Christine DeLozier, LAc, discusses Diet For Great Sex with Dr. Ben Weitz.
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Podcast Highlights
1:06 Hormones, including both testosterone and estrogen, are important for sexual health. In men, not only is testosterone important, but so are small amounts of estrogen and progesterone important for sexual health. Testosterone is also important for sexual health in women.
6:41 Eating the right diet by avoiding junk food and avoiding sugar, consisting of lots of fresh fruits and vegetables and leafy greens can help some women to not have to go on hormone replacement therapy after menopause. Both a diet high in refined carbohydrates and sugar and a diet very high in fat can disrupt your hormones.
13:07 Leafy greens are very high in both potassium and antioxidants, like vitamin C, which protect not only our hormones but our neurological health and reduces oxidative damage to our nerves.
18:19 Omega 3 fats are super important for brain health and neurological health. Dopamine is a neurotransmitter that is a huge component of pleasure and the circuitry for dopamine requires omega-3 fats, which you can attain from consuming wild salmon or from taking fish oil capsules.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me. And let’s jump into the podcast. Hello, Rational Wellness podcasters. Today, our topic is diet for great sex with Christine Delozier, LAc. Christine Delozier is an acupuncturist, herbalist, and author of the new book Diet for Great Sex: Food for Male and Female Sexual Health. Christine, thank you so much for joining us.
Christine: Thank you so much for having me on your show.
Dr. Weitz: So my first question is how much does it facilitate sex to wear an N95 mask?
Christine: Well, it can be a barrier to oral for sure.
Dr. Weitz: So for the first real question, Christine, in your book Diet for Great Sex, you focus on the three systems of our body that affects sexual health, and you break it down into hormones, neurological and vascular. So let’s start with hormones and let’s talk about which are the most important hormones for sexual health.
Christine: Well, the short answer to that is all of them. Our hormonal balance is like a symphony. And when one of them gets out of whack, many of them tend to fall out of whack. It’s very rarely that one hormone is out of balance in isolation. Of course, testosterone is really important. Estrogen is really important, and both of those are important for both male and female sexual health. So men need estrogen just as much as they need testosterone, but of course, in different proportions. So for sexual health, males do better with higher levels of testosterone, lower levels of estrogen and for females is just the opposite.
Dr. Weitz: So when it comes to testosterone for men, I was surprised to see that you wrote that testosterone improves mathematical reasoning and cognitive ability, because we usually think that when testosterone levels rise, those things go out the window.
Christine: Yeah, it’s amazing. How many bodily functions, testosterone affects. I mean, the short answer is everything. Testosterone affects cognition. It affects overall health, it affects our energy levels, it affects everything. So when testosterone is low, that can affect so many aspects of health, the brain, it affects sexual function, it affects cardiovascular disease, everything.
Dr. Weitz: So in the section where you’re talking about men, you also mentioned estrogen and even small amounts of progesterone, enhance sexual function in men. Maybe you could talk about that.
Christine: Sure. Again, it’s in the right ratios. So progesterone, it’s not good when it’s too much, it’s not good when it’s not enough and the right ratio ratios, it facilitates an optimal sexual function, optimal blood flow, optimal hormonal balance.
Dr. Weitz: I mean, we measure a lot of hormones in men and I often find that progesterone is low. And I often wonder if men would ever benefit from taking a small amount of progesterone.
Christine: That’s interesting because the problem with that is that progesterone has actually been used to reduce libido in men like sex offenders and things like that. So when you don’t get the ratio right, you might have just the opposite effect, if that makes sense.
Dr. Weitz: And so when it comes to estrogen, let’s take estradiol. On a serum test, what would you consider a good level of estradiol for a man?
Christine: I don’t know. The most of my research focused on the evidence for how foods effect these different things. So the specific numbers, I wouldn’t say that’s really my specialty, but what I looked at was the research on foods that help to balance hormones. So it’s hard. The thing about it is it’s just like minerals hormones are kind of like minerals in the sense that as soon as we try to kind of play God with them, we can sometimes throw things out of whack and you need somebody who really knows what they’re doing to attempt that game. And it’s the same with minerals. We take a calcium supplement and we can sabotage our iron, we take a magnesium supplement, we can sabotage our calcium, we take a zinc supplement and we can inadvertently, make magnesium levels low. So all of these-
Dr. Weitz: Or you could just measure all of them.
Christine: We could. Yeah, but there’s so many minerals that come into play that your best bet is to try to get as much as you can from food. Obviously, a lot of times that’s not possible. And then maybe take kind of a broader mineral supplement, for example.
Dr. Weitz: So on the testosterone theme with respect to women, testosterone is also very important for the libido, but too much testosterone leads to PCOS. So what about testosterone? And what is a good level and especially what about for post-menopausal women?
Christine: So some women for example, have improved libido by taking testosterone, but again, taking one hormone in isolation can be risky like you mentioned with PCOS. So the answer to that is enough for that individual. There’s no one right answer for every person, but when it’s low women definitely experience low libido, they experience a decline in sexual function. So there are a lot of ways to help normalize those levels though, and help normalize that whole kind of symphony of hormones.
Dr. Weitz: Should women take hormone replacement after menopause, if they want to have good sexual function?
Christine: That’s a conversation I would say, would be best left to their doctor. What I can say is this. Food can help you to not have to go on hormone replacement therapy. A proper diet can help balance your hormones without needing to do that. But again, some women will still need to do that, talk to your doctor about it, but eating well can only help. The way our lifestyles are. It definitely puts a strain on our hormones. The high sugar intake will sabotage hormones. There’s tons of evidence that shows that eating a high refined sugar in our diets, it disrupts our sex hormones. It makes for worse sex. So that’s just one simple thing that you can do to help move your body in the right direction post-menopause or at any time in your life.
And other things also are very high, fat diets can also disrupt our sex hormones. Certain foods can help restore balance to our sex hormones. So when we eat a lot of leafy greens, which is kind of how nature intended it, when we look at other primates, we see that they sit around eating leaves a good portion of their days. We don’t eat a whole lot of leaves. We eat a lot of junk food and leaves, for example, reduce cortisol levels. And cortisol is a stress hormone that can interfere with testosterone in males and females. So that’s one way to help normalize that balance.
Dr. Weitz: I just wanted to mention as far as the hormones that you mentioned for sexual health, one that I often have heard other people talk about that seems to be important for sexual health is oxytocin.
Christine: Yep. I found that in my research as well, that it was important. Again, it’s this symphony of hormones, even things that you don’t think of as being related to sexual health, like ghrelin and leptin. We know that these are hormones that tell us when we’re full and when we’re hungry, but they actually just can interfere with sex hormones when they’re out of whack. So when people have what we call leptin resistance, which is when we eat so much refined sugar, well, in some cases, it’s because we eat so much refined sugar, our body has become desensitized to leptin, which then affects our sex hormones.
Dr. Weitz: So what are some of the principles of the best diet to promote healthy hormones? And should men and women eat differently?
Christine: All the research that I came across was that men and women should eat the same pretty much. The specific hormone ratios are different, but eating in a way that’s in accordance with the natural biological design of humans promotes that balance. So if we were going to say a general overarching theme would be lots of fresh fruits and vegetables, we have tons of research to show that helps with hormonal balance and optimal sexual function related to sex hormones. So lots of fresh fruits and vegetables, lots of leafy greens, that sort of thing.
Dr. Weitz: Some would say if we’re going to go in balance with nature, we’d want to follow a paleolithic diet because that’s similar to what say the caveman ate for hundreds of thousands of years.
Christine: Sure. There’s so much debate about that. And everybody has an opinion. It’s interesting to note that when we look at other animals, whether it’s squirrels or chipmunks or any other animal, they seem to know what to eat, what is the healthiest, but humans have kind of lost their way. If we look at other primates though, they are biologically kind of our cousins. And if we look at how much, for example, meat, that’s a big issue with diet. If we look at how much meat other primates eat, there’s a big range. It’s anywhere from 0% of their calories to 90% of their calories comes from animal product, whether it’s bugs, whether it’s mammals, that sort of thing, where humans fall in that range is a big matter of debate. But what we can agree on is that we know that they eat tons of leaves. We know that they eat lots of fruit and vegetation and that they take in many times the amount of certain minerals like calcium, magnesium, zinc, certainly potassium for sure. And so that’s one thing that we can strive to do, whether we’re following like a keto type diet or whether we’re following a more plant-based diet.
Dr. Weitz: A keto diet is fairly popular these days. And that basically involves a very low carb diet. And a lot of people have found this type of diet to be beneficial for cardiovascular health and neurological health. What about the ketogenic diet?
Christine: The problem with the keto diet is this, it falls short in terms of vitamin C and also things like potassium. Potassium is one of those things that we don’t get enough of. There’s lots of evidence to support that. And it’s lacking in a keto diet. All of the things that contain a lot of potassium almost all of them are high in carbs. So your best sources are potatoes with the skins on. Yams with the skins on. Squash, bananas, oranges, all the things that have carbs in them. There’s one though, if you are following a keto diet, what I would say is really make sure that you’re getting lots of leaves in, because leaves are one of the few non carby sources of potassium. So humans, we used to take in about 10 times as much potassium as sodium in our diets. And now it’s kind of the opposite. We take in about 10 times as much sodium as potassium, and it’s wreaking havoc on our blood vessels and also hormonally as well. So get those leafy greens in if you’re going to do keto.
Dr. Weitz: So talk about some of these aspects of diet that you feel are important for promoting hormone levels.
Christine: So again, eating leafy greens, eating-
Dr. Weitz: And how does eating leafy greens help with the hormone levels?
Christine: Well, like we talked about, for example, we know that it lowers cortisol levels for example. Also even things like antioxidants, leafy greens are very high in antioxidants, even antioxidants can have an effect on hormone levels. So one study I was reading, for example, there was an effect of certain antioxidants on estrogen levels, for example, in the female menstrual cycle. So antioxidants definitely something that you want to focus on, but hormones, aren’t the only piece in this trifecta of great sex. We consider nerve conduction and we consider vascular health and they all kind of mutually influence each other. So when we talk about hormones, every hormone that’s produced by the body, every neuro-transmitter, every substance produced by the body is ultimately controlled by the nervous system. And so in strengthening the nervous system, we also affect hormonal health. And one of the best ways to strengthen the nervous system is through antioxidants, which they help repair damage to nerves just caused by our lifestyles, our environments. And they also protect from oxidative stress because most of that damage comes from oxidative stress. It comes from eating processed food. It comes from not exercising. It comes from being exposed to the environmental toxins that we’re exposed to every day, all of those sort of things.
Dr. Weitz: So what are the most important antioxidants? Because we have a broad range of antioxidants. We have vitamin C, we have the vitamin E family. We have tocopherols, tocotrienols, we have selenium, we have whole bunches of many, many phytonutrients, polyphenols, which are some of the most important antioxidants for sexual health.
Christine: All of them. Yeah. All of them can play their role. Vitamin C is a huge one. Absolutely. It’s important for many different processes, including balancing our body chemistry, also serving to protect our nerves and our blood vessels help repair damage, that sort of thing. So vitamin C is a huge one. Everything that you mentioned is a huge one. Polyphenols are a huge one. Polyphenols were shown to improve vascular health excuse me, arterial function. So they helped blood flow within a couple hours of eating them. They were actually measurably functioning better in their measurably more elastic within a couple hours of eating things like berries, which are high in polyphenols. So those are really high, our mineral balance is really high like selenium you mentioned. So they’re all really important. If you’re getting a broad variety of fruits and vegetables, you’re going to be getting a broad variety of antioxidants.
Dr. Weitz: In your chapter on neurological health, you mentioned mushrooms as a key category of food that helps with neurological health. Maybe you could explain that.
Christine: Sure. Yeah. Mushrooms are so exciting and they’re especially exciting in modern nutritional research with so much emerging research showing how important the microbiome is to our health. It’s important not only to weight, it’s important to cardiovascular health. It’s important to pretty much every system in the body. We’re finding that things we didn’t even think were related to this delicate balance of microbes in our digestive tract affect so many things. They even, for example, we’re able to transfer cardiovascular disease risk from one group of subjects to another simply by trans giving them these fecal transplants where they took feces from the group of high risk of cardiovascular disease and transferred it to those who did not have high risk of cardiovascular disease repopulating their microbiome. And they then developed high risk of cardiovascular disease.
So it affects everything. So the cool thing about mushrooms was that there’s a lot of emerging research showing that one of the actions of mushrooms is on the microbiome. One of the ways that it exerts all of its contribution to health is by actually improving the diversity of microbes in the gut. So improving populations of beneficial microbes and reducing populations of non beneficial microbes, which is really cool. Also, they’re loaded with antioxidants, which again, speed nerves, repair damage. One of the superstars, as far as nerve repair was lion’s mane, but all of them had offered benefit to this aspect of sexual health in terms of their contribution where they had say accidents.
Dr. Weitz: And of course, Omega-3 fats are super important for brain health and neurological health as well, given that most of the nervous system is made of fat.
Christine: Yeah, absolutely. Absolutely. And dopamine is a huge component of pleasure, so the circuitry for dopamine requires abundant omega-3 fats and everybody can’t make it. We have to take it in from our diets. So it just shows us again how omega threes can equate to pleasure. When our dopamine pathways are operating functionally, we experience pleasure when our partner touches us.
Dr. Weitz: Do you advocate taking omega-3 supplements?
Christine: I’m always a little bit more conservative with supplements than I am with whole foods. I’d rather see people having some wild salmon. There’s mercury in fish, a wild salmon is one of the ones that does have mercury, but it’s a little bit more balanced than some of the other ones. It offers a lot of omega-3s and it offers relatively less mercury.
Dr. Weitz: For me that’s one of the advantages of taking omega-3 fats besides consuming salmon. I know I can get a high dosage in a molecularly distilled product that is going to be free of mercury and other contaminants.
Christine: Yeah. And that works for people. So my personal philosophy on supplements is just to be cautious and then when possible get them from the diet, but our lifestyles makes it very difficult to do that. So there’s definitely a reason why that would be an attractive option.
Dr. Weitz: Yeah. So let’s talk about blood flow and sexual health. What is some of the nutritional approaches to improving blood flow?
Christine: Sure. So we all know that males need blood flow for sexual health and for sexual function, but most people don’t realize how important it is for female pleasure, female sexual arousal, lubrication, blood flow is responsible for lubrication. It’s very much involved in the arousal response. It’s very much even involved in how sensitive the female clitoris is to stimulation. So blood flow is important for everybody. And our diets tend to compromise that blood flow in a lot of different ways. One of which is we were talking about our potassium intake. Potassium is something that softens the delicate lining of blood vessels, improving the elasticity and improving blood flow. So getting more potassium in our diets is something that we really want to do. The vast majority of Americans do not get enough potassium in their diets and should increase it.
Not only that, the processed foods that we eat actually sabotages our potassium because in order to deal with all that extra sodium, we have to flush potassium with it. And then your body is forced to conserve potassium in other ways just to have basic bodily function. So getting more potassium will definitely help increase blood flow. Again, leafy greens. Leafy greens are kind of important in this whole trifecta of great sex. So leafy greens, what they bring to the table is they bring a lot of antioxidants for sure which help blood vessels. They also are high in dietary nitrates, which first of all, it promotes vascular health. And secondly, it dilates blood vessels, even in the short run. So dietary nitrates basically convert to nitric oxide, which is a vasodilator. And so in one study that I read, for example, the subjects ate one serving of spinach and within a couple hours, their salivary nitric oxide levels were eight times what they were at baseline. So it can definitely have a very immediate effect on blood vessels, as well as promoting vascular health in the long run.
Dr. Weitz: And of course, drugs that stimulate nitric oxide production are among the most popular to promote libido.
Christine: Yeah. Right. Exactly. Exactly. So if you’re looking for maybe a more natural approach, you might try food. There are three to four categories of food that actually have been shown in research to improve blood flow within a couple hours of eating them. So you can choose certain foods for date night that will do that. As well as kind of avoiding foods that might tank your testosterone. So for example, in research, a very sugary meal that really bumped up glucose a lot sharply reduced testosterone, which is definitely not what you want in the short term.
Dr. Weitz: And of course, beet root juice is something that some athletes take to stimulate nitric oxide production.
Christine: Yeah. And that’s another good choice for a date night sex menu too. Beet juices is a real good one, celery juice, beet juice.
Dr. Weitz: And of course we have supplements on the market with the beet root and L-Citruline and certain other nutrients stimulate nitric oxide production. Are you a fan of those at all?
Christine: I have not used the beet root. My daughter has, my daughter uses a lot of those supplements for her pre-workout, but I haven’t used them myself. Some of the nitrate supplements have not had really great results clinically and have had some adverse risks to them. But that doesn’t necessarily include the B root powder and things like that. But these are just more like strictly, nitrate supplements.
Dr. Weitz: So you mentioned potassium, what are some of the other minerals that are super important for sexual health?
Christine: Yeah. So again, all of them are really important, but zinc is a huge one. Zinc is a huge mineral for sexual health. It’s one of those things that when it’s low, it can affect so many aspects of it can affect hormones. It can affect the vascular system, it can affect nerve function, it can affect everything. So that’s a really big one. And it’s one of those ones that is focused on even in fertility. So it’s good for sexual health, good for fertility. And it’s something that Americans get way too little of. I read a few studies that were saying that 97% of Americans have an inadequate dietary intake of zinc. So really important. It’s antiviral of course as well. And it also promotes-
Dr. Weitz: I certainly have all my patients take an extra zinc because of their antiviral properties.
Christine: Yeah. Yep. Yeah. So that’s a really big one.
Dr. Weitz: Zinc with quercitin because that increases zinc absorption.
Christine: Okay, cool. Cool. Yeah.
Dr. Weitz: So which is some of the best herbs to stimulate libido?
Christine: So we’ve got our culinary herbs, then we’ve got our more medicinal herbs, things that have been used in traditional Chinese medicine, like horny goat weed was one that had a few studies to show its efficacy. So that was a big one. Anybody though, if you’re going to go the medicinal herbs route, I would suggest consulting a practitioner who has been trained in it. Most acupuncturists have a master’s degree in herbal medicine as well, Chinese herbal medicine. So that’s one choice.
Dr. Weitz: Let’s say if you were speaking to practitioners, because we have a percentage of practitioners that listen into our podcasts. Which ones do you find can be most efficacious for female and now sexual health?
Christine: Yeah. So horny goat weed is one. The research on something like [inaudible 00:26:38] is one that was shown to be effective though it also had its risks as well for toxicity.
Dr. Weitz: [inaudible 00:26:48]?
Christine: Yeah. [inaudible 00:26:50] was definitely one that had a few studies to support its use. Then there’s some culinary herbs that also actually had some studies like saffron. Saffron actually had several studies to support its efficacy, to promote sexual health, both animal studies and human studies. It showed that those taking saffron had more sex, higher libido and more blood flow.
Dr. Weitz: Interesting.
Christine: Yeah.
Dr. Weitz: You mentioned viruses. Are more people having sex now that they’re home because of COVID?
Christine: If they can stand their spouse there. Yeah.
Dr. Weitz: So heavy metal toxicity. How can this be a impact on sexual health?
Christine: So I would say most people think of heavy metal toxicity as some sort of freak exposure that happened because they lived near a landfill or something like that. But actually the research shows that all of us are exposed to a growing number of toxins in our environment, from our water, our air, our food, we’ve got ketamine in our food, we know we have ketamine in our food. It goes into the air from smelting and then it comes down into agriculture. And then we see it in our food sources in our food chain.
Dr. Weitz: We know a lot of the soil that fruits and vegetables are groaning contains lead. We have arsenic, we have arsenic in the chicken. We have arsenic in the rice. We have warnings about arsenic all the time. We know we have mercury spewed into the atmosphere from coal fired power plants and we have mercury in the fish.
Christine: Yeah, exactly. So all should be concerned about this, not just somebody who’s living next to a power plant or night or next to someplace that we know has more risk. So one of the things I found in research where there were a lot of studies again with antioxidants, that was a big one in terms of protecting yourself from the damage of these toxic heavy metals. So things like vitamin C, vitamin E, vitamin A were all important. And then there were certain foods too, like cilantro, like onions and tomato were shown to either deal with the effects of that or reduce absorption of those. But as far as reducing-
Dr. Weitz: Do you ever measure heavy metals and use specific protocols to try to reduce them?
Christine: No, I don’t have any experience at all with that. I don’t. But I am familiar with research that has measured specific levels and then measured them following things like cilantro and found that it actually had a stronger ability to reduce. I forgot which one study I’m thinking of. I forgot. I think it was arsenic that it had a stronger ability to actually remove that from brain and liver tissue than some of the pharmaceutical drugs, but minerals were actually really important in reducing absorption. So the fact that we are exposed to all these heavy metals, improving our mineral profile can help us to not absorb as many of those heavy metals, because zinc was a big one actually, zinc is a big one. Calcium’s a big one. And magnesium is a big one in terms of helping our bodies to flush that out before it’s absorbed by our tissues.
Dr. Weitz: How about an EMS? Are those an issue for sexual health?
Christine: Absolutely. And it’s again-
Dr. Weitz: Basically with 5G coming.
Christine: Yeah. I wasn’t sure what kind of research I was going to find on that because it’s such a big controversy with 5G that it’s these extremists or conspiracy theorists that are concerned about the electromagnetic fields or wifi. So I really didn’t know what I was going to think. And everybody thinks of these people with these tinfoil hats and things to protect them from the rays and stuff. So when I looked at the research, I was really flabbergasted because the research is so strong that I found study after study, after study. In fact, I found very few studies that failed to find negative effects of EMFs on our health and the most prominent effects are neurological and hormonal. They definitely disrupted hormones and they definitely caused oxidative stress to the point that it caused neurological damage.
Dr. Weitz: So what are some of the best tips for dealing with that?
Christine: Again, what I found were antioxidants helped deal with that. Helped, it doesn’t eradicate it. We still need to make a conscious effort to reduce our exposure to EMS and including cell phones, things like that, turning off our wifi at night and trying to use a hands-free piece so that our heads aren’t right next to our phones, that sort of thing. All are important in reducing our exposure. Because the studies that I found were that normal exposure, I’m talking about the amount of exposure that the average person has to wifi through their cell phones, for example, was enough to cause damage.
Dr. Weitz: Right. And of course, now people using headsets that are wireless, everything’s wireless. And so we’ve got more of these EMS flying around going through our heads and the rest of our bodies.
Christine: Yeah. Yeah, absolutely.
Dr. Weitz: So what about natural aphrodisiacs?
