’s basically a ginormous probiotic enema.

Dr. Weitz:            Right.

Dr. Singh:             So what you’re doing is reconstituting the microbiome, and if you use my example before, what we may be doing is just basically hiring a bunch more police officers and throwing them into the mix so we can regulate it, and this fecal transplant stuff works really well. I mean, within a day.

Dr. Weitz:            So what you’re saying is that the good bacteria are keeping the bad bacteria in check.

Dr. Singh:             Exactly, and we see that people … so let’s just make up a scenario, person comes in, severe diarrhea, fever, classic symptoms. You do a C. diff test, C. diff is positive. They get Vancomycin or Flagyl, symptoms go away and they’re fine. And then a year later, they do a GI-MAP because they want to look at their gut health, and C. diff is sitting there. Then what? What does that mean? That means that you didn’t kill the C. diff in that it’s, like, executed and entirely gone from your system, you just shut it down.  So I don’t think we really talk about this in the literature much, and I would love for us, some of these scientists to do studies about this particular topic, because it definitely has implications for the general public health, but what are we doing when we treat C. diff? Are we just shutting down the genetic mechanisms that make the toxin, is that what we’re doing? Are we just impacting the functions of the organism?   Perhaps we’re doing that by dramatically decreasing the population of that organism in your gut. That’s why we say, oh, well, you have C. diff as a commensal, you should be cautious about using excessive or unnecessary antibiotics, because then what happens? Well, maybe we’re killing the good guys that are controlling the C. diff and some of the other bad guys, and when those populations of the good ones go down, then C. diff has the opportunity to grow. And when it has the opportunity to grow, they like making toxin. That’s why we call them a bad guy. Then you get sick again.   So really looking at, what are we actually talking about? What is actually happening? That’s really the important part. We’re not really fully around there in having every discussion over every medication and every situation around that, but I think, in the future, that’s where we need to go, because that’s the real deal there. That’s what we’re talking about.

Dr. Weitz:            Right. And from an integrative or functional medicine perspective, if we treat that patient for C. diff, in addition to trying to reduce the levels of C. diff bacteria, if we, at the same time … let’s say, assuming they’re not getting a fecal microbial transplant, with a functional approach, we’re not just giving the antibiotic and that’s it, we’re also trying to restore the gut with probiotics-

Dr. Singh:             Exactly.

Dr. Weitz:            -and nutrients that can help to restore gut health and a proper diet and exercise and lifestyle factors that are going to improve the overall balance [crosstalk 00:24:35]-

Dr. Singh:             That’s the difference between us and conventional doctors, because it’s not so simple as, oh, take these antibiotics for two weeks, you’ll be fine, see you later, follow up with my never type of thing. Okay, we’re going to treat this thing, now we have to rebuild the gut. We’re going to talk about probiotics, we may talk about a serum-derived bovine immunoglobulin, colostrum, other things are good for gut health.

Dr. Weitz:            L-glutamine.

Dr. Singh:             L-glutamine. So we know that this happened, we want to try to not only fix the causative agent, but we also want to repair the underlying things that that causative agent could do, because then, if you look further and we focus on IBD, which I know is one of the things we want to talk about anyways today, how does IBD happen sometimes? I could get C. diff and be treated and be fine. You could get C. diff and get treated and be fine, and then six months later you start have rectal bleeding, and then it doesn’t go away.  And now you have pain and diarrhea, and then they think, well, maybe you got, C. diff came back again, you got C. diff colitis. And they check C. diff and it’s negative. And then time passes, time passes, and then you eventually get a colonoscopy and they say, oh, Ben, you have ulcerative colitis. So how does that happen? This is a classic scenario, actually. It’s not just a make-believe scenario, there’s a classic scenario where somebody gets an infection, it doesn’t have to be C. diff, it could be salmonella, it could be E. coli, it could be anything like that.

                                And what happens is that your immune system may clear it out, or your immune system may not really, fully shut down after this infection is gone. And that may have to do with various different things, whether it’s genetic factors get triggered or environmental factors start coming into play when there’s leakiness of the gut, meaning that something wasn’t causing you a problem, but now you had a flood in your basement and other things are causing a problem where they being controlled before.  And then your immune system just says, oh my God, this is some bad stuff going on, we got to keep knocking it out, even though that C. diff or salmonella is gone. And now your colon gets inflamed. This is the basis of kind of this discussion of autoimmunity, where we started this conversation in the first place.

