Nutritional Deficiencies with Tom Malterre: Rational Wellness Podcast 240

Tom Malterre discusses Nutritional Deficiencies as a Cause of Chronic Disease with Dr. Ben Weitz.

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Podcast Highlights

1:35   Testing for Nutritional Status.  Standard lab panels like a CBC with differential and a chemistry screen pick up broad issues that may be catastrophic, but they don’t pick up nuances. This allows us to see if a person’s ingredients for optimal cellular function are happening.  If you see that someone has estrogen out of balance, but you want to know why and this could be because their fatty acids are out of balance.  It could be because the co-factors that are used by enzymes that regulate estrogen levels.  Just looking at a thyroid panel or a hormone panel or even a gut panel, we don’t necessarily find out what is going on in your cells today and how to help that person.  Tom said that he believes as Dr. Sidney Baker taught us that all disease is caused by two primary things: 1. You’re getting things you don’t need, like toxins, pro-inflammatory foods and foods that you react to, stress, et. and 2. You are not getting enough of the things that you need, such as vital amines (vitamins), minerals, essential fatty acids or amino acids.  If you have arthritis, it can helpful to find out why you have a pro-inflammatory state?  Are you missing your vitamin C? Are you missing some of the things that stabilize complex 2 in your mitochondria? Are you missing fat soluble vitamins that might stabilize the membranes within your cells and therefore reduce the amount of oxidative stress and lipid peroxides?

5:55  The average person sees their doctor, who orders conventional lab testing that is very limited and does not tell us anything about nutrient status.  If we see that a person has diabetes, we never ask why they have diabetes?  Why does this person not metabolize their carbohydrates very well?  Are they having trouble metabolizing their fats?  If they cannot convert their glucose into acetyl-CoA, then they cannot use that glucose for fuel.  Are they missing some co-factors for the actual pyruvate dehydrogenase complex to work, so they can process glucose or fatty acids.  If people are doing a keto diet and consuming a lot of fat, we need to make sure that the fat is brought into the mitochondria via the carnitine shuttle and once in the mitochondria, it needs to go through beta oxidation, which requires specific nutrient co-factors.  But if they have loose stools and their stool floats, this may be a pattern of fat malabsorption and if they are following a high fat, keto type diet, then that diet is not working for them.  Maybe it’s because they need additional riboflavin or carnitine or perhaps they don’t make enough phospholipids, which means they are not producing enough bile that enables them to emulsify the fat and to be able to absorb it. If you have too much fat in the stool, this will draw with it fat soluble vitamins, so fat soluble vitamins will test low, as will essential fatty acids.

8:53  Vitamin D.  If a patient has a low vitamin D, that could be because they have fat malabsorption. This is why it is helpful to have fat soluble vitamins being measured, such as with ION 40 panel, which measures vitamin D, vitamin A, two forms of vitamin E, and CoQ10.  If all of these are in the first quintile, then we know we have trouble with fat digestion/absorption.  And vitamins D and A are important for immune system function. We also see that if glutathione levels go down, so do levels of immune cell function.



Tom Malterre has a master’s degree from Bastyr University, as well as advanced training in Functional Medicine from the Institute of Functional Medicine, where he is also part of the clinical faculty.  Tom has lectured on nutrition and supplementation across the country and he currently coaches doctors and health care practitioners on Functional Medicine protocols and he runs Whole Life Nutrition.  He has written The Elimination Diet and The Whole Life Nutrition Cookbook along with his wife, Alissa Segersten. 

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. Ben Weitz:                   Hey, this is Dr. Ben Weitz’s 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 site, drweitzs.com. Thanks for joining me, and let’s jump into the podcast. Hello, Rational Wellness Podcasters. Today, we have an interview with Tom Malterre on nutritional analysis, as part of an approach to helping patients overcome chronic health conditions. Our special guest today is Tom Malterre, who has a master’s degree from Bastyr University, as well as advanced training in functional medicine from The Institute of Functional Medicine, where he is also a part of the clinical faculty. Tom has lectured on nutrition and supplementation across the country. He currently coaches, doctors and healthcare practitioners on functional medicine protocols, in his progressive practitioner coaching program. And he also runs Whole Life Nutrition with his wife, Alyssa Segersten, and he’s written a number of books, including The Elimination Diet and The Whole Life Nutrition Cookbook. Tom, thanks for joining us.

Tom Malterre:                   Hey, Ben. Pleasure to be here, my friend.

Dr. Ben Weitz:                   Absolutely. We’ve been chatting a little bit on Facebook over the last several months, so I’m glad we finally put this together. So what are some of the benefits we can get from testing for nutritional status?

Tom Malterre:                   That’s a good question. So it’s interesting, I feel like I’m spoiled now. Anytime we’re trying to get an idea as to what’s going on with a person, we oftentimes rely on the person’s symptomology and we rely on conventional lab testing. And what I’m finding is, conventional lab testing, standard blood panels, don’t necessarily pick up nuances. They pick up broad issues that are occurring and whether or not it could be catastrophic. And when they don’t necessarily-

Dr. Ben Weitz:                   What do you consider, standard lab panels?