Christine: Yes. So again, the culinary aphrodisiacs that are really fun at least from my opinion, to play with being a foodie. And I like the aesthetic of food. I like playing with different kinds of concoctions and stuff. So some of them that I really like are things like cloves. Cloves, we’re one of the few culinary aphrodisiacs that were shown to actually have an immediate effect. So within a couple hours of, I think it was within one hour after participants ate the cloves, they had improved sexual function. So that’s a fun one to play with because you can make so many things with it. I like making rice dishes and then throwing in some of those aromatic spices, like cloves, nutmeg was also one that had some research to support it.
And those are two spices that have a really rich history, world history as well. They’ve been highly coveted and wars have been fought over them to control the rights of them, but they kind of are worth it and how they have this wonderful fragrant aroma. And they did have some studies to show that they improve sex. In that case it’s not going to be like a Viagra, it’s going to be more subtle. It’s a more subtle enhancement. So even garlic and let’s see saffron of course, you can kind of combine all those, even onions, things like that have some aphrodisiac properties. So when I say aphrodisiac, I don’t necessarily just mean that it may improves libido. An aphrodisiac can either improve blood flow, it can improve libido or it can improve pleasure. So any of those.
Dr. Weitz: What are the best natural products for lubricants? Because there’s a lot of controversy over what types of lubricants are good. Some people like coconut oil, but coconut oil is very alkaline and the vagina is very acidic.
Christine: Oh, that’s a really good question, but I’ll answer-
Dr. Weitz: I mean, I know it’s not a part of the diet for sex.
Christine: Well, that’s why I’m going to answer you in a cheeky way and tell you that that the best lubricant is exercise, going for a run 20 minutes prior to sex it, it’s going to offer the best lubrication and also eating some of these foods, which improve blood flow because lubrication is subsequent to blood flow. So basically blood flows to the vagina and clitoris. And from that blood flow, it basically diffuses through and becomes a vaginal lubrication, if that makes sense.
Dr. Weitz: Okay.
Christine: So a specific product, I really don’t know. I haven’t even thought about that question quite honestly. So I don’t know which one I would recommend, but I guess if I were to choose, I’d say maybe coconut oil would be a good thing, but as you mentioned, it’s alkaline. So you certainly wouldn’t want to disrupt the pH balance of those tissues. So I would say whatever works for that person that doesn’t irritate them, or irritate their skin.
Dr. Weitz: So maybe a couple of foods that are most damaging to sexual health.
Christine: There’s three. There are three big, huge culprits, and that is… The wrong kind of fats. I mean, high fat in general, but particularly the wrong kind of fats, which is not just trans fats, but if you’re loading everything with oil and frying it, that’s not good either a lot of the processed fats and high sugar, definitely a big one and then high salt. So those three, that’s the worst combination that you can get. And that’s something that should all kind of focus on.
Dr. Weitz: So fat, sugar and salt.
Christine: Yep.
Dr. Weitz: Are there some fats that are really good for us that we want to load up on?
Christine: Yeah. Omega-3 fats. So for example-
Dr. Weitz: What about olive oil?
Christine: Well, even if it’s olive oil, I wouldn’t want to be deep frying things. I wouldn’t want to be using tons of oil in your dishes in general, because it definitely can contribute to plaque accumulation, even when it’s olive oil. So most a high fat meal, even just one fatty meal will increase arterial stiffness within a couple hours of eating it. However, omega-3 fats actually had the opposite effect on arteries within the short term, so they improved vascular function in the short term. So making the blood vessels more elastic for example.
Dr. Weitz: Okay, great. So I think that pretty much completes the questions that I had prepared. Any final thoughts, information you wanted to provide our listeners and viewers?
Christine: No. Just try to eat as close to nature as possible. And that’ll usually steer you in the right direction.
Dr. Weitz: Okay. How can viewers and listeners get ahold of you and find out about your book and what you have to offer?
Christine: My website is dietforgreatsex.com and you can purchase my book Diet for Great Sex on Amazon.
Dr. Weitz: That’s great. Thank you so much, Christine.
Christine: Thank you so much for having me.
Dr. Weitz: Thank you listeners for making it all the way through this episode of the Rational Wellness podcast. Please take a few minutes and go to Apple podcasts and give us a five-star ratings and review that would really help us so more people can find us in their listing of health podcasts. I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please call my office in Santa Monica at 310-395-3111 that’s 310-395-3111. And take one of the few openings we have now for a individual consultation for nutrition, with Dr. Ben Weitz. Thank you and see you next week.
https://drweitz.com/wp-content/uploads/2021/04/rwp204website-1.jpg350785drweitzhttp://www.drweitz.com/wp-content/uploads/2017/06/drweitzdsamplelogo-withtext.pngdrweitz2021-04-29 09:36:102021-05-09 04:21:54Diet For Great Sex with Christine DeLozier, LAc: Rational Wellness Podcast 204
Dr. Mark Houston discusses HDL Cholesterol with Dr. Ben Weitz.
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Podcast Highlights
4:28 What are LDL and HDL? These are apolipoproteins that transport fats through the body and serve many functions, including immunological function. They help protect us against infections and parasites and they are part of our metabolic system for making steroids and vitamin D and sex hormones. Today, the biggest threats to us are no longer infections, but more from environmental toxins, nutritional imbalances, obesity, and other risk factors that result in chronic diseases like heart disease and diabetes that kill us. In order to protect us from environmental insults the LDL particle number may become elevated, which is the driving risk for heart disease and myocardial infarction. LDL is considered the bad cholesterol and HDL is considered the good cholesterol.
7:24The main job of HDL is to produce Reverse Cholesterol Transport (RCT), also termed Cholesterol Efflux Capacity (CEC), which are the primary functions of HDL that go into the cell and the artery walls and pick up the LDL like a garbage truck and take it back to the liver where it will be excreted with bile. HDL if it is functional can reduce atherosclerotic plaques and reduce rupture and it can improve plaque stability. There is soft plaque that is composed of a very aggressive core of lipids and smooth muscle cells and inflammatory cells, and it’s surrounded by a sort of a firm top that is very thin. This protective top can rupture, resulting in the contents of the plaque spewing out into the artery and this can cause thrombosis and an acute myocardial infarction. Such patients may present with an acute MI while doing intense training, such as interval training or a marathon, though they may not have much obstructive disease. The other type is calcified plaque, which is more stable and less likely to rupture, but this type of plaque tends to become obstructive. It may not result in any symptoms until you get to 95% stenosis. Calcified plaques can be picked up by coronary calcium scans or by an exercise echo or by nuclear medicine scans, while soft plaques will often not be seen by such scans or tests. But soft plaques can often be seen on MRI imaging with contrast or by a PET scan or a CT angiogram.
12:36 HDL has a number of positive functions, including RCT, anti-inflammatory, antioxidant, and it reduces vascular immunologic damage in the arteries. HDL is composed of over 100 different molecules, proteins, lipids, and other components and there are at least 25 different beneficial effects of HDL on atherosclerosis prevention. We used to think that the HDL level and the HDL size determined the true risk, but the only thing that really gives you the true risk is the functionality of the HDL.
15:37 There are two labs that can measure HDL functionality, including Cleveland Heart Lab, which is owned by Quest Diagnostics, which offers the HDL Function Test.
18:35 There are some who feel that APOA is a better marker for assessing heart disease risk than HDL. APOA, which is the carrier for HDL, may be a little better marker than HDL, but it still does not correlate as well with cardiovascular disease risk as HDL function does. One study found that in a male if the HDL is over 50 or 55, and in a female if it is over 75 or 80, most of it is likely to be dysfunctional.
20:28Oxidized LDL and Myeloperoxidase (MPO). LDL is not atherogenic (will not cause vascular damage and create arterial plaque) until its oxidized or otherwise modified. MPO is a compound that is made by white blood cells and while it is antibacterial, it is a bad actor. MPO increases coronary calcium and it can cause high blood pressure, coronary heart disease, atherosclerosis, and even plaque rupture. When you have high levels of oxidative stress and high MPO, it damages the HDL and makes it dysfunctional.
22:15 Dr. Houston has developed a nutraceutical that improves HDL functionality called CardioLux with Metagenics that contains quercetin, pomegranate, lycopene, and vitamin E. These components reduce oxidative stress and inflammation, making the HDL more functional.
25:31 A lot of HDL functionality is related to the proteins in HDL. Essentially the reason why we have LDL and HDL particles is that fats don’t move readily through the bloodstream, which is water soluble, so they are surrounded with various proteins that coat the lipids. One of the important proteins in HDL is PON1, peroxidase, which is very important for HDL function. These nutritional compounds (quercetin, pomegranate, lycopene) protect and raise PON1 levels.
27:30CoQ10 is a very important nutrient for heart health, but there is an issue with getting CoQ10 not only into the cell but into the mitochondria. There is a new form of CoQ10 that’s a thousand times more effective than regular CoQ10 at penetrating the mitochondrial membrane, called MitoQ. Dr. Houston has a series of 10 patients who were on the cardiac transplant list who had end stage coronary heart disease. They couldn’t put stents in and they couldn’t do bypass surgery. He put them all on MitoQ and every one is now asymptomatic with no chest pain and their ejection fractions have gone up significantly and they’re off the transplant list. Dr. Houston noted that he still uses the metabolic cardiology program, so he uses regular CoQ10 for the vasculature, MitoQ for the heart, and he also uses d-ribose, taurine, L-carnitine, magnesium and a few other supplements that improve the myocardial contractility and mitochondrial function.
29:44The best diet for improving HDL functionality is a low refined carbohydrate intake and sugar intake should be less than 25 gms per day. You should have at least 8 servings of organic multi-colored vegetables per day, which are rich in phytonutrients. Wild game, a variety of berries, and pomegranates should be part of that diet. Pomegranate raises HDL functionality through raising PON and it has been shown to reverse carotid atherosclerosis in one year.
31:07 Dr. Houston has developed the Coronary Heart Disease Plaque Regression and Coronary Artery Calcium Regression Program, which includes about 15 different nutritional products, including Neo40 (a nitric oxide booster), Arterosil (which protects the glycocalyx), vitamin K2 MK-7 (a dosage of at least 360 mcg per day and K2 does not promote blood clotting or interfere with the blood thinner coumadin), omega 3 fatty acids (EFA-Sirt Supreme), VasculoSirt, curcumin, and quercetin. Quercetin has anti-inflammatory, antioxidant, and anti-immune effects and it’s the only compound that reduces SASPs, which are senescent proteins.
35:30Exercise. Both resistance and aerobic exercise improve HDL functionality. In Dr. Houston’s book, What Your Doctor May Not Tell You About Heart Disease, there’s 2 chapters on the best form of exercise that Dr. Houston wrote with Charles Poliquin, a great trainer who unfortunately died about a year ago with a heart attack. Dr. Houston and Charles also wrote an exercise program that combines aerobics and resistance training with interval training to get the best cardiovascular benefits, which is published in a book titled, ABCT, Aerobics, Build, Contour, and Tone.
38:03 Most of the medications that have been developed to raise HDL levels have not been effective. The exception is niacin, which actually improves total HDL, HDL particle number, HDL size, and HDL functionality. There was an older lipid drug used in the VA-HIT trial, which raised HDL, but we don’t know if it improved functionality.
Dr. Mark Houston is an internal Medical Doctor and a hypertension and cardiovascular specialist. He is the director of the Hypertension Institute in Nashville, Tennessee. Dr. Houston is triple board certified in hypertension as an American Society of Hypertension specialist and Fellow of the American Society of Hypertension, Internal Medicine, and Anti-aging Medicine. Dr. Houston teaches at the Institute of Functional Medicine and the A4M programs. He is a prolific writer and has written What Your Doctor May Not Tell You About Hypertension, What Your Doctor May Not Tell You About Heart Disease, Nutritional and Integrative Strategies in Cardiovascular Medicine, Nutritional and Integrative Strategies in Cardiovascular Medicine, and his two latest books, Vascular Biology for the Clinician, and Precision and Personalized Integrative Cardiovascular Medicine.You can contact Dr. Houston through The Hypertension Institute web site HypertensionInstitute.com.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Podcast Transcript
Dr. Weitz: Hey, hey this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website drweitz.com. Thanks for joining me, and let’s jump into the podcast.
Hello, Rational Wellness Podcasters. Today, our topic is HDL cholesterol, and we’ll be speaking with Dr. Mark Houston. The focus of HDL cholesterol which has been called the so-called good cholesterol is that this molecule could potentially help to prevent and reverse cardiovascular disease. Much of the research about heart disease has really been focused on the so-called bad cholesterol, the LDL, which is now generally seen as a significant player in the formation of atherosclerotic plaques in the artery walls that can lead to heart attacks, strokes, and heart failure over time. of the cardiovascular medications are designed to lower LDL levels including statins, niacin, Zetia, bempedoic acid and the new PCSK9 inhibitors. And there are a number of nutraceuticals that are also effective at lowering LDL particles, including red yeast rice, fish oil, plant sterols, niacin, berberine among others. We also know that the proper diet and exercise can also be very effective in reducing LDL cholesterol in our bodies especially the more atherogenic small dense LDL particles. But today, we’re going to be focused on the so-called good cholesterol, HDL. We’re going to go into how to understand it, how it works, and how we can improve HDL to improve our cardiovascular health.
We first learned about the potential benefits of HDL cholesterol about 70 years ago. And in 1977, we learned through the Framingham Heart Study that low levels of HDL are generally associated with increased risk of coronary artery disease. And we thought at one time that simply the more HDL, the higher the levels, the better off we are. But our thinking about this has changed as we have learned that the HDL story is much more complex than we thought it was. And drugs that were developed to raise HDL have really failed to be effective in reducing heart attacks or death. In fact, some people with very high levels of HDL may actually be more at risk for heart disease. And so, this is why we’ve asked the expert, Dr. Mark Houston, to join us to explain what current knowledge about HDL cholesterol is and how we can use this to prevent a reverse heart disease.
Dr. Mark Houston is a internal medical doctor and hypertension and cardiovascular specialist. He’s a go-to expert on cardiovascular disease in the functional medicine world. He’s the director of the Hypertension Institute in Nashville, Tennessee Dr. Houston is triple board certified in hypertension as an American Society of Hypertension Specialist and fellow of the American Society of Hypertension, Internal Medicine and Anti-Aging Medicine. He also has a master’s degree in human nutrition and a master’s of science degree in functional and metabolic medicine from the University of South Florida. Dr. Houston teaches doctors around the world about cardiovascular medicine as part of the A4m programs. Dr. Houston is also a very prolific author, having written what your doctor may not tell you about hypertension, what your doctor may not tell you about heart disease, nutritional and integrative strategies, and cardiovascular medicine, nutritional and integrative strategies in cardiovascular medicine. And his two latest books which are Vascular Biology for the Clinician And Precision and Personalized Integrative Cardiovascular Medicine. Dr. Houston, thank you so much for joining me.
Dr. Houston: Thank you, Ben. It’s a pleasure to be with you as always.
Dr. Weitz: So, maybe you can give us a little bit of a explanation in general what is HDL. In fact, what is LDL? Why do these molecules exist at all?
Dr. Houston: Well, let’s start with the LDL story first because I think people are most familiar with that one, explain why it exists and then we’ll merge into the HDL story a bit. These molecules are termed apolipoproteins in the medical world. And apolipoproteins exist for good reasons we have to have them for a lot of health benefits. For example, one of the major benefits of all the types of cholesterol whether the LDL or HDL is immunological function. It actually protects you from any type of infection, whether it’s viral, bacterial, parasitic, fungal, or TB, and it’s also part of our metabolic system for making steroids and vitamin D and sex hormones. So, there’s a teleological explanation for why these lipids were important in the early time to protect people from getting serious infections and dying from them. And so, over time, what has happened is the functionality, the levels of HDL and LDL, have changed because in our modern society, people don’t die so much of infections anymore. But they’re dying from other types of environmental toxins, nutritional problems, obesity, and a myriad of other risk factors like diabetes. And so, what has happened to our cholesterol levels, particularly LDL, and to a lesser extent HDL, they’re going in the wrong direction in an attempt perhaps to protect us from these various types of environmental insults. So, LDL for example, if it’s protecting us from something, it tends to go to very high levels. The LDL level’s elevated. And then, what’s called LDL particle number becomes elevated which is the driving risk recording heart disease and MI. There’s also genetic forms of dyslipidemia. But most people who have dyslipidemia in this country, it’s environmental. It’s not genetic. So, LDL has been considered, as you said, the bad cholesterol. And HDL is considered the good cholesterol. But it’s much more complicated obviously than that, and that’s what we’ll get into today. So, that’s sort of an introduction, and we can kind of banter back and forth with questions as you wish.
Dr. Weitz: So, we generally think of HDL, its main function is to produce reverse cholesterol transport, right?
Dr. Houston: Right.
Dr. Weitz: And so, what exactly happens during that process?
Dr. Houston: So, reverse cholesterol transport or RCT, also termed cholesterol efflux capacity or CEC, are the primary functions of HDL that go into the cell, attach to the cell wall through various receptors that pick up the LDL just like a garbage truck and then take it to the liver where it dumps the LDL and is excreted into the bile. That’s the normal process. However, if HDL, RCT and CEC are not working, our HDL becomes we say less functional, then that process does not occur. LDL accumulates in the cell. And then, that starts the LDL process of particle size going up, LDL levels going up, LDL size being smaller. And then, you get atherosclerosis, coronary heart disease.
Dr. Weitz: And so, HDL can actually take the cholesterol from the artery walls, right? And so, it can reduce plaques potentially.
Dr. Houston: That’s right. It can literally take them out of the cell. But also take them from the cholesterol wall itself, and it’s very important in reducing plaque rupture, and improving plaque stability in coronary heart disease.
Dr. Weitz: And what’s the significance of plaque stability?
Dr. Houston: So, there’s at least two, maybe three, major forms of plaque. There’s the vulnerable plaque which has a very aggressive core in the middle composed of lipids and smooth muscle cells and inflammatory cells, and it’s surrounded by a sort of a firm top that is very thin, and that protective top can rupture. So, what happens is all this activity inside the plaque can eat through this protective coating or cap and rupture into the arterial wall once that spews out into the artery. It causes acute thrombosis which is an acute myocardial infarction. That’s the really bad type of plaque. It’s considered soft plaque. It’s usually not calcified as vulnerable. The other plaque is one that has a much thicker cap and has less of a activity in the center with less lipids and inflammatory cells. And because it’s more stable, it’s not as likely to rupture. But over time, it can become very obstructive and impede the blood flow through the artery. The problem we have is those people who have stable plaque may not have any symptoms whatsoever until they get to a 95%-plus stenosis. But the ones who have unstable plaque, the ones that have the really thin cap, those can be only a 50% blockage, but they tend to rupture. And those are the ones that typically present with intense training, like they run a marathon, interval training, whatever, and the plaque ruptures, and they have an acute MI even without much obstructive disease.
Dr. Weitz: And those soft plaques wouldn’t be picked up, for example, by a coronary artery scan.
Dr. Houston: Those can be completely missed because they’re not necessarily calcified, and they can be missed by exercise echo and nuclear medicine scans and other non-invasive ways of looking at plaque because it’s only maybe 50%. So, it doesn’t obstruct the flow.
Dr. Weitz: So, what’s the best way to get a clue as to whether those exist or not?
Dr. Houston: You can do other testing. For example, the MRI imaging with contrast of the heart, which can pick up any kind of plaque, soft or hard. And there’s other types of metabolic testing called a PET scan which picks up activity of plaque in the arteries. You can do a CTA, CT angiogram, looking at plaque. And, of course, the gold standard is a coronary arteriogram where you actually inject dye into the coronary arteries.
Dr. Weitz: Is the MRI being used regularly? I haven’t heard of it being used that often.
Dr. Houston: We use it routinely in the institute. We have an MRI scanner, and it’s incredibly accurate for plaque but also for valve function, cardiac contractility, diastolic dysfunction. It’s expensive. But if you have a patient that needs it and get it pre-approved by the insurance, it’s extremely valuable when you don’t want to do an arteriogram. But also, there’s no radiation exposure, usually not much and with a contrast or some. But you can’t do it in people who have metal. So, pacemakers and artificial joints, you can’t put them in an MRI.
Dr. Weitz: Right. So, we have a number of positive functions of HDL making plaques more stable, helping to reverse cholesterol transport. And in recent years, we’ve learned about the antioxidant and anti-inflammatory properties as well.
Dr. Houston: Right. HDL is composed of probably over 100 different molecules, proteins, lipids, and other components. And with that degree of composition being so complex, it has a very complex anti-atherosclerotic effect. You mentioned a few, anti-inflammatory, antioxidant, anti-immunologic which means it reduces vascular immunologic damage in the arteries, reverse cholesterol transport. I mean there’s probably 25 or 30 different beneficial effects of HDL on atherosclerosis prevention. But the key point here is that no matter what your HDL level is and no matter what the size of HDL is, those used to be thought to be protective or good things. But now, it turns out that those don’t actually tell you the true risk in an individual. The only thing that really gives you the true risk is the functionality of the HDL. Now, in a population, if you look at statistically, is your HDL level this or is your HDL size this, there’s a correlation in a population. But if you take an individual, and you measure their HDL total, you measure their HDL size, whether it’s big or small, and you measure the HDL map, and there’s five forms of HDL from pre-beta all the way up, those may look great on paper. But that patient may still be at risk for coronary heart disease because you didn’t measure the true value and true risk which is functionality of the HDL. Does it do all the things it’s supposed to do to protect you?
Dr. Weitz: Now, why is it that drugs that have been developed to raise HDL have all failed so far?
Dr. Houston: There’s a lot of reasons. Some of the studies were just bad studies. They didn’t have the right population. Another is they had other adverse effects, like one of the drugs raised blood pressure, and that counter balanced the effects of HDL. But what happened is all of the studies were done prior to the understanding really of what HDL function was all about. So, they may have raised HDL. But it wasn’t functional HDL. So, the HDL maybe went up 30 to 50%. But it didn’t work. So, there was no reduction, as you said, in MI or total mortality with it.
Dr. Weitz: Right. So, what is the best way to measure HDL and HDL functionality?