Dr. Weitz:            Yeah. I’m going to get a little off-topic, I tend to do that, but you just mentioned colostrum and serum-derived immunoglobulins. The thought came up recently in a discussion: when you have a patient with autoimmune disease, there’s generally this thought that the immune system is overactive, so is it really a good idea to recommend things like colostrum or immunoglobulins that help to strengthen the immune system?

Dr. Singh:             Well, I think you got to look at each thing on a case-by-case basis. These things I’m less worried about compared to various different kind of herbs. The concern is that if your body is revved up and you give something to further rev up the immune system and that you want to make the immune system work to your advantage, that you might actual, paradoxically, do the wrong thing and actually exacerbate the underlying process.  I think you got to kind of look at what’s realistic for that person. I was just actually looking up for somebody else, a patient a couple days ago, ashwagandha.  Ashwagandha is a great adaptogenic herb, and it’s good for stress reduction, it actually has immune modulating effects. But sometimes we talk about, oh, well, if somebody has Hashimoto’s, you really shouldn’t give them ashwagandha because it might make their thyroid worse, because it’s autoimmune. And I was looking up, I mean, one of the things that’s cited is a case report of somebody who got thyrotoxicosis.

                                This is not like we got thousands of cases that say that ashwagandha equals thyroid disfunction. In that person, on that case report, or maybe in people that are similar to that, there could be a problem. But as we go back to our discussion on metabolites and things like that, that’s where the mystery really lies. We don’t really know who is going to be a problem with ashwagandha and who is not if they have Hashimoto’s. You maybe want to look at what are some of the other factors: they have a lot of autoimmune issues, are there thyroid antibodies just a little bit or is it a lot? Because it may be kind of a case-by-case, and then be aware, if you see that the numbers are going in the wrong direction, then pull back.

                                I’m cautious in these types of situations, I think things like colostrum and serum-derived bovine immunoglobulin, I think they operate a little bit differently in that they’re really kind of working at the microbiome level in the gut. They’re primarily not systemic agents, like if you take an herb, you may get some of the stuff systemically. They’re really, majority of the stuff stays in the gut, and it’s towards that end that they work. And there’s literature on C. diff in bovine immunoglobulin, in H. pylori, in all kinds of different kinds of bacterial infections and situations. There are even case report studies in inflammatory bowel disease where there are patients who were not responsive to much else, and then they got high doses of serum-derived bovine immunoglobulin and voila, the inflammation receded.

Dr. Weitz:            Yeah, and I really also think it’s probably a mis-thinking to characterize somebody with autoimmune disease as an immune system that’s on overdrive. I don’t think that’s really what’s happening. It’s not like, instead of going 60 miles an hour, now they’re going 90. What it really means is they went down the wrong road, their system’s out of balance, really.

Dr. Singh:             We want to try to find that balance back, it’s that dysbiosis concept. We want to trying to bring balance back to the system, because … I started this thought, but I don’t think I finished it. Some of the things that we universally agree on, knowing that everybody’s microbiome is different and different things are happening in different people, what we universally agree on is that diversity in the microbiome is a sign of strength or resiliency. And that’s one of the main goals that we’re looking for. And the concept is simple if you kind of think of it … I’m a king of analogies, so I often give analogies to make people understand.

                                It’s like if you’re starting a business, you’re a CEO and you got to hire 100 people, and you need 100 different employees. When you’re looking at them, you could say, okay, well, I want everybody to be from NYU with an MBA and this background, and they should all have been born in Virginia and have parents who are together for 50 years and be of this age group. They may all be smart people, but they may all have the same skillset and background, philosophies and beliefs. So if you’re thinking that you want to be entrepreneurial and do something good and new and different, it would make sense to get smart people, get people with a good background, get people that have different beliefs, ideas, philosophies, who can come to the table with new ideas and concepts so that you can actually innovate and create and do good things.

