Dr. Ben Weitz, Dr. Howard Elkin, Dr. Jonny Bowden, and Dr. Drew Sinatra pay tribute to Dr. Stephen Sinatra, Integrative Cardiologist.

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Podcast Highlights

2:04  Dr. Stephen Sinatra was a conventionally trained cardiologist, but he discovered natural healing and became one of the great innovative integrative cardiologists integrating nutrition, mind-body medicine, and other alternative therapies.  Dr. Sinatra wrote over 20 books, including The Coenzyme Q10 Phenomenon, L-Carnitine and the Heart, Lower Your Blood Pressure in Eight Weeks, Reverse Heart Disease Now, and The Great Cholesterol Myth

Dr. Sinatra got us to think differently about cholesterol and its role in the atherosclerotic process. After the Lyon Diet Heart Study was published in 1994, which showed that a Mediterranean-style diet could reduce cardiovascular disease by 76% in high-risk patients without significantly changing their total or LDL cholesterol, this spurred Dr. Sinatra to question that saturated fat intake leads to elevated LDL cholesterol, which leads to atherosclerosis hypothesis.  He also became more skeptical of the benefits of taking statins to reduce the risk of a heart attack. He observed that some of his patients with high cholesterol had clean arteries, while some patients with low cholesterol died from heart attacks. In The Great Cholesterol Myth by Bowden and Sinatra, they write that, “There is not evidence that supports a direct relationship between saturated fat and heart disease, and cholesterol is a relatively minor player in heart disease and a poor predictor of heart attacks, and the primary cause of heart disease is inflammation.”

Dr. Sinatra also observed patients who took statins had complained of memory and other cognitive problems, depression, muscle pain, and low libido due to the depletion of coenzyme Q10. Dr. Sinatra was one of the first to recognize and promote the importance of CoQ10 for heart health. He pioneered the use of specific nutritional supplements to help the heart to reverse heart failure, including using CoQ10, as I just mentioned, L-Carnitine, magnesium and D-ribose. 

5:28  Dr. Mark Houston was unable to join us but he gave me this statement to read:  “Steve was a dear friend and one of the best physicians that I have known. We loved working together at meetings and on our two books that we edited. He was a pioneer in cardiology and was never afraid to tell the truth about heart disease. He has been proven correct in many of his early ideas that were not initially accepted by the traditional cardiology community. He was admired by everyone who knew him.  He was kind, compassionate and caring as a man and as a doctor. He was loved by his patients, friends, family, and all his associates. He was a mentor to me,  and I learned enormous amounts of information from him. I will always remember our good times. I will miss him. I send my regards, love, and prayers to all of his family. Steve made a difference in the way we now practice cardiology and will be remembered as a master and one of the most influential of our time.” That’s from Dr. Mark Houston.

8:31  Jonny Bowden explained that Dr. Sinatra was “a gracious, kind, generous, spirited human being”.  Jonny and Dr. Sinatra both stumbled on the Lyon Heart Study and both had an epiphany that the data on heart disease does not support what we’ve been told about the cholesterol hypothesis.  When they wrote The Great Cholesterol Myth together they spent one third of the book talking about HeartMath and about community and relationships and sex life. They talked about the gut, walking in nature, getting sunshine, etc. Jonny had had some success with writing and had written The 150 Healthiest Foods on Earth and the publishers wanted a bunch of sequels, including 150 ways to lower your cholesterol and Jonny instead wanted to write a book questioning the cholesterol hypothesis.  His publisher told Jonny, who is a nutritionist, that they would only publish it if he wrote the book with a cardiologist and it had to be a world-renowned cardiologist. So Jonny called up Dr. Sinatra and said, “Steve, you want to write a book that’ll blow the lid off the whole cholesterol thing?” He says, “I’m in.” That’s how that book got done, and it wouldn’t have gotten done if he hadn’t signed on as a co-author.

15:08  It is now in the news that the the results were falsified in the landmark study that showed that the cause of Alzheimer’s is a buildup of amyloid plaque.  This concept is the basis for much drug development, including last year’s new drug approval for Aducanumab, which is a monoclonal antibody against beta amyloid, but it does not make anyone better.  This is a good example of why we should question the status quo in medicine when things don’t all add up.  Jonny explained that Alzheimer’s disease can be considered to be type III diabetes and we have an epidemic of a metabolic condition called insulin resistance, which predicts heart disease better than any other metric.  Dr. Elkin pointed out that only 12% of adults in the US are metabolically healthy, meaning that 88% have some form of insulin resistance.

19:26  Dr. Stephen Sinatra changed our thinking about the role of cholesterol in heart disease and he emphasized that we have been measuring cholesterol incorrectly.  Jonny explained that cholesterol is a fat that cannot float around in the bloodstream, so it must be contained in a lipoprotein like LDL or HDL.  These lipoproteins are the boats and the cholesterol is the cargo.  The problem with heart disease is that the containers, the LDLs that get caught in the endothelial wall and cause plaque and heart disease.  When it comes to testing, we should not focus on the amount of cholesterol, but on the number of these boats, the LDL particle number that is part of an advanced lipid profile, and not just on the estimated LDL, which is what you get from standard lipid panels.

22:40  Dr. Sinatra was also big on measuring Lp(a) as part of the lipid panel.  Lp(a) is a very atherogenic particle, but it is not easy to change it and there is not yet a specific drug to lower it.  You can get about a 30% reduction with niacin and another 10% or so with L-carnitine. 

25:31  Dr. Sinatra was a big believer in the value of the Mediterranean diet for preventing and reversing cardiovascular disease.  It is the most studied diet for cardiovascular disease and the Lyon Heart Study and the PREDIMED study were two of the most important studies showing it’s value.  Jonny prefers a lower carb approach to diet and he was always trying to get Dr. Sinatra to eat a higher fat/lower carb version of Mediterranean with less grains and more nuts, etc..  Drew related that his dad was paranoid about saturated fat in the 80s and for about 10 years his family ate not meat and they would eat a lot of grilled swordfish and his family was probably very mercury toxic.

 

 

Dr. Sinatra:                          Yeah, he loved Mediterranean diet. I think, for him, being Italian, it was probably hard to get off the pasta. That’s sort of like a staple of the Italian diet, or at least we think it is, and so my father always enjoyed a nice Italian meal with pasta. He did believe that olive oil was really like the secret sauce, and I do think that he was onto something with the olive oil. I do believe that olive oil can help drive a lot of these positive things that we see with Mediterranean diet, and agree with Jonny and all you about, in terms of reducing carbohydrates and that sort of thing.

Dr. Bowden:                         Let me tell you a story about the olive oil.

Dr. Sinatra:                          Mm-hmm.

Dr. Bowden:                         The particle test, this whole thing we’ve been talking about with the particle test, I have a personal story about that. Because my LDL, HDL numbers were perfect, perfect for decades. Any doctor would look at it and, “Your LDL’s ridiculous. You’re just doing fine.” Then when I became a functional nutritionist and learned about this, and saw that that was a bogus test and got the real test, I find that I’m in the high-risk zone for particles, and I’ve got the worst kind of size. I’ve got the pattern B which is, as somebody mentioned earlier, the little-

Dr. Weitz:                            Small, dense, yeah.

Dr. Bowden:                       Yeah, the Small dense ones. I’ve got this. I am an example of how the test … of being undertreated. In other words, I was a false negative. They said, “Oh, yeah, there’s no problem whatsoever,” and in fact, when you looked under the hood with the right test, I had very high particle size. I have all these wonderful, amazing functional cardiologists in my network, starting with Steve, and I asked their opinions, “Guys, what do you … I’ve got a serious particle problem. What should I do?” I’ll be honest. One of them said, “I know you’re not crazy about the statins. I think we should try, maybe, five milligrams of Crestor.” Others said, “At your age, it’s absolutely not necessary to do.”

I went to a cardiologist at Scripps who gave me certain supplements. I got a little stricter on my diet. Here’s what Steve’s advice was. Steve said, “Before you go on the statin, I want you to take a quarter cup of olive oil every day for three months, and then let’s remeasure,” so I did. He literally prescribed olive oil, and I do it to this day. If I had the bottle, I’d show you. I literally swig it from the bottle, as a medicine. Every day, it’s one of my supplements, and I did that. I can’t say it was just that, but that, the supplements that Dr. Triffon at Scripps Institute recommended, the stricter adherence to the higher fat, lower carb diet. My particles went from 2,200 to 1,600, and my particle size went from B to A.

 



Dr. Howard Elkin is an Integrative Cardiologist and he is the director of HeartWise Fitness and Longevity Center with offices in both Whittier and Santa Monica, California.  Dr. Elkin has written a book, From Both Sides of the Table: When Doctor Becomes Patient, that will soon be published. He can be contacted at 562-945-3753 or through his website, HeartWise.com.

Dr. Jonny Bowden has a PhD in Nutrition, speaks around the world and has written a number of books, including Living Low Carb, Smart Fat with Dr. Steven Masley, The 150 Healthiest Foods on Earth, and The Great Cholesterol Myth with Dr. Stephen Sinatra. His website is JonnyBowden.com.

Dr. Drew Sinatra is a Board Certified and Licensed Naturopathic Doctor, addresses and treats the underlying causes of chronic disease. Specializing in gut support, lyme disease, mold illness, and autoimmune disease. His practice is in Mill Valley, California and he can be reached at 415-388-5520 and his website is DrDrewSinatra.com.

Dr. Ben Weitz is available for Functional 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. 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. To learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.

Okay, great. Welcome everybody. We’re here today to honor one of the giants in the world of functional medicine, integrative cardiologist, Dr. Stephen Sinatra, who died on June 19th. I’m Dr. Ben Weitz, doctor of chiropractic and functional medicine practitioner, and the host of the Rational Wellness Podcast found on Apple Podcasts, Spotify, as well as on YouTube. I’m joined by Dr. Howard Elkin, integrative cardiologist at HeartWise in both Whittier and Santa Monica, California. Dr. Elkin participated with Dr. Sinatra on a study on the benefits of grounding for heart health, and they published a paper pertaining to that.  We’re also joined by nutritionist and PhD, Dr. Jonny Bowden, who co-wrote the book, The Great Cholesterol Myth, with Dr. Sinatra. We’re also joined by Dr. Drew Sinatra, a naturopathic physician, and he’s also the son of Dr. Sinatra. They worked together on quite a number of projects. Unfortunately, Dr. Mark Houston, who was an associate of Dr. Sinatra and a close friend, was unable to make it because of some last minute scheduling problems.

While I did not know Dr. Sinatra personally and never had the honor to interview him, I certainly knew of him, listened to him speak, and read some of his books and articles. Dr. Stephen Sinatra was a conventionally trained cardiologist, and at one time, was the chief of cardiology at Manchester Memorial Hospital in Connecticut. He discovered natural healing and became one of the great innovative integrative cardiologists integrating nutrition, mind-body medicine, and other alternative therapies.

Dr. Sinatra was a great educator, lecturing frequently, and he wrote or contributed to over 20 books, some of which include The Coenzyme Q10 Phenomenon, L-Carnitine and the Heart, Lower Your Blood Pressure in Eight Weeks, Reverse Heart Disease Now, and The Great Cholesterol Myth. He also published over 45 peer-reviewed papers and wrote hundreds of blogs and other articles on various topics in natural approaches to cardiology.

As a bioenergetic psychotherapist, Dr. Sinatra used mind-body medicine to help his patients to heal, including looking at how unexpressed negative emotions such as anger and sadness could contribute to hypertension and heart disease. Dr. Sinatra got us to think differently about cholesterol and its role in the atherosclerotic process. After the Lyon Diet Heart Study was published in 1994, which showed that a Mediterranean-style diet could reduce cardiovascular disease by 76% in high-risk patients without significantly changing their total or LDL cholesterol, this spurred Dr. Sinatra to question that saturated fat intake leads to elevated LDL cholesterol, which leads to atherosclerosis hypothesis.  He also became more skeptical of the benefits of taking statins to reduce the risk of a heart attack. He observed that some of his patients with high cholesterol had clean arteries, while some patients with low cholesterol died from heart attacks. In The Great Cholesterol Myth by Bowden and Sinatra, they write that, “There is not evidence that supports a direct relationship between saturated fat and heart disease, and cholesterol is a relatively minor player in heart disease and a poor predictor of heart attacks, and the primary cause of heart disease is inflammation.”

Dr. Sinatra also observed patients who took statins had complained of memory and other cognitive problems, depression, muscle pain, and low libido due to the depletion of coenzyme Q10. Dr. Sinatra was one of the first to recognize and promote the importance of CoQ10 for heart health. He pioneered the use of specific nutritional supplements to help the heart to reverse heart failure, including using CoQ10, as I just mentioned, L-Carnitine, magnesium and D-ribose.  Dr. Sinatra, as I mentioned, was unable to make it. Dr. Sinatra is a very prominent expert on an integrative approach to cardiovascular.

Dr. Bowden:                       You mean Dr. Houston.

Dr. Weitz:                            Dr. Houston. Dr. Houston, sorry. Dr. Houston was unable to make it, but he did give me a statement that I’d like to read now to get things started. “Steve was a dear friend and one of the best physicians that I have known. We loved working together at meetings and on our two books that we edited. He was a pioneer in cardiology and was never afraid to tell the truth about heart disease. He has been proven correct in many of his early ideas that were not initially accepted by the traditional cardiology community. He was admired by everyone who knew him.  He was kind, compassionate and caring as a man and as a doctor. He was loved by his patients, friends, family, and all his associates. He was a mentor to me,” to Dr. Houston, “And I learned enormous amounts of information from him. I will always remember our good times. I will miss him. I send my regards, love, and prayers to all of his family. Steve made a difference in the way we now practice cardiology and will be remembered as a master and one of the most influential of our time.” That’s from Dr. Mark Houston.

I thought, before we get into the science of some of Dr Sinatra’s innovations, I’d like to go around and ask each of you to mention something that you recall that Dr. Sinatra said or did that would tell us something about who he was as a person. Howard, would you like to go first?

Dr. Elkin:                              I think, my first meeting with Sinatra was very memorable. This was maybe 12, 13 years. I was doing my A4M membership, American Academy of Anti-Aging Medicine. We had an afternoon of cardiology with Dr. Sinatra, so it was great. We had like three or four hours with him. I kept on asking questions, and I kept on raising my hand because I knew the answers. Finally, after about 45 minutes, he says, “May I ask you what your specialty is?” I said, “Cardiology.” Everybody laughed because I was the only cardiologist in the room other than me and him, so, “I want to see you afterwards,” so we met afterwards. I ended up participating in an infomercial that we did here in Los Angeles, where I met his wife, Jan. Then he got me interested in earthing, which is another great topic of his. I was extremely interested in it, and we did a study together on the effects of blood pressure.

He was a wonderful teacher and I’m most proud and honored that he wrote the forward to my book that’s coming out after Labor Day, so it’s precious to me that he wrote that forward and he did an excellent job. I’m indebted to Dr. Sinatra because I was always a thinker outside the box, but I finally found someone in my field who was successful in what he did, so I didn’t have to feel alone anymore. I owe a lot of … I have a lot of gratitude, and I honor him tremendously. I’m glad to be here tonight.

Dr. Weitz:                            Thank you, Howard. Jonny?

Dr. Bowden:                       Gee, I don’t even know where to start. I owe so much to Steve. He was such a gracious, kind, generous, spirited human being that infused every interaction you had with him. In no particular order, he and I both stumbled on that Lyon Diet Heart Study that you mentioned, completely independently, and had the same kind of epiphany. That data does not support what we’ve been told, and we both started wondering about it, and we had so many other things we found in common. We both did postdoctoral work in psychology. I have a master’s in psychology. He was trained as a bioenergetic psychologist. I think it really informed the way we looked at disease in general.  We devoted, in the revised version of The Great Cholesterol Myth, we spent one-third of the book not talking about diet, exercise, supplements, or anything. We talked about HeartMath. We talked about community. We talked about relationships. We talked about sex life. We talked about the gut, all of these things. Walking in ecotherapy, walking in the greenery and getting sunshine and how all of these things had powerful, powerful effects on our physiology, on our hormones, on our immune system, on all of these things. He realized that so profoundly when no one was talking about mind and body.

Also, when you were listing his books, one that you didn’t mention was so influential, not just for me, and so prescient. It was Heart Disease for Women. He was one of the first people to shout out, “The emperor has no clothes,” when it comes to all the studies that have been done on heart disease that used only male patients. He was one of the first, even pre-woke, to say, “Heart disease presents differently in women. It’s different symptoms, it’s different … They’re different creatures. They respond differently to pain. You got to look at this as a whole other thing.” People, now they talk about that, but they forget that that was Steve, I don’t know how many years ago he wrote that book, Drew. It must have been 15 years ago. He was on to a lot of this stuff very, very early on.

I had some writing successes before I met Steve. I had a bunch of books, the food book and stuff, but if he hadn’t agreed to write that book with me, and I’ll tell you exact, if you’re interested. I had a book deal with Harper because I wrote The 150 Healthiest Foods on Earth, and they wanted a whole bunch of sequels to that because it was a hit, so Die Hard you want Die Hard 5, Die Hard … Well, that’s what they do, so we had 150 Best Ways to Promote Your Energy, and 150 Best Ways to Live Longer. They came to me with this idea. They said, “We think the next great book will be, how about The 150 Best Foods to Lower Your Cholesterol?” I said, “That’s a wonderful idea, but it’s certainly not for me.” They said, “Why?” I said, “Because I think that’s the wrong target for heart disease, and I think we’re just moving in the wrong direction.” They said, “What are you talking about?”  It led to a discussion, and I presented my case. I sent them studies and they were afraid to publish a book that questioned the cholesterol hypothesis. Finally, after much debate, and I was very persistent, and I sent all the studies, they said, “Look, we can’t publish this by some cockamamie nutritionist who’s a …” I’m left-wing of things, anyway. Said, “We will publish this if you can find an MD to co-author it, but it can’t be just an MD. It’s got to be a cardiologist. It can’t be just a cardiologist. It has to be a world-renowned cardiologist. You got one who will endorse this, we’ll do it.” I call up Steve, I said, “Steve, you want to write a book that’ll blow the lid off the whole cholesterol thing?” He says, “I’m in.” That’s how that book got done, and it wouldn’t have gotten done if he hadn’t signed on as a co-author.