Tom Malterre:                   Just a standard blood count, maybe with differential, cholesterol, possibly some sort of vertical auto profile, like a Cleveland HeartLab type analysis, type thing. It tells us about what’s going on in a certain aspect of a person’s health. But the reality is, human beings are built up of organ systems, and organ systems are built up of tissues, and tissues are built up of cells. So the reality is, you want to make sure that a person’s ingredients for optimal cellular function are happening. So this is one of those things where you go out and you say, “Wow, look at this person’s estrogen levels.” And you say, “Well, why is the estrogen out of balance?” Is it possible that the substrates for the estrogen itself, like the fatty acids are out of balance?  Is it possible that some of the co-factors for the enzymes that regulate estrogen levels are out of balance? Is it possible that some of the co-factors for the enzymes that detoxify or bio transform the estrogen are out of balance? You want to know all those details. By looking far upstream, and looking at a thyroid panel, looking at a hormone panel, or even looking at a gut panel, we don’t necessarily find out how to help that person today. What’s going on in that cell today? How can nourish that person to metabolize, transform, to detoxify, to exist in the presence of certain bugs. You’re always wanting to create an environment of resilience in the cell. And how do you do that? The same today, as we’ve learned from Sidney Baker from the get go, which is, all disease is caused by two primary things.

One, you’re getting things you don’t need. Two, you’re not getting enough things you do need. So you’re getting too many irritants and not enough nutrients, you’re getting toxins from mold, from air pollution, whatnot. You’re getting stress, you’re getting some sort of anti, or I should say, pro-inflammatory food components, like oxidized, fatty acids or whatnot. But you’re not getting enough of the things you do need. And those things are vital amines, they’re vitamins. They are minerals. They are essential fatty acids. They are amino acids, which is probably the most under looked aspect of functional medicine that I would suspect, are amino acids. And we don’t analyze those things. They are the primary building box for neurotransmitters, for cell repair, for proteins, for everything. But we don’t look at them. So I’ve said, why not? I’m a nutritionist, one who nourishes.

I have both a bachelor’s and a master’s in science and nutritional sciences. I’ve been studying it since I’ve been 10. Why not? We go in and we get a doctor’s diagnosis, and they’ll look at a set of symptoms. And they’ll say to you, “Well, you have diabetes or you have arthritis, or you have osteoporosis”, but they don’t necessarily say, why. Why do you have arthritis? You have pro-inflammatory markers in your system, but why do you have pro-inflammatory markers? Are you missing your vitamin C? Are you missing some of the things that stabilize complex 2 in your mitochondria? Why do you have a pro-inflammatory state? Are you missing fat soluble vitamins that might stabilize the membranes within your cells and therefore, reduce the amount of oxidative stress and lipid peroxides? Why don’t you check these things? You just take it for face value, that you have an inflammatory state, but why? So I ask, why?

Dr. Ben Weitz:                   Well, I think one reason why, is because the average person is not really aware of all this. They go in and see their doctor and they say, “Well, all my labs were perfect. There’s nothing wrong.”

Tom Malterre:                   Right. Yeah. And that’s I think, where we run ourselves into little boxes. When you look at conventional lab testing and that’s all you know, or you look at a diagnostic code and that’s all you know, and you say, “I would like to treat diabetes.” Well, why does the person have diabetes? Does this person metabolize carbohydrates very well? Do they metabolize fats very well? Are they efficient with their mitochondrial energy function? It’s possible that this person cannot convert their glucose into acetyl-CoA. And if they cannot convert their glucose into acetyl-CoA, then they cannot use that glucose for fuel. Then that can cause a backing up of the system. They may have a lactate buildup. They may have symptoms of muscle pain and fatigue and whatnot. And they’ll have these blood sugar abnormalities. Why, what’s the chemistry?  How does glucose get broken down? Are we dealing with some sort of issue with the actual pyruvate dehydrogenase complex, missing some co-factors, to allow for the normal processing of glucose, or when it comes to fatty acids? I have a lot of people who are doing keto diets, carnivore diets, whatnot. They’re consuming a tremendous amount of fat and/or protein. And they’re not taking into consideration when they’re consuming the fat, that the fat has to be brought into the mitochondria, via carnitine shuttle. Once it’s in the mitochondria, it’s going to need to go through beta oxidation, beta oxidation needs specific nutrient co-factors. All these things are a chemical process.

Dr. Ben Weitz:                   This is so the fats can be converted into energy in their body, because they’re eating very few carbohydrates.