                                So you want a diverse workforce, that’s a very kep concept to being successful. You don’t want a bunch of robots in your business, you want a diverse workforce, because that’s a sign of resiliency within your workforce itself. And it’s the same thing. That microbiome is your workforce. So we want a diverse, resilient microbiome, and in order to do there, there are a lot of things we have to do: we want to try to … we can get into the conversation over lifestyle measures, but diet, a varied diet, a lot of plant foods and different kinds of things on an ongoing basis are part of that whole process as well so that we can grow that diversity and resiliency.

Dr. Weitz:            What role can gluten or glyphosate play in the development of autoimmune diseases?

Dr. Singh:             Yeah, Dr. Tom O’Bryan is the king of gluten; he often talks about the study by Harvard, which I often refer to as well, scientists at Harvard where they suggested that everybody, it was a big study, it was thousands of patients, I think, everybody develops some leakiness or some permeability of the gut when they’re exposed to gluten.

Dr. Weitz:            Right.

Dr. Singh:             Now, if you don’t usually eat a lot of gluten and you go to Paris and you want to have a baguette because you’re in Paris and that’s the cool thing to do, that’s fine, right? As long as you don’t have an allergy to gluten or whatever. But if you’re eating bread all the time, every day, then you may develop this leakiness of the gut on a chronic basis. Remember, the whole key concept is chronicity. And when that happens, it itself may not be the actual problem per se, but it may open the door; those tight junctions are now open so that problems can occur.   So it’s just like, if you get pneumonia, I’m not going to say, no, Ben, antibiotics are bad, you’re just going to have to suck it up, and you might die. Nobody’s going to say that. They’re going to say, take the antibiotics. We’re in 2020, we’re a civilized group of people, we have science and technology behind us. Medications are not all bad, they can save your life. But if you say, every time I get a runny nose I take a Z-Pak, I’m going to say, no, Ben, that is not the right thing to do. You are messing up your gut. You’re creating leakiness of your gut barrier by doing that.

                                So it’s the same kind of concept. These things, our body is not so weak that you’re exposed to a non-organic apple one day and you get a little glyphosate, oh my God, I’m going to die. That’s not what’s going to happen. Your body is stronger than that. But if you’re doing this on an ongoing basis, you’re literally just giving small punches to your gut every day all day, and then you have a problem. And it’s not just glyphosate, it’s not just gluten. Stress can do this too. Not sleeping well can do this too, not exercising and being sedentary can also do this too.   This is actually how I got really excited about lifestyle modifications and how that can influence the microbiome, because believe or not, there is literature on all of these topics as well, that you get imbalances in the microbiome when proper lifestyle choices are not followed.

Dr. Weitz:            By the way, for those who don’t know, glyphosate is the main active ingredient in Round-Up, which is a herbicide that’s commonly sprayed on wheat and corn and other crops, especially to ones that are genetically modified to be resistant to Round-Up.

Dr. Singh:             Yeah, and we’re directly ingesting it, we may be exposed to it inhalationally. Traces are found in common things like sugar, corn, soy, wheat. These stuff disrupts our detoxification capacity, it may directly disrupt the microbiome and its ability to have various different kinds of functions. It’s almost like the reason why I think I went to antibiotics is like, it’s not an antibiotic, but it’s kind of like the same concept of an antibiotic, because it’s supposed to kill stuff, basically.    So that’s what it’s doing. Maybe the purpose is to kill the bugs so it doesn’t ruin the plants, but when you eat that stuff, it’s killing what the bugs that are inside your gut do, and you don’t want that. That’s not the point. And there are some associates that they have felt to be from glyphosate related to diabetes, obesity, depression, Alzheimer’s, cancer. Even in the news probably a year or two ago now, there was a big lawsuit against the company that makes this stuff, because what was he … a groundskeeper at a school and he was spraying Round-Up everywhere, and he got cancer as a result.

Dr. Weitz:            Yeah. There have been a series of others after that.

Dr. Singh:            Yeah.

Dr. Weitz:            So when you have a patient who sees you for some gut health issues and also has some autoimmune disease, setting aside IBD right now, do you place them on a gluten-free diet, do you put them on a gluten-free, dairy-free, do you take them off of corn, soy, peanuts?  Do you have a certain protocol you use?