Dr. Weitz:                            What a great story.

Dr. Sinatra:                          I love that.

Dr. Weitz:                            Drew?

Dr. Sinatra:                          Gosh, I’m like Jonny here. I don’t even know where to begin with a story. I think seeing my father evolve from a conventional cardiologist into the man that he was two months ago was such a beautiful journey to see him move along with. This guy had a health food store that he opened in, I think it was like 1987. I was 10 years old then. Just, I remember all the food on the shelf. He had this thing called, something like the Roger Buffalo cookie, which was just like the first PowerBar ever out there. Maybe PowerBar was there at that point, but there was no other bars on the market.

Dr. Bowden:                         Tiger Milk bars.

Dr. Sinatra:                          What’s that?

Dr. Bowden:                         They had Tiger Milk bars.

Dr. Sinatra:                          Yeah, exactly. He was just a pioneer in the thinking ahead. It’s like, “People need food on the go. Let’s develop this bar that people are going to quickly eat.” Look at the bar market today. It’s massive.

Dr. Weitz:                             Right.

Dr. Sinatra:                          He was always a thinker. He was always ahead of his time. It was such a beauty watching him evolve and develop supplements that I started taking when I was a young teenager. My friends made fun of me because I took all these vitamins and such, but I’m so grateful that he got on that path because then it really put me on the path of becoming a naturopathic doctor.

Short story here with the cholesterol is I think I went to the Manchester Memorial Hospital, which you mentioned, Ben, where he was chief of cardiology. He gave a talk on statins, and it was just the coldest energy in the room. All the fluorescent lights were flickering. I looked out in the audience, and all the doctors just were unhappy. They just weren’t happy, and they were very angry that he was presenting another side of cholesterol, which was, “Hey, be a little cautious in your prescribing. You don’t want to just give this stuff out like candy like we’ve been doing for the last decade.”

I saw that and I really looked up to how much courage he had to stand up to these doctors and say, “Hey, we’re basing this on a theory right now. This is only a theory, and we should take it as that. Let’s have more evidence come in before we just willy-nilly put everyone on a statin.” Then the doctors were mad. They were furious. They said, “How can you do this? This is against standard of care.” The thing about my dad is he didn’t get angry. My dad never got angry. He just said, “Okay.” He’d walk away, and I could tell that he would think to himself, “Well, when these guys are ready, maybe they’ll join on and look into the theory of heart disease in terms of cholesterol.” I could go on and on, but I just had to share that story about the cholesterol and Manchester Memorial Hospital.

Dr. Weitz:                            That’s great. It’s interesting. You guys both brought up the idea of questioning conventional thinking. In the news, just in the last day or two, is this revelation that the landmark study that showed that the cause of Alzheimer’s is a buildup of amyloid plaque, it turns out that, according to this analysis, that study was falsified.  Yeah, it’s a huge shock to the whole medical establishment, the research, and very, very interesting. They’ve been developing drugs for Alzheimer’s based on this concept, and of course, the drugs don’t do very much. That’s why we had this big controversy last year over that aducanumab, or I’m sure I didn’t pronounce it properly, but this new drug, this first new drug for-

Dr. Bowden:                        Oh, I know [inaudible 00:16:10]

Dr. Weitz:                            … Alzheimer’s. That was-

Dr. Bowden:                        Terrible drug.

Dr. Weitz:                            Exactly.

Dr. Bowden:                        Terrible.

Dr. Weitz:                            30% of the patients get inflammation and swelling in their brain, and nobody gets better. They just get worse at a slower rate. Anyway, it’s all based on this concept of what the cause of Alzheimer’s is, and now that whole concept is now in question. There is a perfect example of wanting to question orthodoxy.

Dr. Bowden:                        Can I interject something here?

Dr. Weitz:                            Of course, go ahead, Jonny.

Dr. Bowden:                        Tie something in with Steve’s message and with what you just brought up. I think it’s so important, and he would kill me if I didn’t make sure that we all knew this. Because you had mentioned earlier that one of our theses is what really causes heart disease is inflammation and oxidation. Alzheimer’s, as you guys know, and maybe some of the people in the audience do, Alzheimer’s is now being referred to as type 3 diabetes.

Dr. Weitz:                            Right.

Dr. Bowden:                        The reason for that is that we have an epidemic of a metabolic condition, which underlies not just diabetes and pre-diabetes, and hypertension, and obesity, and heart disease, but also Alzheimer’s. It is the same metabolic condition and it is called insulin resistance. It also, coincidentally, underlies the three major comorbidities for COVID as well as the ones I mentioned, lung disease, kidney disease, and liver disease. We have this insulin resistance. This is epidemic.  When Steve and I, we did The Great Cholesterol Myth, when we went back and did the revised edition and looked even more deeply into the research that had been done since 1970, we found that insulin resistance predicts heart disease better than any other metric, except possibly lung capacity and volume. It is a fantastic predictor for every chronic disease that we care about.  It’s been my passion and my message, especially since Steve died, but really since the book came out, to get that message across to people that insulin resistance is where the action is. That’s what we should be looking at, and insulin resistance can be turned around, it can be prevented, it can be reversed by diet, fasting, and lifestyle. That was the message of our book, and Steve believed that. Since you brought up Alzheimer’s, I think it’s only appropriate to bring that up because that’s central to all of those kind-

Dr. Elkin:                             Problem is not gone by any stretch. In fact, a research study came out … I knew from a study about two and a half years ago that only 12% of the adult American population is metabolically healthy.

Dr. Bowden:                       That’s what I’m … What does that mean? What does that mean?

Dr. Elkin:                             [inaudible 00:18:42] 3% of the adult American population is metabolically healthy. More women than men. This just came out about a week and a half ago.

Dr. Bowden:                       Yeah, and that study, the one you were talking about, which came from the NH, NHANES data-

Dr. Elkin:                             Right, correct.

Dr. Bowden:                        … that says only 12% are metabolically healthy, they are talking about insulin resistance. 88% of us have some degree of this insulin resistance. Guys, if you don’t know what that is, it is an inability of the body to manage the carbohydrate load that you’re giving it. That leads to inflammation, oxidation and slowly but surely, heart disease. Alzheimer’s, pre-diabetes and the whole gamut of metabolic diseases, and Steve knew that.

Dr. Weitz:                            Right. What else should we say about the role of cholesterol and heart disease, and what other things did Dr. Sinatra revolutionize in terms of the way we think about LDL?

Dr. Bowden:                        I think that he was as passionate as I about saying that we are measuring cholesterol incorrectly, that we are still talking cholesterol. Can I just, two seconds of background for those who don’t-

Dr. Weitz:                           Absolutely. Go ahead, Jonny.

Dr. Bowden:                       Cholesterol is carried in a container, and the reason for that is the molecule itself is hydrophobic. It can’t live in water. It’s oil and water. It doesn’t mix, so it has to go in the bloodstream in a container. The container is the lipoprotein, the L in LDL.

Dr. Weitz:                           Right.

Dr. Bowden:                       Some lipoproteins are low density, which means that they float. Some are high density, which means that they’re heavy and they sink. These lipoproteins are the boat, the cholesterol is the cargo. Somewhere in 1963 or so, when they figured out that cholesterol travels in two basic kind of containers, and they gave them the idiotic names of good and bad, we got into this notion that there’s a different kind of cholesterol that travels. It’s all the same cholesterol. It travels in two containers. What we have realized in the last 20 years, that the mainstream profession does not get, is that the containers are what the problem is. It’s the containers, the LDLs that get caught in the endothelial wall and cause plaque, and heart disease, and all the rest of the stuff. The new tests for cholesterol look at the number of boats in the water.

Dr. Weitz:                           The LDL particle number.

Dr. Bowden:                       Yes. That is the test that we should be using. Any prescription that’s given based on the old test is about as valid as a prescription given on the Cosmopolitan horoscope of the day. It’s completely magical thinking. We need to know how many boats are in the water. That’s the message of the book, and it was Steve’s message. When people tell us, “My cholesterol’s high,” the first thing we always ask is, “By what test?” If they say, “Well, the LDL and HDL,” we stop talking. “Go back and get the real test. That’s a fake test.”

Dr. Weitz:                           Right. Because that LDL number is the estimated-

Dr. Elkin:                            [inaudible 00:21:45] happening in the real world right now. You’re absolutely-

Dr. Bowden:                       What?

Dr. Elkin:                            I’ve been doing specialized cardio lipid testing for 20 years. If you’re dealing with Medicare, Bluecross, Blueshield-

Dr. Bowden:                       Forget it.

Dr. Elkin:                            They do not like me. They do not like a doctor that orders specialized lipid testing.

Dr. Bowden:                       I’m with you. I understand.

Dr. Elkin:                            It is unbelievable what my staff has to go through just for the labs to get paid because we have to send records, why I ordered it. It’s crazy, so there’s so much work that needs to be done.

Dr. Bowden:                       So much work.

Dr. Elkin:                            The doctor’s ordering the right test. It’s getting these things to be paid because they just want us to do a simple lipid panel. That’s all they care about.

Dr. Bowden:                       I know. 

Dr. Weitz:                           For my take, you’re never get to get anywhere with insurance companies. The key is, is maybe some point in time, we’ll stop insurance companies from running the healthcare system.

Dr. Bowden:                       Well, that would be very nice, wouldn’t it?

Dr. Weitz:                           Yeah.

Dr. Elkin:                            It’s expensive testing you’re talking about. It ain’t cheap.

Dr. Weitz:                           Yeah.

Dr. Sinatra:                        Well Jonny, correct me if I’m wrong here, but I know my dad was really big on Lp(a) lipoprotein (a), and making sure that was added on to any sort of lipid panel.

Dr. Bowden:                       Yeah.

Dr. Sinatra:                        That can be a more atherogenic lipid particle.

Dr. Bowden:                       The NASH use of the LDL particles. The thing about Lp(a) is that there’s really no way of changing it, and that’s kind of the dirty secret. I think Steve had a couple of supplements he thought might make a difference with that like nattokinase and stuff, but it’s a really hard number to change, so once you know your number … I don’t get it tested every year.

Dr. Sinatra:                         Yeah.

Dr. Bowden:                       I think that might be why it doesn’t get as much attention. There’s no drug that can bring it down. I mean-

Dr. Weitz:                           That’s exactly why. Yeah, yeah. By the way, there will be a drug in a couple of years and then everybody will be testing it.

Dr. Bowden:                       Right, exactly. Then they’ll tell you how important it is. Right now, it’s not important because [inaudible 00:23:32] paying for it.

Dr. Weitz:                           Niacin can move the number some. L-Carnitine can move the number some. There are some things that can move the needle.

Dr. Bowden:                       Oh, good to know. Okay.

Dr. Weitz:                           Yeah. You can get about a 30% reduction with niacin.

Dr. Sinatra:                         Yeah, that’s the biggest mover, but nattokinase, Boluoke, all those, I haven’t had great success with those.

Dr. Elkin:                             Neither have I. Neither have-

Dr. Bowden:                       It’s like raising HDL. I mean, they tell you, “Exercise.” No, it doesn’t. Come on. Nothing gets HDL higher, in my experience, and I’m not even sure it matters that much.

Dr. Weitz:                            Right. Then we not only had the LDL particle number, but the particle size. The fact that the small, dense LDL is much more atherogenic than just the amount of LDL.

Dr. Bowden:                       The size is also a very good stand-in for insulin resistance. If you’ve got a small particle size, and you got a high triglyceride to HDL ratio, you almost don’t even need to be tested for insulin resistance because that’s a great surrogate right there.

Dr. Weitz:                           By the way, that’s one of the unfortunate problems with statins is they don’t do anything to improve LDL particle size.

Dr. Bowden:                       Nothing, nothing.

Dr. Elkin:                            Well, they have an anti-inflammatory effect, which we were not aware of when they came out in the ’80s when I was a fellow. We just thought, “Oh, it lowers LDL cholesterol. It does it quite nicely.” We later learned, years later, 15, 20 years later, that it actually does have an antiinflammatory effect.

Dr. Bowden:                       It also, as Steve used to point out all the time, it tends to thin the blood slightly, so it turns, what he called, ketchup into red wine. Those are important values of statins. As Uffe argues, statins would probably be better medicines if they didn’t lower cholesterol and they just did that. I would argue that though they may have a slight benefit as being antiinflammatory and slightly thinning the blood, you can do both of those things with zero side effects with ginkgo, Vitamin E, or fish oil.

Dr. Sinatra:                          Mm-hmm. Well said.

Dr. Weitz:                            Okay. Next topic is Dr. Sinatra’s contribution to the importance of a healthy diet for preventing and reversing cardiovascular disease. Howard, do you want to maybe start us off?

Dr. Elkin:                              Yeah. The whole thing with, already been mentioned is the Mediterranean diet, and it started with Lyon Heart Study in the ’90s. Then the PREDIMED Study came out in 2013, which was actually primary prevention. The Lyon Heart Study was really based on secondary prevention. It showed whether you combine olive oil or nuts, whatever, that Mediterranean diet actually with … It’s no other diet’s been shown thus far to be as effective in decreasing heart disease, so it put that on the map.  That’s my take, and I know that Sinatra and I have had many talks about the Mediterranean diet. There are lots of different aspects to it. Some people think it’s too much carbs, too many … I don’t imbibe on cereals. I don’t think there’s a healthy cereal out there, but I think the basic premise behind Mediterranean diet is quite good and we have research behind it.

Dr. Sinatra:                          [inaudible 00:26:41]

Dr. Bowden:                       Yeah. I don’t think Steve and I 100% agreed on the Mediterranean diet thing. I was always trying to get him to eat a higher fat version of it with less grains. The thing is, he came from that world where the Mediterranean diet was the dietary answer, and epidemiologically, there’s great evidence that it’s associated with all kinds of great things. I’ve always been much more of a skeptic. There are 22 countries in the Mediterranean. They don’t all eat the same diet. There’s Turkey, there’s North African countries. They don’t. When I was writing Living Low Carb and looking into the Mediterranean diet as a thing, I looked at menus that are currently available at all of those countries in the best restaurants, and every one of them has meat on it.

I think that there’s a variety of ways to eat Mediterranean style, I think, and Steve and I agreed on this. It’s not just the diet, it’s the lifestyle. They spend time in the sun. They take naps, they talk to each other, the men express their feelings. There’s a lot of differences between the way they live in the Mediterranean and the way we live here, so it’s not really just this one thing. Definitely, that style of eating, if you will, or the things that has in common. The higher amounts of nuts, and the good fats, and all of that stuff is a very good place to start. I would tweak it a little with less grains and a little more fat, but that still, that doesn’t make it any less Mediterranean.

Dr. Sinatra:                          Right. Well, let me lead into this with a story, and that my dad was paranoid about saturated fat in the ’80s, and so guess what we did for 10 years? We had no meat. Okay. He just didn’t buy meat, and instead, we had swordfish steaks on the grill all the time. I can’t even tell you how mercury toxic my whole family probably is, but that’s how, at the time, he was thinking to himself, “Hey, I’m giving my family fish. There’s omega-3s in there. It’s got to be good for you.” Then, all of a sudden, we learn about tuna, and swordfish, and all the other different larger fish in the sea that are mercury toxic, and so I thought that was kind of funny because I can still taste what swordfish is like.

Dr. Bowden:                         Wow.

Dr. Sinatra:                          Yeah, he loved Mediterranean diet. I think, for him, being Italian, it was probably hard to get off the pasta. That’s sort of like a staple of the Italian diet, or at least we think it is, and so my father always enjoyed a nice Italian meal with pasta. He did believe that olive oil was really like the secret sauce, and I do think that he was onto something with the olive oil. I do believe that olive oil can help drive a lot of these positive things that we see with Mediterranean diet, and agree with Jonny and all you about, in terms of reducing carbohydrates and that sort of thing.

Dr. Bowden:                         Let me tell you a story about the olive oil.

Dr. Sinatra:                          Mm-hmm.

Dr. Bowden:                         The particle test, this whole thing we’ve been talking about with the particle test, I have a personal story about that. Because my LDL, HDL numbers were perfect, perfect for decades. Any doctor would look at it and, “Your LDL’s ridiculous. You’re just doing fine.” Then when I became a functional nutritionist and learned about this, and saw that that was a bogus test and got the real test, I find that I’m in the high-risk zone for particles, and I’ve got the worst kind of size. I’ve got the pattern B which is, as somebody mentioned earlier, the little-

Dr. Weitz:                            Small, dense, yeah.

Dr. Bowden:                       Yeah, the Small dense ones. I’ve got this. I am an example of how the test … of being undertreated. In other words, I was a false negative. They said, “Oh, yeah, there’s no problem whatsoever,” and in fact, when you looked under the hood with the right test, I had very high particle size. I have all these wonderful, amazing functional cardiologists in my network, starting with Steve, and I asked their opinions, “Guys, what do you … I’ve got a serious particle problem. What should I do?” I’ll be honest. One of them said, “I know you’re not crazy about the statins. I think we should try, maybe, five milligrams of Crestor.” Others said, “At your age, it’s absolutely not necessary to do.”