Tom Malterre:                   That’s exactly right. It’s interesting, right? You run these panels and you see people who have then, an inability to digest fat, and they’re eating tons of fat. So you’ll see low levels of fatty acid, whether it’s monos, saturates, essential fatty acids, and you’ll see low levels of fat soluble nutrients. And you’ll see on the intake form, a pattern of fat malabsorption. So they’ll say, “I have looser bowel movements. I have multiple bowel movements per day. They’re floating, they’re lighter in color.”  And you say to yourself, “Wait a second, keto isn’t working for you. Keto might be the best thing for you, metabolically, but it’s not the best thing for you currently, physiologically.” Why? Possibly, they have a carnitine deficiency. Why? Possibly, because they need additional riboflavin. Why? Maybe it’s genetic. Maybe they’re not making enough phospholipids, and the phospholipids aren’t allowing them to produce adequate bile. The bile is not allowing them to emulsify the fat and then allow them to absorb the fats efficiently. And they’re ending up with the fats in the stool. When the fats are coming in the stool, the fats then draw with them, all the fat soluble vitamins. So there’s these nuantic pieces that you want to put together. You can’t just-

Dr. Ben Weitz:                   Well, that’s a great point right there. You could have somebody with low vitamin D, and if the vitamin D is being pulled out of their body because of fat malabsorption, and then we’re giving them more vitamin D and we’re going, “Gosh, why isn’t this person’s vitamin D going up?”

Tom Malterre:                   That’s definitely a panel that you want to look at too, is constantly look at the vitamin D. The neat thing about these nutrient panels that include fat soluble vitamins, like the ION 40, they include the vitamin D. So you can look at vitamin D, you can look at vitamin A, you can look at two E markers, both the alpha and gamma tocopherols, and then you can look at coenzyme Q10, and you can form an image on these panels where you look at, across the board, they’re in Quintiles. So five little segments, and you can see if everything’s in the first Quintile, then obviously you have an issue. You have an issue with a person getting in enough, fat soluble vitamins. If they have that issue, then where’s the conversation about looking at additional ox bile or looking at lipase or looking at something that would help that person digest, and therefore absorb their fats and their fat soluble vitamins. Because if they can’t get the fat soluble vitamins in, then what’s the use of supplement?

Dr. Ben Weitz:                   Exactly. And we know vitamin D, among its many, many benefits, is immune system function. And we all know that right now, having a highly functioning immune system is super important.

Tom Malterre:                   Yeah. Well, that’s another aspect. It’s interesting. We’re seeing a lot of data coming out and I saw this through the Institute of Function Medicine, while studying toxicology. And when we saw that people were deficient in glutathione, and we saw their immune cell function went down. And when their glutathione levels go up, it appears their immune function improves. So you can track both, where the glutathione might be coming from, and the actual glutathione itself, indirectly, via some of these nutrient analysis. So if we were wanting to say, “Well, gosh, it’d be great if we could take a peak inside someone’s cell and determine if they’re taking their homocysteine and turning it into glutathione and keeping their glutathione levels up, and/or determining which specific amino acid substrates might be low in this person. This panel can’t look at cysteine, it oxidizes, but it can look at cystine, looks at homocysteine, looks at glycine and looks at glutamic acid.  So you can determine, am I low in all the substrates? Where is the metabolism going of these substrates? Am I producing enough glutathione. And we’ll see a imprint of that with pyroglutamic acid. So we can get a glimpse too, of what’s happening with the antioxidant detoxification systems, by looking in the urine and organic acids, by looking in the plasma, at amino acids or in some cases, the urine. But I always look at plasmas, it’s a longer picture of how long the amino acid levels have been low in the body, or high. Most of the time, people have low amino acids, not high. And in fact, once again, we have nine essential amino acids. Some are transitionally essential, and no one measures these things. These are the building blocks for all repair tissues.

You’ve got a person who’s got Ulcerative Colitis or Crohn’s, and they cannot seem to repair their intestinal tissue. And I run an ION panel on these people, and their amino acid levels are in the tank. Their phospholipid levels are in the tank, their magnesium levels in the tank, their zinc levels in the tank. They don’t have enough of the raw ingredients to help rebuild their own intestinal tract.  So when they’re actually getting injured by microbes, by food particles, by whatever it is, toxins, then they don’t have the ability to repair the tissue. So we know that the-

Dr. Ben Weitz:                   That right there, is a great clinical insight for patients with chronic gut problems. You could have a patient dealing with IBS, SIBO, one of the other forms of dysbiosis, and you might be taking the appropriate steps that, normally are supposed to work to help this person get rid of, or reduce the levels of the problematic microbes. And you could be giving them probiotics to build up their microbiome. But if they’re lacking essential nutrients to allow their intestinal system to function properly and to heal and to repair, none of those are going to be effective.  And we may be running down various wrong paths, looking for the next problematic microbe, when we have to go back to the basics, which is, looking at the importance of our nutritional status, which of course, is something that only us in the functional medicine world look at, because conventional doctors are not going to do this. They might run a vitamin D or a serum B12, but that’s about the end of it because all the other tests are not going to be covered by insurance. And they have a 10 minute office visit anyway, limited by what insurance pays.