Dr. Singh:            I often do, especially if we’re going to do an empiric kind of food elimination and we’re thinking about how we can modify the diet. People are often resistant to eliminating too many things, so the conversation that I have is, we can do some tests to see if we can kind of direct it a little bit, but-

Dr. Weitz:            What kind of food sensitivity testing do you like to do?

Dr. Singh:            Well, I guess the caveat to this is I always tell people that these are not like you’re getting the commandments from Heaven, coming down and telling you that if this is a positive test, that 100% certainty, that carrots are bad for you, you’re going to go get sick. So they can be very helpful. In some cases, we hit the home run.  And in some cases, they’re not so helpful.  So everything has a risk and benefit, so the risk in this is that you gave some blood or you did a finger prick and you paid some money for it.  It’s not like we’re talking about experimental chemo or anything, it’s just food we’re talking about here.  As far as that, the risk is low. I use a lot of Cyrex for the food stuff.

Dr. Weitz:            Okay. 

Dr. Singh:            Huh?

Dr. Weitz:            Yeah, I think they’re among the most accurate.

Dr. Singh:            Yeah. Dr. Vojdani is a friend of mine, both of them, father and son, and I talk to them often, and I think the methodology and the way that they make the test is pretty sound and they’re very well-intentioned, so I use a lot of Cyrex for the food stuff.  But even in the conventional literature, if you look at food elimination, what are they talking about? The top things, it’s like the big six things is gluten, soy, dairy, shellfish, tree nuts … I missed one.

Dr. Weitz:            Eggs.

Dr. Singh:             Eggs.  And then I throw in the number seven as corn. And so when people are like, I don’t want to do any tests, I just want to kind of … what can I do? Then you tell them all those things, they’re like, whoa-whoa-whoa, that’s a lot of stuff. So what am I supposed to eat, then? So I say, well, let’s just do this for a set period of time. If it was four weeks, six weeks, something like that, we want to do it for a reasonable amount of time so that if something is actually causing an immune reaction, that we have a chance for that reaction to calm down.  And then, one by one, we can try to reintroduce them in two-week intervals, so we can see if you notice anything symptomatically in your body and health as far as something happening as a result of that reintroduction. The problem is that often, at the microbiome level, you may not really feel like, it may be something that you see and you feel it in a different. So you have to kind of be astute to that, maybe follow other things like your microbiome evaluation and things like that over time, and I always try to hit home the idea of non-GMO organic, because if you’re going to reintroduce something, at least try to make it a clean product so that we’re not being confused by contaminants as driving the problem.

Dr. Weitz:            I wanted to talk a little bit about the TMAO concept. I saw it in your slide presentation that you sent me. TMAO, as maybe not a lot of people know, is a marker that was developed by Cleveland Labs that is a marker for increased risk of heart attack, stroke and … it’s very controversial. One of the reasons why it’s controversial is that TMAO is found in high amounts in fish, and there’s just tons of research showing that eating fish lowers your risk of heart disease. It’s also stimulated by eating choline or L-carnitine, and L-carnitine is found in meat and a whole lot of other foods that are often considered part of the healthy diet as well.   And in choline, of course, is found in a whole series of different things that we eat, and we’ve always found choline actually be super-beneficial for brain health. So I’ve always had a tough time believing that we should really stop eating all these things because some test shows an elevated TMAO level.

Dr. Singh:             Yeah. I presented this, these slides that you’re referring to, at a conference to specifically point out the controversial viewpoint on TMAO.

Dr. Weitz:            Right.

Dr. Singh:             Because this is what we like to do in science: we find something, we find association, and then we just go gangbusters in a kind of tunnel vision about it. TMAO bad, equals heart disease. TMAO bad, equals heart disease. Well, I mean, fish are made up of a lot of TMAO. When you do a test and you’re checking for TMAO, you’re actually supposed to stop your fish oil and don’t eat fish for 24 hours before because it can falsely create an elevation. And I actually had a specific patient whose TMAO came back at, like, 120. This guy was like, what in the world is going on? I’m a healthy guy, I’m exercising all the time, I’m eating majority plant foods, the only meat I eat is fish.