I went to a cardiologist at Scripps who gave me certain supplements. I got a little stricter on my diet. Here’s what Steve’s advice was. Steve said, “Before you go on the statin, I want you to take a quarter cup of olive oil every day for three months, and then let’s remeasure,” so I did. He literally prescribed olive oil, and I do it to this day. If I had the bottle, I’d show you. I literally swig it from the bottle, as a medicine. Every day, it’s one of my supplements, and I did that. I can’t say it was just that, but that, the supplements that Dr. Triffon at Scripps Institute recommended, the stricter adherence to the higher fat, lower carb diet. My particles went from 2,200 to 1,600, and my particle size went from B to A.

Dr. Sinatra:                          Wow.

Dr. Bowden:                         I think the olive oil … It may not have been the whole story, but that’s the way Steve was. He’s, “Hold the medicine. Try the olive oil. Let’s see what that does.”

Dr. Sinatra:                          That’s great.

Dr. Weitz:                            Yeah. I know Dr. Houston’s very big on olive oil too.

Dr. Bowden:                        It’s a great food. It’s a medicinal food. There’s no doubt.

Dr. Weitz:                            Yeah. You got to get the right olive oil.

Dr. Bowden:                        Yes.

Dr. Weitz:                            Yeah. It’s got to be extra virgin, organic. It should all come from one country. You should name the specific type of olive that’s there. If it has a bitter taste, that means it’s going to be higher in the polyphenols.

Dr. Sinatra:                          There you go.

Dr. Bowden:                        Yeah. By the way, I don’t know if anybody knows this, a little trivia. There was a book written not too long ago by the food writer and expert, and he said the four most faked foods in the world, Kobe beef, Parmesan cheese. I forgot the third, and the fourth was extra virgin olive oil. It is so … They lie about that on the label consistently, so you got to be really, really careful. Steve had his own olive oil company.

Dr. Weitz:                            Yeah, be honest with you, most olive oils don’t even say on the label what type of olive, where they’re from.

Dr. Bowden:                        A lot of them are mixed and compounded with other oils, and-

Dr. Weitz:                            Right.

Dr. Elkin:                             They’re tainted, they’re tainted.

Dr. Bowden:                        They’re tainted.

Dr. Weitz:                            Yeah, yeah. I had an olive oil expert on the podcast, and one of the things he emphasized is it should say what country and it should name the specific type of olive, like koroneiki olives from Greece.

Dr. Bowden:                        Yep, yep, yeah.

Dr. Weitz:                            Next topic. Let’s talk about the importance of some of these nutraceuticals that Dr. Sinatra pioneered like coenzyme Q10, L-Carnitine, magnesium, D-ribose.

Dr. Bowden:                        He called them the awesome foursome. Drew could probably talk about it just as eloquently. I mean, he-

Dr. Sinatra:                         No, you go ahead first, Jonny. Go ahead.

Dr. Weitz:                           Yeah.

Dr. Bowden:                       Well, these were the four nutrients that he felt were really powerful for heart disease. Carnitine because it transports fat into the mitochondria, so it can be burned for energy. Magnesium, because it’s just needed for 300 different biochemical operations and it lowers blood sugar and it lowers blood pressure. Coenzyme Q10, he was one of the biggest proponents of coenzyme Q10, which basically is a nutrient that helps your heart make more ATP. It helps everything make more ATP, but the heart never takes a vacation, so it was a very, very heart-healthy nutrient. D-ribose is something we’re using to this day.

It’s so funny, because he was prescient about that one as well. D-ribose is a naturally occurring sugar, which has a number of incredible properties that he realized, way before the rest of us did, number one, it helps the cells to make ATP. It does this by turbocharging an enzyme called AMPK, which is a master metabolic controller. It’s like the air traffic controller of the cell. It is responsible for making the cellular bitcoin, which is ATP. That’s the stuff you need to do absolutely everything from talking, to waving your hands, to dancing the Mambo, to blinking your eyes, you need ATP, and coenzyme Q10 helps you make that. I’m sorry. D-ribose helps you make that.

What we have found recently about D-ribose … I use it in my coffee because it’s just such a great way, at the cellular level, to help make energy. I wondered myself. I thought, “This is awfully sweet-tasting.” It’s really fantastic if you like stevia, or monk fruit, any of that stuff in your coffee. This is just as good, but it’s got to raise your blood sugar, right? No. The miraculous thing about this naturally occurring sugar that’s good for energy is it actually has been used in diabetes treatment, and it actually helps lower your-

Dr. Elkin:                              It’s a five-carbon sugar versus a six-carbon sugar like glucose and sucrose.

Dr. Bowden:                       Exactly.

Dr. Elkin:                              That’s the difference.

Dr. Bowden:                       Exactly. That was one of his awesome foursome and to this day, I use … I would never be without magnesium. It’s one of my three basic supplements for everybody, and D-ribose is right on my counter, right now to this day, and coenzyme-

Dr. Weitz:                            That’s great.

Dr. Bowden:                       [inaudible 00:36:02] my vitamins.

Dr. Sinatra:                          Yeah. I’ll add to this that I think my dad pioneered it with cardiovascular disease and supporting heart, circulatory system, and all that. He wrote his book, Metabolic Cardiology, which was all about using these supplements, and talked about heart failure, helping with hypertension. I believe now that, just with things, we’re going, we’ve learned that, hey, you could use this protocol in someone with migraines. You could use this protocol in someone with chronic fatigue, or fibromyalgia, or someone that’s suffered with a long, chronic illness like Lyme disease, for example. It’s multifactorial in what we can use it for, which is beautiful because it’s not just for the heart, but it’s for the whole body, charging up every cell, like you were saying, Jonny.

Dr. Bowden:                       Yes.

Dr. Sinatra:                          I just feel like my dad really … Especially CoQ10. I really feel like CoQ10 was like his baby. He really nourished that baby and brought it to life. I believe it was 1986 that he had that on formulary at Manchester Memorial Hospital.

Dr. Bowden:                       Wow.

Dr. Sinatra:                          Think about that. 1986. I think I was around six years old when that happened. That just blows me away that he was just so advanced in his thinking back then of CoQ10, and then all these others were brought onboard. It was sort of, CoQ10 was really the beginning. Then I think it was magnesium next, and then it was L-Carnitine, and the last one was really the addition of D-ribose. It was really just so beautiful to see the evolution of the awesome foursome over time, and how it can not only support the heart, but the rest of the body as well.

Dr. Bowden:                       Getting CoQ10 into the formulary, I can’t emphasize how important that is. My mother died of congestive heart failure in the late 1900s. I went there and I said, “Can we put her on a couple hundred milligrams of coenzyme Q10?” They said, “What is that?” I said, “It is an enzyme that is used to make energy for the heart. It’s used in Japan as a prescription medicine for congestive heart failure. There’s major research on it.” We didn’t have the internet then. I printed out pages and pages of stuff. I brought it to them. Didn’t matter. Wasn’t in the hospital formulary. They never heard of it. Do you realize-

Dr. Elkin:                              It is still not in the formulary.

Dr. Bowden:                       … what Steve did-

Dr. Elkin:                              It’s still not in the formulary.

Dr. Bowden:                       Huh?

Dr. Elkin:                              It’s still not in the formulary.

Dr. Bowden:                       Getting it in the formulary in Manchester General was, people-

Dr. Sinatra:                          It was huge.

Dr. Bowden:                       Hats off, man. That’s just incredible.

Dr. Weitz:                            Well, one of the things that not everybody may realize is that the heart, unlike all the other organs, is the most dense with mitochondria-

Dr. Bowden:                       Of course.

Dr. Weitz:                            … which is what produces the energy, and coenzyme Q10 is so crucial for mitochondrial function, so it makes a huge amount of sense. I know, Dr. Elkin, you use those nutrients in your practice as well.

Dr. Elkin:                              Well, I have a very active practice, and a lot of patients with cardiomyopathies. They all, everyone with cardiomyopathy gets all four of those. I do CoQ10 levels. People that have cardiomyopathies and congestive heart failure really should have levels of four or five, and so I go by levels. Usually, they go on at least 400 milligrams a day. It’s also been used for Parkinson’s patients, for Parkinson’s as well. The L-Carnitine, and the D-ribose, I’ve used it in chronic fatigue. I’ve used in other states like that.  It’s funny. Now, I do have patients on statins because I have a lot of patients with confirmed coronary disease that have stents and bypasses, so I don’t just have preventative. I mean, I have primary prevention, and I have secondary prevention. People need to know that in secondary prevention, it hasn’t really changed. Still, the standards are pretty strict because patients that are on statins generally do better. Anyway, anyone that goes on a statin in my practice automatically goes on CoQ10. It’s a must. I tell them right and then there.

Dr. Bowden:                       Where do you stand, just as a side, on the ubiquinol versus the standard-

Dr. Weitz:                            Ubiquinone, yeah.

Dr. Bowden:                       Ubiquinone.

Dr. Elkin:                              That’s funny. Because I asked that question more than once to Steve, and he didn’t think it made a difference.

Dr. Bowden:                       I did too.

Dr. Elkin:                              I specifically said that patients are saying ubiquinol because they see it in the Life Extension Foundation, right?

Dr. Bowden:                       Yeah.

Dr. Elkin:                              Well, I asked Steve about it. Do you know anything, Drew, about that?

Dr. Sinatra:                          No, the same thing. I kept asking him over and again, and he basically would say that they’re equal, and that there was a big marketing push out there to get-

Dr. Bowden:                       Huge.

Dr. Sinatra:                          … ubiquinol a better product, but it really was the same.

Dr. Bowden:                       Yeah.

Dr. Elkin:                              Right.

Dr. Bowden:                       Yeah. He told me that there may be cases in which, for some reason, the person doesn’t absorb the standard one as well, and there may be an advantage in those cases, but he was very squishy on it. He thought, basically, that as he pointed out once, there’s like 18,000 studies using ubiquinone before ubiquinol even came out and we had pretty good results, so it was …

Dr. Elkin:                              Checking levels do help. Cleveland does it. Labcorp does it. Boston Heart does it. They will do CoQ10 levels.

Dr. Sinatra:                          Well, Howard, thanks for doing that because I know my dad measured levels way back in the day, and thank goodness you’re carrying the torch there and continuing with that, because just a reminder, I don’t do that with my patients and I probably should.

Dr. Elkin:                              Thanks.

Dr. Sinatra:                          Yeah.

Dr. Bowden:                       I’ve never had my levels measured. I may come to you and get them measured. That’d be an interesting metric to know about.

Dr. Weitz:                            Yeah, yeah. It’s also included in the Micronutrient test from Vibrant.

Dr. Bowden:                       Ah, good.

Dr. Weitz:                            Which is-

Dr. Sinatra:                          Oh, okay.

Dr. Weitz:                            Yeah. They’ve done the old SpectraCell Micronutrient test quite a bit better. Let’s talk about the role of emotions in heart health, which is something that Dr. Sinatra was probably one of the few cardiologists ever to talk about.

Dr. Elkin:                              Stephen gave me his book.

Dr. Bowden:                       Heartbreak. I’m so glad you brought that.

Dr. Elkin:                              I started reading it. I said, “Steve, this is amazing.” He said, “Howard, that book was written 20 years ago.” I thought it was … I said, “Are you kidding me?” Because I related to it so much, because I’m a body-mind kind of doctor. I believe, whether it’s cancer or heart disease, they’re correlates.

Dr. Sinatra:                          Yeah.

Dr. Elkin:                              Yeah, so I totally support his work in this. This book was [inaudible 00:42:21]

Dr. Weitz:                            Are there certain insights you got from Dr. Sinatra’s thinking about this that have helped you with some of your patients?

Dr. Elkin:                              Yeah. Specifically, it’s interesting. My cancer patients are a little different than heart patients. Because heart patients, they have a type A personality, which has changed over the years. Competitive, and blah, blah, blah. I’m type A, but I’m not cynical and I’m not angry. Those are the two, those are bad characteristics. Cancer patients are a little different. They tend to repress a lot of their feelings.

 He talked about that in this book, and I see that a lot. I do talk a lot … In my practice, I teach patients how to breathe. Meditation is an important part of what I do. I teach it, and about getting emotions out. I talk about it in my book and I practice it every day with my patients. They have to get it out. I think this book was just revolutionary for me, and I’ve said it to my patients as well.

Dr. Weitz:                            How about yourself, Jonny?

Dr. Bowden:                       Well, I was just thinking about, as I mentioned earlier, we had both had training in psychotherapy, and we’d both been patients of psychotherapy, so we both really felt this way about the connection and the bimodal communication between heart and mind, and brain and body. What’s striking to me is how much the research has supported his intuition. They’re writing now about, we all know, maybe people who are listening might not know, there’s this major thing in the body called the vagus nerve, and its job is to do communication from the back of the brain all the way through. It has outposts in the heart, in the immune system, in the gut. There’s really no more debate about body and mind, and separation in the vagus. That’s why all that, gut feeling and stuff like that, where so much, 80% of your serotonin is made in the gut, and all of that information flows back and forth, and the science is supporting that.

Dr. Bowden:                       There’s a new book that just came out by a professor of medicine at Harvard, who also has a divinity degree from Princeton, and it’s called Cured. They looked into some of these cases, remarkable cases of remission that are not medically explained, but are documented and stuff. It seems that the thing that all of them have in common is that these patients somehow figured a way to tap into their parasympathetic nervous system and calm themselves down.

Dr. Bowden:                       A lot of them got stage 4 diagnoses. They quit their job. They moved to Costa Rica, and miraculous … Without thinking that was going to happen, they did what Steve always talked about, which is to tap into that natural healing that the parasympathetic system does, the rest and digest system, and to be able to get off that treadmill a little bit. That’s all about emotion. It’s all about stress and anxiety, and about finding stillness, and finding calm, and taking off-

Dr. Elkin:                              Drew, I think you see a lot of this as a naturopath. My last YouTube Live was on this very thing, the parasympathetic nervous system, and using the vagal maneuvers, and so forth, but we are so sympathetically overdriven.

Dr. Bowden:                       Overdriven.

Dr. Elkin:                              Look what’s happening in the world right now. Besides our health issues, just look at the world, how divided we are in this country. Everybody’s tense. I’ve never seen such a tense world before. No wonder disease is rampant right now. It’s terrible, so we need to really calm and do these vagal … That was one of the things that’s interested me about earthing and being grounded is it actually helped get back to your normal circadian rhythm and increase the parasympathetic tone. Very fascinating. Stephen taught me that.

Dr. Sinatra:                          Yeah. I’m guessing, I’m feeling called to share these stories tonight.

Dr. Weitz:                            That’s great. We appreciate it.

Dr. Sinatra:                          My dad was a storyteller. When I used to shadow him when I was a teenager, and I think in my early 20s, I did a lot of shadowing of him, which I’m so grateful for at this point now. What I loved about the way my dad handled his patients was that he listened. He let them tell their story, and a lot of emotions would come up. Sometimes, the patients felt rushed, but he’d always give them the time and the space to allow them to tell their story. That in itself was the medicine, listening to the story. Because a typical doctor’s visit is what, six minutes, when you go see a conventional doctor? What do you do? You just go in, you got hypertension. You come back with an ACE inhibitor, whatever it is, but my dad was different. He had a little bit of a longer visit, and he allowed that space for transformation and for storytelling of the patient, which they needed.

Dr. Sinatra:                          That’s primarily why I became a naturopathic doctor, because I was so interested in counseling. Really, he was doing counseling the whole time, the psychoenergetic training that he did. That blew me away with his patients because he sometimes wouldn’t even have to recommend something. He would listen to them, and, all of a sudden, they’d give him a hug at the end, and ah, that was the medicine they needed at the time. I think my dad just had that uncanny ability to be present and to listen with compassion, and open ears. Patients really, they came to see him for that.

Dr. Elkin:                              I think, now with large medical groups and HMOs, the medical world is so corporate. I still have my own individual, solo practice. I’m a dinosaur, I guess, but patients really appreciate this. The number one complaint, if you look at surveys with patients, they feel they are not being heard by their doctor. They don’t feel heard. My mother, who’s 96, said, “Yeah. They got one foot out the door, one foot in the door.” It’s a complaint. People, they don’t feel heard.

Dr. Sinatra:                          Yeah.

Dr. Weitz:                            Yeah. Unfortunately, it’s the system. It’s hard to blame doctors because they’re part of the system. I know on the West Side, there aren’t too many physicians who are independent. Most of them have become part of a group, and the group’s been bought out by a hospital. The hospitals come in and run the show. They prescribe to them how many people they need to see, and so they’re caught in the system.

Dr. Sinatra:                          Yean.

Dr. Weitz:                            Let’s talk a little bit about earthing. I know that that’s something that Dr. Sinatra pioneered. I know you worked with him on that earthing study, Howard. What is earthing and what role can this play in heart health?  I think this is the remarkable. It’s basically using the negative electrons from the Earth’s surface. First of all, if you look at free radicals, they’re positive though. How do you squelch them? Well, free radicals, it’s the Earth’s surface, and I did this. I’m not doing it as regularly now as I used to. When I would do earthing every single day, grounding in my front yard, and so forth, I would literally feel tingling from the ground within. I really felt that sense.

Dr. Elkin:                              Stephen and I did it. We wanted to see the effects on blood pressure. We know it helps to decrease viscosity. We know it’s antiinflammatory, antiaging, but hinted, it also had an effect on blood pressure. We did a small study. Unfortunately it was a grassroots study, so we didn’t have a lot of patients. It was just me and a nurse that did this, but we did find a very positive correlate. You had to make sure the patients were grounded for at least 10 hours, which is hard to do.