Tom Malterre:                   Exactly, and it’s not just the intestinal lining, it’s the mucus layer. So you need specific nutrients for mucus. Ideally, we’d have optimal electrolytes. People don’t even think about that for mucus production. There’s so many different things when it comes to structure of the human body, that are all chemical. You need the actual chemical ingredients to build rebuild, repair, do anything you need to do, with a human cell. So if you’re not thinking of the nutrients, you’re not thinking of what’s the optimal health of a cell.  So that’s why I’m always trying to get people to run these panels. And when you have these panels, the interesting piece is, and a lot of people will say, “Well, I’ve run these things and there’s no validity on these. And there’s no science to back this up.” You got to be kidding. I have a textbook that I keep in my desk drawer right here, with all my supplements.  It’s the Laboratory Evaluations… Oh, you can’t see that, but Laboratory Evaluation for Integrative and Functional Medicine, 2nd Edition by Richard Lord and Dr Bralley.  I spent time with Dr Richard Lord over a decade ago. We hang out at all the Functional Medicine conferences. They’re wonderful people, the Bralleys’ and Dr Lord. They’re from Metametrix, that now got absorbed into Genova, right?

Dr. Ben Weitz:                   Right.

Tom Malterre:                   This crew was not wasting their time. They sat and buried themselves in scientific literature for decades, to come up with some of these evaluative tools. And then, the wonderful thing about this analysis is, there are checks and balances. So if you have a urinary organic acid, and it’s the only marker you have, like methylmalonic acid, for example, B12. And you’re like, “Well, gosh, does this person really have a functional B12 deficiency?” Well, the fatty acids that need to be transformed by adenosylcobalamin, into other metabolites that can be used for energy Succinyl-CoA at all, if they cannot be transformed, you’ll see a buildup in odd-chain, fatty acids on the panel. So you can see functional adenosylcobalamin deficiencies, via MMA and odd-chain, fatty acids. There are multiple, different ways throughout the test. Let me give you an example.  I had 46 year old female, just two days ago. And this 46 year old female has weight loss resistance. She has these immaculate standard panels. I’m working through another healthcare practitioner. I’m pulled in as a consultant sometimes, on cases.

Dr. Ben Weitz:                   Okay.

Tom Malterre:                   And this other practitioner shares these three different lab sets and they all look pretty immaculate, everything looks great on this woman. She’s fabulous, mentally, gut wise, supposedly everything’s great. How come she’s not losing weight, what’s going on? And so we look at essential fatty… Or excuse me, we look at essential amino acids. And all we see is these little things of this real big spike in valine real big spike in threeanine. And we’re like, “Huh, what’s the commonality between these two. Everything else looks relatively normal, straight down the middle.”

Well, those particular two amino acids need vitamin B6 in order to be metabolized. So you say, “Huh, okay. Let’s go down the list and look at alpha amino and butyric acid”, which is a marker of B6. And it’s skyrocketed. It’s huge. So immediately I can see, there’s this drastic need for vitamin B6. Well, B6 takes place in all these transaminase enzymes. So anytime you want to transfer one amino acid into a different shape amino acid, you have to have adequate B6. B6 takes place in the brain, when we’re transferring glutamate over to GABA. We need B6 as a specific co-factor, to calm down neuro excitability. B6 is needed all over the place. There are hundreds of different reactions, whether it’s a form of metabolism or metabolism itself, or for glucose or other things, B6 is everywhere.

B6 for tryptophan, B6 for the formation of melatonin, B6 for dopamine, it’s all over the place. So if you have a person who’s deficient in B6, you have a person who’s, malfunctioning across the board. And it’s interesting when you run nutrient analysis, one of the most common nutrient deficiencies I see in humans is B6. And it’s weird because you say, “Well, why B6?” Well, B6 can be wasted, via a certain gene analysis. You look at their genes and they might be having specific enzymes that allow them to either, use up or excrete or more B6. That’s one. Two is, certain medications will deplete B6. Come on, Ben, what kind of medication do we know in females all the time, is depleting B6? It’s oral-

Dr. Ben Weitz:                   Antidepressant.

Tom Malterre:                   Antidepressants, can be, and oral contraceptives. Well, guess what? This gal’s been on oral contraceptives for a couple decades. So it’s like, wow, she’s super deficient in the B6. Now, you partner that with a low tyrosine, she has a flat affect. She’s not really excited in life. And you say, “Oh, B6 is needed for dopamine metabolism.”

Dr. Ben Weitz:                   By the way, if that person were to get a serum B6, is that going to show us what we need to know?

Tom Malterre:                   Not always, interestingly enough. No, and you have this reflected here in a couple of different spots, but you’ll see it in the urinary organic acids, as kynurenate and Xanthurenate. And then you’ll see it again here, in the amino acids and alpha-Aminobutyric acid.

Dr. Ben Weitz:                   Now, why is it? I’ve seen a number of patients who, their serum B6 was actually high, but they needed B6.

Tom Malterre:                   Okay. Well, B6 is once again, needed all over the place. And so you’re not always going to find B6 just in circulation, where you want it to be. So if you’re using B6 intercellularly, if you’re using B6 in multiple use, and you’re looking in just one area in the serum to find out if your level is adequate, then you may not see what you’re looking for. Not only that, you need to transfer B6 into pyridoxal phosphate and if you’re looking at pyridoxine, and you’re looking at pyridoxine in the serum, you’re not necessarily going to determine if this person is utilizing the B6, in the bio available form because of their enzyme function, their co-factors for that enzyme, they may have insufficient magnesium, for example. And so they may not have functional use of their B6, even though they have B6 in circulation. So it’s not enough, right?