Dr. Houston: There are two labs that are presently available clinically to measure functionality of HDL, and that’s really the key to getting at the risk for a patient in their coronary heart disease and MI risk. As I mentioned to you earlier, Ben, we’re in the process of completing a large clinical trial on HDL functionality looking at a nutraceutical compound that not only improves HDL function, but also can improve HDL size and also HDL particle number which is another thing I neglected to mention earlier. And let me just maybe comment on that while we’re talking about it. HDL function is the most important thing to measure. So, we can do that now clinically. HDL particle number, how many particles of HDL do you have, is also very high correlated with HDL functionality. And you can measure this in traditional labs to do advanced lipid testing. So, when you look at those two, there’s a 90% correlation between HDL particle number and HDL functionality. But what we’re trying to do is see which of those has the best overall predictability in a population and see if we can actually improve both of those numbers.
Dr. Weitz: And then, when it comes to particle size, you want larger HDL particles.
Dr. Houston: That’s what we used to think. But that now has not turned out to be correct either because there’s labs that do HDL mapping, and there’s five HDLs: pre-beta and alpha one, alpha two, and others that range from very small to the large ones. For example, the pre-beta which is a really small one is the one that actually picks up the HDL, excuse me, that picks up the LDL out of the cell. So, if your pre-beta is not working well, you can’t do good transport out of the cell. But then as the HDL matures, it goes to different sizes, and that progress across there involves a lot of different enzymes, a lot of different complexities, but eventually gets to the form of HDL which takes it and dumps it into the liver through what’s called scavenger receptor SR1 receptor in the liver. So, you’ve got to have all five of these. And we used to think, “Well, the big one’s like a big dump truck, and it can carry more LDL with it.” It turns out, the size turns out to be not a great predictor nor does the actual total HDL level for heart disease.
Dr. Weitz: Now, I’ve heard one prominent functional medicine doctor talk about measuring apoA, and that being maybe a better marker than HDL. What’s the relationship between apoA and HDL? And is there a value in measuring the apoA?
Dr. Houston: There’s apoA1 and apoA2, and those are the carriers for HDL. So, that’s the apolipoprotein we mentioned earlier, and they are probably a little bit better than HDL total. But even those do not correlate well with risk because neither of those are functional tests. You’re again just measuring apolipoprotein as a carrier for HDL, and it can be again dysfunctional. So, for example, if you measured total HDL in a population, you could say, “Well, if it’s between…we’ll just throw out some numbers here, 30 to 100. If you’re below 30, you’re probably in trouble, and if you’re over 100, you’re probably in trouble because those tend to be people who have more dysfunctional HDL. There’s actually a study that was done in men and women, and it suggested that if a male was over around 50 or 55 of their total HDL, most of it was likely to be dysfunctional. And a female, if it was over 75 to 80, was more likely to be dysfunctional, and that’s because these tend to build up in the blood because they’re trying to cancel the bad effects of the LDL. So, you make more and more of it. But as you make more of it, it’s more dysfunctional. So, the levels keep going up. But less of it’s actually working.
Dr. Weitz: And what is the relationship between oxidized LDL and myeloperoxidase and HDL functionality?
Dr. Houston: So, all of those are inflammatory and oxidative stress measurements. Oxidized LDL is the form that is atherogenic. So, LDL and its circulating in the regular serum is not at atherogenic until it’s modified into a oxidized or some other form. There’s different forms of LDL that are called modified LDL, and that’s the one that go across the vascular endothelium and actually cause damage or plaque formation. Myeloperoxidase or MPO is a compound that’s actually made by the white blood cell, and MPO causes all kinds of havoc. Well, it’s good that it kills bacteria. But if you keep making MPO due to other reasons, it causes high blood pressure, coronary heart disease, atherosclerosis, and even plaque rupture. It’s a bad actor and increases coronary calcium. So, MPO has both inflammatory and oxidative stress implications. Now, once you develop those, they are the cause for atherosclerosis and myocardial infarction. So, your HDL has to be around to clean that up. What happens when you have a high oxidative stress and MPO level, it damages HDL, and it makes it dysfunctional. So, when your MPO is high, you can say, “Well, chances are, my HDL is not functioning well.”
Dr. Weitz: So, what’s the best way to improve HDL functionality?
Dr. Houston: What we’ve developed is a nutraceutical product that underwent initial study with 10 patients just to see if we could demonstrate effects, and that’s actually published as a white paper through… Can I mention the name of the company? Is that okay?
Dr. Weitz: Sure. Yeah.
Dr. Houston: Okay. So, the initial study with 10 patients with Metagenics. And then, they asked us to do a double blind placebo control trial which is really the way to get the true data. The initial trial showed that the nutraceutical proprietary compound that we’ve developed is called CardioLux, CardioLux, and it’s got pomegranate. It’s got quercetin, curcumin, vitamin E and few other things in it, looked positive in the initial pilot trial of 10 patients. So, we’re in the process of finishing the double blind control trial now. We’ll be then done April 15th. I don’t know the results because I’m blinded, and we’ll do the statistical analysis. We will then publish the trial in a journal, and we’ll know the true efficacy of CardioLux in these patients.
Dr. Weitz: Now, why did you pick those particular nutritional compounds?
Dr. Houston: It’s based on all the scientific trials that are in the literature. Plus, what we’ve done in patients over the years trying to figure out which works the best. And when you take each one of those, it improves HDL function. Each one of those also has other good effects on reducing oxidative stress, inflammation, and immune dysfunction and although they actually had an effect on raising total HDL and improving the HDL mapping and the HDL particle number. So, the only missing piece was can we put all this together into one product and take the best of each and make the entire picture better but specifically concentrating HDL functionality.
Dr. Weitz: Yeah. The interesting thing is those particular compounds, we generally think of a lot of them more as antioxidants than as cardiovascular-related compounds.
Dr. Houston: Yeah. And that’s exactly correct because it may be that what we’re doing when we reduce oxidative stress and inflammation is we’re making the HDL compound which has all these proteins and lipids in it work better. So, the functionality actually gets improvement. And the other thing we’ve seen then is when HDL becomes dysfunctional, it’s not all or none. And so, think of it… We’ll just pick a number. Let’s say you’ve got 100 different components in HDL, and let’s say 20 of them become damaged, but the other 80 work well. So, that HDL still functions but just not at 100% whereas you can go all the way down to zero, everything gets wiped out. And you have no function whatsoever. So, the two tests that we use actually give you the ability to measure the functionality of HDL with a number. So, you can see where you are on the scale from that 100% great to zero which is terrible.
Dr. Weitz: So, a lot of this functionality has to do with the proteins, and it’s my understanding that basically the reason why you have these LDL HDL particles is because fats don’t move readily through the bloodstream because that’s more water soluble. So, we surround them with these protein structures. So, you have all these various proteins that are coating the lipids and the HDL. And one of these proteins is PON1, I understand, which is an important one.
Dr. Houston: Yeah. What you said is exactly right, Ben. You have to package the lipids into a water-soluble form which is apolipoprotein. And so, one of the proteins you mentioned is called PON, peroxidase, and peroxidase is incredibly important to make HDL function. And if it’s damaged, HDL does not work well. And what we found in all the different compounds we were looking at, most of these raised PON, which helps to improve the functionality.
Dr. Weitz: It’s kind of interesting how in the body, if you want to get something into the bloodstream that’s a fat, you have to make it water soluble. And then in a lot of other areas, we’re taking things that are water soluble and surrounding them with lipids, so we can get them into the cell membranes.
Dr. Houston: Right. Yeah. It’s a conundrum of how to get it into the blood. But also get sure into the cell.
Dr. Weitz: Right. Even a couple of the new vaccines for COVI actually take the RNA instructions and surround them with a lipophilic surrounding to get them into the cells.
Dr. Houston: Yeah. Exactly.
Dr. Weitz: And we do the same thing with glutathione and other ingredients that we’re trying to get incorporated into our cells.
Dr. Houston: Yeah. And actually, another compound that we use that everybody is familiar with is Coenzyme Q10. Well, the problem is it’s got to get into the mitochondria. So, it’s not only got to get into the cell, it’s got to get into the mitochondria to be affected. And a lot of the CoQ10s, they get in the serum fine. But they don’t even get into the cell. But if they get to the cell, they don’t penetrate the mitochondrial membrane. So, there’s new forms of CoQ10 developed now, that get into the mitochondria in a concentration that’s like a thousand times greater than regular CoQ10. So we’ve able been able to reduce congestive heart failure, improve ejection fractions, reduce diastolic dysfunction using a very highly potent CoQ10 that gets into the mitochondria.
Dr. Weitz: Is that like the ubiquinol versus a ubiquinone?
Dr. Houston: No. It’s actually called MitoQ. MitoQ.
Dr. Weitz: Right, right, right.
Dr. Houston: It’s from New Zealand.
Dr. Weitz: I heard about that. I saw a study where it reversed… What was it? Like aortic stenosis or something like that.
Dr. Houston: Yeah. It’s amazing. Actually, I’ve got a series now of about 10 patients who were on the transplant list, a cardiac transplant list, and also a couple that were at end stage coronary heart disease. They couldn’t put stents in. They couldn’t do bypass. Every one of them that we put on CoQ10, has become asymptomatic with no chest pain for their coronary heart disease or their ejection fractions gone up significantly, and they’re off the transplant list. This stuff is a breakthrough, I think, in cardiology.
Dr. Weitz: Oh, interesting. Are you still using the combination of the CoQ10 and the ribose and the L-carnitine for the-
Dr. Houston: Yes, we still use the metabolic cardiology program. So, we use regular CoQ10 for the vasculature, CoQ10 MitoQ for the heart, and we use d-ribose, taurine, carnitine, magnesium and all these other wonderful supplements that improve the myocardial contractility and mitochondrial function.
Dr. Weitz: Interesting. So, what diet and lifestyle factors outside of these specific supplements? What type of diet is beneficial for improving HDL functionality?
Dr. Houston: Well, you want to use a low refined carbohydrate intake. Sugar intake should be less than 25… excuse me 25 grams a day which is pretty strict, a lot of vegetables, at least probably eight servings of multi-colored vegetables per day. That’s got all your phytonutrients, high-quality protein that has no pesticides, organicized hormones in it. So, you got to kind of go to wild game for that, and then a wide variety of berries particularly that are low glycemic index, blueberries, blackberry, strawberries, and always pomegranates. So, pomegranate seeds, if you’re not prone to dysglycemia. You can use the juice. But any pomegranate whether it’s the seeds, the plant, or the juice has benefit in atherosclerosis and raising HDL in raising PON.
Dr. Weitz: Interesting. A pomegranate’s kind of an amazing compound seems to have a lot of efficacy and prostate issues as well.
Dr. Houston: Yeah, and it’s been shown to actually reverse carotid atherosclerosis in one year.
Dr. Weitz: Really?
Dr. Houston: Yeah.
Dr. Weitz: Wow. What’s your current protocol for patients who come in who have plaque who want to reverse it?
Dr. Houston: We have a very specific protocol. It’s called the Coronary Heart Disease Plaque Regression and Coronary Artery Calcium Regression Program. We’ve actually been able not only to stabilize plaque but actually to reverse it in patients. So, we use a whole host of things. It’s probably about 15 things we use. I’ll give you the name of some of them. We use Neo40 which is a nitric oxide booster. We use Arterosil which protects the glycocalyx, vitamins-
Dr. Weitz: Like a seaweed moss or something like that, sea moss.
Dr. Houston: Well, yeah. Sort of like that. It’s a glycocalyx with all kinds of glycoproteins in it. And you can get that from a company called Calroy. So, Arterosil. We use a vitamin K2 MK-7, omega-3 fatty acids.
Dr. Weitz: What’s the dosage of MK-7?
Dr. Houston: K2 MK-7 is a minimum of 360 micrograms minimum per day.
Dr. Weitz: So, how high might you go?
Dr. Houston: K2 MK-7 probably is very safe even up to 1000, 2000 micrograms. It’s really good for reducing coronary calcification and plaque formation.
Dr. Weitz: And unlike K1, there’s not a significant effect on blood thinning.
Dr. Houston: We’ve never seen any issues with Coumadin or warfarin with K2 MK-7. Now, if you got really high doses, it might. But at 360, there’s no issues like there is with K1 because that can interfere with the clotting. But it has no issues with the new antithrombotics, the factor X inhibitors like Eliquis. Those are not affected whatsoever by any form of vitamin K. So, they’re okay. The other things we use are omega-3 fatty acids in high dose. We use one from biotics research called EFA-Sirt Supreme. Then, we have a compound called VasculoSirt which I developed about five years ago with Biotics, and it’s really good. It’s got 25 or 30 different compounds in it that improve endothelial function, reduce inflammation oxidative stress and so forth. And then, we’ve got curcumin, use a very highly absorbable curcumin, quercetin, and then there’s a few other things you’re throwing. That’s the primary things that we use for plaque regression.
Dr. Weitz: Right. How does quercetin have activity in this regard?
Dr. Houston: Quercetin is an amazing nutraceutical. It has anti-inflammatory effects, antioxidant effects, anti-immune effects, and it’s the only compound I know that actually reduces SASPS. SASPS were like the garbage in the cells. If a cell gets sick, for example, it starts to die, and it makes saps. So, it’s senescence proteins.
Dr. Weitz: Oh okay.
Dr. Houston: Senescence proteins. And so, these senescent proteins leak out, and they kill all the cells around it. So, you start to get a fast aging process in the blood vessel or you get a fast aging process in general. So, quercetin reduces SASP formation. So, it actually can slow down vascular aging and aging in general.
Dr. Weitz: Interesting. interesting. So, you’re talking about cleaning out the garbage from cells. Do you think intermittent fasting or fasting can play a role as well?
Dr. Houston: Absolutely. Intermittent fasting of any type, we’ve used the prolonged trial. We published it. It’s going to be published pretty soon, we hope. But the initial data with fasting, in general, is you can slow down aging. You can actually reduce some of the SASPS. You can improve stem cell production, increase nitric oxide, and actually maybe even stabilize reverse type 2 diabetics.
Dr. Weitz: Really? Wow. Cool. And what about the benefits of exercise? Can exercise play a role in HDL functionality and then reversing cardiovascular disease?
Dr. Houston: Absolutely. HDL is generally improved in all the parameters we’ve talked about with resistance and aerobic exercise. In one of the books you mentioned, what your doctor may not tell you about heart disease, there’s two chapters in there on the best form of exercise that we developed with one of the great strength trainers, Charles Poliquin, who unfortunately died about a year ago with a heart attack. But Charles and I did some clinical trials. And then, we wrote together an exercise program which is published in this book called ABCT, Aerobics, Build, Contour and Tone. And it’s combining aerobics and resistance training with interval training to get the best cardiovascular benefits, protection for coronary heart disease but also improve your lipid profile and your blood pressure.
Dr. Weitz: Interesting. What about hormones? I know some of the men that I’ve seen who had the lowest HDL levels were guys who were taking testosterone.
Dr. Houston: Yeah. That’s a really tricky topic. In my practice, I have really not done hormones. I’m not trained in hormones, and I’m really probably not qualified to even prescribe them and really talk intelligently about them, and then source in. So, I would just say this. When I review the data hormones and heart disease and hormones and lipids, it’s very confusing. It’s very controversial and you can kind of find whatever you want to out there to support your opinion. So, I’ll leave it at that and let the hormone specialist get into the intricacies of that topic.
Dr. Weitz: Yeah. Did you see that paper, that Felish Gersh published recently on the benefits of estrogen for reversing cardiovascular disease?
Dr. Houston: Yeah. There’s a lot of good articles out there that you can read. Absolutely.
Dr. Weitz: Yeah. I mean you know it makes some sense since we know women have much lower rates of heart disease than men until menopause. So, it makes sense that estrogen has somewhat of a protective role.
Dr. Houston: Right. Exactly.
Dr. Weitz: Cool. And what about any of the medications for HDL?
Dr. Houston: None of them work. There’s a whole list of things out there. Probably niacin’s been sort of the primary nutraceutical that’s been looked at. And niacin actually does work. But it’s not really a medication per se. I mean, obviously, you can get it as a prescription. You consider it that way. But we don’t think [crosstalk 00:38:29]. Niacin improves total HDL, HDL particle number, HDL size, and HDL functionality. They’re one of the few supplement/drugs that does that. Most of the other drugs that have been attempted really don’t work well. There was an older lipid drug that was used in the VA-HIT trial, and it raised HDL. But they didn’t even measure the functionality in that study. So, we don’t really know whether that change in HDL had anything to do with the outcomes.
Dr. Weitz: I mean when you look at all the benefits of niacin, it’s pretty amazing. It’s one of the few compounds that will increase LDL particle size. It’s one of the few compounds that can have measurable effect on Lp(a). It’s one of the few things that can improve HDL, and yet it’s not generally considered something that should be recommended by most cardiologists today.
Dr. Houston: Yeah, and that’s a shame, Ben, because it’s based on three clinical trials that came out that said that niacin didn’t work to reduce coronary heart disease and all these other things. But if you go back and look at all those studies as you’ve read them as I have. They’re flawed. They have an incredibly bad methodology. I mean you can take them apart literally, just massacre those trials if you really know about what they looked at. And I’ve written several editorials with a lot of folks that that tear up the studies and say, “Look. Niacin is still a good supplement. It’s a good drug, [inaudible 00:40:13] you want to classify it.” You should use it. But you have to know how to use it. You’ve got to know what dose to give. You got to know what side effects it has, and what to monitor. If you know how to do that, you can be a very wise clinician and use niacin to improve your lipidology and your coronary heart disease risk and a lot of other factors.
Dr. Weitz: Yeah. I think if you use niacin as part of the package rather than just rely on a super high dosage of niacin, you can avoid some of the blood sugar, liver stress that can occur.
Dr. Houston: Yeah. And you’re exactly. If you keep it in kind of a low dose and you use it as a combination agent, I mean I don’t usually go much over 500 milligrams of niacin in one day with one exception in Lp(a), that’s about the only time, and that’s about the only thing that really works. You’ve got to go to higher doses to get Lp(a)down. But for the other things we’ve talked about, 500 milligrams used with other compounds is very effective, and you don’t get the hyperhomocysteinemia, the hyperglycemia, the liver dysfunction, the itching, the pruritus, all that stuff is not very, very bad.
Dr. Weitz: Yeah. Lp(a) is a tough one. Anything new on the horizon for that?
Dr. Houston: Well, it’s interesting you should ask me that because our next clinical trial product development will be with Lp(a), and we’ll be working again with Metagenics on that one. [crosstalk 00:41:40] the HDL trial. I hope that we’ll be starting the Lp(a) study.
Dr. Weitz: Let me guess.
Dr. Houston: There is a drug being developed in fast track as you know that could be out within one to two years if everything goes well.
Dr. Weitz: Right. Then, all of a sudden, all the conventional MDs will want to measure Lp(a). But right now, you try to get it measured [inaudible 00:42:06] What are you doing that for? It’s a [crosstalk 00:42:07].
Dr. Houston: Once you get the drug for, people will start measuring kind of backwards thinking.
Dr. Weitz: Well, let me guess. Niacin, L-carnitine, let’s see, vitamin C, lysine.
Dr. Houston: But what we’ve got right now, we’ve got niacin [inaudible 00:42:29] aronia berry which is chokeberry. Yeah. It doesn’t work all the time. It works pretty good. And you mentioned the others. There’s a Linus Pauling Protocol, vitamin C, lysine, proline, carnitine, CoQ… I mean there’s a lot of things that may work. The number consistent is the problem.
Dr. Weitz: All right. Okay. Cool. Okay. I think that’s the things I really wanted to talk about here. Any final thoughts you want to leave our listeners and viewers?
Dr. Houston: I think you’ve covered the topic incredibly well, Ben. You’ve asked all the pertinent questions, and I think that’s kind of the state of the art right now. Now, you and I both know it could change in a month. But at least after today, we’re up to date.
Dr. Weitz: So, are there any conferences that are going to occur this year or is that going to be-
Dr. Houston: Yeah. We’re getting back online. We’re going to probably have A4M in Las Vegas in December.
Dr. Weitz: Oh really?
Dr. Houston: I think that’s going to happen. They actually have something even in the fall if this pandemic ends. But I think the virtual meetings are going to phase out, and we’re finally get back to live ones pretty soon.
Dr. Weitz: By the way, I don’t say we’re going to wrap this up. But have you had any long COVID patients with cardiovascular issues, and do you have any insights on that?
Dr. Houston: I will give you my insight. I have had not very many patients in Tennessee. I live in Nashville. So, at least in my practice. I haven’t had a lot of patients who’ve had COVID. I’ve had a few. But just give me just a second. I think the reason I haven’t had a lot of people in my practice with it is because we had a lot of patients on high dose vitamin D plus a lot of nutraceuticals. They were healthy people in that respect. And so, that was a protective thing. But the ones who did get COVID, none of them got very stick with it. Very few of them even ended up having more than like a seven-day period. They quarantined, but they stayed at home. Almost none of them ended up in the hospital. But I’ve had a few that have ended up in the hospital.
Dr. Weitz: Have you had any that had the long-term-
Dr. Houston: We’ve had a few people had had, I would say, more short-term stuff with shorts of breath. But I haven’t really seen any long-term in my practice like long-term effects with cardiac dysfunction or pulmonary dysfunction.
Dr. Weitz: Okay. Cool. What’s the best way to get a hold of you?
Dr. Houston: Oh, probably go to my website. We’ve got everything on there. It’s hypertensioninstitute.com. Our website’s very user-friendly. You can find our emails, phone numbers, all our protocols, books and so forth thrown there.
Dr. Weitz: And once again, the product from Metagenics for HDL is-
Dr. Houston: CardioLux, C-A-R-D-I-O-L-U-X, CardioLux.
Dr. Weitz: And that’s currently available.
Dr. Houston: Available through Metagenics presently.
Dr. Weitz: And the dosage that you recommend for that.
Dr. Houston: It’s two twice a day with food.
Dr. Weitz: Okay. Excellent thank you so much, Mark.
Dr. Houston: My pleasure, Ben.
Dr. Weitz: Well, thank you, listeners, for making it all the way through this episode of the Rational Wellness Podcast. Please, take a few minutes and go to Apple Podcast and give us a five star ratings and review. That would really help us, so, more people can find us in their listing of Health Podcast. I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please, call my office in Santa Monica at 310-395-3111. That’s 310-395-3111, and take one of the few openings we have now for a individual consultation for nutrition with Dr. Ben Weitz. Thank you and see you next week.
https://drweitz.com/wp-content/uploads/2021/04/rwp203website.jpg350785drweitzhttp://www.drweitz.com/wp-content/uploads/2017/06/drweitzdsamplelogo-withtext.pngdrweitz2021-04-21 11:05:592021-05-26 04:18:25HDL Cholesterol with Dr. Mark Houston: Rational Wellness Podcast 203
Dr. Warren Brown of Genova Diagnostics speaks about Nutritional Testing with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on March 25, 2021.