Dr. Bowden:                       How did you ground? How did you do-

Dr. Elkin:                              We had grounding mats. We had grounded sheets. We encouraged … They had to report it, and they came in once a month. I set this up with Stephen and Guyton Chevalier, I think, and we had a whole protocol set. It wasn’t easy to do, believe me, it wasn’t, because you’re dependent on people. It was difficult, but patients loved it and they felt more calm, and they got … Here was the best thing. They felt they got more rested sleep. In some of these patients, we weren’t testing for this, the C-reactive protein, which is a marker for inflammation, came down-

Dr. Bowden:                       Wow.

Dr. Elkin:                              … in several of these patients, which is a marker of inflammation, so it’s fascinating. I wanted to, we talked about doing a bigger study and more studies, and we talked to Clint Ober. We never got around to it. I think that the reports on earthing, being grounded are significant. They’re phenomenal, but for the medical world to appreciate this, we need to have more studies. That’s just it.

Dr. Sinatra:                          Yeah, no, agreed. My dad was really big into understanding when this started to occur when we weren’t grounding anymore, and it was really when we started to wear these shoes that were rubber-soled, which connected you from the Earth. If you ever met my dad at any point, he probably came walking through the door in these radical cowboy boots. He had ostrich cowboy boots, and all these snakeskin ones, crazy ones. Those cowboy boots were grounded. They had a leather sole, and he, I think, maybe unconsciously, was moving towards the realm of grounding, even though he didn’t really know it.

When he stumbled upon this, I believe it was like 2007-2008, as I remember we were first talking about this idea, concept of grounding and earthing. It really blew his mind. I believe too, that it was great, because I saw him bring the science of it into effect, meaning like you were saying Howard, this free flow of electrons into the body helps with free radical stress, et cetera. I saw him finally connect to the Earth, and that was one thing that made me really happy, because my dad was always such this busy guy. He’s like go, go, go, go, go. Always there for someone. Traveling a lot, working a lot.

It was so good to see him ground out, as we called it, and connect to the Earth, and not only get the physical benefit of this free flow of electrons into your body, but also this connection with Mother Earth that I saw him evolve with over time, and it was great. It was great to see that. He’s such a strong believer in grounding, I can’t tell you. Every time we’d do something or go somewhere, he’d say, “Son, ground out.” We’d fly in an airplane, “Go ground out.” Every time, just, “Go ground out.” It’s imprinted in my mind, and now I do it with my kids too. I’ll be like, “Kids, take off your shoes. Go ground out.”

Dr. Elkin:                              He’s right.

Dr. Sinatra:                          Yeah.

Dr. Weitz:                            That’s great. Maybe, Jonny, do you want to add anything about the grounding?

Dr. Bowden:                       No. There were times when we were doing the cholesterol book tour, and we were doing appearances and stuff, and he was really into it. I had the crisis of conscience that I felt it was outside the Overton window for our audience. We were already taking on the medical establishment with such outrageous claims, “Saturated fat doesn’t cause heart disease, and cholesterol is being measured wrong, and it’s not the …”  It was already a little bit outside, and when he started talking about grounding, I was just worried. The Overton window, it’s like, “Dude, it’s a little too much. Maybe just don’t talk about it on the Dr. Oz show, because I don’t think that they’re going to quite get it.” I was always trying … I thought he was on to something, but I was fearful that because it was such a radical, new concept and so easy to characterize … You know how conventional medicine would … You know what they … I wanted, not to silence him, but I wanted him to keep it private because I was afraid it would dilute or make it easier for people to dismiss our message about heart disease and the stuff we’ve been talking about for the last hour.

Dr. Elkin:                              The thing I remember about Steve is that he was so passionate and energetic. He could have sold me on anything. When we had this luncheon and talked about grounding, would I be interested? I jumped at the chance because I felt somewhat protected by him because I wasn’t paving the way. He’d already done it, or was doing it. I was just riding on his dovetail, you know?

Dr. Bowden:                       Mm-hmm.

Dr. Elkin:                              I was honored to be able to participate. It was great.

Dr. Weitz:                            Maybe we could wrap up by saying something about what we should all focus on to help carry on Dr. Sinatra’s legacy in the world.

Dr. Elkin:                              Gosh.

Dr. Weitz:                            Howard?

Dr. Elkin:                              I think we’ve all said it, but I think, because I’m in an active practice, I am living it every day. I give him a lot of credit for how I practice, really, because I don’t think I’m a maverick. I learned from him and I gleaned from him, and so it just seems natural to me, because I’m a thinker too. I don’t just pass out pills. His memory remains indelibly within me, and as long as I practice, as long as I live, I’ll always remember the role that he played and how he helped me. I’m very grateful, having known him.

Dr. Sinatra:                          Yeah. I want to say that my dad was a phenomenal cardiologist, no questions about it. He was also an amazing heart doctor. There’s a difference there and that is-

Dr. Bowden:                       Good. Good one.

Dr. Sinatra:                          … he had such a high level of compassion and unconditional love for himself, his patients. He had dogs, guys. He had two or three dogs, sometimes in the office, come in with him. What doctor does that? What doctor does that? That, in a way, protected him, actually, energetically, from some things that would go down with patients.  Also, gosh, he just had such an open heart, and he shared that love with everyone, and that’s what attracted people to him. Just his level of compassion is just, it’s infinite. That’s the message I want to go out to people, is that we live in a very difficult time now. There’s a lot of stress, and it’s very easy to be judgemental of others, but maybe open your heart more and allow love to come into your heart so that we can live more in peace in this world and not so much anger.

Dr. Elkin:                              Beautifully stated.

Dr. Weitz:                            That’s great. How about you, Jonny?

Dr. Bowden:                       I’m reminded of a parable I heard, something I heard once to describe the difference between Eastern and Western medicine. I think it describes the way Steve practiced. It said that in Western medicine, we look at the symptom that the patient has in front of us. In Eastern medicine, they ask, “Who is this person in front of me?” Steve didn’t practice by lab tests. He practiced by treating patients, not numbers, not metrics. I think that’s probably the biggest message, the biggest tribute I can give him. He saw the person, the whole person, their story, everything about them. The lab tests and the symptoms were just part of that. They weren’t what he treated.

Dr. Weitz:                            Awesome.

Dr. Sinatra:                          Well said.

Dr. Weitz:                            Yeah, I don’t think I have much to add, other than to say that some of the most important messages I’ve heard from you guys is the importance of questioning orthodoxy and thinking outside the box. Even though medicine is a science, there’s also an art to it, and listening to your patient, which is just so sorely needed, and to have compassion for your patients, and do everything with a passion for what you do.

Dr. Elkin:                              I want to thank you, Ben, for bringing us all together.

Dr. Bowden:                       Yeah. Thank you, Ben.

Dr. Elkin:                              This was Ben’s idea, and I jumped at the chance.

Dr. Bowden:                       Thank you, Ben, and thank you, Howard, and thank you, Drew.

Dr. Elkin:                              It was really a pleasure.

Dr. Weitz:                            Okay. Well, thank you, Howard, Jonny, Drew. Thank you for everybody who’s watching it live, and who’s going to watch it on the recorded version.

Dr. Elkin:                              All right.

Dr. Bowden:                       Goodnight.

Dr. Weitz:                            Okay, goodnight.

Dr. Elkin:                              Bye, guys. Bless you.

Dr. Sinatra:                          Thank you.

 


 

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. If you enjoyed this podcast, please go to Apple Podcasts and 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. 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. 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.

 

 

Dr. Ami Kapadia discusses Small Intestinal Fungal Overgrowth 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

1:58  Small Intestinal Fungal Overgrowth (SIFO).  Some of the most common symptoms of SIFO include some of the common IBS symptoms, including gas and bloating, nausea, constipation or diarrhea, though more commonly constipation, skin rashes, allergies, and brain fog.

2:58  Risk Factors for SIFO.  Some of the risk factors include decreased intestinal motility, the use of antibiotics or acid suppressing medications (such as omeprazole or Prilosec), opiate use, and certain GI surgeries. Some patients have a hypersensitivity reaction to yeast that live in the GI tract and on our mucous membranes.  Decreased intestinal motility refers to the lack of the cleansing waves that happen when you don’t eat for at least 3 hours and that function to clear out excess bacteria and fungi from the intestines.  The lack of these cleansing waves can occur because of stress or not spacing our meals out and just snacking all day.

6:50  Antibiotic use can lead to fungal (candida) overgrowth because when you reduce the population of the good intestinal bacteria, candida can overgrow and fill up some of that space.  Dr. Kapadia recommends that when someone takes an antibiotic, we should have them take saccharomyces boulardii or other potentially botanical antifungal options to help keep that yeast population down so it doesn’t overgrow.

8:11  Testing for SIFO.  Dr. Kapadia usually starts with ordering candida antibodies and a candida immune complex from a routine lab like Quest or Labcorp.  An organic acid test can look for fungal metabolites in urine. including arabinose.  Stool testing often does not tell us that much about what is in the small intestine.  The other issue is that we don’t have a normal concentration of yeast as a standard to define what’s normal and what is above normal on a stool test.

11:25  Nutritional Deficiencies.  There are certain nutritional deficiencies that tend to occur with SIFO, including iron, zinc, copper, B12, and vitamin D, so Dr. Kapadia will often check for ferritin levels, as well as zinc, copper, B12, and vitamin D, which is important for the immune system to regain balance.

 

 



Dr. Ami Kapdia is trained in family medicine as an MD and she has also pursued training through the Institute of Functional Medicine and the American Academy of Environmental Medicine and she is certified by the American Boards of Integrative and Holistic Medicine. She now works in Portland, Oregon at the Kwan Yin Healing Arts Center and her website is AmiKapadia.com.

Dr. Ben Weitz is available for Functional 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, 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. Let’s jump into the podcast.

Hello, Rational Wellness Podcasters. Thank you for joining me again. Our topic for today is small intestinal fungal overgrowth with Dr. Ami Kapadia. Many of us who listen to the Rational Wellness Podcast are familiar with small intestinal bacterial over growth or SIBO, which is the most common cause of irritable bowel syndrome. We have had a number of episodes with Dr. Mark Pimentel, Dr. Allison Siebecker, Dr. Steven Sandberg-Lewis, and other experts on the podcast speaking about SIBO.  Today we’re going to speak about fungal overgrowth. So this also exists as well as bacterial overgrowth, even though this topic has been less studied and there’s also no breath test to test for it as there is for SIBO. Dr. Ami Kapadia, did I pronounce that properly?

Dr. Kapadia:                        You’re close, you’re close. Kapadia.

Dr. Weitz:                            Kapadia. Ami Kapadia, she’s trained in family medicine as an MD, and she’s also pursued training through the Institute of Functional Medicine, the Academy of Environmental Medicine, and she’s certified by the American Board of Integrated and Holistic Medicine. Her practice is in Portland, Oregon at the Kwan Yin Healing Arts Center. Ami, thank you so much for joining us today.

Dr. Kapadia:                        Yeah, thank you for having me.

Dr. Weitz:                            Great. So why don’t we jump right into SIFO. If you had a patient, what are some of the symptoms that might alert you to the possibility that your patient might be suffering with small intestinal fungal overgrowth?

Dr. Kapadia:                        Yeah, so the symptoms are really similar to SIBO and you can’t really tell clinically which is which, but it’s some of the common symptoms we see like IBS, bloating and gas, nausea. It can really be constipation or diarrhea, but we tend to see constipation more clinically. A lot of my patients who end up having something with fungal overgrowth often have skin rashes. Sometimes they have mast cell histamine related issues, allergies. So there can be sort of like intestinal related imbalances, but then also extra intestinal symptoms. Brain fog is also pretty common. So those are some of the things we look for.

Dr. Weitz:                            Okay. So it looks like you listed some of the risk factors, like decreased intestinal motility are similar to some of the risk factors for SIBO.

Dr. Kapadia:                        Right. So, some of the risk factors are the same. There’s some that are a bit different that we can talk about. Definitely if there’s motility issues where someone’s prone to overgrowth in general, they can end up with issues with bacterial or fungal overgrowth. If they’ve been on a lot of antibiotics or acid suppressing medications that can also lead to potential overgrowth. Opiate use and certain GI surgeries.  Then the one that’s quite different is sort of, I wouldn’t say it’s been fully defined or elucidated, but a lot of us who work with patients over the last several decades have suspected a sort of allergic or hypersensitivity reaction to yeast that live in the GI tract and on our mucus membranes. That would be a different risk factor that we can talk about that we tend to find more in people who are prone to allergies.

Dr. Weitz:                            Let’s go into a couple of those a little more. So one of them, say, is decreased intestinal motility. So the concept behind how that leads to SIBO, at least Dr. Pimentel’s explanation, it may have evolved over time, was that you don’t get the cleansing waves that help clear out bacteria. I guess those are the same cleansing waves that would clear out fungal overgrowth?

Dr. Kapadia:                        Right. With the migrating motor complex. So, if that’s affected for any number of reasons, which a common one is stress or not spacing our meals out and just snacking all day, those little things can still affect motility. Then of course there’s other neurologic conditions and other reasons people might develop motility disorders, but it’s the same idea as with SIBO.

Dr. Weitz:                            Now, in terms of, Dr. Pimentel also talks about this autoimmune issue. Is there something similar for fungus?

Dr. Kapadia:                        That’s a good question. I have not read anything about an autoimmune condition per se. There’s been some research that there might be a role of genetics in some people who are prone to more fungal issues, but I haven’t seen anything per se, like with Dr. Pimento’s IBS smart test, that type of thing, which would help give us a cause from food poisoning or something.

Dr. Weitz:                            Right. So fungal overgrowth, is basically we’re talking about for the most part candida, right?

Dr. Kapadia:                        Yeah. We’re mostly talking about candida, when we’re talking about yeast overgrowth in the GI tract. Occasionally there can be others.

Dr. Weitz:                            By the way, yeast, fungus, are basically synonyms. Right?

Dr. Kapadia:                        Right. So you have over overarching fungi and then under that would be molds and yeasts as the separate categories. The main yeast we’re talking about would be candida. Occasionally for people who do stool testing and other things that may or may not be helpful in determining this diagnosis, we’ll see other forms of yeast, but that’s the main one is we’re talking about candida.

Dr. Weitz:                            Right. Candida occurs naturally in a gastrointestinal tract. In this case, we’re just talking about an overgrowth of candida.

Dr. Kapadia:                        Right. So it’s a commensal organism on the mucus membranes and the GI tract. The problem occurs when there’s an overgrowth again, often with antibiotic use and for other things. But there’s this sort of interplay with people who potentially genetically, some people can be on antibiotics and not have any problems and other people, one course of antibiotics, and they tend to develop a whole host of problems. So, but yes, it’s normally a commensal organism.

Dr. Weitz:                            Now, maybe you could explain how antibiotics would lead to fungal over growth.

Dr. Kapadia:                        Right. So when we take an antibiotic, it’s going to reduce our population of the good bacteria that live in our GI tract and those good bacteria actually secrete certain products that can help keep yeast in check. So when we reduce our population of the good intestinal bacteria, yeast can overgrow and fill up some of that space.  Since the antibiotic doesn’t work on yeast at all, we can end up with this imbalanced picture. Which is why sometimes at this point, if we’re going to have someone who has to take an antibiotic, we’ll have them take something like saccharomyces boulardii or other potentially botanical antifungal options to help keep that yeast population down so it doesn’t overgrow.

Dr. Weitz:                            Right. So, people take antibiotics because they have either a bacterial infection with a pathogenic bacteria or an overgrowth of bacteria, but yet most of these antibiotics also damage the healthy bacteria in the microbiome.

Dr. Kapadia:                        Right. With Dr. Pimentel I’m sure spoke about with Rifaximin we don’t really worry about fungal overgrowth, but with most other antibiotics, it can be a potential problem. Especially the broad spectrum, tetracycline and those types of antibiotics.

Dr. Weitz:                            Right. So since there’s no breath test for SIFO, how do we test for it?

Dr. Kapadia:                        So there’s different things you can do. There’s some questionnaires that Dr. Crook from his books many years ago had come up with various questionnaires. I use those occasionally, but more so I definitely do some lab testing with patients. The way I explain it is that there’s no perfect test for this. Gastroenterologists can do a duodenal aspirate during an endoscopy procedure, but that’s invasive and not many of them do it. So the standard testing I start with, with most patients is what’s called candida antibodies and a candida immune complex.

Those are routine labs that you can get through Quest or Labcorp with the doctor. So that’s where I generally start. If any of those are positive, particularly the immune complex or the IgG antibody, those have some research that potentially could correlate with an intestinal overgrowth. The other antibodies, I still pay attention to them, but I just let patients know this isn’t like a yes, no. It’s more like it’s giving me clues that your body might not be having a balanced relationship with yeast in the GI tract and in other areas.

Dr. Weitz:                            Okay. Is there other testing?

Dr. Kapadia:                        Yes. There’s other testing as well. So there’s something called an organic acid test that can look at different fungal metabolites. The metabolite that’s most been written up about with fungal overgrowth is arabinose. So that I’ll sometimes do, if we just don’t have a clear picture and we’re trying to get a sense of if someone might have this as part of what’s going on. Then there’s different interpretations of stool testing that the challenge with stool testing is that it’s mostly looking at the large intestine and we don’t know where the overgrowth potentially is in that patient, but it’s not really going to give us a representation of small intestinal overgrowth.  The other issue is that we don’t have a normal concentration of yeast as a standard that we could go by to define what’s normal and what’s above normal because almost everyone does have yeast in the GI tract. So there’s a couple challenges. That being said clinically, if we see it on a stool test, some labs that I’ve talked to have said, they do seem to correlate it more with patients who have an issue with overgrowth, even though I can’t prove that based on a normal range.