Dr. Ben Weitz:                   Right.

Tom Malterre:                   So anyway, so we find out right away, this gal has a B6 insufficiency. And then we look down the line and gosh, there’s all sorts of things. Her thiamin is insufficient. Well, what do you need thiamin for? Well, thiamin is going to be the primary determinant, to turn on pyruvate dehydrogenates. So when a person is taking glucose and they’re turning that glucose into acetyl-CoA, as we were talking about earlier, it has to pass through pyruvate and pyruvate has to turn into acetyl-CoA. Well, that complex, it’s a big protein complex, it has to have thymine first and foremost, to come in contact with that pyruvate and then break it down into multiple different steps, with the help of B2 and B3 and B5 for acetyl-CoA. And then we also have alpha-lipoic acid, which stimulates the whole response.

So if you’re missing a B vitamin like B1, the whole complex slows down, you can’t get the energy from the pyruvate. You also cannot get energy from your branched-chain, amino acids, your isoleucine and leucine, and valine. Those things need to go through alpha-keto acid dehydrogenase as well, which needs the thiamin. So you’re not getting energy from amino acids. You’re not getting energy from your glucose. Then all of a sudden, what happens? The system backs up. You have some issues. You’re not utilizing your energy from your foods. Now, partner that with one more thing, she’s eating mostly keto. And what do we see? We see that same scenario we were just talking about, where the fat-soluble vitamins are low. The coenzyme Q10, the vitamin A, the beta-carotene, the vitamin E, they’re low, the vitamin D was low as well.

And then we see monounsaturates low. We see saturates low, see essential fatty acids low. We see omega-6 low. So all of her fatty acids, all of her fat soluble vitamins, are trending low. So if these are all low, she may be on this higher fat diet. She may be trying to exist with keto. And she has a [inaudible 00:22:25] elevated, which is an indication of poor fatty acid metabolism. So we say, “Wait a second. Of course, she’s going to have fat loss resistance.” I don’t know if you’ve seen this, Ben, but I’ve run nutrient panels now, for 15, 16 years. And when I see people who are low in essential fatty acids, they hold onto their fat. The body, for some reason… I tell my own story here where I say, well, the body really needs these essential fatty acids.

And if it’s not getting the essential fatty acids, whatever fat it takes in, it will hold onto. It’s looking for that missing link. It’s wanting that piece. And so therefore, it has a difficult time letting go of the fat, until it receives the beneficial fats that make it function well. Now, if we looked at the fatty acid panel too, which is fascinating, we’ll see that she had a block on DPA, turning into DHA. We see she had some blocks from GLA to DGLA. Both of those things need elongase to work. And what does elongase need? Vitamin B6. So even some of her essential fatty acid, some of her prostaglandin forming, omega-6 fatty acids, they were out of whack, once again, because that B6 was missing. So there’s this wonderful story that gets told in your own chemistry, by looking at these nutrient analysis tests, but here’s the challenge-

Dr. Ben Weitz:                   So let me just stop you on this particular case. So then, how much B6 and what form of B6 did you give her? How did you know how much B6 to give her? And did you use… Which form?

Tom Malterre:                   Yeah, so the reality is, I’m usually using higher doses of B6 than the average bear. And I’ll usually use 25 milligrams throughout the day, three to four times a day. So up to a hundred milligrams of B6, depending on the response, and usually titrating up. What I find is that, B6 travels really well with magnesium. So I’ll do a magnesium-

Dr. Ben Weitz:                   Do you use the P5P form?

Tom Malterre:                   Yeah. Depends on the person. So you’ll see responses and tolerance in different ways. It’s weird, some people do not respond well to P5P and some people do not respond at all to pyridoxine. So I’ll usually start out with a P5P/magnesium combo. And if there’s any sort of negative response, then I’ll move over to pyridoxine. So just a standard facility.

Dr. Ben Weitz:                   Okay.

Tom Malterre:                   But magnesium, I’ll usually have the magnesium along with it. Now, the magnesium is especially important when it comes pyridoxine, because you need it to convert over to P5P, which needs-

Dr. Ben Weitz:                   How much magnesium will you use in a case like that?

Tom Malterre:                   Thank you for that, asking. I really appreciate it. So what I found with magnesium over the years is, number one, the magnesium receptor sites don’t really, optimally function above 200 milligrams per dose. So a lot of people who are doing single dosing of 400 milligrams or 600 milligrams at night for sleep or leg cramping or whatnot, I don’t see that works. I find that, when somebody does smaller dosing throughout the day, 125, 150 max, three, four times a day, that’s better, both absorbed and tolerance wise. And the reason people don’t tolerate magnesium is usually, they’re doing too high of a dose of a form that’s not well absorbed, that causes an osmotic gradient, draws the fluid out, causes the cramping. They flush out the content of the intestinal tract. So of course it keeps-

Dr. Ben Weitz:                   We sometimes use that for constipation patients.