[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]
Podcast Highlights
This podcast episode is essentially a Tutorial on the NutraEval test from Genova Diagnostics, which is a very detailed test to assess the functional need for various nutrients in patients. For reference, here is a link to a sample report for the NutraEval.
4:55 Some of the common reasons for ordering the NutraEval test include conditions like Fatigue, Chronic stress, Chronic inflammation, Mitochondrial dysfunction, Digestive disorders, Hormone imbalances, and Mood disorders. The NutrEval is a great way to assess nutrient status in someone with a poor diet, for athletes looking for peak performance, for those looking to optimize their health as part of their anti-aging protocols, when patients are on a restricted diet, have had GI surgery or are on medications that can lead to nutritional deficiencies.
6:15 The NutraEval includes organic acids, oxidative stress markers and antioxidants, amino acids, essential fatty acids, nutrient and toxic elements and you have the opportunity to add on vitamin D and genomic SNPs. There’s about 125 biomarkers in the test and it really casts a wide net looking at what’s going on in the patient’s biochemistry.
10:27 The NutraEval measures organic acids and amino acids, which gives us a perspective on the metabolome, which are the various metabolites that provide a functional readout of the activity within the cells and this is based on medical biochemistry. The NutraEval measures both nutrients directly, like DHA, which is one of the omega 3 fats, and it measures the functional need for various nutrients. This is based on the concept that if we’re looking at a given metabolic pathway and A converts to B, which converts to C, and we know that that pathway is driven by enzyme one and two and if enzyme two has a nutrient co-factor that is not being met due to a nutrient deficiency, we can see an accumulation of metabolite B that is measurable in the urine or the blood. Methylmalonic acid is a good example, which is a nutrient that accumulates if we lack B12. The NutraEval is measuring things both intracellular, like red blood cell magnesium, and extracellular, like plasma amino acids, plasma copper and zinc, and serum CoQ10.
16:24 The first page of the NutraEval now has Functional Imbalance categories with scores from 0 to 10, so you can zoom in on which are the most significant areas to focus on to help the patients feel better. These categories include oxidative stress, mitochondrial dysfunction, omega imbalance, toxic exposure and methylation imbalance. A score of 0 to 4 is a minimal need, 5 to 7 is a moderate need for support and 8 to 10 would be a high need for support. This helps clinicians take a systems approach with patients.
19:08 The second page of the report lists the nutrient needs with a score from 0 to 10 and there is room on the right for the practitioner to list specific recommendations or write in a product name for that particular patient. Page 3 through 6 are the interpretations at a glance pages and these list the nutrients, the causes of the deficiency, and some food sources of each nutrient. Each nutrient recommendation is supported by between 5 and 14 biomarkers.
23:20 If conventional MDs are skeptical of the NutraEval, you can point out that it includes many markers that are very well represented in the published literature, including methylmalonic acid, the omega-3 index, RBC magnesium, CoQ10, and glutathione.
25:08Organic acids are on pages 7-9 and these are byproducts in a number of different body systems. There are end products in these pathways that help us to biopsy the metabolome. And they are indications of vitamin and mineral co-factor needs because of the enzymes involved in those pathways. The enzymes that drive these pathways are nutrient dependent. And there are heavy metals and toxins that can inhibit these metabolic pathways, like the Kreb’s Citric Acid Cycle, and some of these toxins are measured on the NutrEval. This includes the fatty acid pathway, the beta oxidation pathway, which is how we move long chain fatty acids into the micochondria and if that pathway is inhibited, then we might see high levels of adipic and suberic acid and this often indicates an unmet need for magnesium or B2 or L-carnitine. Dysfunction here contributes to a higher score on mitochondrial dysfunction on page 1. Page 8 shows markers for malabsorption, dysbiosis (bacterial and fungal), cellular energy and mitochondrial metabolites, B vitamin markers, toxin and detoxification markers, and oxalate markers, which those will be listed on the following page.
26:57 If we look at the section for malabsorption and dysbiosis markers, the first 2 markers are indoleacetic and phenylacetic, which can be elevated if there’s bacterial fermentation of tryptophan or phenylalamine, which could be an indication of poor protein digestion. This would help us make a recommendation for digestive enzymes. A more direct measure of the need for digestive enzymes would be the pancreatic elastace that is measured on the GI Effects stool profile. The dysbiosis markers are metabolites of gut bacteria, and there are 5 markers including Dihydroxyphenylpropionic acid (DHPPA) and benzoic acid. If these dysbiosis markers, you should consider ordering stool testing or you might want to recommend probiotics. The next section are markers of fungal overgrowth, including D-arabinitol, which is a marker that was recently added, replacing arabinose, and D-arabinitol is a direct metabolite of candida albicans. If D-arabinitol is elevated, you might think about supplementing with Saccharomyces boulardii or limiting simple carbohydrates in the diet to reduce candida overgrowth.
39:33 There are a number of markers for the need for B vitamins and for alpha lipoic acid, including Fomiminoglutamic acid (FIGLU), which indicates the need for folic acid, and Methylmalonic acid, which indicates the need for vitamin B12. There are also markers for B1, B2, B3, and Biotin.
41:07Neurotransmitter metabolites. These are metabolites of things likes tryptophan (Kynurenic acid and Quinolinic acid), dopamine (Homovanillic acid), tyrosine (Vanilmandelic acid), norepinephrine (3-Methyl-4-OH-Phenylglycol), and serotonin (5-Hydroxyindolacetic acid).
Dr. Warren Brown is a Naturopathic Doctor who graduated from Bastyr University and he practices in Scottsdale, Arizona. Dr. Brown has spoken at functional and integrative medicine conferences across the United States on the topic of laboratory testing. In his work with Genova’s Medical Affairs department, Dr. Brown enjoys consulting with practitioners from all medical disciplines and providing the support needed to help improve clinical outcomes. In his private practice, Dr. Brown helps athletes and active individuals to reach their highest levels of health and performance through his advanced clinical approach. Here is a link to the NutraEval Test from Genova Diagnostics: NutraEval. Here is a link to Dr. Brown’s website: Clinical Advances for Sport.
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
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 everybody, I’m Dr. Ben Weitz, in case you don’t know, and welcome to our Functional Medicine Discussion meeting this evening. And tonight, we’re going to take a deep dive into learning about how to interpret and apply clinically, the newly designed NutrEval test from Genova Diagnostics with Dr. Warren Brown. I want to thank Genova for sponsoring this evening. I encourage all of you to participate and ask questions by typing in your question in the chat box, and then I will either call on you, or simply ask Dr. Brown your question when it’s appropriate.
Please consider joining some of our upcoming functional medicine discussion group meetings. April 22nd will be on integrative dermatology with Dr. Julie Greenberg. May 27th is with Dr. Dale Bredesen on prevention of Alzheimer’s disease. June 24th, we have Dr. Felice Gersh and she’ll be speaking about hormone replacement in post-menopausal women, and she’s actually just published a paper on post-menopausal hormone therapy for cardiovascular health in a journal called Heart, which is in the British medical journal family. And then, July 22nd, Dr. Mark Pimentel will be joining us again to give us another update on IBS and SIBO.
And if you’re not aware, we have a closed Facebook page, The Functional Medicine Discussion Group of Santa Monica that you should join, so we can continue the conversation when this evening is over. I’m recording this event and I’ll include it in my weekly Rational Wellness podcast, which you can subscribe to on Apple Podcast, Spotify and there’s also a video version on YouTube, so please check out the Rational Wellness podcast and if you enjoy it, please give me a five star rating and review on Apple Podcast.
So now, I’d like to introduce our speaker for tonight, Dr. Warren Brown from Genova Diagnostics. Dr. Brown earned his doctorate degree from the School of Naturopathic Medicine at Bastyr University. He’s spoken at functional medicine and integrative conferences across the United States on the topic of laboratory testing. In his work with Genova’s Medical Affairs department, Dr. Brown enjoys consulting with practitioners from all medical disciplines in providing the support needed to help improve clinical outcomes. In his private practice, Dr. Brown helps athletes and active individuals to reach their highest levels of performance through his advanced clinical approach. Dr. Brown, you have the floor.
Dr. Brown:
All right, thank you, Dr. Weitz. Let’s see if I can share my screen here. Okay, are you seeing that first slide?
Dr. Weitz:
Yeah.
Dr. Brown:
Okay, great. All right, so Biopsy the Metabolome with the new NutrEval profile. And here I am, I’m the clinical science liaison for Genova Diagnostics. Been with the company about six years. Been in practice since 2012 and so, I’ve relied pretty heavily on specialty diagnostic testing to help make decisions about my patients and the NutrEval is one of my favorite tests to talk about and to utilize as well.
Here are the objectives for this presentation. I just want to have on the agenda this evening, please feel free to use the chat box for any questions, I’ll try to address those as they come in. I’m planning on 45 minutes here and some time at the end for questions as well, if needed. So we’ll take an overview of the NutrEval, we’ll talk about some of the most common clinically applicable questions that I get from clinicians in talking to them about the test as well, and we’ll try to handle the questions along the way as well.
So, here are some common reasons why clinicians might order a NutrEval profile. It’s not a complete list of reasons, but as Functional Medicine clinicians, I’m sure you’re all aware that nutrient deficiencies are commonly found in these conditions here. Things like fatigue, chronic stress, chronic inflammation, mitochondrial dysfunction. We also see them with digestive problems, hormone imbalances and mood disorders. And you might also consider a NutrEval if you’re looking to evaluate the patients and the quality of the nutrients that’s coming in through diet. It’s often used for sports fitness and for people interested in optimal health and it’s also a good tool if you have a patient on a gluten-free diet or a special diet. Those diets do have a place and they’re really important, but anytime there’s a narrowing of the diet, there’s a narrowing of the opportunity to get all the nutrients that we need and the NutrEval can help to cover some of those nutrient deficiencies. GI surgeries, medications, those can also lead to or contribute to nutrient deficiencies as well.
These are the tests and the biomarkers included within the NutrEval profile. So the organic acids, the oxidative stress markers and the antioxidants, amino acids, essential fatty acids, nutrient and toxic elements and you have the opportunity to add on vitamin D and for genomic SNPs as well. So this is the big picture, and we’ll cover all of these in more detail as we work our way through the test, but just wanted to lay it all out here. There’s about 125 biomarkers in the test and really cast a wide net looking at what’s going on in the patient’s biochemistry. If you were to lay out all of the pages on the test, there would be 13 pages. The first few pages would consist of the overview and the interpretation at a glance. That’s followed by three pages of organic acids, one page of amino acids, fatty acids that would cover the biomarkers and their layout and their metabolic pathway, as well as nutrient toxic elements. And, of course, the genomics which are optional, they’re issued as a separate report, but it is an optional add on for the NutrEval.
I included this slide here, just in case some of you were more familiar with the ION or with the Metabolomix. This is a quick comparison between the NutrEval and those tests. They all do answer many of the same clinical questions, but we can come back to this a little bit later if needed, but I just wanted to illustrate here that these tests are looking at a lot of the same things, so organic acids, amino acids, oxidative stress markers.
And the other interesting thing that I was talking with Dr. Weitz about a moment ago, was telemedicine. And of course, the NutrEval requires both a blood draw and a urine collection and the Metabolomix would be an alternative to that, because that is a test that patients can collect entirely at home, so it’s a first morning urine and a finger stick for the blood spot. So the tests are very similar, but if you’re looking for a test, if you do a lot of telemedicine, you’re looking for a test that patients can collect entirely at home, the Metabolomix would be a really attractive option for that.
Dr. Weitz:
By the way, since you just mentioned the urine part, how crucial is it if the patient, let’s say, we’ve had a number of occasions where the patient came in for a blood draw in the morning. We usually have a mobile phlebotomist come in and do the blood draws in the office and they didn’t collect their urine ahead of time, right? You’re supposed to collect the urine ahead of time, freeze it for a period of time and then bring it in before it’s sent in. And let’s say they didn’t do that and we just collected then, how much would that change your results?
Dr. Brown:
It could be a problem if the creatinine is low. That’s probably the most common thing that we see in patients who don’t collect their first morning void. Maybe they run it from a second morning void. If the creatinine is too low, because their organic acids are reported as a ratio to creatinine, you could potentially see very high organic acid markers. Wouldn’t affect the blood markers in the test, but it could potentially affect the organic acids. And the creatinine is reported in the test, so you’ll be able to see if it’s too low. That would be something to look out for, if you know it’s not a first morning void.
Dr. Weitz:
Right, okay.
Dr. Brown:
All right, moving into this. So, the title of this presentation, Biopsy of the Metabolome. The metabolome is basically metabolites that provide a functional readout of the activity within the cells and this is based on medical biochemistry and this is a picture of a poster I used to have on my wall that looked at an amino acid metabolism and organic acid metabolism and the Krebs cycle and all of that and how those related to each other. And so, by looking at organic acids and amino acids, we really get a glimpse of the metabolites and the precursors. This is the virtual biopsy that I’m referring to, and the NutrEval report, and even the Metabolomix report as well, do a really nice job of taking into account those organic acids and the amino acids and fatty acids and trying to acknowledge the nutrient co-factors that drive those pathways and that is the functional readout, in my opinion, so this is sort of the groundwork that I’m trying to lay for our discussion here in a moment about the new report.
Two more little issues I think will be helpful and will answer a lot of questions, is the conceptual framework behind the NutrEval. So, we have a combination of direct indicators of nutrient deficiency, like DHA, for instance. This is one of the omega-3’s. We measure this, if we see it low, it’s something we can intervene directly, to address, so very important, omega-3. A functional indicator of nutrient deficiency would be looking at metabolites, looking at organic acids and amino acids and, for instance, if we’re looking at a given metabolic pathway here, A converting to B converting to C, we know that pathway is driven by enzymes, enzyme one and enzyme two. And if enzyme two has a nutrient co-factor that is not being met due to a nutrient deficiency, we can see an accumulation of metabolite B, and that will be measurable in the urine or in the blood. Methylmalonic acid is a really good example of that, it’s something that accumulates if we lack B12, which helps to convert it into its next step.
So, the NutrEval, you’re getting both, you’re getting some things measured directly, some things from more of a functional assessment. And speaking of methylmalonic acid, which is, we make a case that’s a functional metabolite, we also have direct, or let’s say, intracellular and extracellular measures of nutrient deficiency. So, I’ve included some examples here of what we might consider intracellular, things like red blood cell magnesium, the essential fatty acids which are reported in the red blood cell, the citric acid cycle which happens inside the mitochondria, and methylmalonic acid is one of those reactions that happens in the cell as well. However, because there is a strong body of literature behind plasma amino acids, plasma copper and zinc, serum CoQ10 for instance, those kinds of things are also included in the report and they also help us to make recommendations for those things. So, in the NutrEval, you’re really getting the best of both of those intracellular and extracellular.
Dr. Weitz:
It’s interesting, there’s another popular nutrient evaluation test that looks at white blood cells kind of through a complicated process and they’re always describing theirs as intracellular evaluation.
Dr. Brown:
Right. Right. Yeah, and citric acid cycle intermediates, this is something that happens inside the mitochondria, so it’s a direct readout of that. So, now we get into our page by page analysis, and I know that you all like literature citations, I do as well. I’ve linked the NutrEval support link in the chat box. Should be the first comment in the chat box. But it has over a thousand literature citations in it and more than I could include in the slide, so I highly recommend you check that out. It’s a great resource to have. It lists all the literature citations here. So, this is the first page of the new report and you can see, it has two main components here of results overview, which has these colorful icons here. Patients seem to like that. It’s been a very nice addition to our GI Effects profile, so we’ve carried over some of that.
Dr. Weitz:
Hang on a second, Doc. One of the participants ask, “Can you link it again, please? I think I joined after you posted it.”
Dr. Brown:
Sure, certainly.
Dr. Weitz:
I didn’t know it worked that way.
Dr. Brown:
Give me just one second. This should be it here. You’re seeing it now? All right.
Dr. Weitz:
Yes, she said thank you.
Dr. Brown:
Okay, excellent. All right, so this is just the overview of the first page. So we have a scoring system now. That’s also similar to the GI Effects, that was a change that really helped a lot of clinicians and patients in making sense of the GI Effects, so we’ve added some of that here. And if we zoom in on those functional imbalance scores here, we can see they’re ranked zero to 10 in terms of the significance of the score. So, zero to four is a minimal need, five to seven is a moderate need for support and eight to 10 would be a high need for support. And these areas include oxidative stress, mitochondrial dysfunction, omega imbalance, toxic exposure and methylation imbalance.
And this is one of my favorite changes about the report, because the previous version of the test, we just listed the nutrient needs on the first page and I think this is a better way to do it, because we want to talk about a systems approach and a functional approach to health and wellness and these are areas where a lot of patients need support. So this is really framing it more in terms of function and in terms of a systems approach, rather than just looking at nutrient needs. Those scores are based on the biomarkers listed below each score and we’ll talk about a lot of those as we go through the test, but this gives you a little bit of insight into how we calculate the scores as well, which is based on the severity of the abnormal biomarker and the strength of evidence behind that biomarker, so it is a weighted algorithm in terms of how we generate the score.
Dr. Weitz:
I noticed you have FIGLU under mitochondrial support, and I think FIGLU is an indicator of the need for B vitamins, right? Folic acid?
Dr. Brown:
Yes.
Dr. Weitz:
But you don’t think about that for mitochondrial support so much?
Dr. Brown:
Yeah, it is, because of its strong association with the need for folate that it’s also listed under the methylation imbalance heading, so some of these biomarkers are connected in more than one of these functional pillars here. FIGLU is a good example of that. Carries a little bit more weight in terms of methylation imbalance, but because folate is important to so many of aspects of cellular health, it also carries a little bit of importance in terms of mitochondrial function.
Dr. Brown:
This is now the second page of the report, so we used to have in the first page and the second page, there was a lot of overlap between that. We’ve sort of condensed that into one page and tightened that up a little bit. And we have recommendations here for antioxidants, B vitamins, minerals, essential fatty acids, digestive support, so you’ll see a probiotic and an enzyme recommendation in some tests. And of course, amino acid recommendations are at the bottom of this page, just like last time as well. There’s also space provided on the right side of the page for you to make any adjustments, since you know more about your patients than just looking at the biomarkers alone. You can make some adjustments, write in a product name, however you would like to use that column on the right. We always encourage you to customize further if you deem that necessary with your patients.
This is the interpretation at a glance page. So page three through six of the report are laid out like this, pretty similar to last time. We list the nutrients need there. This is also ranked one to 10 scale. We’re looking at a high need for alpha lipoic acid here. The nice thing about these pages is that this can help to explain the test results to the patient and you also have the function of the nutrient provided, the causes of deficiency, the complications of deficiency and some food sources, which is a really nice tool if you don’t want to prescribe a supplement for everything for your patients, you can circle a few of the foods listed like spinach and broccoli and Brussels sprouts. Those could be good sources of alpha-lipoic acid and it might be good enough to meet a moderate need.
Dr. Weitz:
So, can you explain where, say, this eight for lipoic acid comes from? What exactly are you looking at that you’ve come up with this recommendation?
Dr. Brown:
Things that trigger alpha-lipoic recommendations are things like pyroglutamic acid and oxidative stress markers, because it’s an antioxidant, so if we see evidence of an up regulated glutathione recycling pathway, like pyroglutamic, or if we see oxidative stress markers, those kinds of things are used to help make the decision about how important alpha-lipoic acid would be, but it’s not-
Dr. Weitz:
So, how many markers are you looking at that go into this recommendation on average?
Dr. Brown:
For alpha-lipoic acid?
Dr. Weitz:
Yeah.
Dr. Brown:
These vary, depending on the analyte, but anywhere from five to 14 markers, depending on the nutrient need.
Dr. Weitz:
And that explains why sometimes you’ll get one of these tests and it’ll say, for example, over here that they need magnesium and then you go in the back and you’ll see that their red blood cell magnesium is fine.
Dr. Brown:
Yes, that’s a good point and I’ve got a good example of that on the Krebs cycle page for this test, where we see magnesium as a co-factor in one pathway that. Does have an influence on our recommendation for magnesium, but red blood cell magnesium also helps us make the decision. So we ultimately have to look across different body systems to try and make that recommendation and it’s based on the balance of the information and whether or not we see it as a pattern. That’s a good point.
Dr. Weitz:
I think that’s one of the really unique things about the NutrEval as compared to just measuring serum levels of some nutrient.
Dr. Brown:
That’s right. That’s right. If we see needs for a nutrient across different pathways, it tends to make a more reliable recommendation and so, that’s why there are so many biomarkers in this test.
Dr. Weitz:
Now, how well has this test been standardized and proven for people who are, let’s say, we talk to a primary care doctor, conventional doctor, who’s very skeptical of this test.
Dr. Brown:
Yeah, I’ve talked to quite a few of those about this test and I always try to focus on the markers that they might have seen before, or might have heard at some point in their training, like methylmalonic acid. There are even some pretty mainstream organizations that acknowledge that methylmalonic acid is a stronger marker for tissue level of B12 status, than serum B12. And a lot of those same clinicians that are very conventionally focused are still measuring serum B12, unfortunately. So, I always try to point to those markers where they might have heard of, or come across in their training at some point just to sort of remind them that yes, there’s a lot of this that is very well validated and very well represented in the published literature, so I think you could point to the omega-3 index as one of the markers that has a wealth of data behind it. You could point to red blood cell magnesium, you could point to CoQ10, glutathione. There’s quite a bit in the test that should be at least familiar to some degree for conventional providers, but it kind of depends on how open-minded they are and there’s a lot of nuances that goes into-There’s a lot of nuances that goes into that from what I’ve seen.
Well, the organic acids would be page seven through nine in the report, and these are byproducts in a number of different body systems. There are end products or byproducts in these pathways that help us to biopsy the metabolome. And they are indications of vitamin and mineral co-factor needs because of the enzymes involved in those pathways. The enzymes that drive these pathways are nutrient dependent. And these are grouped into sections. So what you will see on the Krebs Cycle page is fats, carbohydrates, and proteins metabolizing into acetylcholine and that entering the citric acid cycle. Ultimately the end goal of that is to support the electron transport chain and make ATP. And this, we lay things out here in pathway format to help visualize some of the backups or blockages in these pathways. So there are nutrient co-factors that drive the pathways, of course, but there are, in some cases, metals, heavy metals or toxins that can inhibit the pathway.