Dr. Weitz:                            Now, there are different forms of candida, different strains. Does that matter? Is there a particular type that’s more problematic?

Dr. Kapadia:                        The candida albicans is the more common strain.  In different parts of the world there can be more resistant strains.  In the US, for example, for women that come in, if we’re doing vaginal testing, sometimes it can be harder to treat some of those other strains like candida tropicalis, and glabarata, and those types of strains. So as far as if it makes a difference, it could potentially be more challenging to eradicate if it’s not the albicans, but fortunately that’s not super common.  If it is one of those, there’s still things that can work. Particularly if we’re using botanicals, there’s many that could still work. In pharmaceuticals as well they’ve done some studies on women with recurrent vaginal fungal issues, on which protocols to use if someone has a different strain.

Dr. Weitz:                            Now, I understand that there’s certain nutritional deficiencies that tend to occur with small intestinal fungal overgrowth.

Dr. Kapadia:                        Yes. So the nutrients that I always check for, if there’s this form of dysbiosis or other forms as well at times, ferritin, iron stores can be low and you want to be replete that. It’s kind of like a Goldilocks principle with iron. We don’t want too much or too little, but that can be important for the immune system. Zinc deficiency, I find pretty commonly. Then sometimes B vitamins can be low.   So as far as testing, I commonly will check a zinc and a copper, a ferritin, and a B12. I often will supplement with a B complex just to cover our bases because those are all important, and vitamin D. Those are all important for the immune system to help regain that balance that we’re trying to get to.

Dr. Weitz:                            Now, because you have excess fungus lining the intestinal walls, just the same as if you have excess bacteria and because the small intestine is where many of the nutrients are absorbed, that’s one of the reasons why you’re more likely to have nutritional deficiencies.

Dr. Kapadia:                        Right. Then you could develop elevated intestinal permeability and food allergies and all of these things that can affect nutrient absorption in what you mentioned in these other ways as well.

Dr. Weitz:                            So for the patients with SIBO, we often use a low FODMAP diet, low amounts of fermentable fiber. What about for SIFO? What kind of diet do you find most effective?

Dr. Kapadia:                        So for a diet, there’s a couple things I look at. One is sort of, I do what we call a five day yeast mold elimination challenge, just to determine if the patient has become sensitive or allergic to molds and yeast and foods. So we remove things like yeast, vinegar, dried fruit, alcohol, and sugar, fermented vegetables. There’s a whole list that we give people. We’ll remove those for five days, challenge them back and try to get a sense of if their bodies develop a cross-reactivity.  Those foods are also high in histamine. So it’s sometimes tricky to determine what they might be reacting to. If they’re reacting, then we’ll keep those out for a few weeks while we try to treat the overgrowth. So that’s a piece of the puzzle. I’ve had some patients where their IBS symptoms go away completely when they take those foods out. Then we try to correct things enough so that they can eat them again.

Dr. Weitz:                            So what are some of those foods?

Dr. Kapadia:                        Yeah, so yeast, vinegar, dried fruit, alcohol, and anything fermented really would be in that category, like kombucha, fermented vegetables, those types of things.

Dr. Weitz:                            Okay.

Dr. Kapadia:                        We’ll remove those. I try to be really clear. Those can be very healthy foods. We’re just trying to make sure there’s not a cross reactivity. Then we try to get those back into the diet. They’re not feeding the yeast per se. So that would be part of it. Then the other part is, I try to make sure we’re getting a sense of what someone’s food sensitivities are. So we can talk about this, but some people have a cross reactivity to gluten for many reasons, but with a candida overgrowth, there can be a cross reactivity of the proteins.  So I’ll do significant testing to figure that out. So we’ll try to troubleshoot what that person’s sensitivities are, whether it’s gluten and dairy, or both, as well as that yeast, mold related piece. I don’t typically use low FODMAP per se with this, just because it’s so restrictive, unless someone has come in on that already and they’re comfortable and want to do it for a period of time. We try to find other ways so they don’t have to stay on that.

Dr. Weitz:                            You use an anti-candida diet, like low sugar, starchy carbs?

Dr. Kapadia:                        Yeah. Well, I remove sugars except for fruit. I don’t limit starches as long as we’re being reasonable because I don’t want to restrict things too much. So unless they’re telling me that every time they eat any starch, they’re having a lot of symptoms, we try to leave in the starches they tolerate as long as they’re healthy. We do remove added sugars because they suppress the immune system. So no maple syrup, honey, refined sugars, all of that we remove until we get further along.

Dr. Weitz:                            Have you ever felt the need to use a keto type diet for fungal patients?

Dr. Kapadia:                        I’ve had some patients come in on that. I haven’t put people on that specifically for this, but I definitely have a handful that say that, that helps keep their symptoms in check.

Dr. Weitz:                            Right. What are the most effective treatments?

Dr. Kapadia:                        So, I always try to start with foundational things, which we all do. If we skip those, then nothing ends up working, but try to make sure as best we can. Sleep, general nutrition, exercise, and some sort of stress reduction. Then we build on that. We check those nutrients to make sure we’re repleting those. Then as far as building on the diet, once we’ve got that in place, antifungals. I use a lot of botanicals for that. So Thorne sf722 is an old one that we’ve been using for a long time. That works well.

I’ll use neem, berberine, some of the things we use for SIBO can also work well. Coptis. There’s a product called MYCOREGEN from Beyond Balance that works well, and olive leaf, those would be some of the main ones that I’ve tried. I don’t use a lot of pharmaceuticals, but sometimes I’ll use nystatin for one to three months just to see if we get a response from that because it’s more narrow spectrum, it’s only working on yeast. Whereas these botanicals, it could be working on all sorts of different things. So those are the main treatment approaches I use for supplements and medications.

Dr. Weitz:                            Now I was surprised to hear that you’ll use nystatin for one to three months because typically the most common treatment is for one to two weeks.

Dr. Kapadia:                        Yeah. Botanicals I’ll do for a three to four week trial and then I’ll check in with someone. If they’re doing better, if they’ve had long standing issues, we may decide to just do a couple months of treatment if they’re tolerating it well. If they’ve made no progress, we’ll switch to something else.

I would say some of my mentors that I learned from they would be able to resolve this issue sooner, but I think there’s so many different factors. A lot of our patients might be living in a water damaged building or have other chronic exposures that’s going to make it hard for their immune system to recover. So typically it’s at least one to three months and sometimes it can be a lot longer depending on how many other factors they have.

Dr. Weitz:                            Yeah. Exposure to mold often crosses over with fungal overgrowth. Doesn’t it?

Dr. Kapadia:                        Right.

Dr. Weitz:                            That’s another whole layer.

Dr. Kapadia:                        Yes. It’s another layer. It’s challenging to work with, but yes.

Dr. Weitz:                            So as part of your treatment protocol, do you address biofilms?

Dr. Kapadia:                        I’ve been doing that more and more. So in the past, what we try to keep in mind is that we’re not trying to eradicate every last organism of the candida. It’s part of our normal flora. So we’re just trying to reestablish the balance. So I don’t use it right off the bat. If we’re having someone that’s having recurrent symptoms every time we stop treatment or we’re just really not getting anywhere and we think this is part of their problem, that’s typically when I’ll use biofilm treatment for again, one to three months or so, just to see if that helps prevent recurrence of symptoms. That’s been helpful at times. Other times, the biofilm treatment doesn’t seem to have an effect. Other times it just doesn’t seem to be necessary as part of this.

Dr. Weitz:                            What’s your most effective biofilm treatment?

Dr. Kapadia:                        I like Dr. Anderson’s Biofilm Phase-2. So I use that a lot. I do use the prescription version that Dr. Anderson formulated sometimes as well. I’ll usually start with the Biofilm Phase-2 product.

Dr. Weitz:                            Okay. That includes bismuth. That’s one of the key nutrients, right?

Dr. Kapadia:                        It is. It’s bismuth, I think cumin, black cumin seed, and alpha lipoic acid all together.

Dr. Weitz:                            Yeah. Yeah. We’ve used that quite a bit too.

Dr. Kapadia:                        Yes.

Dr. Weitz:                            What about agents to restore motility?

Dr. Kapadia:                        So I think one thing that’s quite common is if we’re in fight or flight all day long and stress is the main contributor, I try to talk to patients about that, but it’s just not very easy to change. So I sometimes will recommend that some sort of limbic system retraining or the Nerva app, just to have them do something on a day to day basis that helps with the parasympathetic component because I think that’s…

Dr. Weitz:                            What is the Nerva app?

Dr. Kapadia:                        Yeah. The Nerva app, they’ve done quite a bit of research. It’s an app that’s based on hypnotherapy developed by, I believe a psychologist, a doctorate psychologist who found that it was just as effective as a low FODMAP diet for IBS. So it’s sort of like a subscription app, I believe that patients can sign up for. A few of my patients have done it with improvement in their symptoms. So that’s one option.  Then I often recommend limbic system retraining, which is a whole other category of working on rebalancing, like the primitive area of our brain that gets stuck in fight or flight. That’s the DNRS program or the Gupta program are the main ones I use for that.

Dr. Weitz:                            Right.

Dr. Kapadia:                        So if we think it’s mostly a stress component, like it is for a lot of people, we’ll try those. I haven’t had a ton of success from the botanical options for motility, but sometimes we’ll try MotilPro or Prokine or some of those. Then sometimes we’ll use Motegrity which is the prescription that’s used with SIBO to prevent relapse. We’ll try that same one and see if we can prevent things that way. There’s not a ton of research on using motility agents, or there’s no research on using motility agents in SIFO, but it would make sense that, that would be something to help prevent relapse.

Dr. Weitz:                            Right. Now, what about the use of probiotics at the same time?

Dr. Kapadia:                        I don’t use probiotics at the same time. Sometimes I’ll use those after. I would say I’ve had… Excuse me, I have to take a sip of water here.

Dr. Weitz:                            I know some people recommend saccharomyces boulardii specifically as a treatment.

Dr. Kapadia:                        Yeah. I found, I think because a lot of my patients have allergies, if I’m suspecting they have this yeast, mold allergy, I don’t often use saccharomyces boulardii. I use it sometimes if they tolerate it, but not during the antimicrobial treatment. Maybe after. Then sometimes I’ll use a spore forming probiotic, and sometimes I’ll use lactobacillus plantarum afterwards. That’s had good research for IBS. So it’s not for everyone. It’s been 50, 50 as far as patients that improve or get worse or don’t improve with probiotics. So we do a bit of a trial and error process after we treat the overgrowth.

Dr. Weitz:                            Right. Yeah. I’m always concerned that if we’re going to get some of the cars out of the parking spaces, we don’t want to leave those spaces empty.

Dr. Kapadia:                        That’s true. It’s like this balance because I think Dr. Pimentel talks about if someone’s prone to overgrowth and we keep giving them probiotics, are they going to then get overgrowth of those bacteria? I can’t say clinically I’ve seen that as much, but I do wonder about particularly people with motility issues, if we’re going to get more overgrowth of something else in that way. So if we can get fermented foods back in or if they tolerate probiotics, I think it’s a good thing to try. Especially the spore forming ones that wouldn’t overgrow anyway.

Dr. Weitz:                            Right. So some patients get a die-off reaction when treating for the overgrowth?

Dr. Kapadia:                        Right. So the die-off reaction is thought to be potentially one clue that they might have an allergy to yeast and the breakdown products of that. So we can use that as a clue. Then to get them through that period we use different tools like decreasing the dose of the antifungal we’re giving, making sure they’re having a bowel movement every day, drinking lots of water, increasing fiber. Sometimes we’ll use charcoal at a different time of the day, or Alka-Seltzer Gold as well can be helpful just to help get them through that initial week or two so that they’re not so uncomfortable.

Dr. Weitz:                            I saw that Alka-Seltzer Gold.

Dr. Kapadia:                        Yeah. That’s an old environmental medicine trick that one of my mentors told me about they had been using since the ’70s, I think with environmental medicine patients to help with all sorts of reactions. Yeah.

Dr. Weitz:                            Okay. When do you also see parasites as a cofactor? Do you see parasites?

Dr. Kapadia:                        Yeah, very frequently. So the way I like to talk about it with patients is that there’s often this sort of multiple layers of the dysbiosis. So bacteria, yeast, and protozoa are very common. So the protozoa, I feel like we have a pretty good shot at eradicating. So if we are going to do testing for that, or if they’ve had testing, we’ll try to treat that first because I feel we have a pretty good chance of eradicating that. So that would be giardia, cryptosporidium, [inaudible 00:24:32]. Those are common ones we see.  Then the bacterial and fungal overgrowth tend to take more time. So that’s one of the reasons I like to use botanicals for that because we can address them somewhat at the same time or at least sequentially. So protozoa I’ll treat first if we have the data. If they can’t do an out of pocket test for whatever reason, then we’ll start with treating the fungal overgrowth and then circle back around to that if they’re not getting better.

Dr. Weitz:                            So what are your favorite treatments for protozoans?

Dr. Kapadia:                        For protozoa, I usually use pharmaceuticals if they’re open to that, just because I found that typically will work a bit more effectively and sooner than doing several months of herbals, especially if we’re going to be using botanicals for the other pieces. So I tend to use Alinia or nitazoxanide and tinidazole, are two of the more common medications that we’ll use. They’re pretty well tolerated. We’ll warn people of potential side effects, but I haven’t seen a lot of side effects with those.

Dr. Weitz:                            Okay. Let’s see. Histamine tolerance. Does that play a role as well?

Dr. Kapadia:                        Yeah. There’s been interesting animal studies that have shown if they induced an overgrowth of yeast or fungus, those animal studies show that it can predispose to developing environmental allergies as well as increase mass cell activity in the GI tract. So this could be one piece of the puzzle for people who feel like they’re reacting to a lot of histamine in foods, or are having a lot of allergic or pseudo allergic type reactions all the time. This can be a piece of that. If we treat the fungal overgrowth, the histamine excess mast activity, it might take one piece of that down a notch.

Dr. Weitz:                            Right. I’m thinking about, I’ve talked to Dr. Rahbar who said that a lot of times when he is treating a patient with SIBO, especially the methane SIBO, he may see fungal overgrowth coexisting with that. Do you see SIFO coexisting with SIBO? Is it more common in methane or you find [inaudible 00:26:42]?

Dr. Kapadia:                        Yeah, it’s a good question. A lot of the patients I see have already had SIBO testing and treatment. I have seen that they definitely can co-occur and I’ve heard that from Dr. Rahbar as well. So I think he probably has more comparisons at the same time of what he’s looking at, but I definitely have seen people with very high methanes who also have a fungal overgrowth. It might be part of this synergistic piece with biofilms and such with these bugs talking to each other where they keep each other going. So it definitely, I think is part of the puzzle and it’s not uncommon to see people with all three of those imbalances at once.

Dr. Weitz:                            Okay, great. I think those are the questions that I had available. You rattled through a lot of information.

Dr. Kapadia:                        I did. So maybe people can listen to it more on a slower speed. I tend to talk too fast.

Dr. Weitz:                            I typically listen to podcasts at one and a half speed.

Dr. Kapadia:                        I know.

Dr. Weitz:                            Maybe we’ll want to listen to this one on half speed.

Dr. Kapadia:                        Yeah, I can talk slower. I just need someone to remind me when we start, if I’m going to talk [inaudible 00:27:48].

Dr. Weitz:                            Great. So any final thoughts for our listeners, viewers?

Dr. Kapadia:                        I would just say that this piece with the candida hypersensitivity or potential allergy, I think is an important piece. So if someone’s not getting… They keep getting treated and they aren’t getting better it would be helpful to talk to their doctor about that. Some allergists recognize it and some don’t, but most integrative type practitioners, whether they’re environmental medicine doctors or functional medicine doctors or naturopathic doctors may be aware of that. There are treatments for that.  Just like we desensitize people to environmental allergens, there are ways through sublingual immunotherapy to work on that. There’s a doctor in New York doctor, Dr. Dean Mitchell, who has some really nice online videos that I’ve referred patients to learn a bit more about that.

Dr. Weitz:                            Yeah. You have some courses that are available?

Dr. Kapadia:                        I do. I have a couple courses. One is a patient course for patients to try to learn as much as they can to help their integrative or naturopathic doctor, because there’s a lot of different pieces like we talked about. So it can help if the practitioner and the patient are keeping track of all of them. It goes through what we talked about, but in more detail, and it does include this piece about a potential hypersensitivity and how to explore that.

Then there’s a practitioner course where I go into a compilation of 20 years of data that I collected on this as much as I could find, as far as a practitioner’s general guide to approaching fungal overgrowth, as well as a direct approach to mold illness, because I found a lot of the information can be overwhelming on that. Most of my mentors had been treating mold since the late ’70s. I continue to use their approaches, which is a more straightforward way to work with mold, which can be sometimes related to fungal overgrowth. So we go into that in a lot more detail as well for practitioners.

Dr. Weitz:                            Just one more thing. When you were talking about the sensitivity to mold, I notice in your PowerPoint as part of your presentation that you shared with me, talking about how when you look at a food sensitivity panel, you can see that there’s hints that they may be sensitive to candida.

Dr. Kapadia:                        Yeah. So I don’t use it, again, to diagnose, but it’s another clue. So if someone’s had an IgG food test that includes bakers and brewers yeast, sometimes that will show up as another clue that their body has developed this cross reactivity to yeast and mold in food. Then we can see if that clears once we treat them, or if that persists, sometimes the allergies need to be treated on their own as a separate step of this.

Dr. Weitz:                            That’s great. So what’s your website so folks can get a hold of you and find out about your courses?