Tom Malterre:                   Yeah. Well, a lot of people do. They’ll use a citrate.

Dr. Ben Weitz:                   Right.

Tom Malterre:                   Hopefully they’re not using an oxide or a sulfate, like the Epsom salts, but my goodness-

Dr. Ben Weitz:                   What’s the negative effects of using an oxide or a sulfate?

Tom Malterre:                   Oh, oxides are miserable. They usually cause terrible cramping in people. Sulfates can as well, it’ll clear out the gut pretty significantly. I have a tendency, not to want to draw out fluid from the intestinal tract like that as much as possible. I will look at motility issues. I will look at bacteriological issues, absence of growth of certain organisms. Lactulose is incredibly underused when it comes to constipation, it’s bizarre. It’s a sugar, it’s a disaccharide. And that specific sugar, not only increases motility like nothing else, but it’s also a prebiotic. It seems to feed, acid forming organisms that change the pH of the upper intestinal tract. They help lower SIBO. It helps to help repair the intestinal lining. It’s one of the few things that’s been used in the medical literature, to repair a leaky gut and lower liver enzymes.

Dr. Ben Weitz:                   Interesting. It’s only available a prescription now, though.

Tom Malterre:                   Yeah. There was a petition going around a couple months back, to make it a non-prescription.

Dr. Ben Weitz:                   It’s insane. We have a sugar that’s a prescription.

Tom Malterre:                   It’s a sugar. Yeah. Welcome to the United States. If you go to Canada or you go to Australia or you go to Europe, whatnot, it’s not. You can go up to a pharmacist, say, “Just hand this to me please.” And they’ll give you a big bottle. And when I used to be able to go across the border, that was an easy thing to do, but it’s crazy now. But I highly recommend considering things like that, as well as there’s probiotics, other prebiotics, dietary changes, essential fatty acids, which help. So instead of causing an irritation and causing something to flush out the contents of the intestinal tract, which will draw other minerals or nutrients with it, oftentimes I’m using secondary measures for normalizing bowel movements.


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Dr. Ben Weitz:                 Can you talk a little bit about, what we can tell about neurotransmitter imbalances from looking at amino acids? Because as you know, in this country, rates of depression and anxiety are really, super high. And over the last several years, have gotten much higher. And the conventional way of treating depression and anxiety is to, assume that this is a result of neurotransmitter deficiency and simply putting all the patients on SSRIs and similar drugs that say, increase serotonin levels.

Tom Malterre:                   Well, first off, one of the most under utilized therapies for anxiety I think is, recognizing that if a person is magnesium and B6 insufficient, they will be anxious. So I shouldn’t say they will be, the chances of them being anxious or having racing thoughts, the monkey mind, startling at loud noises, not being able to turn off their mind at night so they can get some rest, always being hypervigilant, what we call, wired and tired. So commonly Ben, so commonly is associated with a magnesium and B6 insufficiency.

Dr. Ben Weitz:                   So which form of magnesium should we use for these patients?

Tom Malterre:                   Ah, thank you. So if the person has cognitive decline issues, the three and eight might be good to get in the central nervous system. If they are not dealing with that, then a maleate or glycinate, anything could work just fine, Atorate for cardiac stuff, whatnot. There’s or an orotate, whatever. But I’m less concerned about that. They seem to work even a citrate can work if it’s low enough dose and doesn’t create bowel spasms in somebody. But the big thing is, just the smaller doses throughout the day.

Dr. Ben Weitz:                   Okay.

Tom Malterre:                   That’s the thing that seems to get people to where they need to go.

Dr. Ben Weitz:                   200 milligrams, what, two to three times a day, or even more?

Tom Malterre:                   Yep. Three to four times a day, if they have a big issue with it, especially if they’re quite anxious. But you ask questions. Do you have the eye twitching? Do you have the arm twitching? Do you have something going on that’s leading you to believe you may have a magnesium insufficiency? Are you startling at loud noises, whatnot? Do you have the leg cramps? Those are all telltale signs to show that you may have some extra need for magnesium. And if you do, then holy smokes, let’s go, let’s do it. And honestly, out of all the things that we see as patterns on these panels, after 16 years now of running these panels, what is it that I see? Consistent magnesium B6 insufficiency, consistent magnesium B6 insufficiency.

When I have people who are anxiolytic, when I have people who are having a hard time going to sleep, what is it that I see? Deficient magnesium and B6. So it’s one of the most solid patterns. So when I was trying to figure this out chemically, I looked of course, at this book that I have here, and it talks about the NMDA or the N-methyl-D-aspartate receptor in the brain, which is a calcium channel. And that calcium channel is stimulated by glutamate. And the glutamate basically tells the brain, alert and alarm, pay attention, remember, remember, you need to know what’s going on right now. This could be something that’s incredibly beneficial to you or potentially harmful. So you need to know this, you need to know this, that glutamate signal is turned on by toxins, it’s turned on by blood sugar abnormalities.