So we do measure some toxic elements in the report. And if I see a report here where we’re sending a lot of activity, citric acid cycle, a lot of things that are color-coded red indicating highs or lows, and I usually flip to the back of the report look and see if there’s elevated mercury or elevated lead. That can help me know if it’s a toxic reason for an elevation or a nutrient reason for an elevation, or maybe even both. So that kind of information is laid out here in pathway format and a useful tool for trying to understand these energy metabolism pathways.
Here’s the example I was mentioning just a moment ago. So I’m going to zoom in on the fatty acid metabolism pathway, the beta oxidation pathway, which would be how we move long chain fatty acids into the mitochondria ultimately. And if that pathway is having trouble, if there’s inhibition in that pathway, we could see high levels of adipic and suberic acid. And it’s often that inhibition is related to an unmet need for magnesium and or B2. So this is the carnitine shuttle here. And if that’s not working very well secondary to some nutrient co-factor deficiencies, you might see high levels of adipic acid, high levels of suberic acid.
A patient who is having difficulty losing that last five to 10 pounds of weight, they’re doing everything right, hormone-wise, lifestyle-wise, diet-wise, but they just can’t quite get that last little bit of weight off. Sometimes it’s because their beta oxidation pathway is struggling and it could be related to an unmet need for magnesium or B2. And this does factor into our recommendations for magnesium and B2. But, of course, it’s not the only thing that we look at to make those recommendations. Moving on. So this is kind of how I look at this pathway page. I sort of chunk that top part of the page together and just sort of remind myself that this is an indication of some mitochondrial dysfunction. It contributes to that mitochondrial dysfunction score.
And the bottom of that page, we can see some antioxidants like coenzyme Q10 and glutathione. And we can also see if there’s oxidative damage with lipid peroxides or 8-OHdG, which we’ll talk about those in a little bit more detail in a moment. But that’s kind of the overview here of this Krebs Cycle page.
The page right behind that would be page eight, which is the organic acids. And this would include malabsorption and dysbiosis markers, some cellular energy and mitochondrial metabolites, which are shown in pathway format on the previous page, vitamin markers, which help us to make recommendations for B vitamins, and toxin and detoxification markers, as well as oxalate markers, which those will be listed on the following page. We’re going to zoom in on that section by section here, starting with the malabsorption and dysbiosis markers. And the first two markers in that section would be indoleacetic and phenylacetic. These can happen if there’s bacterial fermentation of tryptophan or phenylalamine, which could be an indication of poor protein digestion. And that helps us to make the recommendation for enzymes that we saw on the second page of the test. We also have some dysbiosis markers here for bacteria and yeast, and these are metabolites of bacteria and yeast in nature.
Dr. Weitz:
Can you just explain those malabsorption markers a little more? And how much does that really tell us if we’re dealing with a patient with functional gut disorders?
Dr. Brown:
Yeah. These are metabolites. When bacteria come into contact with amino acids, we’re assuming that protein hasn’t been fully digested and absorbed in the small intestine, and it’s made its way to the large intestine. That’s where huge amounts of bacteria can come into contact with it and metabolize it. Ultimately, those metabolites are absorbed by the body and excreted in the urine. So it is an indirect way of looking at how well somebody might be digesting or absorbing protein. I would put more confidence in pancreatic elastase in something like the GI effects profile. That’s a more direct way to look at the exocrine function of the pancreas. But if I see those elevated and my patient’s telling me that they’re bloated, they have fullness after meals, they notice undigested food in their stool, then I’m more inclined to say, let’s try some enzymes with your larger meals and see if that gets better. If it doesn’t, we’ll look at a stool test, but it’s a good way to-
Dr. Weitz:
So is this something that would occur at the same time or as a result of SIBO, or this is a possible alternate explanation for bloating to SIBO?
Dr. Brown:
That’s a great question, because if there is overgrowth of bacteria in the small intestine, there are more bacteria coming into contact with those amino acids as they’re trying to be digested and absorbed in the small intestine. So that is a possible scenario where you could see high levels of indoleacetic or phenylacetic. So that’s another thing where if your patient says, well, I’m worse when I have a lot of fiber or fermented foods, those make me bloated. My bloating is progressively worse through the day. Those things that clinically make you think about SIBO, that could be a possibility.
Dr. Weitz:
That’s interesting because a lot of times with SIBO patients, we’re taking them off of a lot of the carbohydrates on a low FODMAP or similar diet, and they may be eating more protein. And this could possibly explain why some of those patients are not getting better or getting flares.
Dr. Brown:
That’s a good point, a really good point. The dysbiosis markers, similar in the sense that these are metabolites of gut bacteria, things like DH, PPA, and benzoic acid. That if you see those elevated, you might think about stool testing as a potential follow up. Or maybe probiotics, because those will, if there is some mild dysbiosis, probiotics might be enough to help correct that. Maybe increasing fiber intake, things like that. But if I have a patient who has a lot of gut symptoms, usually I’m ordering a GI effects comprehensive at the same time or shortly after, or maybe sometimes before this test. I think it’s just a more direct way to look at gut function. The use of metabolites. We did make a change there, which this is another thing I’m excited about in the report. So zooming in a little bit on the use of metabolites here, we’ve added D-arabinitol. We’ve replaced the arabinose marker that was in that section. And the reason why is because D-arabinitol is a direct metabolite of candida albicans, and it has a stronger association with intestinal yeast. So this is a marker that we feel provides a greater degree of detail around intestinal yeast. So if you’re seeing a high level of that we could be looking at a patient with some intestinal yeast, if that’s elevated. And you might think about Saccharomyces boulardii or limiting simple carbohydrates in the diet, or however you prefer to deal with these for your patients. This marker could help you make that decision.
Dr. Weitz:
Now, let’s say we see some of these yeast markers high, but it doesn’t show up on the stool tests. They still could have fungal overgrowth, and this could be an indication of that, right?
Dr. Brown:
That’s true. Probably from a published literature perspective, I think mycology culture in stool is the best tool we have. But I wouldn’t say it’s a perfect tool. So anytime I’m interpreting the yeast markers, I’m always trying to make the clinical history part of that interpretation, because I think that’s really important. And I think if I’ve ruled out other things like bacterial dysbiosis, SIBO, other GI issues, inflammation in the gut, if I’ve ruled out all of that, and I’m looking at high D-arabinitol or maybe I see yeast in the mycology culture and the GI effects, then that’s usually my next step. Brings us to these markers. I didn’t mention this, but this was a new addition to this section of the NutrEval. We added alpha-hydroxybutyrate acid. We list it here, on this page, as a carbohydrate metabolism marker. Really this marker is one that you might see elevated if the patient has some early insulin resistance. Or you might see it elevated if they just have very poor lifestyle habits, too much alcohol, smoking, maybe too sedentary, those kinds of things. You might see alpha-hydroxybutyrate acid elevated in those scenarios. So that was a new addition to the report as well. And there’s a lot more detail about that in our support work guide.
These are the vitamin markers and these help us make decisions about B vitamins and also has a little bit of impact in our alpha lipoic recommendation-
Dr. Weitz:
Doc, could you just go back to cellular energy mitochondrial for a second? What do we really get out of some of these markers? What is carbohydrate metabolism? What is that really telling us?
Dr. Brown:
It gives you some insight into how efficient the glycolytic pathway is, how effectively they can take carbohydrates and move it into acetylcholine. And so, if you’re seeing accumulations of pyruvic or lactic acid, if those are building up, it could be an indication that maybe there are some nutrient co-factor requirements that aren’t being met for B1, B2, B3, even lipoic acid, alpha lipoic acid, to some degree.
Dr. Weitz:
Or could this indicate somebody who just has an intolerance to a lot of carbohydrates?.
Dr. Brown:
This would be after carbohydrates are already absorbed. And after that you really wouldn’t necessarily be able to tell us much about their digestion or absorption of carbs, but after that step. And one thing that I’m seeing more and more of these days is, patients who are doing more low carb diets or paleo diets, is the pyruvic or lactic acid low, on the low side of the range. And that could be an indication that the patient’s not consuming many carbohydrates. So you can also use the pyruvic and the lactic in that way to help you gauge carbohydrate intake. Did I answer your question, Dr. Weitz?
Dr. Weitz:
Yeah, sure. Yeah. Thank you.
Dr. Brown:
Sure. That would bring us to these vitamin markers here. And these are helping us make decisions about the need for B vitamins and alpha lipoic acid. And these are things like branch chain amino acid metabolites and formiminoglutamic acid and methylmalonic acid. And these are all informing those nutrient recommendations that we saw earlier on in the report. And they’re listed, there are some headings here that will sort of provide clues about those nutrient needs. So, for instance, this first part of the section mentions that B1, B2, B3, and lipoic acid are something to think about when these are elevated. The next subsection there is formiminoglutamic and methylmalonic acid into heading, also to folate and B12, or something to think about if those elevated. FIGLU is the one that’s more specific for folate. And, of course, we have a couple of biotin markers as well. They help us make the recommendation for biotin. So those are just classic. They participate in a pathway that’s B-vitamin dependent, and that’s how they’re interpreted. Functional indicators, in other words.
That brings us to the neurotransmitter metabolites. And these are metabolites of things like tryptophan and tyrosine. We look at them in the context of nutrient co-factor needs. So if we’re seeing elevations in these, they also help us make decisions about nutrient needs. And there are some things like chronic inflammation, chronic infections, high stress levels that could influence those results. And I think that’s helpful to keep in mind when you’re interpreting. You might see a patient who’s carrying a lot of stress. They may have higher levels of kynurenic acid. There’s some data to support that. If it’s acute stress and it’s earlier on, maybe in the earlier stages of adrenal dysfunction, then it’s more of an acute stress. You might see some of the catecholamine metabolites elevated. Regardless, if those are elevated, or if a patient has genomic snips that could impact those pathways, the answer is often B vitamin support. So that is also factored into our algorithm. And there’s a lot more detail and a lot more pathways to look at in our support guide for those.
Dr. Weitz:
And these give us an indication of brain health, neurotransmitter, psychological health?
Dr. Brown:
It’s a good question. And these are measured in the urine. So we’re not measuring these in the central nervous system between the neurons where it really counts. There’s some debate on if you can interpret them that way, or if they are a reflection of what’s going on between the neurons. Some clinicians feel pretty strongly that is the case. Others are not completely convinced. So there is some, I would say, I have some hesitancy in determining them as a direct reflection of what’s going on between the neurons. But clinically, and just speaking from my own clinical experience, that does seem to make sense, typically, if I often see high kynurenic acid in patients who are carrying a lot of stress. And if they’ve been doing it for a long time and if they’ve been chronically stressed for a long time, you might start to see lower catecholamine metabolites over time. So there’s a lot of factors that factor into this. But I would say it gives us some insight, but I don’t know if we can say there’s a one-to-one relationship between what we see in an epi- and norepimetabolite, and what’s going on in the brain.
Dr. Weitz:
Could the serotonin marker help us with the management of patients with depression and/or is serotonin an important factor in the gut in terms of motility?
Dr. Brown:
Yeah, that’s a great question. I think it’s just, in my own experience, I think it does seem to line up really well. I think it also depends on what the upstream amino acid metabolite is. So if tyrosine levels are low, which we’ll see on the amino acids page, if somebody is across the board low in their amino acids, it does become harder to see elevations. And you might see more low levels in the neurotransmitter metabolites because of that. However, when I see a low 5-hydroxyindoleacetic acid, knowing that is a direct metabolite of serotonin and ultimately of tryptophan further upstream, I do think about supplementation with tryptophan or 5-HTP, especially if the patient’s telling me that they’re having trouble sleeping or their mood is not very good. I do think it’s definitely worth considering. I’ve often seen that be helpful.
The toxin and detoxification markers, in the bottom right of this page here. The first one is pyroglutamic acid, which is part of that glutathione recycling pathway. It’s one of the ways that we can recycle glutathione more specifically through the gamma-glutamyl cycle. But pyroglutamic acid, if we’re seeing that elevated, it could be because the glucose levels are low, there’s not enough glutaphan around in the body. It’s working harder to try to recycle it. You might also see that elevated if a patient has a current toxic exposure and their glutathione is being oxidized and reduced more quickly. You might see pyroglutamic acid borderline high or high. And then, of course, you’ll also be able to see the glutathione level towards the end of the report. And you can put those pieces of information together to help make some useful recommendations.
There is a styrene metabolite here, and a metabolite of MTBE, which those are pretty common environmental toxins. Styrene could be from food packaging or paints or carpeting, things like that can off gas styrene. And the MTBE metabolite is a pretty common water contaminant. So if you see the MTBE metabolite elevated, you could think about encouraging water filtration, that’s often helpful. However, I have often seen the MTBE marker elevated in patients who do have a good quality water filter, or what they tell me is a good quality water filter. And my next thought, when that happens, is do they have enough B vitamins to help support detoxification of it? And I often see the MTBE metabolite elevated in patients who are deficient in B2, and folate, and B12. And to me, that makes sense that if they’re lacking those nutrient co-factors that are really important in liver detoxification, you might be more likely to see an elevation of a toxin.
Dr. Weitz:
I have to say, when I see this section, there’s so many toxins that we’re always talking about and thinking about and worried about that, the toxins that you have included here seem somewhat random, like why would you pick MTBE?
Dr. Brown:
These are common toxins. Of course, there are thousands, you’re absolutely right. And we have to draw the line somewhere. We do have some toxic metals later on in the report. But this gives us a little glimpse into what they might be exposed to in terms of some common toxins. And that does give us a little bit of insight. Of course, you could run a more specific toxic panel, but this is just sort of scratching the surface here. Not meant to be an exhaustive work.
Dr. Weitz:
I know. I guess, just from my perspective, if you have like BPA… And, I mean, I can think of some really common ones that everybody’s concerned about that-
Dr. Brown:
I can appreciate that perspective. Yeah, I certainly can. I believe that you raise a good point. It’s something that we’re always looking to evolve the test and just because it’s not there now, you might see that make it into the next version of the test. But it’s a good point. Well, any other questions on that page? So more of the organic acids show up on page nine, including the new oxalate markers. And these are things like glyceric, glycolic, and oxalic acid. And oxalic acid is the one that, in my opinion-and oxalic acid is the one that, in my opinion, carries maybe the most significance out of the three. That is the one that has the association with kidney stones. And when we think about why we might see high levels of oxalic acid, it could be from oxidative damage. So if there’s not enough antioxidants around or there’s too many pro-oxidants in the body, you might see more oxalic acid or some of these other oxalates show up. You could also see that say if somebody is breaking down their collagen, so if they’re more catabolic, if there are your high cortisol levels and they’re breaking down lean mass and body tissues, that they’re more catabolic, you could potentially see more of these metabolites as well. So a useful tool to have, if you’re seeing patients with family history of kidney disease, or a nice tool to help protect them against that.
Dr. Weitz:
And then can this be helpful if we’re treating patients with gut problems and we’re suspecting that maybe they have problems with oxalates and needs to be on a low oxalate diet?
Dr. Brown:
That’s a great question. If I see high oxalates or oxalic acid high, I do think about that as an option. I also think about, do they have enough beneficial bacteria in their gut to help metabolize those oxalates. Lactobacillus, Bifidobacteria and Oxalobacter can degrade oxalates. And that can be really helpful if you’re putting together a treatment plan to help try to lower the oxalates. Oxalate-rich foods or avoidance of oxalate-rich foods, that I think is a valuable tool for some patients. I try to think of that as a last resort, because a lot of those are [inaudible 00:52:14] for other reasons, but it something to consider if you’re seeing high oxalic acid in particular. Let’s see here. There’s a lot more about this glycosylate pathway in our support guide, it goes into these in a lot more detail. But if I had to pick one of those oxalate markers that I put the most confidence in, it’d probably be oxalic acid.
So speaking of oxidative damage, that could be a reason for elevated oxalate, but you also have this assessment for oxidative damage with things like lipid peroxides and 8-OHdG. And they’re on the right side of this slide, but lipid peroxides is telling us about oxidative damage to cell membranes and 8-OHdG is telling us about oxidative damage to DNA, and really useful to be able to measure those. And there’s quite a bit of published literature on those, looking at signs of oxidative damage. Of course, on the other side of it [inaudible 00:53:36] here is a measurement glutathione and the [inaudible 00:53:40] and measurement of enzyme Q10 and the serum. And so you can see some pretty potent antioxidants for through a direct measure of those. So we’re always trying to balance the pro-oxidants that the patient has in their body with amount of antioxidants need to protect themselves. And this is one place in the report where you can really get into those side by side. Of course, you also have that assessment on the first page, which even broadens the approach even further. But some things measured directly here.
The amino acids… We were talking about that earlier Dr. Weitz, this sec at the bottom of this slide talks about the difference between the NutrEval Plasma and the NutrEval FMV. So no matter what kind of NutrEval is ordered, it will require blood and urine. The difference is in what part of the specimen we look to report the amino acids. And the plasma amino acids, as you would get in the NutrEval Plasma, will tell you more of a steady state of amino acids and protein intake. And this would be about anywhere from several days to three weeks of status. So if you have a patient who’s got an inconsistent diet in terms of the amount of protein they get from day to day, it might be more valuable to look at a NutrEval Plasma. However, if your patient’s pretty consistent in terms of their protein intake from day to day, you could do just fine with the NutrEval FMV, which would give you about 48 hours status for their amino acids. So that is the difference.
Now, as far as what we’re measuring, we’re measuring all of the essential amino acids and the non essential amino acids. And they’re listed here on the left side of the page. And the importance of these is that they are building blocks for tissues, hormones, enzymes, and even precursors to neurotransmitters as well. But they’re essential, they have to come from the diet or from supplementation, and you can see the levels measured here directly. So a useful tool to have. If I’m seeing signs that the patient has detoxification needs and things like taurine are low, or maybe they’ve got some hypertension and their arginine is low, these are things that by correcting these amino acid levels, we might be able to make some headway in those areas.
Dr. Weitz:
Should there really be an upper range for these? Is it really bad if they’re higher?
Dr. Brown:
It’s a great question. I think it can only be a bad sign if they’re high. And the reason why is, we do need B vitamins and minerals like magnesium and zinc in order to utilize the amino acids. And there may be situations where you have a patient who is not utilizing their amino acids and they’re building up and they’re circulating, but they’re not making their way into tissues or neurotransmitters or enzymes, or what have you. And it can be due to a nutrient co-factor need. So that is a scenario where I think high levels could be a bad sign, but it could be easily corrected with some nutrient co-factor support.
Dr. Weitz:
Now, what if some of these on a high protein diet, like a keto diet?
Dr. Brown:
High protein diet, I would expect to see them at the upper end of the normal range. If they’re really high, I do have some concerns about kidney health, but I rarely see them really high. I think most patients, if they’re… Unless they’re just at the extreme in terms of protein intake, I think are going to be okay on a keto diet a higher protein diet. But it’s a good question. I think one thing that would also concern me potentially is if you see the essential amino acids very high or robust, and you see the non-essential amino acids kind of at the lower end of the range, that could be an indication that they’re not converting some of the essentials into some of the non-essentials, which could also be an indication of a need for B6 and a few other B vitamins. So there are some circumstances, but you’re right. I mean, therapeutically, those diets can be really helpful for some patients. So I don’t think they’re all bad.
On the right side of the page, we have some intermediary metabolites, these are amino acid metabolites, and they sit in various pathways that are nutrient co-factor dependent. And B vitamin markers, these, of course, aren’t the only B-vitamin markers in the tests we look for multiple other ones as well. But one of those I always look at in the reports and it’s cystathionine, which is the fourth marker from the right. And here in this example, it’s kind of hard to see, but the cystathionine level is really high in this patient and cystathionine sits right in between homocysteine and cysteine in the conversion of methylation to transsulfuration. And you might see that elevated in somebody who has a CBS snip. And it might prompt you to think about a methylation panel to look at the methylation and transsulfuration cycle in a little more detail, but that’s something that I found helpful to look at in patients where I’m suspecting CBS network problems with methylation or transsulfuration.
Dr. Weitz:
And you guys offer a methylation panel?
Dr. Brown:
We do, we have a methylation panel and it’s in addition to some amino acids and metabolites of amino acids that make up the methylation cycle and transsulfuration cycle, there is also the opportunity to add on some genomic snips to that profile as well.
Dr. Weitz:
I guess the only issue I have with every time we get into a discussion about methylation and looking at the snips, it gets very complicated, but then the answer to everything is just, “Take more B vitamins.” So I wonder sometimes how helpful it is.
Dr. Brown:
Yeah, I find that methylation panel helpful for ruling out methylation issues, if I’m highly suspicious of it. With the help of the genomics snips and the biomarkers included in our profile, I can see if the patient’s hitting the target in terms of how well they’re methylating and if that looks good, then I tend to move on towards other things. Cause that methylation cycle touches on so many different areas of our biochemistry. I think the panel has a lot of use in ruling out methylation issues as well, but it does focus the lens a little bit more on methylation. And one of the things that I’ve found helpful about that profile too, is that B3 and B2 are often forgotten about in the methylation discussion. And there’s been a pretty heavy focus on folate and B12 and B6, but B2 and B3 are also supportive. And if you see backups at steps that are B2 and B3 dependent in that test or this test, that can be helpful for supporting methylation without giving higher doses of folate or B12. So it could potentially help you make a clinical decision about some of the lesser known B vitamin co-factors in that cycle.
Dr. Weitz:
Somebody asked if the CBS snip is one of the snips that you can add on?
Dr. Brown:
Unfortunately not for this test, but it is included in the methylation panel if you add on the genomics to that test.
Dr. Weitz:
We have a question about how do we choose first morning void or plasma tests for a particular patient?
Dr. Brown:
I favor the NutrEval Plasma, and the reason why is because my patients don’t always get the same amount of protein from day to day. So for me, I always go with NutrEval Plasma. Usually after I have that conversation with clinicians about what you’re getting with the NutrEval FMV versus what you’re getting with the NutrEval Plasma, they’ve often sort of lean that way towards plasma as well. There’s nothing wrong with the NutrEval FMV test, but it is just a shorter snapshot of the amino acids, which for some patients, I think if they’re just not consistent with their protein intake, I think it becomes more important to look at a NutrEval Plasma. So I would say make that your default and you’ll probably be okay, but that’s sort of just my own perspective on it. We still have a lot of clinicians that order the NutrEval FMV
Dr. Weitz:
Somebody asked, “Is the FMV a shorter window for all the markers or just the proteins?” And the answer is, it’s only for the amino acids, everything else-
Dr. Brown:
Correct. And that’s about 20% tests. So it doesn’t make a huge difference in the grand scheme of things, but it could make a difference in how you interpret the amino acids.