Dr. Kapadia:                        Yeah. My website is just my name dot com, so amikapadia.com. A-M-I K-A-P-A-D-I-A dot com. There’s a resource tab that just has sort of all sorts of information for patients. Then there’s a courses tab as well.

Dr. Weitz:                            Awesome. Thank you, Ami.

Dr. Kapadia:                        Yeah. Thanks, Ben.

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. If you enjoyed this podcast, please go to Apple podcasts and 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. 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.

 

Bridgit Danner discusses Toxic Mold Illness 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

1:22  Bridgit moved into a new house in Portland, Oregon and she was having a lot of recurring symptoms of poor health, so she worked on her gut and did some IV therapy and saw some naturopaths. She wasn’t getting much better and someone asked if there might be mold in her home, since her symptoms got much worse when she moved into the new house. There was no visible mold in her house but Portland has a very moist environment and they had a musty basement and there had been a little water intrusion. They turned out to have a mold problem land besides remediating the mold by removing walls, etc. you have to get rid of most of your belongings, since mold can penetrate anything that’s porous and even nonporous things like refrigerators and computers. Bridgit and her family lost pretty much everything and she only has one Tupperware bin left of important documents.

6:41  The most common symptoms of mold illness include fatigue, brain fog, digestive issues, chronic pain, headaches, weight gain, hormone problems, mood issues, and immune issues.

11:30  The best first step if you suspect mold illness is to do a visual inspection of your home and look under your sinks and around your bathtub and in your basement and in your crawl spaces.

12:13  Mold inspector.  A good mold inspector should be taking multiple sample types and not just one air sample.  They should be swabbing and they should use a moisture meter to check the walls. They need to look at gutters and how well water is draining away from your house.

14:41  Once mold is found, there is no other good solution but to cut out all the affected materials–wood, carpet, flooring, etc.  Afterwards you need to clean your air ducts and surfaces using a soapy or essential oil-based cleaner.  Some surfaces, like wood beams will need to be sanded and then cleaned.  Your furniture and your clothes and books should really be removed.  If you can’t part with all of them, you can put them in storage and then revisit them in a few months.

20:49  Mold can be an underlying causative factor in chronic digestive issues, in Lyme disease, Hashimoto’s thyroid problems, and in various hormone imbalances, such as low libido, weepiness, gaining weight, and irregular periods.

26:24  Mold detoxification. First get out of the moldy home. Then make sure you are eating a whole food diet and Bridgit recommends a MATH diet, which is microbiome-friendly, anti-inflammatory, time-restricted, and hydrating.  Also make sure that you are doing some exercise and getting sunlight and make sure you are sleeping and pooping daily.  She loves for clients to use sauna and coffee enemas and dry brushing. Bridgit also likes castor oil packs and Epsom salt baths and she will often combine these with essential oils. 

27:58  Essential Supplementation.  Before going into the specific mold protocols, Bridgit likes her clients to be getting some essential nutrients for the liver and brain to work, including B vitamins, magnesium, and fish oil. 

28:50  Specific Detoxification Protocols to get rid of Mycotoxins.  Bridgit’s top favorite supplements include binders, CoQ10, Broccoli seed and sprouts, and Glutathione.  CoQ10 helps support the mitochondria, which are really affected by the toxicity.  CoQ10 is also an antioxidant, and antioxidants are also very important. And so are electrolytes.  Glutathione is the most prevalent antioxidant in the body, so it gets depleted with chronic mold exposure.  Broccoli seed extract supports the glucuronidation pathway where some mycotoxins are broken down.  Some of Bridgit’s favorite binders include charcoal, zeolite, pectin, and humic acid.

 

 



Bridgit Danner is a licensed acupuncturist and a certified Functional Diagnostic practitioner.  Her interest in natural health grew from an interest in protecting the environment. Bridgit now educates about toxins and detox through her online community and coaches women on how to detoxify through a Functional Medicine approach. Bridgit has published a book on this topic, The Ultimate Toxic Mold Recovery Guide: Take Back Your Home, Health, and Life.  Her website is BridgitDanner.com.

Dr. Ben Weitz is available for Functional 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, 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, dr.weitz.com. Thanks for joining me. And let’s jump into the podcast. Hello, Rational Wellness podcasters.

Our topic for today is toxic mold and mycotoxins, and how this can make us sick, and what to do about it with Bridgit Danner.  Bridgit Danner has been a licensed acupuncturist since 2004 and a certified Functional Diagnostic practitioner since 2015. Her interest in natural health grew from an interest in protecting the environment. Bridgit now educates about toxins and detox through our online community and coaches women on how to detox through a functional medicine approach. Bridgit has also published a book on this topic, The Ultimate Toxic Mold Recovery Guide. Bridgit, thank you so much for joining us.

Bridgit:                  Thanks for having me. I love talking about mold.

Dr. Weitz:              So, please tell us about your personal journey with your health and your experience with mold illness.

Bridgit:                  Yeah, so I moved to Portland, Oregon to start my practice and didn’t really know anything about mold or anything like that. It’s a wet climate. I think a lot of the homes there have mold actually. So, second or third home I lived in, yeah, I was having increasing symptoms like working on my health a lot. It would get better and then worse again. It was hard to pin down because there’s so many different symptoms and mostly, people would just tell me, “Oh, it’s stress.” I started studying functional medicine. I worked on my gut.

Bridgit:                  I had a really clean diet, but then I just tanked again and started getting some IV therapy and seeing some naturopaths and it just wasn’t getting better. That was the first time someone finally mentioned to me, “What about your home? Is anything changed in your environment?” And that’s the first time mold came up as a question, which I think many of us who have these mold stories have one of those moments where you’re like, “Oh, could it be mold?”

Dr. Weitz:              That’s always a tricky question too when you’re talking to clients, because a lot of times, they’re not aware that there’s any mold.

Bridgit:                  No. I made a lot of mold inspector friends now. Most mold isn’t visible. It’s in the walls. For us in our home, yeah, we had very, very little visible mold, but I did know that we had a musty basement and a basement that it had a little water intrusion that I did know. And then, we got an inspector. And then, our house, like many homes had more than one place where water had intruded and mold had grown. So, that can be part of the problem is if you have a whole big home, it’s often not just one area.  There’s been something in the attic and the crawl space and the basement and the windows. And so, that was the case for us and the start of a big journey of cleaning up the house and working on our health and all that.

Dr. Weitz:              And not an easy thing to get rid of mold, huh?

Bridgit:                  No. If you have a widespread problem and your health has really been affected, it’s worst case scenario for your finances because you can’t really keep much. And I hate to tell people that. If you have generally a good home and maybe you just had a brand new incident in the bathroom that you take care of right away, you’re not going to lose all your belongings or anything. But if you’ve been living for a long time in mold, it’s affected all your belongings, it affects all those porous areas or even like little nooks and crannies and nonporous things like refrigerators and computers. So, it becomes very hard to clean those things.  So, we really lost everything. I have two Tupperware bins. Maybe I only have one Tupperware bin left now of important documents. That’s all I have from that whole time in my life. So, a lot of grief. There’s a lot of shocks that you’re dealing with the same time that your health isn’t good.

Dr. Weitz:              Yeah. What about the fact that some people are just not sensitive to mold? Do you think… because a lot of times, you might have four people in a family and one is really sick and maybe one or two, they haven’t noticed anything? Do you think that they’re actually affected and just don’t know it or their bodies able to get rid of it and it just doesn’t affect them?

Bridgit:                  Yeah. I think both things are true. So, some people do just detox better genetically or they’re younger or just whatever’s happened so far in their life positions them better to identify and clear toxins. Like my son, for example, was basically born in that home. He had a huge mold colony under his floor. And he did, to your point, when we finally much later tested his urine, he did have mycotoxins but he never really presented. So, I think sometimes, we do have them but we’re living with them fairly successfully.  I think it can catch up with you though too. Like some people are just very hardy and they don’t really notice things going on with their body. Even things like-

Dr. Weitz:              Maybe some people just make friends with the mold.

Bridgit:                  Kind of, but then you can also be ending up with cancer out of the blue, right?

Dr. Weitz:              Right. There you go. Right. They didn’t know about that stuff, right?

Bridgit:                  You’ve been in a moldy house for 20 years. Yeah. So, it is connected with some long-term diseases too.

Dr. Weitz:              Yeah. Autoimmune diseases, hormonal problems, thyroid.

Bridgit:                  Alzheimer’s is a big connection I know about now too, which is something we’re all afraid of really.

Dr. Weitz:              Yeah. Dr. Bredesen talks about mycotoxins.

Bridgit:                  Yeah.

Dr. Weitz:              Yeah. Can you talk about what are some of the most common symptoms related to mycotoxins?

Bridgit:                  So, I think the two biggest ones are fatigue and brain fog. Those are pretty common and you pretty much hear those reported the most. It’s from the mitochondria and the brain being affected. And then, from there, it could be so many different things. Digestive issues probably right up there, lots of food sensitivities, chronic pain and headaches, weight gain, hormone problems, mood issues, because it’s a toxin that can affect and travel in so many places in the body and affects the immune system.  That’s why there’re going to be just so many different types of symptoms. So, it sounds a little ridiculous how could it be causing all these things, but it really can.

Dr. Weitz:              Yeah. It’s just similar to a virus. If it hits your GI tract, you’re going to have GI symptoms. If it hits your brain, you’re going to have more brain symptoms.

Bridgit:                  Yeah. I don’t work with a lot of long-haul COVID but when I hear about it and read about, it’s pretty similar in some of its effects. It’s this chronic inflammation. So, that’s what mold creates too.

Dr. Weitz:              Yeah. And mold seems to also adversely affect immune system in a similar way that viruses do also.

Bridgit:                  Yeah. For sure. Creates a lot of confusion and like you said, it can lead to autoimmunity.

Dr. Weitz:              So, when you suspect one of your patients may have been exposed to… they’re showing symptoms that might be related to mold illness, to mycotoxins.  How do you recommend they go about testing your home and or office?

Bridgit:                  Yeah. So, this is tricky one because it depends if you rent or you own and your budget. Let’s just say hypothetically-

Dr. Weitz:              Let’s say you own your home.

Bridgit:                  Yeah. Let’s say you’re a homeowner.  In the end, you’re going to need a mold inspector to see what the source is and a good one.

Dr. Weitz:              Right, but do you recommend maybe starting with something less expensive?  Because what I have found is sometimes when you first start talking to a patient about this, if they’re not aware of there being any mold, they’re going to be a little apprehensive about spending thousands of dollars until they really know that there’s something there.

Bridgit:                  You can. I don’t think it’s foolproof to do some DIY testing when you’ve never done it before, but there’s a company called ImmunoLytics that you can buy these plates and swabs and they’ll tell you how to position them around the house.  It’s very affordable. They’ll do a consultation with you.  So, that’s a decent option.

Dr. Weitz:              Have you seen ERMI testing?

Bridgit:                  Yeah. Personally, I don’t think the ERMI results on their own give you much insight.  But there’s a friend of mine who has something called the ERMI Code where you can take your ERMI results.  And it’s pretty affordable. They’ll put them into their supercomputer because they’ve analyzed so many homes.  So, with that information, you can say this is a high-risk home or that thing.  But because the ERMI wasn’t designed for a residential homeowner situation, the test is very difficult to read for the average person.

Dr. Weitz:              Okay. So, for those who are listening who aren’t aware, ERMI is a way to test the dust in the house to see if there’s evidence of mycotoxins, right?

Bridgit:                  Yes. But it was designed for some governmental use first before the public caught on to it, so that’s why the results are pretty [inaudible 00:10:43].

Dr. Weitz:              Is there another way that you can test the dust in your house?

Bridgit:                  There’s one other test called the EMMA that tests for specifically mycotoxins. So, I like that in terms of being a health practitioner, like the ERMI is just telling you overall mold load, not all the strains are toxic, blah, blah, blah. The EMMA, at least telling you about toxicity. I wouldn’t say their report or their consultation is very interesting. Like it’s very basic. It’s just yes or no. So, yeah, it’s tough because there’s a lot of questions in this space about what’s best and there isn’t an easy answer.

Dr. Weitz:              Right. But maybe it’s a good first step.

Bridgit:                  Yeah, yeah, yeah. The cheapest first step. Well, even before your plate tests, just walk around your home. I have that in my book is like you can say, “Oh, there’s no water in my home.” Well, think about it, look around, look under your sink. Most people probably never been in their crawl space. And I had someone on my mold summit. He said 100% of crawl spaces are moldy, 100%.

Dr. Weitz:              Wow.

Bridgit:                  He’s never seen one not. So, there’s just areas of our home we don’t check, signs of like a brown line or a white crusty line, mold around your bathtub. So, that’s a first thing you can do, that’s totally free, is start looking around.

Dr. Weitz:              Okay. And then, when you get an inspector, how do you know you’re getting the right inspector and what should the inspector be doing?

Bridgit:                  Yeah. I think you can read reviews, you can ask questions. So, they should be taking multiple sample types, not just one air sample. So, they should be swabbing. They can do a moisture meter of the wall, which you can also buy yourself. They’re going to look for like how things are draining, how your gutters are draining if there’s any water around your foundation. So, basically, you want somebody who’s really thorough and investigating in many ways. I’ve definitely heard these stories where somebody just walks in and they’re like, “Looks good to me,” and then leaves. And that’s like I don’t know what that’s about.

Dr. Weitz:              That’s probably the inspector sent by the apartment manager.

Bridgit:                  Yeah. Yeah. And I think in this space, it will happen slowly. Like some of my friends in this space are starting to offer some training programs and stuff so that people in those situations can be more informed about how to properly inspect.

 



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                                For those of you who might be interested in getting the Apollo for yourself to help you reset your nervous system, go to apolloneuro.com and use the affiliate code, Weitz10. That’s my last name, WEITZ10. Now, back to the discussion.

 



 

Dr. Weitz:               And then, once they do find mold, what are some of the hints for what needs to be done for proper remediation?

Bridgit:                  So, there really much isn’t a way to avoid like actually cutting it out and removing. I think that we tend to want to save money by, “Oh, can we put bleach on it or paint over it?” That’s not how it works. So, if there’s materials like drywall, carpet that have been affected, they need to be just completely removed and then re-drywalled and the area cleaned and different steps. So, I would say just don’t think you can skip the step of just old fashioned like it’s a construction project.

Dr. Weitz:              Right. And then, you’ve got to make sure they get all of it out, right

Bridgit:                  Yeah. And then, afterwards, be cleaning your air ducts and surfaces. You can use a soapy or essential oil-based cleaner. Some surfaces need to be sanded before they’re cleaned. Like if there’s been wood beams, you can’t really just wipe those with soap. You have to actually sand them a bit and then clean them. And then, like we mentioned earlier, depending on the extent of it and the extent of your ill health, you have to think about, “Is my couch that’s been sitting in this room for 10 years harboring mold and mycotoxins?” So, you can potentially put a plate on that and test it is one option.  Or another thing you can do for instance, like with your clothes or books, you can put them in storage and then revisit them in a few months. That’s what we did when we moved. We put some things in storage that we still hoped we could keep. As soon as we opened that storage unit, I was instantly sick. So, I knew, “Okay, I can’t keep these things.” But sometimes, you’re not ready to just give stuff up. Right?

Dr. Weitz:            Right. But generally, things that are porous like furniture and carpets are going to be… and mattresses are very likely going to have mycotoxins, correct?

Bridgit:                  Yeah.

Dr. Weitz:            So, you’re pretty much going to need to get rid of them, unfortunately. Right?

Bridgit:                  Yeah. Unless, like I said, if this is just some new incident that you catch right away, that’s a different story. This is more like a chronic thing. Yeah.

Dr. Weitz:            Right. And then, what about clothing? What’s the best way to wash and de-mold your clothing?

Bridgit:                  Well, you can potentially use borax in your laundry or there’s a few other products out there. I think one’s called EC3 or something like that. Honestly, I couldn’t really save any of my clothes. I think I’ve saved five items because I would wash them and do these things. And then, I’d put my face up to them and they’d give me a headache. And then, you’re affecting your washing machine. So, I feel like you can spend a lot of time spinning your wheels, trying to clean things, and then realize it didn’t work, but it could work. So, something-

Dr. Weitz:            And do you recommend that people move out or do you think as long as they put up plastic sheets and stuff, it’s okay to live in the house while it’s being remediated?

Bridgit:                  I think while it’s being remediated, you should definitely not be there. And that’s a big mistake that I made that made me a lot sicker. And now, to be honest, my remediator could have been more conscientious of protocols, but they just aren’t all. And some of us don’t really know what we’re getting into.

Dr. Weitz:            And if you decide to move out, wherever you’re going, whether you’re going to stay in someone else’s home or apartment or a hotel room, how do you know that place is going to be mold-free?

Bridgit:                  Yeah. You don’t know for sure but you can do that visual inspection again or your five senses inspection. Don’t move into a basement apartment. There’s some simple things to chat. You can ask questions if you’re… Generally, it’s not recommended to try to go buy immediately because it is pretty common that there’s mold. And at this moment in time, you’re very sensitive. So, committing to a purchase right away is a bit risky. So, it is better to live with family, live in your RV, whatever. But yeah, definitely re-exposures are pretty common, but they’re not guaranteed. Right?  So, it really frankly took us moving out of state to be in environment we felt was safer. But I’ve lived in two homes in Arizona now. I haven’t had any problems. So, I think it can feel like it’s following you and it’s everywhere. But there will be a point where you get in a better home, but you have to maintain that home. Right?  You don’t change your washer hose, which many of us don’t even think about. Eventually, it’s going to crack and fail. So, a lot of this is just learning about home maintenance and, yeah. Because as long as we live in homes, there’s always a chance of floods, plumbing errors, that thing.