It’s turned on by all sorts of different stressors. And that glutamate will turn on. Well, once the glutamate turns on, it causes an influx of calcium into that channel. And that causes that neuro excitability. How do you then regulate that? How does the body regulate the NMDA glutamate excitability? Well, two ways, primarily. Well multiple, actually. But the two primary ways that I’m seeing chemically is, you can take that glutamate and you can turn it into GABA. Glutamate is excitatory, GABA is calming. How do you do that? Well, you do that through an enzyme, and that enzyme is a B6 dependent enzyme. So you have B6 in adequate levels, you can convert that glutamate to GABA. Fantastic, there you go. You get the exact opposite effect. You get a calming effect. The other way is, you have this [inaudible 00:33:51] which is calcium that’s coming in, and you have another [inaudible 00:33:53], which is magnesium.

So two positive charges, two positive charges. And you can have adequate magnesium that will sit in the middle of this calcium channel. And as the calcium will come in, it will electrically repel the calcium. So if you have adequate magnesium, it regulates the amount of calcium that actually can come into this receptor. So you have two primary things, stopping the calcium influx and turning the actual signal of glutamate made into GABA, that can help you regulate the anxiety response. So Mag-B6 for anxiety. I would hope more and more people would start thinking about that. Now the other piece is, of course, you have the normal pathways of dopamine. Dopamine’s going to coming in, via phenylalanine going to tyrosine, tyrosine going into dopa, dopa going into dopamine, and then dopamine going down into norepi and epinephrine. And if you have too much, norepi or epinephrine, because you have a zinc insufficiency or riboflavin insufficiency, and you’re not working on the aldehyde dehydrogenase complexes, and you’re not really processing your adequate dopamine or R epinephrine, you’re going to have some issues with neuro excitability.

The neat thing about these nutrient panels is, you can get clues. You can say, well gosh, do I have enough zinc? Well, yeah, the mineral zinc is here on this panel. Do I have enough B vitamins? Well, there’s a lot of different markers on here that would indicate sufficient or insufficient B vitamins. So you can get these clues all over the place. Plus, you can look at the neurotransmitter precursors. So you see phenylalanine levels, you see tyrosine levels, you see the ratio of phenylalanine to tyrosine. So you see if the conversion’s happening very well. And then you also see some of these things like VMH, VA that are actual end-products of, part of the metabolism of these neurotransmitters. So vanilmandelate, homovanillate, these are markers to show you, are they succeeding in going down the process of both, making the neurotransmitters and metabolizing them successfully?

So you can start telling yourself stories about the chemistry of whether or not this person’s metabolism is working. Now, if you partner this with a gene panel, and this is where the magic comes in, when you start looking at the actual precursors, and then you start looking at the end products, and then you start looking at, how are their enzymes? Are they able to actually process efficiently and effectively? And if they’re not, and they have the co-factors that are challenged, well, no wonder this person is anxious or no wonder this person doesn’t feel like they’re satisfied with life or rewarded or whatnot. So you can really start putting the biochemical pieces together, as to where the blocks may be in neurotransmitter metabolism.

Dr. Ben Weitz:                   Awesome. This is fascinating stuff.

Tom Malterre:                   Yeah. And it’s actually quite freeing, Ben, because when I see standard clients that have not had lab analysis, whether it’s nutrient panel or gene panel or both or whatnot. The more pieces of information you get, the more of a story you can tell. I worked for a Alzheimer’s company for a while, that would charge people $50,000. They’d run these massive brain scans and $10,000 worth of labs. And then I would sit with the lab material for a number of days, and I’d put all the pieces together and then come back with a protocol or a plan. And it’s incredible, how specific you can get when you have all these pieces of analysis. You’re no longer guessing, you’ve tested, so you know exactly where to go next.

Dr. Ben Weitz:                   Yeah. And Dr Dale Bredesen has shown in the last year, that we can use a functional medicine approach on patients with Alzheimer’s and actually reverse the condition, and actually make people better, as compared to that recent drug that got approved for Alzheimer’s that cost $60,000 a year. Causes bleeding and inflammation in the brain, and nobody got better.

Tom Malterre:                   Yeah. That’s a wonderful breakthrough. He has done some fantastic work. And the amazing piece about his work was this. If you start with one intervention, you get zero results. Well, not zero, you get minimal results for a shorter period of time. The more interventions you add, changing your lifestyle, your sleep processes, your exercise, your psychological wellbeing. And then he has a whole host of nutritional items that he recommends for mitochondrial function or gut function, or essential fatty acids or whatnot, amino acids. There are all these different things that he’s examined that say, you know what, for each one of these that you include, the chances of this person getting better, improve up to a 38 point protocol.

Dr. Ben Weitz:                   And by the way, I know they included the NutrEval in the analysis as well, among their lab testing.