Dr. Weitz:
Okay.
Dr. Brown:
Good questions. Peptide markers. This is also worth looking at on this page because if you see these peptide-related markers elevated, and you’re seeing low amino acids at the same time, it could be somebody who’s not digesting or absorbing their protein very well. And it’s because the peptide-related markers here at the bottom right of this page, they sit right in between the crude protein that comes in through the diet and the amino acids that we ultimately need to break it down to. So if you’re seeing a lot of these dietary peptide related markers or seeing those elevated rather, then that might prompt you to think about the pancreatic enzyme recommendation on page two a little more seriously, especially if you’re seeing amino acids low cause that could be a patient who’s just not digesting or absorbing their protein very well. So that is the amino acids page.
Dr. Weitz:
What do you think about recommendations for specific amino acid supplements based on this panel?
Dr. Brown:
I sometimes do that, if I see taurine low, that’s one that I like to replete, especially if the patient’s feeling fatigued or they’re having detoxification issues. If I see arginine low and somebody who has vasoconstrictive headaches, or maybe some hypertension, I might think of that as part of the strategy. Methionine, you know those kinds of things-
Dr. Weitz:
I know there are labs that will put together like a multiple amino acid profile based on this test that is higher levels of the ones that are lower.
Dr. Brown:
Right, right. And some compounding pharmacies will do that as well. I think those are great options. Those can make a big difference for people. So I do think those are valuable tools. You could take another approach though. You could say, “Well, if the peptide related markers are elevated, if the patient’s telling me they’re feeling fullness after meals,” or something that makes you think that they might not be making enough enzymes, you could go that route and they may be able to get more amino acids out of the protein that they’re already consuming.
Dr. Weitz:
So you’ve seen giving digestive enzymes and/or hydrochloric acid?
Dr. Brown:
Yeah. I mean, that could be an option. Mm-hmm (affirmative). Absolutely. And I think also too, if you’re saying low amino acids and low peptide markers, then you might have to think about telling that patient to increase their protein intake a little bit or add in a protein snack or a protein powder.
Dr. Weitz:
Right.
Dr. Brown:
Yeah. You have a lot of options in terms of how you want to support amino acids, but I think digestion should also factor into it, I think how much protein is coming into the diet should also factor into it.
Dr. Weitz:
Somebody asked, “Is this issue common with diabetics?”
Dr. Brown:
Well, it’s a good question. It kind of depends on their diet, cause I haven’t always seen low results for amino acids or high results for amino acids with diabetic patients. So it may depend on the diet. Also, there is at least a couple of studies that mentioned that the branch chain amino acids might be a little higher in diabetic patients or patients with metabolic syndrome and it might be due to utilization of those amino acids. It’s a good question, but it they’re probably a lot of other factors that weigh into that.
Dr. Brown:
I see another question here, “I have a patient who seems to have fullness after meals, even when meal is not large. He is diabetic.” Okay. Yeah. Fullness after meals, if it’s because of bloating, then you might consider a SIBO test or you might do a therapeutic trial of some digestive support. Those could be some things to look at.
Dr. Weitz:
By the way, when is Genova going to be getting the additional marker on the SIBO test?
Dr. Brown:
Yeah, it’s something we’re looking into. I haven’t heard a timeline for that, but it’s an interesting point. We measure hydrogen and methane.
Dr. Weitz:
Okay. And now the new test also measures hydrogen sulfide that Dr. Pimentel developed.
Dr. Brown:
Yeah. Any other questions on this page? (silence) All right. So a central and metabolic fatty acids here, we’re looking at omega-3s, 6s and 9s, really important for neurological function, cardiovascular function, skin health, brain health, so many different things depend on omega-3s and managing chronic inflammation, which we’re often trying to fight in our patients with chronic illness. Just sort of a quick way to get a sense of these 3, 6s and 9s is to look at the bottom of each category. The omega-3 percentage is listed right there, the omega-6 percentage is listed right here. And we can see the 3s are kind of at the bottom of the range and the 6s are borderline high here, the omega-9s look fine. So this is a patient who’s not getting enough omega-3s here and has more of a pro-inflammatory pattern based on that. Of course, you can-
Dr. Weitz:
Why is there a top range for omega-9? Is it the more olive oil, the better?
Dr. Brown:
Some say that, but what I’ve seen with omega-9s is that if patients are getting a lot of omega-9s are often not getting enough omega-3s, and that would be something to consider if you’re seeing omega-9 is high.
Dr. Weitz:
And olive oil is the main source of omega-9s, right?
Dr. Brown:
Right. Exactly. And it has health benefits, no doubt about that, but if they’re overemphasizing olive oil or olives themselves, then they might be forgetting about the omega-3s. So, that could be important. Saturated fats are listed at the lower left. You can really kind of get an overall sense of saturated fat intake by looking at that percentage at the bottom of the saturated fat category. In this particular example, it was fine. But if you’re seeing saturated fats high and you know the patient has an APOE issue, or if you’re seeing the saturated fats high and the omega-3 is low, then that could help you make some valuable recommendations in terms of healthy fats for the patient. So that’s a nice tool to have.
There’s also a trans fat marker in this test. On the right side, there’s a trans fat marker called elaidic. If you’re seeing now in borderline high or high, that could tell you something about a patient’s diet in terms of trans fat exposures, so that’s a nice one to have. And the cardiovascular risk markers are at the bottom right of the page. The omega-3 index has a lot of published literature behind it. And if we’re below four for the omega-3 index, that puts us that increased cardiovascular risk. If we’re between four and eight, it’s intermediate risk and if we’re above eight, it’s lower risk.
Dr. Weitz:
Now some people argue that human beings at one time consumed a diet that was close to the 1:1 omega-3 to 6, and that getting below 4:1 is optimal.
Dr. Brown:
Yeah. Yeah, it’s a good point. I think for some patients that might be where they need to be. And we are currently in the standard American diet, we’re getting far more 6s than 3s.
Dr. Weitz:
Right.
Dr. Brown:
Yeah. It’s a good point. So this provides you a sense of what their omega-3 intake like, their omega-6 intake, their omega-9s and saturated fats as well. Any questions about saturated fats, the low fat, non-fat diet? It’s a good question. Sometimes you do… Every now and then I get these patients that are avoiding fat. They’re like, “Oh, I’m just doing protein and avoiding saturated fat. I don’t want to have any saturated fat.” But saturated fat comes along in the diet with cholesterol and cholesterol is the backbone for the sex hormones. So I’ve seen a few times where patients have had what looks like hypogonadism because they’re so depleted in saturated fats. I think that’s a good reason why you would have a low end or a high end for the saturated fat percentage there. But it’s a good question.
Dr. Weitz:
Unfortunately, when it comes to diet there’s still huge disagreement. I’ve interviewed vegans, vegetarians on my podcast who are promoting dairy, low fat, high carbohydrate diet. And I interviewed a couple of guys who are type 1 diabetics and find that the super low fat, high carb-
PART 3 OF 4 ENDS [01:15:04]
Dr. Weitz:
And that the super low fat high carb diet is the best diet for diabetics. And they claim that getting the fats low improves insulin resistance.
Dr. Brown:
That’s a good point. I think there’s some individuality to that and my own set point, my own belief on that is that, the more extreme the diet is the more concern I have for the patient in terms of other nutrient needs and there may be patients, based on their genetics, where they do much better on a low fat diet. There may be other patients who would perform terribly on that. So I think there’s a lot of individuality that we’re still trying to sort out. And I think it might have a lot to do with genomics, but it’s a good point. But this at least gives you something that you could compare your patients to and track the effectiveness or their compliance to those particular types of diets.
Dr. Weitz:
So would you say the go-to thing to look at on this page, if there was one thing you’re really going to honing in on, would it be the Omega-3 index? Would it be the 3:6 ratio? What would be you think the best measure? [inaudible 01:16:27]
Dr. Brown:
I would say the Omega-3 index in my personal opinion. I think that one has the most literature support behind it.
Dr. Weitz:
And optimal levels should be above 10, right?
Dr. Brown:
Above eight, according to the published literature on it.
Dr. Weitz:
Do you think it should be above 10 for optimal?
Dr. Brown:
It’s not a bad idea if the patient has a chronic inflammatory condition or a significant cardiovascular family history.
Dr. Weitz:
Or it doesn’t want to have one?
Dr. Brown:
Well that’s true too. I’m okay with seeing it above eight but you could make an argument to see it higher than that. Yeah.
Dr. Weitz:
Okay.
Dr. Brown:
The fatty acids are also reported in pathway format here and the color coding would apply here as well. So green indicating a normal level, yellow indicating a high or a low level and red indicating, or I’m sorry, yellow indicating a borderline finding and red indicating a high or low level. I do find this page helpful to look at because if we see that linoleic acid is normal, which is one of the Omega six, with the very first Omega six at the top right. That has to convert into gamma-linolenic acid and then ultimately into dihomo-gamma-linolenic acid. This is driven by enzymes with nutrient co-factor needs. Sorry, let me go back to that slide. And if we’re low in dihomo-gamma-linolenic acid, as we’re saying in this example, the patient loses out a little bit on the anti-inflammatory benefit of dihomo. And it’s not because they didn’t have enough linoleic acid it’s because they’re not converting it very well into gamma and then ultimately into Dihomo. So just to the left of those arrows, which is showing up here in the middle of the page, you can send nutrient co-factor requirements and the enzymes make those conversions for us.
I see a question in the comments, which ratio? I think that from the previous page omega-6:3 ratio. The omega-3 index is probably the one I’d put the most emphasis on. No, they’re all good markers.
That brings us to the final page here of the elemental markers. And we’re looking at nutrient elements and toxic elements on this page. And the magnesium that you’re saying here is measured in red blood cell. But as Dr. Weitz said, sometimes you can see a normal level in red blood cell, but still see a nutrient mutation for magnesium on page two of the report. And that would tell you that there were some other pathways involved that were acquire magnesium, where the patient might need to be a little higher up on the reference range. So based on a functional analysis. So it’s ultimately, would really try to bring all of the patient’s biochemistry into this to make that nutrient recommendation for my magnesium. Serum plasma, I’m sorry, serum copper and plasma, copper and zinc, sorry, are reported here directly to, so you can calculate a copper to zinc ratio here by dividing the copper by the Zen care if you so choose.
Dr. Weitz:
You might want to add that to the report. That would be something that would probably be helpful.
Dr. Brown:
Yeah. It’s something I’ve been pushing for a while, but hopefully the next version of the test, but that’s a nice tool to have. That’s what most of the published literature is looked at for copper and zinc ratios.
Dr. Weitz:
But by the way, that’s an important marker for helping patients to reduce cancer risk. And it would be really neat to put a bunch of those markers, that functional medicine practitioners who are trying to improve the milieu for reducing risks for cancer and have a panel that had a bunch of those markers in it like CRP and there’s all bunch of them that… It would be neat to have a panel like that.
Dr. Brown:
That would be.
Dr. Weitz:
Answer the lube panelists.
Dr. Brown:
Good points.
Dr. Weitz:
So I am going to asks what do you use the zinc-copper ratio for?
Dr. Brown:
Well. I believe it’s been looked at in terms of neurological function, immune function, various different health issues. But if you were to plug the copper into the calculator, hit the divide sign, plug the zinc into the calculator, you’d be looking for a ratio between 0.7 and 1.7 typically.
Dr. Weitz:
I think one of the issues is, if you’re taking a lot of zinc, you could end up being low on copper, and that could be an issue. And copper is important for a number of functions. On the other hand, a lot of people get exposed to copper. Maybe they have copper pipes, maybe they have other reasons for getting copper and having higher copper levels is generally considered to be a potential negative for health. And I had mentioned the cancer issue and higher copper levels are generally thought to increase the likelihood for new blood vessel formation, which could make it easier for cancer metastasis or for cancer tumors to grow. So that’s another thing to think about when it comes to copper.
Dr. Brown:
A great point, Dr. Weitz, and I know copper, if it’s too high, can be pro-inflammatory.
Dr. Weitz:
Yes. Like all the metals really?
Dr. Brown:
Yeah. That’s a good point on the right side of the page, you can see the toxic elements they’re measured in whole blood, and that would give us estimated exposure of maybe a few months leading up to the blood draw. So it’s a nice tool to have, because most of the enhanced data looked at whole blood measures of those toxic elements. So there’s a lot of good, useful data we could compare that to, and that helped us to establish our reference ranges there for those. So it’s a good snapshot of exposure, not the full story there, but it does list lead, mercury, arsenic and cadmium.
Dr. Weitz:
Is there really an acceptable level of mercury?
Dr. Brown:
Yeah, that’s a good question. 4.35 is our tolerance. And I think that was somewhere between the maybe 80th or 95th percentile of the [inaudible 01:24:06] NHANES data for that. But I generally like to see it as low as possible. There is a link to the support guide embedded in the report now. That’s new, so when you get to page 13 of the report, if you order this on your patients, you can just click on the link there in the commentary and it will take you right to that support guide that I shared earlier in the comments there. Then of course, if you added on vitamin D for this test, the result will be right here on page 13, it’s 25 hydroxy vitamin D, which we like to see somewhere between 50 and 80. That is the profile. And I know we’re running up on time here. I wasn’t going to go into some of the genomic add-ons, but Dr. Weitz, it’s up to you. Do we need to wrap up now?
Dr. Weitz:
No, no. As long as people want to stay, I’m okay with saying a little bit.
Dr. Brown:
Okay. Well, we can go through these fairly quickly and I’m sure some of you are probably familiar with these already, but I will give you the brief overview and feel free to chime in with questions. You have the option to add on four different genomic snips to the NutrEval, the first one you’ll see is APO E and here the patient’s genotype is a two for genome type. APO E is an Apo lipoprotein. It helps to remove cholesterol from the bloodstream. So you’ll see the patient’s results here. Generally. I think if patients have an APO E2 genotype, they tend to have a higher triglyceride response from carbohydrates in the diet and folks who are [inaudible 01:26:11] forging no type. They tend to have a harder time removing cholesterol from the bloodstream and have a harder time with saturated fats, metabolizing, saturated fats. So this could potentially help you make some decisions there about coaching them on their macronutrients.
Dr. Weitz:
So what you’re saying is from your reading of literature, patients who have one or two of the APO E four variants, will tend not to do as well on a higher fat diets, such as the ketogenic diet.
Dr. Brown:
Yeah. I have some concerns about folks doing an acute agenetic diet who are APO E44.
Dr. Weitz:
Or a 3-4.
Dr. Brown:
Yeah. Exactly. That’s a good point too. In a 3-4 or a 4-4, I am a little more hesitant in terms of recommending a higher fat diet. Of course not all keto diets are the same, so I don’t want to vilify all of that, I also don’t want to say across the board, it’s not a good idea, but I am a little more cautious about saturated fat intake if somebody has an APO 4, for either or both copies. I don’t know. How do you feel about that? Dr. Weitz?
Dr. Weitz:
Yeah, in general, I had a patient a couple of weeks ago, a 40 year old guy and he had a 4-4 and he was, doing a kind of a paleo diet, bulletproof coffee, and he had a heart attack. The guy was in great shape. Everything seemed healthy. And that was a significant factor for him.
Dr. Brown:
Yeah. Wow.
Dr. Weitz:
Somebody just asked about blood draws, unfortunately on the West side of LA, there’s no labs in the Santa Monica West side area that will draw for a NutraEval for Genova labs or actually functional medicine labs in general. So I think the nearest lab is in Beverly Hills, which, once traffic gets back can be a pretty long drive. Do you of any labs or we’ll draw for Genova on the West side of LA?
Dr. Brown:
I don’t, let’s see here…
Dr. Weitz:
There is a Beverley lab. I forgot what they’re called. What, by the way, what I do, [inaudible 01:28:50] Jessica, is we use a mobile phlebotomist. I use Rosemary Mata. So what I usually do is, when I have patients for blood draws, we group them together and then she’ll come in the office maybe every two weeks or so. And then she charges each patient, a $50 for the draw, or she can go to their homes, if they rather do that. So that’s another option and of course, there’s other mobile phlebotomists around.
Dr. Brown:
A good recommendation, and I can reach out to the Genova lab in the area and see if she has some other suggestions, but she would be a good resource.
Dr. Weitz:
It’s been an issue with not having… There was one lab that was withdrawn for all the functional medicine labs. And they got bought out about four years ago. And since then we don’t have a single lab in the whole Santa Monica West side area that will draw for any of the functional medicine testing.
Dr. Brown:
Okay.
Dr. Weitz:
Yeah. Unfortunately conventional labs like Quest and Lab Core only want to draw up their labs.
Dr. Brown:
Yeah. The metabolum X plus would be worth considering as an alternative [inaudible 01:30:22] test can be collected entirely at home and you’ll get a lot of the same markers.
Dr. Weitz:
One more time. The name of that test, cause you broke up. I think when you were saying it.
Dr. Brown:
The metabolum plus and I’ll see if I can just flip back to that slide so you can see the name here, but it’s this one here, this one in the middle metabolomics plus, this one does not require phlebotomy. And you can see that it does have quite a bit of overlap between this and the nutri[inaudible 00:15:58].
Dr. Weitz:
Can you add on a blood spot, vitamin D with that test?
Dr. Brown:
You can’t get vitamin D unfortunately, but you can get the fatty acids in blood spot. That’s what’s run from the blood in that test.
Dr. Weitz:
You guys should consider adding on a blood spot, vitamin D.
Dr. Brown:
Yeah, It’s a great suggestion. I’ll definitely move that up the ladder at Genova. See if we can make that happen, but is the…
Dr. Weitz:
Maybe as a follow-up to this, somebody’s asking about a phlebotomist service in Orange County. Maybe if Genova has a list of phlebotomists that work with the genomic testing and or labs that will draw for Genova in Southern California, maybe if you could compile a list and then we could email it out to everybody.
Dr. Brown:
Yeah. It looks like Jamie mentions [inaudible 01:32:00].
Dr. Weitz:
Yeah. [inaudible 01:32:02] Kimberly Jones we’ve used her as well.
Dr. Brown:
Okay, great. I’ll reach out to Jamie. Jamie’s listening it looks like, so I’m sure she’ll have some other suggestions. All right. The next SNP that you can add on to the NutrEval or the metabolomics would be the MTHFR SNP. And I won’t go into a whole lot of detail about this one, but this is one where if a patient has a snip peer, it could potentially mean higher homocysteine levels. This is the enzyme that helps us convert full late into the active form, which helps to convert homocysteine into methionine ultimately as a really important part of the methylation cycle. We looked at two different locations on the gene, the 677 and the 1298 location. And of course at each location, looking at both copies of the gene, one from the mother, one from the father, and it’s a nice tool to help add more context to the evaluation for methergine.
COMT, another methylator, another SNP that tells us about methylation or the propensity towards methylation. And I think of this more of a detoxification type of methylation helps us to remove catacholamines like benefrine or epinephrine dopamine helps us to eliminate estrogens and environmental toxins as well. So in a lot of ways, it’s helping us to detoxify those substances. And as part of the second phase of liver detoxification and has associations with a lot of different clinical conditions in the published literature, which we tried to summarize in the right side of the slide there, but this is one where if you see a snip here, you might see higher recommendations for a full aid B12 and the rest of the B-vitamins when patients have this snip.
But an important thing to remember though, that the genomic snips don’t factor into our nutrient recommendations in the NutrEval, they’re typically consistent with what we would expect to [inaudible 01:34:41] see in terms of need, but they are not interpreted as part of the NutrEval recommendations. They’re completely independent, but I don’t often see you when patients have COMT snips that we’ve recommended some B vitamins.
TNF alpha is a pro-inflammatory cytokine. And this is one that’s used by macrophages. Snips for TNF alpha would mean an up regulation of production of pro-inflammatory cytokines, and would mean that the patient might be making or more, I should say more susceptible to chronic inflammation. And you might see higher needs for antioxidants in the neutra realm, because if there’s chronic inflammation that can deplete antioxidant status more quickly potentially, and you could see, you’d think about antioxidant support to help protect the body against some of the damage that might be produced from the up regulation of these cytokines. It also has associations with auto-immunity. That’s also something you would see mentioned in the commentary there.
Dr. Weitz:
So what would this SNP tell us?
Dr. Brown:
And that snip might help you determine how important antioxidants are going to be in terms of a long-term strategy for the patient. So if you’re seeing some of the oxidative damage markers elevated, and you’re seeing a TNF alpha snip, where they’re homozygous, they’ve got mutation on both copies, then you might think about antioxidant support with another supplement or, or through the diet as part of a long-term strategy for that patient, not just something, do this for the next six months and you’ll be good, but not that we’re doing that anyway, but it might mean that the patient is fighting this battle against chronic inflammation. There’s going to be more of a long-term strategy in terms of supporting them in that battle. And antioxidants can be helpful for that.
Dr. Weitz:
Probably not a good idea to be prone to a cytokine storm at this time.
Dr. Brown:
Yeah. That’s a good point. Good point. Well, the educational resources that Genova offers are numerous, and that includes the NutrEval and metabolomic support guide that just got updated and earlier this month. We’re really happy about that. That is hot off the press. So to speak, let’s see here, we’ve of course have video modules on our websites and webinars. We call them live GDX webinars, and we have the lab report podcasts as well. Patty and Michael are just really entertaining and lots of great information about Genova testing and a really nice resource to have. And of course we have medical education consults as well. And that’s if you have a Genova account and you want to talk about a patient test result with us, you can let 800 number and set up a phone consult. You can request to speak to me if you’d like on that consult, but there are a great team of doctors here at Genova that can offer assistance with picking the right test or answering questions about the test. Those kinds of things.
Dr. Weitz:
Okay, great. Thank you so much, Dr. Brown. It doesn’t look like we have any additional questions. So I thank everybody and we’ll see you next month. The discussion of dermatology is going to be really good. Julie Greenberg has some great clinically useful information to help us with our patients.
Dr. Brown:
Yeah, she’s great. I’ll be tuning in for that one as well.
Dr. Weitz:
Oh, okay.
Dr. Brown:
Thank you for having me, Dr. Weitz.
Dr. Weitz:
Thanks much everyone in attendance. I appreciate that. Thanks for your time. Take care.
https://drweitz.com/wp-content/uploads/2021/04/rwp202website.jpg350785drweitzhttp://www.drweitz.com/wp-content/uploads/2017/06/drweitzdsamplelogo-withtext.pngdrweitz2021-04-14 12:21:362021-07-18 03:45:14Nutritional Testing with Dr. Warren Brown of Genova Diagnostics: Rational Wellness Podcast 202
Shivan Sarna discusses a personal perspective on SIBO with Dr. Ben Weitz.