                                And I said, “Well, did you eat fish right before you did this test?” He said, “Uh, well, I think I might have.” So we repeated it, and it was normal. So fish need TMAO, it’s what helps make them float. I don’t think fish are croaking over with heart attacks in the ocean every five minutes. So we have to really look at what’s the big picture, what is TMAO, what are we actually talking about? TMAO is a metabolite that’s produced by microbes.

                                Actually, TMA is the metabolite that’s produced by microbes, so TMA is called trimethylamine, and trimethylamine is produced by, there’s a whole host of microbes, I could tell you the names of some of them, but it probably wouldn’t make sense to anybody just listening to these names, you know? But there’s maybe eight or so of these microbes that make TMA. And when TMA is produced, it goes to the liver. The liver converts TMA to TMAO, trimethylamine-N-oxide, and the Cleveland Clinic discovered this, and that’s why it’s available through Cleveland Labs, because they’re associated with each other.

                                It was felt that high levels of TMAO were associated directly with risk of heart disease. And then when they looked back at, well, where does TMAO come from, what are the kinds of foods? Like you mentioned, eggs, dairy, red meat and things like that. So therefore, the inference was that red meat equals TMAO, which equals heart attack. And maybe there is some truth to some of that, but I don’t know that that’s really the full picture. I think there’s really, again, it’s in individualized type of situation, because I guarantee you, you get a couple carnivores on your show, they’re going to have a problem with that statement.

Dr. Weitz:            Absolutely. 

Dr. Singh:             Not that I promote the carnivore diet at all-

Dr. Weitz:            When the TMAO stuff came out, right away that became a new weapon for vegans to tell everybody why they shouldn’t eat meat.

Dr. Singh:             I have seen people that don’t really eat a lot of meat that have elevated of TMAO, too. I don’t deny that their elevated TMAO is related to increased risk of cardiovascular events, MI, stroke, cardiovascular death. I mean, they have literature suggesting that. But going one step behind that one step behind that, is where is this risk coming from? TMAO directly, or other factors and they happen to have high levels of TMAO? I don’t know that we know all that stuff, you know? This is a bacterial metabolite-generated issue, then looking at the microbiome level is where probably better answers are going to come from.

Dr. Weitz:            Right, so what you’re saying is somebody with a certain microbiome with certain microbes could eat some of these foods and they would not produce a lot of TMAO-

Dr. Singh:             Maybe.

Dr. Weitz:            Somebody else with a different microbiome might, or is more likely to, and so therefore the thing to focus on is somebody with a dysbiotic microbiome and fix that, and you don’t have to worry about the TMAO.

Dr. Singh:             Yeah. So one of the slides I had in this presentation is actually, there’s literature on this stuff, but people don’t talk about it as much because I guess it’s not as beneficial for whatever argument you’re making. It’s not like you eat red meat, you have a high TMAO level, now you’re going to have a heart attack. It doesn’t work like that. TMAO levels are determined by other factors also: your host genetics. TMA and TMAO are distributed throughout the body; it can accumulate, so that may depend on what you’re eating regularly on an ongoing basis and what other factors are going in your body.

                                Half of the TMAO is excreted unchanged in the urine, through sweat, your breath and urine. So you may be excreting half of this, if you want to call it a toxin or bad substance, out of your body anyways, as it is. Then the other half may be turned into TMA, back to the original metabolite, by a bacterial TMAO reductase in the gut. So then it may become nothing again. That’s not going to be harmful. So what makes it harmful in somebody versus not? Well, maybe it has to do with TMAO reductase in the gut, how much of that is being produced? Maybe that has to do with dysbiosis, maybe that has to do with all the gluten you’re eating, not the red meat. I don’t know.

                                So these things need to really be teased out, so understanding this on a case-by-case basis, because TMAO is an osmolyte, it stabilizes protein structures against destabilizing forces, that sounds like a good thing to me, right? Maintains the volume of interstitial cells under osmotic and hydrostatic stresses. So these are some of the other things that I’ve talked about as well, and they sound like good effects. So really, this whole discussion on metabolites, which TMAO is, is really going to become a very personalized thing.