Tom Malterre:                   Yeah. And once again, the NutrEval overlays the ION panel and vice versa. There are some slight differences. They’ve added a couple of new things like, oxalates and whatnot, to the NutrEval, but the ION 40 still has 20 additional amino acid markers. And it still has fat soluble vitamin markers that I enjoy looking at. So I’m old school. A lot of people like the NutrEval, because it comes out with this wonderful readout that tells you about all these algorithms. And it says, “This vitamin is low. This vitamin is low.” I’ve been doing this too long to want somebody else to tell me how to do it. I’ll look at it and I’ll say, “Well, if that’s going here and this is going there, wow, this person needs more glycine. So it’s a little different for me, but I really wish people would examine this.

And if they need assistance, they would somehow contact me and start a study group or whatever we have to do. But I would hope that people would understand, there are answers. There are clues, there are pieces of this investigation that you can add into your repertoire. You don’t have to just walk in and assume you know the diagnosis. Therefore, you assume you know the chemistry. I have to tell you, man, I’ve been so humbled by this, because I’ve been studying this for a very long time. And I’m reading the research and talking to colleagues and training colleagues and working on case studies with groups of people. And every time I run these, I’m always finding something that’s counter to what I thought it would be. So I think it’s smart for us to be humble and recognize, while we may have a whole plethora of things in our tool chest, without testing, we’re guessing.

Dr. Ben Weitz:                   Right. I love your test, don’t guess approach. And I also have found it very helpful in my functional medicine approach with patients. There’s an interesting trend in our profession, where some practitioners are out there saying, “If you run all these tests, then you’re treating the test and you’re overburdening the patient with excessive cost. And if the patient presents with these symptoms, just put them on this diet first. And if that doesn’t work, then use a couple of simple interventions. And most of the time that’s going to fix it. And all this other stuff is over testing and over charging and all this kind of stuff.”

Tom Malterre:                   Yeah, totally. I get it. And here’s what I would say. If you’re not up on it, you’re probably down on it. So this is what David Primler talked to me about a long time ago when I was talking to him at an AFMCP, years and years and years ago, he used to say, “People are down on what they’re not up on.” So if you haven’t run these for a number of years, they’re confusing. You look at them and you’re like, “Ah, chemistry. I don’t understand this.” But I’ve spent years, literally years going through the individual markers, reading the research on it, looking at the biochemical pathway, seeing how one biochemical pathway interacts with another biochemical pathway, and you see patterns forming. And you see that, well, yeah, this one’s not really accurate in this particular client because they’re gut’s so out of balance.

And this one’s not really accurate here, because they’re not digesting this amino acid very well, or I can’t really rely on this MMA value because they don’t really have adequate BCAAs. And so it’s not really going to tell me what their methylmalonic acid is looking like. So there’s a lot of little nuances that you have to gain with experience and time. And until you do, you’ll poo poo it. You’ll say, “There’s no validity to that. This doesn’t work.” This is an incredible tool, if you choose to understand what it is. You look at its limitations and you use it how you can, with limitations. But once you see the patterns and once you see it come out as hundreds of and hundreds, and now thousands and thousands of clients, you go, “Oh.”

This is one of many tools. And while I used to order these when they were $1,800. And now you order them and they’re $465. They have so much value, that I’ve never thought that I’ve wasted a person’s time and/or money, ever, not once. So I understand those arguments, and they’ll say, “You’re treating now, the lab.” Well, no, you look at the person’s symptoms. You look at the person’s history. You look at what they’re presenting with, right in front of you. You layer that with some of the information from this lab, and then hopefully you can get a gut panel and the gene panel and some other standard lab tech panels. And you start putting all those pieces together. And then you form the actual picture that determines where your plan or protocol is going to go.

Dr. Ben Weitz:                   This is brilliant, Tom. I am really enjoying this discussion. I wish we had two more hours, but mither you, nor I have two more hours available. So we’re going to have to wrap it here. I’d love to come back and discuss some of these issues in the future. How can listeners and viewers find out more about the programs that you have to offer?

Tom Malterre:                   Yep. So some are on wholelifenutrition.net. So there’s a functional lab analysis course that I was teaching for a number of years, that I’ve stopped teaching now. But if I have enough interest, I’m happy to coach people on that. And they can just shoot me an email at plantsarewise@gmail and say, “Oh my gosh, I got to know this.” And if you got to know this, I’ll teach you, we’ll make it happen.

Dr. Ben Weitz:                   Awesome. Thank you so much, Tom.

Tom Malterre:                   Pleasure, Ben. Take care of yourself.

Dr. Ben Weitz:                   Okay. Have a great day.

Tom Malterre:                   You as well, my friend. Bye-bye, now.



Dr. Ben Weitz:                   Thank you for making it all the way through this episode of the Rational Wellness Podcast. And if you enjoyed this podcast, please go to Apple Podcast, give us a five star ratings and review. That way, more people will be able to find this Rational Wellness Podcast when they’re searching for health podcasts. And I wanted to let everybody know that, I do now have a few openings for new nutritional consultations, for patients at my Santa Monica, Weitz Sports Chiropractic and Nutrition Clinic. So if you’re interested, please call my office, (310) 395-3111 and sign up for one of the few remaining slots for a comprehensive, nutritional consultation with Dr Ben Weitz. Thank you, and see you next week.


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