[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.]
Podcast Highlights
2:30 Shivan recalls having food poisoning when she was five and then again when she was eight. She spent a lot of time in the bathroom growing up due to constipation and she was called “Buddha belly” due to abdominal bloating. Then after college she found herself working in a moldy building and she was getting really sick. She went to a Gastroenterologist who told her that she had IBS and prescribed an antidepressant. Shivan did a SIBO breath test and she was told that the results were negative, but it was actually positive but someone had written positive and then crossed it out and wrote negative. She finally saw another doctor she calls the digestion detective, who showed her that it was clearly a positive test result. She became an ideal patient and she sought various treatments, including seeing Dr. Allison Siebecker and going for Ayurevedic, rolfing, steroid shots for firbromyalgia, acupuncture, etc. and she took notes and became knowledgeable about SIBO and IBS. Then Shivan started the SIBO SOS Summit One and then did SIBO SOS Summit Two and the IBS and SIBO Summit. Shivan also did the documentary Digestion SOS: Rescue and Relief for IBS, SIBO, and Leaky Gut. She also did the Microbiome Rescue Summit and then her book, Healing SIBO: Fix the Real Cause of IBS, Bloating, and Weight Issues in 21 Days, came out.
8:40 Shivan has post-infectious IBS that she learned through taking Dr. Pimentel’s IBS Smart test, which is a blood test that measure antibodies to Cytolethal Distending Toxin and to Vinculin. The concept that Dr. Pimentel discovered is that after a bout of food poisoning, the bacteria secrete an endotoxin called Cytolethal Distending Toxin. The immune system reacts and creates antibodies to the Cytolethal Distending Toxin and then these antibodies cross react with a structural protein in the intestinal wall called Vinculin, which then damages the motility of the digestive tract. This is the autoimmune component of IBS and SIBO, aka, post-infectious IBS.
11:12Essentially the IBS Smart Test tells us that IBS is an autoimmune disease. There is a new breath test from Gemelli Labs called the Trio Smart test that can diagnose SIBO and the type of SIBO based on which gas is found, whether it be hydrogen, hydrogen sulfide, or methane. Treatments include pharmaceuticals, herbals, or the elemental diet. For hydrogen and hydrogen sulfide the preferred pharmaceutical would be rifaximin, while for methane rifaximin would be combined with Neomycin. The advantage of rifaximin is that it acts locally in the small intestine and it is not systemic, so it will not devastate your microbiome, which can happen with broad spectrum antibiotics.
13:40 Shivan took rifaximin but had to do multiple two week rounds of it. She kept relapsing because her migrating motor complex was not working properly, so a key for her recovery was to take a prokinetic drug. Shivan described the migrating motor complex (MMC) as the sweeping motion of the small intestine, which is like the crumb clearing that occurs when the waiter at a restaurant clears your tablecloth. If you have scleroderma or diverticulitis or endometriosis, these can all inhibit the migrating motor complex. The collagen condition, Ehlers-Danlos, also negatively affects the MMC. If the MMC doesn’t clear out the small intestine, then bacteria can overgrow and then the bacteria eat fermentable carbohydrates and it becomes like a microbrewery. It causes bloating, and can lead to nutritional deficiencies, anemia, rosacea, and restless leg syndrome.
16:05SIBO breath test preparation. This test requires a 12 hour prep diet followed by a 12 hour fast. For the diet, there are no veggies. You can have white rice, eggs, chicken without the skin, and black coffee. You don’t want to eat anything that will take a long time to digest and that can cause fermentation. Shivan also suggests for the 12 hour fast to sleep as much of that time as possible. She suggests to do the test at home instead of at the doctor’s office. It is best to pre-label all of the tubes ahead of time and so you don’t mess it up, it is best not to plan to do anything else during those 3 hours. It is also helpful to have two timers, like two phones or a timer and a clock. But this test is important to find out what your levels are and what type of gas you have.
18:43SIBO can cause brain fog, which Shivan suffered both from doing the breath test and from SIBO. Dr. Satish Rao has done an interesting study about brain fog and gut issues. (S. Rao, A. Rehman, S. Yu, N.M. de Andino. Brain fogginess, gas and bloating: a link between SIBO, probiotics and metabolic acidosis.Clinical and Translational Gastroenterology: June 2018 – Volume 9 – Issue 6 – p e162.)
19:52Does taking probiotics help with SIBO? Do probiotics, which are bacteria, contribute to the bacterial load in bacterial overgrowth and make the condition worse? Some practitioners find that prescribing probiotics can be very helpful for patients with gut problems like SIBO/IBS, while other practitioner find that they often cause their patient’s symptoms to flare and get worse.
21:50Quick Symptom Relief Strategies, which includes strategies for relieving bloating, pain, constipation, diarrhea, acid reflux, etc., including applying castor oil packs by getting good, organic castor oil and apply it to a piece of flannel or an old T-shirt and then place it over your stomach with a piece of parchment paper and a hot water bottle on top. It will stain your sheets and make your night clothes sticky, but it really helps with pain, inflammation, and motility. It works best if you do it consistently for a while, like five nights in a row. Activated charcoal can help with diarrhea, but you should take it apart from food and supplements. There is a form of butyrate–tributyrate–that helps with diarrhea. Iberogast is a good natural prokinetic, though it is hard to find. For constipation, you want to drink a lot of water and magnesium can be really helpful. Abdominal pain can be related to visceral hypersensitivity and curcumin can be helpful. For abdominal bloating, Atrantil can be helpful, and it helps irradicate SIBO, esp. the methane form. Peppermint oil and peppermint tea are helpful for pain. Gas-X and Pepto-Bismol can also help with pain. Also IB Gard is a form of peppermint oil capsules that is sold in drugstores.
32:16SIBO diet. Shivan used the SIBO specific food guide developed by Dr. Allison Siebecker, which is her version of the low FODMAP diet. You want to eat in a manner that will reduce your fermentable load. You have to understand that while diet can help to avoid feeding the bacteria and this can make you feel better, diet alone cannot cure SIBO. To this day, even though she feels much better with her SIBO, she still cannot tolerate garlic or onions and she eats gluten free. You can get green onions and just eat the green part, so it is like eating an onion without eating an onion.
37:30 Shivan used antimicrobial herbs, including oil of oregano, allicin in the form of Allimax or Allimed. She used CandiBactin-AR and BR from Metagenics. She also tried the Elemental diet and she tried both Integrative’s and Dr. Ruscio’s version of it. Shivan continues to take a prokinetic and she cannot really tolerate most of the natural ones because most of them contain ginger and she gets reflux from eating ginger. She takes Motegrity, which used to be called Resolor. You also have to make sure to space your meals out so you have 4 or 5 hours between meals to stimulate your migrating motor complex to work. Shivan also found it helpful to use the biofilm busting agent that was developed by Dr. Paul Anderson at Priority One.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness Podcasters.
Today our topic is SIBO, small intestinal bacterial overgrowth, with Shivan Sarna. Now, we’ve certainly discussed SIBO quite a number of times. However, there’s always different perspectives, and today we’re going to get a little bit of a patient’s perspective, along with additional scientific information that she’s gleaned both from her own experiences, as well as being the primary interviewer and creator for the docuseries Digestion SOS: Rescue and Relief for IBS, SIBO, and Leaky Gut, as well as the SIBO SOS Summit. And now Shivan has published a book, Healing SIBO. It’s a very readable, helpful book for anybody dealing with SIBO. And so, what is SIBO? SIBO is small intestinal bacterial overgrowth, and it is the most common cause of irritable bowel syndrome, IBS, which is the most common digestive disorder. IBS is characterized by one or more of the following symptoms: abdominal pain, gas, bloating, diarrhea, constipation, sometimes alternating, nausea, and the urgent need to defecate, as well as a whole bunch of other symptoms. Sometimes skin issues, sometimes brain fog, et cetera. And so, Shivan Sarna, thank you so much for joining us today.
Shivan: Oh my gosh, thank you so much. I’m a long time listener and a huge fan. I appreciate it. I got to get the word out, man, so thank you for letting me talk about constipation, diarrhea, and bloating on your show.
Dr. Weitz: Yeah. Hopefully, we won’t have constipation of the mouth. Maybe you can tell us about your personal journey with digestive disorders and SIBO.
Shivan: Before I tell my story, I always say I’m going to tell the story in a way that hopefully will help someone else. Not just like, “Ooh, what’s my story?” Because I usually … As an interviewer, I’m like, “Oh, is anyone going to listen to the story? What’s in it for you? I’m going to tell you.” I had food poisoning when I was five. Then I had food poisoning when I was eight. Trip to India. Trip to a farm. And I was never the same afterwards. And the reason I know that, it’s not that I have these overly vivid memories of that time in my life, although I do remember the episodes. My father’s from India. My mom’s from Upstate New York. And my dad, familiar with Ayurvedic basics, was like, “I don’t think Shivan’s going to the bathroom enough,” to my mom. And my mom made inquiries to me, the five-year-old. And that was the first time ever experienced shame. Like, “Really, am I doing something wrong? Get out of my beeswax. I’m five.” But that was a big, like, “Is something wrong with me?” And they had a poster in the bathroom with this long quote on it and it’s the first thing I ever memorized, because I spent so much time in the bathroom. So, that’s the beginning. I grew up and we called it “Buddha belly,” with all respect to Buddha. And I’m skinny everywhere else, but I have this bloated belly, and-
Dr. Weitz: So we’re going to talk about the spiritual aspect of SIBO.
Shivan: Oh, absolutely. Oh, honey. There is no doubt about it. It has taken me there. Lot of praying. Praying, expressing gratitude. It all blends together in my world.
Dr. Weitz: There you go.
Shivan: So, I went to college and my girlfriends in the sorority house, they clearly didn’t have the same patterns that I had. I had been drawn into health food starting at age 15 with food combining, if you remember that. And just, I was different, which I’m used to. It’s fine, but there was something going on. And then fast forward, I have this big career. I work in a moldy building that I didn’t know was moldy for 20 years, and I’m getting really, really sick. And people are asking me if I’m pregnant on Facebook, which I am not. And that’s devastating for somebody who’s supposed to be an aspirational TV host. But I’m also really not feeling well. So, I finally go to a gastroenterologist, and the gastroenterologist is like, “Well, you probably have IBS. Run three miles. Here’s an antidepressant.” And I thought, “Are you trying to tell me it’s all in my head? And I don’t have the energy to run a block, much less three miles.” So, I had this other girlfriend at work, and she was another weirdo, because we were gluten free, and we were weird. Fine. That’s fine. And she told me … I saw her randomly and she’s like, “Oh my gosh. I’m doing this really crazy antibiotic, and I had to do this test where I breathe into this test tube. Got to go. Talk to you later. Bye.” And I was like, “What? Wait a minute.” So, I got the information. She was not … She was wonderful, but did not know what the heck she was talking about. She was just doing what her doctor said. I did a SIBO breath test. Same thing, didn’t know what I was talking about. I was just like, “Whatever. Maybe it’ll help me. I don’t know. I’m desperate.” And I got the wrong information, in that someone said it was negative, when actually, it was positive, and I lost 18 months. And when you’re chronically uncomfortable and you’re trying to figure out your diagnoses, you’re like, “Oh, don’t have that. Great.” I begged for a colonoscopy on the last appointment before Christmas break. They were closing the outpatient clinic down, basically, as I was recovering. “Oh. No, I don’t have cancer.” Which is great, thank you. But, “Oh, don’t have cancer. What is it? What is it? What is it?” So, it was difficult because I actually did have SIBO, but for 18 months of intense questing, didn’t know that was it. Finally went to a doctor who I call “the digestive detective,” and he’s like, “I want to see the results. I want to see that graph.”
Dr. Weitz: Yeah, there’s a lot of differences in interpretation.
Shivan: Well, there it was. Someone had written “positive,” crossed it out, and wrote “negative.” And when you look at the graph, if you’re even mildly familiar with this, it’s so blazingly obvious that it was a positive result. So, that made me really mad and sad. And my husband was getting his CPA as a grown-up, and so he was studying a lot. And I became, for the first time since the ’80s, someone who had a little bit of time on her hands. So I sat there in front of my computer and did Dr. Google, and took all my notes, and the typical chronic condition patient journey. And I would go to all my doctor’s appointment. Ayurvedic, Rolfing, steroid shots for fibromyalgia, acupuncture, you name it. And every time I’d sit down, I’m like, “Here are all my notes.” I was super like, nerd patient. And they’d look at me and they’d be like, “You know, you really need to write a book.” My spiritual teacher: “You know, you really need to write a book.” So I’m sitting there and I’m like, “Listen, God. I really need to tell the world about what I’m discovering, and if I figure it out, I will tell the world.” What happened was, I was trying to write the book. It’s not that easy. I’m a TV person. I can definitely do an online summit. I can do video. I can do interviews. So, I started with the SIBO SOS Summit One, which Dr. Allison Siebecker was so pivotal in, because she introduced me to all of her colleagues. And then, I did SIBO SOS Summit Two. I did the IBS and SIBO SOS Summit. I did the documentary you referred to, Digestion SOS: Rescue and Relief for IBS, SIBO, and Leaky Gut. Looks better on paper than mouthed. And then I’ve done the Microbiome Rescue Summit, and then the book came out, because I took everything I learned from these summits as well, and put it into the book. So, that’s how I got here. I do have post-infectious IBS. I learned that from Dr. Pimentel’s blood test, which I know your listeners … Go back and listen to Dr. Mark Pimentel’s session, if you haven’t listened to it. So I know I have the antibodies, which we’ll explain, and therefore I’m very religious with the prokinetic, which we’ll also explain. And so, another message is, if you have a chronic condition that goes untreated, you can feel horrible. If you have a chronic condition that is treated, you can feel 100% better. And that’s what I do.
Dr. Weitz: Right. So, for those listening who don’t understand about the autoimmune component, how you could take a blood test and tell you that you have SIBO, is that Dr. Pimentel discovered that one of the most common causes of SIBO is that somebody gets food poisoning, and the bacteria that causes the food poisoning causes an immune reaction. And the immune system reacts against a toxin that that bacteria secretes, called “cytolethal distending toxin,” and then those antibodies, again, cytolethal distending toxin, then also react against a structural protein in the intestinal wall called “vinculin.” And so, there’s a blood test that Dr. Pimentel developed, that measures antibodies to cytolethal distending toxin and vinculin. And so, when this test is positive, it shows … and then what happens as a result of the immune system, the antibodies attacking the vinculin, it affects the migrating motor complex and the motility of the small intestine, and that allows the bacteria to build up. And so, this blood test will tell you that you have these antibodies, and that’s how your SIBO developed.
Shivan: So, officially, if you have post-infectious IBS, like if you talk to the guys at the lab, they will not say that it’s a SIBO test, right? Because the SIBO breath test, which Gemelli Labs, also from Dr. Pimentel, does. But it tells you have post-infectious IBS, which is SIBO, which is … but it’s not a SIBO, officially, according to all the medical people. It’s not.
Dr. Weitz: Right. [crosstalk 00:11:07]
Shivan: Yeah. But I’m really glad I did it, because now I know my underlying cause.
Dr. Weitz: Yeah. And one of the most fascinating things about that test is, it tells us that IBS, which is the most common digestive condition, is actually an autoimmune condition. So, how should patients think, who have IBS and they go to a conventional gastrointestinal doctor, and they’re told to just take some drug to treat the symptoms, like you were told to take a antidepressant? Or maybe they have diarrhea and they’re given a drug to control the diarrhea, or maybe they even got diagnosed with SIBO and were given two weeks of an antibiotic known as rifaximin, and then they’re still not better? What should SIBO patients think about that situation?
Shivan: Well, first of all, there is a breath test for SIBO that you can take, that will tell you what kind of SIBO you have. Do you have hydrogen-dominant? Do you have methane-dominant? “IMO” for short. Or do you have hydrogen sulfide? And that’s called “Trio Smart” from Gemelli Labs, and also Aerodiagnostics does a beautiful job with breath testing. So, you find out what your levels are, right? And what kind of gas you have: hydrogen, hydrogen sulfide, or methane. Then that will dictate the treatment, and there are three major treatments. One is pharmaceuticals. One is herbals, and one is the elemental diet. And that rifaximin that you were just talking about is the antibiotic that Dr. Pimentel discovered works in the small intestine, stays in the small intestine. It’s actually the one given for traveler’s diarrhea. So, since e. Coli is the cause of much of the SIBO out there, that makes sense. And then if you have the methane-dominant, it’s combined with Neomycin, and then if you want to do … and there’s some other variations, but those are the main ones. And you need to realize that, after you do that round, it’s not like normal antibiotics, where like, “I was sick. I took the antibiotic. I’m well.” You may have to do multiple rounds, but the studies show that to rifaximin, the resistance … I would say the clinical experience, at the very least, the resistance is not like with other antibiotics. It also stays in the small intestine, so it’s not like a nuclear bomb goes off in your microbiome, whereas Neomycin, it is bigger.
Dr. Weitz: You took rifaximin, right?
Shivan: Oh, yeah. Oh, yeah. I’ve done it all.
Dr. Weitz: What was your experience with it?
Shivan: Well, so to your point, I was not told that I would have to do multiple rounds. So I took it and wasn’t better, and I was like, “What the hey?” Like, “Wait a minute. This isn’t normal.” So I took it and then re-tested, and saw that it helped, so then I did a couple multiple rounds. This whole time, though, I was not told to do a prokinetic. So, I was relapsing because I wasn’t still moving my migrating motor complex. So, in a prokinetic-
Dr. Weitz: Maybe you can explain what the migrating motor complex is?
Shivan: Yeah. Sure. You know…
Dr. Weitz: I know, I know.
Shivan: You [crosstalk 00:14:22]. The migrating motor complex is that sweeping motion of the small intestine. They call it the “crumb-clearing” … like, think of a waiter in a white tablecloth restaurant who comes around with that little crumb clearer. Fancy, fancy. That’s not my analogy, but I do love that one. And it sweeps out the debris from the small intestine, and if you have adhesions, if you have scleroderma, if you have endometriosis, diverticulitis, those all can impact the migrating motor complex, along with the antibodies that you were just talking about. And if it’s adhesions or endometriosis, it’s because literally, it can be pulling the small intestine out of a particular place in the body. Ehlers-Danlos, the collagen condition as well. So, your migrating motor complex actually might work from a mechanical, chemical perspective. But the physicality of the placement of the intestines could be inhibiting that motion.
Or if you’re like me and you have post-infectious IBS, then you have that mechanical chemical thing going on. So, when you don’t sweep the debris out, the food in the small intestine can overgrow, thus small intestinal bacterial overgrowth, because … not the food. The bacteria eats the food in the small intestine, and that is what overgrows, and become like a micro brewery. And it ferments your food, all that bacteria overgrowing, and that’s why the bloating comes, and it can rob you of your nutrition. It can lead to imbalances of anemia, rosacea, restless leg syndrome. I’ve spoken to some of these doctors and they theorize, some of them, that it may even impact fertility, which I found fascinating.
Dr. Weitz: Interesting. So, do you have any suggestions, you mentioned a breath test, for patients who are getting ready to take the SIBO breath test, from a patient’s perspectives?
Shivan: Yeah. No, I’m a vegetarian, so it’s even more intense because you have to do a 12-hour prep diet, followed by a 12-hour fast. And so, they suggest that, for the 12-hour fast, you sleep-
Dr. Weitz: You don’t have any vegetables?
Shivan: Oh. Well, during the diet, it’s no veggies … Well, it’s rice. You could do white rice. You can do eggs. You can do chicken without the skin. You can do black coffee. It’s super, super limited. And the reason is, is because they’re trying to get you to not ferment your food. And even though rice is a carbohydrate, it stays higher up in the intestine and gets digested fairly quickly, so it doesn’t really get a chance to ferment in the low intestine. So, I suggest doing the prep diet, being very strict on it.
Then I suggest sleeping for as long as possible the next day for that 12 hours. I’m not saying sleep for 12 hours, but if you can sleep for eight hours, then you only have a four-hour window until it’s time to take the breath test. And you could take it in the office of a doctor who gives them, but you can also do it at home. And I prefer that, because I can … especially now, do it at home. But I tend to not do well with lactulose, which is the sugar that you drink prior to breathing into the test tubes. The body doesn’t digest it, but the bacteria love it. And then, you breathe into these test tubes every 20 minutes for two or three hours. It depends on whichever test you’re doing, by the manufacturer and the lab. But I tend to get a lot of brain fog when I drink lactulose, so I have messed the test up, simply by going, “Did I just breathe into this test tube? Is this test tube eight or is this test tube nine?” So, pre-label everything. Have two timers, like two phones or a timer and a clock, and try not to get too distracted, because keeping track after a while … and it looks … not nothing, but it looks like, “Oh, I can handle this.” Now, Dr. Siebecker will run an errand, go to the grocery store and do a SIBO breath test no problem. I’m like, “Okay. I’m locked and loaded. For the next three hours, no one bother me.” So, everybody’s different. But it is a little bit of a project but it’s totally worth it to find out what your levels are and what type of gas you have.
Dr. Weitz: Right. And so, you have some issues with brain fog from lactulose. Do you get that from your SIBO as well?
Shivan: I do. I did have really bad brain fog from … I do believe it was my SIBO, combined with my mold. At one point, I couldn’t … It was one day, I should say. I mean, it’s been fluctuating, but the worst brain fog I ever had was, I couldn’t speak. And that was extremely scary since I talk for a living. And it was on a weekend, so I was able to actually recover. But I couldn’t speak. And it’s fine to lose a word every now and then, but I literally could not find a couple of words. Not to mention the mechanical, putting my lips together and breathing, speaking. It was bad. It was bad. So, that was the worst case scenario. But brain fog is real. And Dr. Satish Rao has done a very interesting study about brain fog and these gut issues, which was not without controversy, but I think was quite compelling.
Dr. Weitz: Are taking probiotics good or bad for SIBOs? Some practitioners say if you take any bacteria, it’ll only add to the bacteria you’re trying to eliminate. There are some practitioners, like Dr. Ruscio, who feels that probiotics, after you institute a diet, should be your first intervention, and that alone can take care of the SIBO. What do you think about probiotics and SIBO?