                                It’s the same concept, you know, not that I’m promoting meat here, because I actually promote a very plant-heavy, focused diet, but I’m not afraid of meat, I’m not an anti-meat person, because I think diet is such a personalized thing. When they do these studies about red meat, they’ll often say red meat and processed meat, and they lump it together in the same phrase. Well, red meat and processed meat are different things, you know? I mean, lunch meat is not the same thing as an organic, grass-fed four-ounce filet mignon.

Dr. Weitz:            And the average person’s not getting a grass-fed organic filet mignon, they’re getting a less-quality meat that’s sort of produced at a factory farm.

Dr. Singh:             Exactly. So I just encourage people, when you’re looking at these things, these stories and these literature articles that come out or people talk about these things, dial it back and see what are they actually talking about and what are they citing? I think a lot of people notice, they’re eating lunch meat all day long and it’s not … lunch meat comes in different varieties, too, you know? If they’re eating the lowest-level salami all day long, okay, I could see how you’re going to have a problem. That’s not healthy for you.

Dr. Weitz:            Right.

Dr. Singh:             But if you’re eating clean foods that are free of toxins and that were taken care of throughout the life of that animal, the nutrient profile and what happens when you ingest it is going to be different than when you’re eating something that’s not. It’s a good idea to have a varied diet, remember, because the microbes want resiliency and diversity in their system. So it’s good to have a lot of plants, because plants do that in your diet as well, they help diversify the microbiome.   So it’s important not to just be uni-focused in how you’re eating as well. We want to have a varied diet, and I’m not allergic to the concept of people having meat, but I do suggest that you kind of look at what you’re doing, make a personal choice for who you are, what works for you, and if your numbers are good and your microbiome is happy, do what you like, because that’s you. That’s the whole concept of Precisione Clinic that I started, because you can’t just say everybody should eat this and that’s what’s going to make you healthy. That’s not how it works.   So in Precisione Clinic, we look at everybody on a very personalized level and we say, this is what I think you should eat, based on da-da-da-da, all these things that we kind of determined.

Dr. Weitz:            Yeah, absolutely. I’m with you on that. I know we started talking about autoimmune diseases and we thought that we would go into it later, but I’m pretty much out of time. So …

Dr. Singh:             We could talk for hours, probably.

Dr. Weitz:            We definitely could. Unfortunately, today’s patient day in my office, so let’s wrap this discussion and then hopefully we can have one in the future about some of the other topics.

Dr. Singh:             Sounds good.

Dr. Weitz:            So how can our listeners and viewers get a hold of you, Marvin?

Dr. Singh:             I’m pretty active on social media, it’s @DrMarvinSingh, my website is PrecisioneClinic.com, Precisione with an E, so P-R-E-C-I-S-O-N-E Clinic.com. Email address is there, the contact information is there, so I’m pretty readily accessible.

Dr. Weitz:            Any final thought you want to leave with everybody?

Dr. Singh:             I guess the final thoughts is just to summarize the key concept of when you’re talking about gut health and microbiome, it’s not necessarily one microbe and that’s your solution or your problem. We want to look at what’s happening in the entire ecosystem. Look at it from a global perspective, because when we’re talking about even environmental pollution and things like that in politics, it’s not just necessarily one thing that we have to go after that’s going to really solve global warming or something.

                                There’s a lot of different things. We want to attack all of these things, just like if I say, well, your diet needs to be healthy, and you say, okay, I eat a perfect diet, but I sleep two hours a day, I don’t exercise at all, I’m stressed out and I yell at everybody all the time. You’re not going to be healthy, man. It doesn’t matter what you’re eating. So you got to look at, just as we look at our lifestyle factors in that perspective, we have to look at the microbiome in that perspective, too. It matters what’s happening in the ecosystem, what’s the ecosystem generating? What’s it doing and how healthy is it, how balanced is it? Because therein is where the inflammation and chronic problems are going to come out of.

Dr. Weitz:            Great, awesome. Thank you, Marvin, and thank you for spending this time with us.

Dr. Singh:             No problem, it was my pleasure.