Dr. Weitz:              Yeah. One of the things I notice in California is they try really hard to make homes airtight so you don’t necessarily get moisture in, but then if there is any moisture, the walls don’t breathe that well.

Bridgit:                  Yeah. That’s a great point. Opening windows and doors is a super easy thing to do to let moisture out and let clean air in. Even probably in LA, indoor air quality is worse than outdoor air quality now because of everything like off-gassing in our home. So, yeah, I’m a big fan of just opening up the home.

Dr. Weitz:              Right. So, what other health conditions do you find most frequently mold is an underlying cause of or a factor in?

Bridgit:                  Definitely like I mentioned, digestive issues like chronic digestive issues. I think you should look for mold if you just can’t seem to be getting over things and your practitioner is like, “You’ve got parasites, you’ve got candida, all this stuff.  Lyme disease is really closely associated with mold.  Hashimoto’s, there’s often a connection there.  Let me think.  What else?  And then, just a lot of symptomatic stuff.  Well, I’ll speak to hormones because I think we never think about hormones being caused by mold.  You think, “Oh, it’s stress or my diet,” or what have you, but they can lodge in your hypothalamus, pituitary access and inflame it. So, you’re getting like top-down dysregulation of your hormones, plus your liver is burdened, your gut’s probably off.  So, yeah, if you’re having chronic symptoms of low libido, weepiness, gaining weight, irregular periods, any of that, it’s totally possible that mold’s involved.

Dr. Weitz:              So, what about testing the person for mold?

Bridgit:                  Yeah. Luckily, there’s a pretty easy at-home urine tests. There’s a few good companies who do that.

Dr. Weitz:              Yeah. I know you mentioned Great Plains and Vibrant.

Bridgit:                  Yeah. I think those are the two top ones. I think both of those, you need to go through a practitioner, but I think that’s best anyhow, because just like with… I mentioned the ERMI. It’s hard to read. You’re going to get your own mold results and you’re not going to know like is this really bad? Is this not bad? What do I do about it? You’re going to have a million questions.

Dr. Weitz:              Now, I noticed in your book, you were explaining how each one of those tests test a certain number of mycotoxins related to a certain number of species of mold. But of course, there’s so many different species of mold and so many different forms of mycotoxins that I guess either of those tests could miss some of the mycotoxins that might be there.

Bridgit:                  So, yeah, I think the few different tests all have a bit of their strengths and weaknesses and different strains they test. I think there’s one company that will catch like Stachybotrys better than another. Some practitioners will have you run a few different tests for that reason. But there’s actually only a dozen or so categories of mycotoxin so there’s many, many types. But there’s actually only about 12 toxic molds and about 12-ish mycotoxin groups. So, I think that’s how they’re able to not test as many.

Dr. Weitz:              Right. And I noticed you said you like to do provocation.

Bridgit:                  Yeah. I’ve gotten a little trouble for some of that. So, now we just say use the sauna or fast. We did say use glutathione. We don’t say that anymore.

Dr. Weitz:              Okay.  Yeah, because I know Great Plain says not to do provocation.

Bridgit:                  Yeah.  So, I would say we do light provocation now, which is just an overnight fast and sauna.

Dr. Weitz:              Oh, okay.  So, I know other practitioners who recommend glutathione as a provocative agent.  I just talked to somebody from Great Plains recently.  And they said, “Well, the glutathione can bind to the mycotoxins, and then you might not find them in the urine.”

Bridgit:                  Yeah. That’s what they told me too. We were recommending it because that’s what I had been taught or heard was best. Of course, we want to find things. We don’t want people to get false negatives, but I have one client who took NAC, so precursor. She was in a moldy home and her first test was negative. Then when she was out, she had a positive test with another company and she wasn’t happy.  So, it could have been that, or it could have been just that she wasn’t pushing out mold while she lived in that moldy home. I guess we can’t say for sure, but after that experience, I was like, “Okay, I guess we should just be more cautious and not use,” but yeah.

Dr. Weitz:              Yeah. I wasn’t sure if I understood because it was not my understanding that glutathione binds to mycotoxins necessarily.

Bridgit:                  I think it can because besides being an antioxidant, it can bind in the liver as a detoxifier. But I think what they told me on the phone was that they measure… what did they say? Like they measured the mycotoxins by weight. And if there was some binding of glutathione, it could change the weight, and then it wouldn’t be measured. Something like that.

Dr. Weitz:              Yeah. I’ve always understood that the glutathione helps to stimulate the detoxification process and then it’s the binder that it really attaches to.

Bridgit:                  Yeah. Yeah. I think potentially, you could do glutathione a few days before. But besides that one person, I never experienced a false negative. We see tons of positives. It’s pretty rare to ever see a negative, which is why I feel like that one case was a little odd.

Dr. Weitz:              Right. So, let’s go into your recommendations for treatment of mold illness.

Bridgit:                  Sure. So, first, do the basics. First, don’t be in a moldy home while you’re trying to detox. It doesn’t work. Be eating a whole food diet, be getting some exercise and sunlight, and making sure you’re sleeping, making sure you’re pooping. So, those are my readiness steps. And if you are doing okay on those, you can start pushing toxins a little more. I really love detox techniques like sauna and coffee enemas and dry brushing. For me when I was really sick, doing those movement techniques helped me a lot. So, I’m a big advocate for getting those in, castor oil packs, Epsom salt baths. There’s some more options.

Dr. Weitz:              Oh, where do you place the castor oil packs?

Bridgit:                  I just do abdomen.

Dr. Weitz:              Okay.

Bridgit:                  Yeah. It’s a glutathione recycler and also helps digestion. And then, I usually do some essential oils with it when I do it at home.

Dr. Weitz:              Right. I know you’ve talked about a MATH diet.

Bridgit:                  Yeah. That’s an acronym I made up at one point because people were always asking what to eat. So, it’s microbiome-friendly, anti-inflammatory, time-restricted, and hydrating. So, it’s just a good base diet to be thinking about.

Dr. Weitz:              Right. And you mentioned some essential supplementation you like everybody to be on before you go into the specific mold protocols.

Bridgit:                  Yeah. Thank you for asking about that. I think we get excited about sexy supplements we’ve heard of like some new binder and all that, but really the liver needs nutrients. The brain needs certain nutrients to just work, and it is burdened. So, getting B vitamins, getting magnesium, getting fish oil. I find sometimes people are skipping some of those basic nutrients. So, I really recommend everybody be on those really for life, our soil quality, our diet, our stressors, just we have more demand for those things and ever.

Dr. Weitz:              Yeah. I would pretty much consider those things, baseline nutrition for pretty much everybody as well.

Bridgit:                  Yeah. Yeah.

Dr. Weitz:              So, let’s go into some of the specific detox treatment protocols. How do we get rid of the mycotoxins?

Bridgit:                  Sure. This was a little tough to organize because everybody’s obviously a little different on how they’re going to react. So, I just picked my top favorite detox supplements. Those are binders, electrolytes, CoQ10, broccoli seed and sprout. And I’m missing one.

Dr. Weitz:              Glutathione.

Bridgit:                  Glutathione. Thank you.

Dr. Weitz:              And you also mentioned CoQ10.

Bridgit:                  Yeah. I like CoQ10 a lot. A lot of times, your mitochondria are really affected by the toxicity. And so, your cells are tired, you’re tired. So, I based it on things that I really observed helped me quite a bit.

Dr. Weitz:              Let’s go into some of the rationale. So, you like CoQ10 for mitochondrial support.

Bridgit:                  Yes. And it’s a general good antioxidant. It has a lot of different functions. So, I think we think about detox just like the liver, but it’s also creating a lot of oxidative stress. So, I’m a big fan of antioxidants.

Dr. Weitz:              And then, why electrolytes?

Bridgit:                  So, electrolytes came up because one thing that happens often when you have mold is you make less of a hormone called antidiuretic hormone. So, you’re peeing more often potentially and losing minerals that way. Also, we hope you’re using your sauna. So, just staying hydrated. So, our particular electrolyte, we just add some extra B vitamins antioxidants because you can take a very basic electrolyte and that’s fine, but I figured if we’re formulating one for people going through this, we give it a little extra boost.

Dr. Weitz:              Do you particularly like infrared sauna?

Bridgit:                  I do like infrared sauna, but I also advocate for just getting in any sauna.

Dr. Weitz:              Just sweating.

Bridgit:                  Yeah. When I was first sick, I didn’t have my own sauna. I was using saunas at a gym. This was before COVID and they were old-fashioned and they would make me feel amazing. So, I think infrared is great. Far infrared is the best wavelength for detox, but there’s a lot of sauna options out there now, which is great. And we have to be realistic about everybody’s budget. Not everyone can afford a super high-end sauna.

Dr. Weitz:              And then, what’s the rationale for glutathione and broccoli seed extract?

Bridgit:                  So, glutathione, the most prevalent antioxidant in the body. It is leading the charge on oxidative stress and some detoxification in the liver like we talked about. So, if everything’s working normally, it recycles itself and everything’s in balance, but if you’ve been in chronic mold, it’s going to probably be depleted. It’s needing to be restored. So, that’s there just to restore that. Some people may react differently to glutathione. Some people, it’s too much for them, what have you, but it’s always been pretty neutral for me.

Dr. Weitz:              What’s your favorite glutathione supplement?

Bridgit:                  Well, we make one, so I guess I’ll do a little myth-busting then. I think there’s a lot of talk like it has to be liposomal or IV is best. It just has to be absorbed. So, I think there’s more and more ways to [inaudible 00:32:27].

Dr. Weitz:              Right. Because a long time ago, we were told glutathione does not get absorbed through the gut. And so, therefore, any oral glutathione’s not going to work. And so, then we thought you could only use IV, and then at some point, we realized, “Well, that’s not really accurate.”

Bridgit:                  Exactly. Yeah. We hear something from somebody. And so, our glutathione is called S-acetyl glutathione. So, they just attach a group to the glutathione so that it stays on the glutathione in the gut into the bloodstream and then breaks off in the bloodstream so it can go in the cell. So, yeah, basically, any way you’re making… I think if you just ingest straight glutathione, it will be broken up in the stomach, but yeah, any way that they’re making it more absorbable is what’s important.

Dr. Weitz:            Okay. And then, broccoli seed extract.

Bridgit:                  Yeah. This one’s super interesting. So, we were already using this.

Dr. Weitz:            Yeah. Not everybody includes that in their mold detox.

Bridgit:                  It’s a little, yeah, it’s unusual. I first learned about it from just, it detoxes a lot of chemicals like gasoline additives and stuff. Then I learned about it during COVID. It’s actually quite good for your liver health where some of your immune cells mature. And then, later, I found out it’s good for supporting the glucuronidation pathway where some mycotoxins are broken down. So, I was like, “This is amazing because I already loved broccoli seed and sprout.” They’re very well tolerated.  And we want to decrease our overall toxic burden, which it does and it helps the liver work more efficiently. It actually helps direct the liver to make more… or direct your genes to make more antioxidants. So, it’s just one of those things where you read the data on it and it’s pretty incredible.

Dr. Weitz:            Okay. What about binders? What binders should we use? Are there certain binders work better for certain types of mycotoxins?

Bridgit:                  Yeah. So, there’s been more reporting I’ll say around which binders work for which mycotoxins. Most of that research was done in terms of animal feed. In animal industry, there’s been a lot of issues with mycotoxins and animal health. So, a lot of that research wasn’t done for humans. It was done for farming, but now, I would say modern functional practitioners are mining that data and saying, “Well, this is good for this. So, this is good.” I think that’s really interesting. And when we made our binder, we just used some of that information to make sure we hit all categories of mycotoxins.  But I think it’s also a little dangerous. So, let’s say you get a urine test and it shows one or two types of mold. We don’t know that that’s the only thing you’ve been exposed to. It’s just a snapshot. So, you can play around with matching your type with the binder that goes with it. Especially if you’re sensitive like if you want to just use a single ingredient binder, you may want to play around with matching it or you can rotate.  You can take charcoal and then pectin and then humic acid. You may not like all of them. Your body may not like all of them. So, we can play around.

Dr. Weitz:            Which are some of your favorite binders?

Bridgit:                  Well, I like charcoal. It’s affordable and it gets the job done and also helps for like stomach upset and little stomach bugs. It can be a little constipating for people. It’s never been for me, but binders in general can be a little constipating for people.

Dr. Weitz:            And then, zeolite, is that a good one?

Bridgit:                  Yeah. Zeolite is good. It’s like a porous rock if I remember correctly. Most of them are porous in some way or have a charge to pull toxins to them. So, the binder we formulated, we just have a bit of a grab bag of just different types of binders so we can catch different things.

 



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Dr. Weitz:              Do you often or sometimes use antifungal, natural antifungal agents while treating the mycotoxins?

Bridgit:                  Yeah, usually I would do it as a later step in a gut protocol. Once the body’s cleared some things, is improving, the immune system is getting stronger. I think doing it too soon isn’t going to stick usually. And there’s a lot of die-off can be happening.

Dr. Weitz:              Right. So, what do you do if there’s die-off?

Bridgit:                  You cut back on whenever you’re taking, for sure. You could do an Epsom salt bath. In the moment, you can do a binder, you can have an Advil if you need to, but generally, you want to back off and manage it differently. If you’re having die-off, your body… If you’re having die-off symptoms, I’ll say, like you’re getting headaches, you don’t feel well from your detox. It’s too much. Your body’s not keeping up. So, it’s a detriment to you to get in that state for too long.

Dr. Weitz:              Do you incorporate supplements to try to stimulate bile flow since a lot of times, these toxins end up in the bile as part of how they get into the digestive tract?

Bridgit:                  Yeah. I think those are good. We have artichoke and our binder for that. Coffee enemas will help facilitate that, bitters help facilitate that. A lot of people have motility issues with mold, and I think there’s some brain inflammation like vagal nerve issues. So, yeah, I think stimulating everything to move is often needed for these folks.

Dr. Weitz:              Okay. I noticed you also mention in your book, Epsom salt bath, dry brushing, and mouth taping.

Bridgit:                  Yeah. Yeah. Mouth taping probably sounds like the weirdest one, but it was really helpful for me. I didn’t know it, but I was like a mouth breather when I slept and now my immune system was depleted. So, I wake up with sore throats all the time and it would take me hours to feel better again. And so, then, I saw a video about mouth taping and I was like, “Oh, sounds like something.” Basically just putting a little bandage over your mouth at night so you breathe through your nose.

Bridgit:                  It’s so simple that it makes more nitric oxide. It helps you sleep better. It’s good for your oral hygiene, your immune system. So, again, because it really did make a difference for me, I put it in my top five.

Dr. Weitz:              Okay. And then, you have a section where you talk about diet for patients with mold illness. And you mentioned your microbiome-friendly MATH diet, but in there, you also mentioned a low mold diet, a low FODMAP diet, and even a low histamine diet. And I think it’s pretty common to typically recommend a low mold diet, which means foods that are actually fungi like mushrooms or food that may contain mold should be avoided.

Bridgit:                  Yeah. Usually, there’s some crossover that some of these foods that tend to be moldy like alcohol and cheese and like conventional meats, grains. They’re all so often histamine-related foods. Or they’re just inflammatory foods. So, mostly, in our modern society, you’re not going to get a huge amount of mold from food, but when you’re already dealing with it from your home when you’re trying to recover, you don’t want foods that are going to stimulate a reaction or more inflammation or a histamine release. Excuse me.  So, it’s not forever, but yeah, there’s generally going to be… you know what I mean? You have to be on good behavior for a while.

Dr. Weitz:              Okay. And then, why do you sometimes use a low FODMAP diet?

Bridgit:                  Yeah, that one I learned about from Susanne Bennett, who’s in LA too.

Dr. Weitz:              Who’s a good friend of mine. Yes.

Bridgit:                  Oh, nice. Yeah. She was one of my practitioners when I was sick and she wrote a mitochondria book and she had the little FODMAP diet in there because she said the gases that are produced from digesting these foods are like a strain on your system. So, I thought I might as well try it. So, I did it for a month and then I started reintroducing foods. And I thought it was a really interesting experience. There’s some foods I kept out of my diet. So, I think for certain people who are experiencing a lot of poor motility, SIBO bloating, it could be a good temporary diet for people.

Dr. Weitz:              Yeah. I use it quite frequently for patients with SIBO IBS. Yeah.

Bridgit:                  Yeah. Yeah. It doesn’t have to be forever and it may not be every food on the list.

Dr. Weitz:              No, you don’t want to do it forever. Because you’re excluding a lot of super healthy foods like broccoli.

Bridgit:                  Yeah, yeah. Yeah. And for me, I just found a couple of foods were my biggest trigger. Actually, grapes were one of them. And I just bought some this week and I did fine with them all week. But there was some years where every time I had grapes or apples, I would feel really bloated.

Dr. Weitz:              Interesting. Why do you think that was?

Bridgit:                  Well, they’re FODMAPs and those particular ones for some reason, maybe because I don’t eat them as much. Like garlic and onion were not a problem for me at all, but maybe I eat those all the time so my body was more used to them.

Dr. Weitz:              I know apples can, especially apple juices, can often be a source of mold. Right?

Bridgit:                  For sure.

Dr. Weitz:              Right.

Bridgit:                  Yeah. When they say from concentrate, that’s like it’s bad. It’s very processed. And it’s not like they’re picking the apple off the tree. It’s like just dumping them in a barrel and smashing them up and making them into powder then adding water.