Shivan: So, I’m definitely a big fan of Dr. Ruscio’s, and I’ve heard his … I’ve interviewed him about this topic, about the rotation and the different types of probiotics. I think it’s fantastic. I mean, if you’re sitting there going, “I’ve tried everything.” First of all, Dr. Siebecker always says, “Have you really tried everything?” But anyway, if you feel like you’ve tried everything, I would definitely read Dr. Ruscio’s book and go to his website for his blog posts about it, about the rotation of these three types of probiotics, to see if it helps. He has incredible clinical results with it. Classically, people are very split down the middle. Why would you take a probiotic and add more bacteria when you already have an overgrowth of bacteria? But if you sit and think about it, is that bacteria making it to the small intestine from the probiotic? Is that probiotic full of a gatekeeper-style probiotic that will actually help to balance the diversity, and actually help to get rid of the bad guys in an overgrowth? So, I think it’s very personal as the microbiome is, and I think if you feel like you’ve tried everything, it’s worth a try. But so, I don’t have an answer for you that’s clear-cut and like, “Yes, this always works,” because it doesn’t. It’s very personal. I know people that it has been like a miracle for, and I know people that it’s been really uncomfortable for.
Dr. Weitz: You have a chapter in your book on quick symptom relief strategies, and I thought some of those were really interesting. Maybe you can talk about some of these quick symptom relief strategies for … You have ones for bloating, pain, constipation, diarrhea, acid reflux.
Shivan: So, remember, I’m the patient, right? And I’ve interviewed all these experts, and so this is based on Dr. Allison Siebecker’s symptomatic relief guide. And-
Dr. Weitz: Right. Now, one of them that you talked about was applying castor oil, and you put that directly over your stomach. Tell me about that.
Shivan: Love it. Love it.
Dr. Weitz: Okay, so how do you do it, exactly?
Shivan: Okay, so there are a couple of techniques. So, you get the organic, good castor oil that’s in a dark glass bottle, and you take a … This is an old school naturopathic technique, right? You take a piece of flannel. I know some people who only do organic flannel, whatever. I have seen people use a T-shirt before. This is before you go to bed, right? And you put the castor oil on, and you put the flannel on. Maybe you put a piece of parchment or wax paper on, and then you put a hot water bottle. Some people put heating pads. They’re going, “Oh, the EMFs,” whatever. So you have to decide. But then you just keep it on for as long as possible. It will stain your sheets. It will make your night clothes sticky, so I put on a … To be very personal, I take my husband’s boxer briefs. I wear them that night, and I take an old T-shirt of his, and I put it on underneath and kind of tuck it in and around, and it works great. This is not something to wear with your pretty nighties. And basically, the castor oil, which is, in my opinion, not a great idea to consume, it’s an old school, very, very strong laxative. There are so many other options.
Dr. Weitz: Yeah. Remember, castor beans are where the poison ricin comes from.
Shivan: Exactly. Let’s not go crazy here, people. There are too many other options. But it reduces inflammation. It helps with motility. It helps balance things. So I know people with diarrhea that have done really well with them. I know people with constipation. Just even the bloating. It’s very soothing. I also … I have a Facebook group with 18,000 people in it. So when I’m talking about, “I’ve seen people do this and I’ve seen people do that,” the SIBO SOS Facebook community is what I’m referring to. Not to mention all the emails I get. But I’ve heard people say like, “I tried it for two nights and didn’t notice it.” Give it like five nights in a row, and I mean, chances are you’re really going to notice something good. It’s pretty magic from that perspective. So, that’s very soothing. Very, very soothing. And I think we need to be soothed. I think we need to be comforted.
Dr. Weitz: Yeah. What are some of the other relief strategies?
Shivan: Some of the other relief strategies include, if you have diarrhea, activated charcoal which is sold everywhere. If you feel like you ate something that was, “Did I just get food poisoning?” That’s really handy, and it does tend to constipate, so Dr. Siebecker suggests that you take it with magnesium if you’re worried about that. Although it does also absorb nutrients, so maybe wait a little bit, then take the magnesium. You don’t want to take it with food. We see charcoal showing up as an odor remover, as a teeth whitener, which I don’t suggest. I’m doing a dental summit, so I know, don’t do that. I mean, it can be totally life-changing for people. So charcoal if you have diarrhea. I also just talked to Steve Wright, I don’t know if you know him, from SCD Lifestyles?
Dr. Weitz: Oh, I’ve heard him. I’ve never met him. Yup.
Shivan: Lovely guy. Really smart guy. And he just talked to me about Tributyrin-X, basically tributyrate, for diarrhea, and that works like a champ as well, so I thought that was really interesting, that particular-
Dr. Weitz: Tributyrate? Is that similar to butyrate?
Shivan: Yes. Yes, but they’re different forms of butyrate, so this is the tri. But yeah. He’s had great success with that. Some of the other things are Iberogast, which is hard to find with American English writing on the box. You can get it on Amazon, and it looks like it might be an Eastern European language. I don’t know if it’s Russian or what. But that is a natural prokinetic, and interestingly enough, will help people if they’re nauseous, help people if you have diarrhea, constipation. It’s really interesting. It is not to be taken if you are on opioids, so that’s just a little disclaimer. But that’s been also pretty miraculous for a lot of people, and you can play with how many drops that you take. I personally don’t like the taste of it. I’m a super taster, so I was doing our course, the SIBO Recovery Road Map with Dr. Siebecker, that we created together. And we were taping that day and I was like … I’d just come back from work. I’d just been in the mold. I didn’t really feel well. And we had all these products out in front of us, and I’m like … She’s talking to me about Iberogast and I’m like, “You know I hate the taste.” She’s like, “Yeah, but you don’t feel well to begin with.” I’m like, “I know. It’s terrible. I feel terrible.” So, we caught me on tape taking it, and then how I reacted within an hour, and it did the trick. It really did the trick, so that’s my personal testimonial for that.
Dr. Weitz: What about for constipation?
Shivan: So, that does work for constipation too, but certainly, making sure you’re drinking enough water. I’m not going to say, “Do fiber,” because if you have SIBO, the bacteria feeds on fibers. So that’s why, in my book, it’s a vegetarian set of recipes, because you can always add any kind of protein you want. But when you are doing recipes and eating for SIBO, it’s hard if you want vegetables. Of course, we all want veggies. And so, if you are constipated, I’m not going to say, “Do fiber.” I am going to say that Dr. Siebecker talks about … Let’s see. I’m going to try to remember here.
Dr. Weitz: Well, magnesium, of course.
Shivan: Oh my gosh. Magnesium, of course. Magnesium is her go-to. Most people, she says, don’t do enough. Right? So we think, “Gosh, I’m doing 600 milligrams. That seems like a lot.” And for somebody, it is. But maybe for you, it’s not. So, she likes the Vitamin Shoppe’s magnesium. I like it, but my husband has it around the house, so I usually just take that, but magnesium is like magic for a lot of people with constipation.
Dr. Weitz: And what about any other hints for pain? You had a couple of interesting ones in there.
Shivan: For pain, it’s definitely something that … So, I just want to talk about pain for a second, from the perspective of people with IBS. You may have visceral hypersensitivity. And visceral hypersensitivity is pretty much what it sounds: visceral, the belly/abdominal area, and hypersensitivity. What hurts you might not hurt somebody else. It could feel over the top for you. Like, “Oh my gosh, I feel like I’ve got a knife in my belly.” Other people could eat the same thing or have the same experience and they’re like, “Oh, I’m fine. It’s no big deal.” So, in your practice, how do you handle visceral hypersensitivity?
Dr. Weitz: Curcumin is an interesting nutrient that’s been shown to be beneficial.
Shivan: Oh, we love. Love. Okay, do you do the pepper or no pepper?
Dr. Weitz: No pepper. I don’t like the pepper.
Shivan: I don’t like the pepper either!
Dr. Weitz: Patients hate it, especially if you want to do a high dosage. The pepper’ll just irritate their gut, so we use the one blended with phosphatidylcholine, the Meriva form.
Shivan: Oh, yeah. Nice. Nice.
Dr. Weitz: Yeah.
Shivan: So just real quick, this is the section on the symptoms, like you were talking about. There’s a section on bloating. Oh, Atrantil, I have to give a shout-out to. If you have methane-dominant, methanogen overgrowth, Atrantil is worth looking at.
Dr. Weitz: Yeah, we use that. Dr. Ken Brown, yeah.
Shivan: He’s awesome. Awesome. So, peppermint oil and peppermint tea is also great for pain. It helps things move, but not in a laxative way. Also, some of the pain, I think is … depends, obviously, but from gas. And Gas-X helps to break the big gas bubbles into smaller bubbles, so it doesn’t feel as much pressure. And also, Pepto-Bismol is around for a reason, for a really long time. There is a brand from Target. I can’t remember the name of it right now. I think it’s in here, but it’s the in-house brand of Target. They have the safest for SIBO-
Dr. Weitz: We just can’t do that. I just can’t … Artificial sweeteners and artificial colors, and …
Shivan: Yeah. Oh, the color. Oh, yeah. The nature pink. What? I’m not saying it’s natural. I’m not saying it’s natural.
Dr. Weitz: I know, I know.
Shivan: I’m saying, in desperate times, sometimes, desperate measures. This is full of natural [crosstalk 00:31:35]
Dr. Weitz: I notice in your book, you talked about, if they’re having abdominal pain, that if they use … If the pain is in the upper part of the abdominal cavity, that peppermint tea might be better, whereas if it’s lower down, enteric coated peppermint capsules might be better.
Shivan: Because of the enteric coating, it’s going to make it further down.
Dr. Weitz: Right. Yup, yup.
Shivan: The IB Gard, I think is what it’s called. And that’s been studied, and you can get it at all your local drugstores, so that’s a Godsend too. And it’s something like … It’s not going to hurt. It might help, right? So, very low risk. Very low risk.
Dr. Weitz: So, let’s go to diet. Which version of the SIBO … There’s multiple SIBO diets out there. The one that’s talked about today the most is the low FODMAP diet. And you mentioned the specific carbohydrate diet. There’s one diet where you actually count up the points for the amount of fermentability.
Shivan: Fast tract diet, Dr. Norm Robillard. Yeah.
Dr. Weitz: Exactly, so there’s that one, and then there’s Nirala Jacobi’s got her version in phases, and …
Shivan: Bi-phasic diet, which is based on …
Dr. Weitz: Bi-phasic diet.
Shivan: Which is based on Dr. Allison Siebecker’s SIBO specific food guide, which is kind of all of them combined.
Dr. Weitz: Right. And Pimentel likes the Cedars-Sinai white bread, white rice diet, of low fiber diet.
Shivan: Diet Coke.
Dr. Weitz: And then, Allison Siebecker has her version of it. So, what did you find best for you?
Shivan: For me, I did the SIBO specific food guide, and that’s in the book. Allison very graciously let me use her work in the book, and it’s based on all of those things combined, to way oversimplify it. And it’s very portion-specific, so you have to be careful not to get too focused on the portions, or I think we can go a little bit overboard. And also, on the one hand, it’s careful. Like, “Oh, I can only have this many grams of this, or half a cup of this.” And then we get really, really uptight about it. On the other hand, this is what happened to me in the beginning. Like, “Oh my gosh, I can eat zucchini.” And I would eat five zucchinis in a day. That’s the other end of the spectrum, so you have to be aware of those portions. But you’re trying to reduce your fermentable load, so that the bacteria doesn’t go crazy on these carbohydrates that are more easily fermented than others. So, this is so important. The diet does not cure SIBO. The diet controls the symptoms. That’s really important. There is a lot of mythology around that the diet is going to cure SIBO, and it doesn’t. It will make you feel better. It definitely controls the symptoms. You could feel better in a couple of days by fixing your diet, by being on the SIBO specific food guide, or some of these other carefully calibrated, low fermentation carbohydrate diets. So, that is a huge point in the book. But also, I have 40 recipes, vegetarian. Again, if you’re a vegetarian, it’s much harder if you have SIBO. And so, I wasn’t going to make it like, for the easiest common denominator. I was going to make it for the most difficult common denominator. And then you can always add whatever protein you want.
Dr. Weitz: So, how long do you have to stay on this kind of diet? And do you still have restrictions in your diet?
Shivan: So, do not give me garlic. It’s not going to work. It’s not happening. I stopped liking it. It doesn’t work for me. It makes me sick. I hate it. I love the smell and I’ll put it in some garlic-infused oil. That’s fine, and it’s occasional. So, how long should you be on the diet? So ideally, you’re on the diet while you’re trying to get your treatment under control. This is not a long-term fix, because the biodiversity of the microbiome will be impacted. It’s not going to be devastated. If you’re doing it for eight weeks, you can rebuild it. Your microbiome is changing all the time. Ideally, you’re trying to do, even within these foods … In the back of the book, there’s this chart. There’s a lot of diverse foods in there. It’s not like you’re eating three foods. You can do bok choy and all kinds of fruits and vegetables and cabbage and green beans. I mean, it’s not like you’re going hungry, and it’s not like you couldn’t even really, maybe eat some foods you didn’t usually eat to diversify your microbiome. But it shouldn’t be forever. I know people who’ve been on it for five years. That’s too long. It’s really too long. You need to diversify.
Dr. Weitz: So, other than garlic, where are you in terms of food restriction?
Shivan: I’m, by choice, gluten free. I don’t do onions. Really, it’s onions and garlics. I used to not be able to do apples, which are notoriously high in FODMAPs, and something I literally said to myself, “I’ll eat an apple. It’s good for me. It’ll keep the doctor away, right?” And then was like, more bloated. This was way back. So, I can eat almost anything now. I just don’t do garlic and onions. That’s me. Everybody’s different.
Dr. Weitz: I noticed in one of your recipes, you were talking about taking a green onion and just not eating the white part. So, it’s kind of a way of sort of getting an onion without getting an onion.
Shivan: Exactly. So, the green part of scallions is-
Dr. Weitz: “How to get an onion without getting an onion.”
Shivan: Yeah, that’s the way to do it. That’s the way to do it.
Dr. Weitz: So, let’s see. What else do we want to talk about? Did you do antimicrobial herbs? And which ones did you find helpful for you?
Shivan: So, I did the pharmaceuticals. Then I did the antimicrobial herbs. I did oil of oregano. I did the allicin, like Allimed, or Allimax. And Allimed is stronger, even though “Allimax” makes it seem like it’s stronger. And I also … This was on a rotational basis. I did CandiBactin-AR and BR, which is what was studied compared to the rifaximin, and was found to be a little bit more effective, but you have to do it for a month versus two weeks. I’ve pretty much done it all. I’ve done the elemental diet as well, and that was okay for me. I didn’t last the whole time, which is supposed to be anywhere between 14 and 17 days. My lifestyle at the time … You have to really be prepared mentally, because it’s only liquid diet for that time, and-
Dr. Weitz: Really hard.
Shivan: It is hard, and a lot of people say, “Oh, I wish I had this to begin with,” because it’s so effective. It is the most effective treatment, but it is hard. And I couldn’t take 17 days off to do it. And if you do the high performance job that I have, of doing live television, you can’t mess around. You have to feel good when you go out there. There is no messing around. So, I played with it. I also have used it as a meal replacement on occasion, and it’s a great gut reset. This is a diet that is originally a liquid diet that was for feeding tubes, and it’s made up of amino acids that are quickly absorbed into your body, almost like instantly digested, and it feeds you but it doesn’t feed the bacteria, so you’re starving the bacteria instead of killing it through a killing agent like an antibiotic. They used to taste disgusting. Disgusting. And people, speaking of desperate times, were so desperate to change the flavor that it became sort of famous that people put Crystal Lite to fix the flavor, and it still didn’t fix it. But Dr. Ruscio and Integrative Therapeutics, they’ve made a much, much better-tasting set of elemental diets that you can pick from, like chocolate and vanilla, and they taste like really sweet milkshakes, like really sweet. But I mean, it’s so much better by comparison.
Dr. Weitz: I think that’s Ruscio’s version, not Integrative’s. Theirs is just one flavor.
Shivan: Yeah, it’s vanilla. Right. He’s got more variety. I like his taste better, but maybe you’ll like the Integrative Therapeutics better. Who knows? But you have to make you’re doing enough calories so you don’t lose weight.
Dr. Weitz: Right. Prokinetics. Do you continue to use a prokinetic? Is it a natural one or a prescription one? Have you tried the natural ones?
Shivan: I can’t do ginger, because I tend to have a little reflux with my lower esophageal sphincter, so I get the ginger burn. Or you get it once and you never even want to try it again. But other people love ginger. It is a natural prokinetic which is what we talked about earlier, of moving the migrating motor complex so that it sweeps the bacteria out of the small intestine so it doesn’t overgrow. It’s what helps prevent relapse. There are prescriptions that are … like Motegrity, which was called “Resolor,” which was usually only available in Canada, and now it is available in the States. There’s MotilPro, which is also natural. It has a lot of ginger in it. There’s one called … It used to be called “Zelnorm,” and it was taken off the market, and it’s back on the market. And I cannot remember the name of it to save my life right now.
Dr. Weitz: I think it’s called “Prucalopride.” No?
Shivan: Yup. Well, Prucalopride is the Resolor, which is now Motegrity.
Dr. Weitz: Oh, okay. Okay.
Shivan: Tegaserod. I think it’s called “tegaserod,” or something similar to that. That is another prokinetic. You could literally type in “Zelnorm” and you’ll find the new name for the prokinetic. These are IBS medications sometimes.
Dr. Weitz: Right. So, do you continue to take a prokinetic?
Shivan: I do. Oh, yeah. I definitely do.
Dr. Weitz: Which one do you take?
Shivan: I still have those antibodies, so I definitely still take it, and that’s-
Dr. Weitz: Which one do you take?
Shivan: I take Motegrity, which was Resolor in Canada.
Dr. Weitz: Okay.
Shivan: Love the stuff. Love it. I never thought I’d say that about a prescription medication, but I’m like, “I love it.” Does the trick. And it doesn’t necessarily cause a laxative type reaction, so prokinetics are not laxatives. You may have a laxative experience, but it’s not the goal. The goal is to keep the migrating motor complex going.
Dr. Weitz: Right. So, you have the motility that occurs when you’re eating, that pushes the food down, and then you have these cleansing waves that happen in between eating when you haven’t eaten for three or four hours, and that’s what you’re really trying to stimulate.
Shivan: Yeah, and I’m glad you just said that. Meal spacing is super important. You want to not eat small meals throughout the day, unless your doctor’s advised that because of your blood sugar scenario. But to get the migrating motor complex moving, you need to not consume calories for about four to five hours, because the migrating motor complex will not work when you have that full mode of the body and calories indicate that, so you need to have, like … A lot of people take their prokinetic at night. I do, because you’re not taking calories in at night.
Dr. Weitz: Right. You mentioned biofilms, and that being an issue with trying to get rid of the bacteria. Did you find anything that was effective in breaking up biofilms on your journey?
Shivan: So, I’ve had the pleasure of interviewing Dr. Paul Anderson multiple times, and his combination, he’s got a formula at Priority One, and then he has a prescription biofilm buster. That has proven to be really helpful for me, and if anybody doesn’t know what a bio-
Dr. Weitz: Do you use the Priority One one, or the prescription one?
Shivan: I’ve used them both. I’ve used them both. They were both great for me. If people have long-term SIBO and they have not been able to reduce the bacterial load, I do suggest reading up on how a biofilm buster can help you, because maybe that biofilm is keeping that bacteria overgrown in a lockdown position … not to be medical, because that’s not a medical term, but in a state where it isn’t breaking up and releasing, so it’s not behaving as it normally would, if a biofilm wasn’t there. And we have biofilms everywhere, right? The skin, the mouth, the genital area. Yeah, the intestines. So, it’s like … I call it “mucus” in my head. I just think of that as a biofilm, and it keeps pathogens trapped in it, and it’s very elaborate in the way that it likes to survive. It’s quite interesting.
Dr. Weitz: Right. Yeah, I think we’re all aware of the fact that bacteria often have biofilms, and that could be a problem in getting rid of them. The problem is, is a lot of the strategies we try, the products on the market all seem to be somewhat disappointing, so maybe we’ll have to look into the Paul Anderson formulas a little more.
Shivan: Oh, yeah. I think people have a lot of success with those. A lot of success. And if you have been trying for a long time to get rid of SIBO and you just can’t beat it, and you haven’t done a biofilm buster, I would definitely suggest doing that in conjunction, very carefully timed with your treatment.
Dr. Weitz: Right. So, how can our listeners and viewers get ahold of your book? Where is it available?
Shivan: Well, I’m so glad you asked, darling. Thank you. It’s on Amazon and …
Dr. Weitz: Barnes and Noble.
Shivan: Barnes and Noble, and where all books are sold. We’ve just gotten it into the UK, and a couple of other overseas markets, at the very least, in Kindle. And yeah. I mean, this is what I wish I had known five years ago when I started my figuring out about SIBO. It is loaded with information. Some of the feedback, which I so appreciate, has been like, “It’s an easy read.” It’s something that they’re highlighting. On page 111, there is a map. We call it the “SIBO recovery road map.” It is the algorithm that Dr. Pimentel originally created, that then Dr. Allison Siebecker and Dr. Steven Sandberg-Lewis added to. And it literally takes you step by step through what to do. Like, “Test, symptom relief, diet. Then do your three-hour lactulose breath test. Choose a treatment: elemental, herbal or antibiotics. Afterwards, test again. And if you’re well, manage. If you’re not well, treat again.” And it just takes you through the whole cycle so you don’t have to keep memorizing everything I was just talking about. So, that’s in there, and that’s also what the core SIBO recovery road map is based on as well, is that algorithm. So, sibosos.com is my website. And our SIBO SOS Facebook community, we’d love to have everybody there. And that’s how you can get ahold of me.
Dr. Weitz: Awesome. Thank you.
Shivan: Thank you so much. Keep up the great work. We love your work, and getting us all educated. Appreciate you.
Dr. Weitz: Excellent, excellent. Thank you so much.
Dr. Weitz: Well, thank you, listeners for making it all the way through this episode of the Rational Wellness Podcast. Please take a few minutes and go to Apple Podcasts and give us a five star ratings and review. That would really help us, so more people can find us in their listing of health podcasts.
I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please call my office in Santa Monica at 310-395-3111. That’s 310-395-3111. And take one of the few openings we have now for a individual consultation for nutrition with Dr. Ben Weitz. Thank you, and see you next week.
https://drweitz.com/wp-content/uploads/2021/04/rwp201website.jpg350785drweitzhttp://www.drweitz.com/wp-content/uploads/2017/06/drweitzdsamplelogo-withtext.pngdrweitz2021-04-07 21:33:442021-05-08 18:13:17SIBO, A Personal Perspective: Rational Wellness Podcast 201