Dr. Weitz:              Right. I remember seeing somebody cut open some of this apple sauce that comes in these squeezy containers and stuff. And it was just horrible. You couldn’t believe the amount of mold in any of these squeezy foods, apple sauce or yogurt, or any of these things. It’s really bad.

Bridgit:                  Oh, wow. I didn’t know about that. Yeah. Fruit juices can be one. Just a side note, as we feed our toddlers, a lot of times, we’re giving them these low-quality process things that crackers and juice boxes and stuff and, yeah. They’re not clean foods.

Dr. Weitz:              Yeah. And speaking of kids, I remember the same presentation, she showed some of these bath toys, like the little rubber ducky and you cut it open and inside, it just really, you know.

Bridgit:                  Oh, yeah. I’ve had that experience. Like you squeeze out the ducky and there’s mold coming out and you’re like, “Oh, my gosh.”

Dr. Weitz:              All right. Great. So, anything else that we haven’t covered that you’d like to talk about?

Bridgit:                  I think we covered a lot of things. I think mostly, if people just are curious and they want to get started, you’re mostly curious about your home and that’s often a great starting point. Right? Because it is your environment that affects your health. So, even though I’m not as much of a home expert, if you suspect it because you’ve been chronically ill. Or like you said, you might not even really suspect your home, but if you’ve been chronically ill, you’re just going to doctor after doctor, you’re not getting better.  We have some free eBooks on the website and blogs like just start informing yourself like could this be mold because if it is, you want to know about it because you’re not going to get better without doing something about it.

Dr. Weitz:              Good. And so, for resources for practitioners, your book is an excellent resource.

Bridgit:                  Yeah. Thank you. Yeah. I definitely think it’s detailed enough that a lot of practitioners are going to get at. Because as a practitioner, I’m sure this happens for you. People are like, “Well, which stuff can I keep? And how do I can find a good inspector,” and all these questions and yeah. And you want to try to have answers. So, there’s just so many questions. So, I think it’s a great book for, you’re already out of the home and you’re still healing or you’re in the beginning. It’s just the whole process.

Dr. Weitz:              Yeah. Speaking of that, I’m glad we talked about the ERMI test because I often recommend that. But every time I get to report back, it’s like, “Well, it shows you have some mold.”

Bridgit:                  Yeah. It’s so hard to read. You’ll have to look at that ERMI Code. I think it’s only $37 for people to enter their ERMI in there. So, I think that’s a great innovation. Yeah. It’s tough. Those first questions about the home are… it’s like a puzzle.

Dr. Weitz:              And then, you got all the types of mold and then you got the types of mycotoxins, and then putting it all together is a bit tricky.

Bridgit:                  Yes. It’s very confusing.

Dr. Weitz:              Okay. So, any final thoughts?

Bridgit:                  No, I really appreciate you actually reading the book. It warms my heart. So, thank you so much. I worked very hard on that. I can really tell-

Dr. Weitz:              That’s really a labor of love, right?

Bridgit:                  Yeah. I can really tell you’re just learning and I really just appreciate you doing that and sharing it with your audience.

 


 

Dr. 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 and 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.

 

Dr. Sam Rahbar discusses The Interplay of SIBO, Fungal Overgrowth, Food Allergies, and Mast Cell Activation with Dr. Ben Weitz at the Functional Medicine Discussion Group meeting on June 23, 2022.

[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

8:04  Dr. Rahbar’s new topic for this talk is “The Interplay of SIBO, fungal overgrowth, food allergies, mast cell activation, and FODMAP intolerance”.  Dr. Rahbar is sharing his presentation notes and references from his Dropbox: Here is the link to Dr. Rahbar’s Dropbox. 

12:31  Dr. Rahbar presented some cases from his practice that can teach us about some of the patterns of GI dysfunction that he has treated successfully.  The first case that he calls the Paradoxical Clinical Outcome, which is a young female with a history of methane SIBO and she previously responded well to Xifaxan and neomycin and at times to fluconazole and nystatin with good results.  This indicates that the microbiome of that patient goes through a dance where at one point bacteria become predominant and at another time, it becomes fungal dominant.  Dr. Rahbar decided to treat with the Elemental Diet and he also treated with fluconazole and nystatin. Three days after starting elemental diet, the patient complained of severe abdominal bloating, which is very unusual for being on the elemental diet.  He speculated that the clinical picture was one of fungal overgrowth and that the fungi had become resistant to nystatin and fluconazole and he changed the treatment to itraconazole and within few days her abdomen became flat and the patient reported that she has never felt this good ever.

19:32  The next case is a young female with high methane level SIBO, which Dr. Rahbar calls a Mega Meth Pattern.  The patient was given Xifaxan and neomycin with good response and then a second course and a breath test that showed 80% improvement. The patient wanted to do a third round and after this the patient felt much worse and then her breath test became terribly abnormal.  Dr. Rahbar checked the patient for tickborne diseases and Babesia duncani came back clearly positive, so he treated the patient with Malarone for 6 weeks and after 2 months the patient was completely symptom free and her breath test was now completely normal.  Retesting for Babesia was now negative. Clearing the Babesia altered the immune system to allow it to reduce the archaea that produce the methane.

22:20  Another case of a patient with a very high hydrogen pattern of SIBO.  This patient’s SIBO kept recurring after successful treatment. He ran an organic acid test that showed high levels of markers for fungal dysbiosis. This patient also had evidence of environmental toxins, BPA and glyphosate, and some mycotoxins. Dr. Rahbar treated her with a variety of binders and antifungal therapy for several months and then went back and treated the SIBO and this time the SIBO cleared and did not recur. In fact, this patient felt better and then pursued pregnancy. There is a drawing of fungal overgrowth that disrupts the mucous layer and the hypae actually grow down between the intestinal enterocytes and disrupt the tight junctions of the intestinal wall. This also can cause aggravation of the mucus layer and aggravation of the mast cells and the release of histamine and other inflammatory chemicals.  Fungus is an underappreciated player in cases of mast cell activation and can be a player in recurrent cases of SIBO, of recurrent urinary tract infections, and also with recurrent sinus infections. And each time you prescribe antibiotics, you promote the fungal overgrowth and this creases a vicious cycle. The mucus layer along the intestines and the rest of the digestive tract and if it is damaged, it creates more opportunity for opportunistic bacteria and fungi to lodge there. The probiotic Akkermansia muciniphilia is important for the health of the mucus layer and if the stool test shows that Akkermansia is depleted, it might be beneficial to incorporate supplements of Akkermansia into the therapeutic protocol.

 

 



Dr. Sam Rahbar is an Integrative Gastroenterologist in Los Angeles, California, combining conventional gastroenterology, performing colonoscopies, endoscopies, and Heidelberg pH testing, but incorporating anti-aging and Functional Medicine into his unique treatment approach to digestive disorders. He can be contacted through his website http://www.laintegrativegi.com/ or by calling his office 310.289.8000.

Dr. Ben Weitz is available for Functional 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, 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.

Okay, so welcome to the Functional Medicine Discussion Group Meeting tonight, and the topic is the interplay of SIBO, fungal overgrowth, food allergies, and mast cell activation. That’s a mouthful with Dr. Sam Rahbar. I’m Dr. Ben Weitz, and I’ll make some introductory remarks before introducing our sponsors, and then I’ll introduce our speaker for this evening. And please, that our sponsors for this evening are Integrative Therapeutics and Vibrant America Labs. So I’d like to introduce Dr. Steve Snyder from Integrative Therapeutics to tell us a little bit about some of the integrative products. Steve?



Steve Snyder:                    That’s cool. Thanks. I just got a doctorate. That’s awesome. You guys, if you haven’t seen or heard Dr. Rahbar before you’re in for a treat, we work with him, can I say that? Pretty, pretty extensively for a long time, and he’s great. And this is kind of right up our alley. We have one really, really important product for this that I want to… I see a lot of people who already know this on the attendees, but our Physicians’ Elemental Diet is a medical food for moderate-to-severe gut dysfunction, and it was formulated based on the research that Dr. Mark Pimentel did using the product Vivonex with elemental diets and SIBO. That research is pretty impressive for this treatment. And although if anybody’s ever tasted Vivonex, it’s the most gross thing ever. So they asked us to try and make something that was a little better tasting, that was hypoallergenic, and kind of a more functional medicine appropriate product.  So we have protocols, we have samples, we have discounts for patients that can’t afford the treatment. We have tons of support for this product. And it’s something that we think is really important and really powerful. So we want to make sure people are well armed to get the positive results that this can yield. If anybody has any questions about it or anything, reach out to me. I know several of you know about it. The research continues on it. It’s really the only real elemental diet out there, aside from Vivonex, so there’s a few trying to pretenders out there, but if you really look at the labels on those, it’s not really what it’s supposed to be. So without any further delay, Dr. Rahbar

Dr. Weitz:                            Actually, you know what, Steve? For those of us who might be listening to this recording afterwards, who are not functional medicine practitioners, maybe you could just tell us briefly what is the benefits of elemental diet? Exactly, what is it accomplishing?

Steve Snyder:                    Well, there’s different ways to use it, but in the context of SIBO, the main two things you’re doing are you’re providing complete gut rest, so you’re providing all of the nutrition the person needs in elemental forms, so it’s easily assimilated. There’s no work of digestion necessary, and it’s all absorbed in the upper GI, so it doesn’t get down there to feed the displaced bugs, which is the other reason that it’s good because it’s starving those bugs. In the Pimentel research, it was about 80% negative breath tests after two weeks of the elemental diet and the people who were still positive, they did another week and it ended up being about 85% breath test negative. So the antibiotics and antimicrobials are one way to attack this problem and the elemental diet is a different way. Especially, for people, who’ve had been through a lot of courses of antibiotics and stuff and want to try something different, this is a great option.

Dr. Weitz:                            Essentially, you’re starving the bacteria.

Steve Snyder:                    Correct. And also giving your gut a chance to sort of reboot. In other uses, you don’t have to do a whole two weeks necessarily. You can get pretty good effects with just even a three-day treatment, but the research in SIBO is at two to three weeks.

Dr. Weitz:                            And you guys have a dextrose-free and a dextrose one [inaudible 00:05:04]

Steve Snyder:                    Yeah, the original one was dextrose. We did that because we wanted it to be a little different than Vivonex, which is dextrose-free. It works great, it’s very sweet, so we came out with the dextrose-free one. We jiggered a little bit with the percentages of fats and carbohydrates and protein equivalent, so it’s a little less sweet, and some people prefer that one better. It’s all a matter of taste really, and that’s why we have the samples.

Dr. Weitz:                            Great. Steve. And thanks to Integrative Therapeutics.



 



Vibrant America Lab

 

Dr. Weitz:                              The Vibrant is also co-sponsoring this evening. If you’re not aware of Vibrant America, they’re an awesome functional medicine lab testing company, and it’s pretty much a one-stop shop. There’s not much they don’t offer. They have all sorts of great gut testing. They have a great stool test. They offer a great food sensitivity testing. They have hormones, everything that you could possibly want to get. They have great toxin testing. They offer excellent testing for Lyme disease. So it’s a great go-to lab. It doesn’t go through insurance and their prices are very, very awesome for cash prices. So consider Vibrant America and thanks to Vibrant for sponsoring this evening.

 



 

Dr. Weitz:                             So our speaker for this evening is Dr. Farshid Sam Rahbar, and he’s the founder and medical director of Los Angeles Gastroenterology and Nutrition in Century City. Dr. Rahbar is one of the few integrative gastroenterologists in the country, and he performs endoscopy, colonoscopy like traditional GI doctors, but he also incorporates anti-aging and functional medicine for a truly integrative, holistic approach to digestive care. Dr. Rahbar, thank you so much for joining us this evening.

Dr. Rahbar:                         Thank you everybody. And thank you, Ben, for inviting me. I must say it was a little bit of a short notice. I know the other speaker did not show up or canceled it. But I was able to put this talk together in a busier schedule. I apologize, I don’t have slides, but I put my thought process and the message delivery on Dropbox paper, which I can send a link to Ben and he can put it on the website. Here is the link to Dr. Rahbar’s Dropbox. If everybody’s ready, I’ll proceed. I did modify the title a little bit. Originally, Ben and I spoke about the interplay of SIBO, fungal overgrowth, food allergies, mast cell activation, and then I added the syndrome of FODMAP intolerance.  We were seeing more and more people becoming intolerant to FODMAPs, and my recollection is that this thing wasn’t there before, why we’re seeing more of this now coming that we are becoming intolerant to the small molecules. And the word interplay, it’s really refers to a dance of these elements in the intestinal lumen of all these elements, they’re part of the microbiome, and kind of a… It appears to me that as practitioners, we try to interfere by trying to optimize this relationship of the microbes in the gut, so our role would be more of a choreographer to see if we can have them play correctly.

Now, my goals for this presentation are appreciation of the connection of the chain of events that lead to immune dysregulation and addressing the transkingdom playground of again, bacteria, fungi, and how do these things communicate with each other. The role of fungi in promoting bacterial persistence by mechanical disruption of the mucosal integrity.  The unappreciated role of fungi in creating an anaerobic environment and promoting methane-producing archaea. The role of fungi in supporting C. difficile infection and appreciation of the mucus barrier in intestinal barrier disruption, so called the leaky gut and the immediate and delayed food allergies and sensitivities. Digging deeper to potential causes of dysbiosis persistence, environmental factors, stealth infections, mold, toxins, and exposure to environmental chemicals, and other interplay of elements.

And then, I put some references here and I encourage you to read these references. This is not something you see in traditional textbooks, and these concepts are probably about 10 years out before standard academic centers will start to incorporate these, in my opinion. Intestinal microbiota in health and disease from a disrupted equilibrium to clinical opportunities, this is from Immunology in 2019, To Be or Not Be a Pathogen, Candida albicans and celiac disease. And we will come back and look at this picture here. This is really out of this world the way this was drawn and we see the significance of that. The role of fungi in C. difficile infection, an underappreciated transkingdom interaction. And again, a reference here, an article Intestinal Mucus Barrier, the Missing Piece of the Puzzle in Food Allergy. And this is in journal of… I guess, I forgot to put the link for this article, but this was published in 2021. It’s really a basic science article, but it’s significantly talks about the role of mucus, which I’m going to touch base on that.

And just a comment about alkaline phosphatase. Intestinal alkaline phosphatase is different than the bone alkaline phosphatase, and the one from liver intestinal alkaline phosphate, which is zinc dependent as a cofactor and their good quality zinc, particularly zinc carnosine, available to support this enzyme, which has antibacterial and antifungal properties to keep the gut clean. And here’s a reference to the talks about immunity and microbes and alkaline phosphatase. Now, before we proceed and to be able to appreciate these concepts and these goals that I’ve created, I thought I present to you in the 30 minutes that I have to do this presentation some case examples, and see if I can stimulate the mindset of the audience to see if we can say, “Okay, let’s go back to the literature.”

One other reference I did not add here. It is my personal experience. We are observers, and at one point we start to appreciate what we observe. We have hundreds of patients who have similar pattern. I don’t believe I always need another article to come out in 10 to 20 years from now, when you have hundreds of a similar pattern coming out. At least, in our practice, which I think is quite unique in the type of patients we encounter, there seems to be, what I call, a pattern recognition. A pattern that is recurrent, and that has prompted us to come back and see what is out there, put these references out there for you, but these references, they support our own personal experience. Okay? Now, in these case examples, I’m going to go with this first one, and this relates to elemental diet that Steve were just pointing out. And if you ever heard my talk from 2019 at the SIBO conference, at that time, I presented the pattern that we see with SIBO, and generally there are about 10 different patterns that we see.  I think, Ben, you were there in that conference and I think that’s one of the classification appear to be appealing just to be able to memorize these type of SIBOs that we see based on the clinical response. This first case, I call it the paradoxical clinical outcome. Young female with history of methane SIBO, previously responded well to Xifaxan and neomycin. And at times to fluconazole and nystatin with good results. This by itself tells us that the microbiome goes through a dance. I call it the dance of the microbiome. Sometimes it becomes more bacterial predominant, and sometimes becomes more fungal predominant. And at times, it’s difficult to know which one is the player. You have to do a therapeutic trial. In this particular instance, when we went back and forth, we got to point that the patient was having some bloating and SIBO symptoms, and a SIBO test showing you hydrogen predominant SIBO. At that time, we decided to treat with elemental diet, but because of fear of fungus associated with the sugar, I incorporated nystatin and fluconazole, both of them concurrently with the elemental diet.

Dr. Weitz:                            Now, why did you decide to include both of those?

Dr. Rahbar:                         Because of the experience I had with the patient and the testing results previously that fungus at times was a player and she had clearly responded to these two previous. I said, “Look, there’s a little bit of a carbohydrate in the elemental diet and I don’t want this thing to take over.” Three days after the elemental diet, patient complained of severe abdominal bloating, what do you do?  Now, it is not usual to hear anybody saying, “I got bloated on elemental diet.” Indeed, in 40 years of practice and 20 years of doing this, I’ve never heard of that scenario before.  But I like you to think about it for a moment, and then we can come back and say, “You know what to do?”  Unfortunately, this is not a completely interactive dialogue with audience, but what do you do?  Patient is already on fluconazole.  Patient is already on high dose nystatin, 3 million units a day compounded and pure, and abdomen is bloated on the elemental diet. What do you do at this time?  So just to make a long story short, what we did, we had to stop everything and-

Dr. Weitz:                            By the way, what kind of testing had you done for this patient?  She had a SIBO breath test?  Had she had other testing?

Dr. Rahbar:                         She had a SIBO breath test showing that the SIBO was there, but it wasn’t very severe. We didn’t know if it’s a fungus or bacteria, but there was still some element. Generally speaking, when people go on elemental diet, there’s usually no bloating because you don’t really have any substance there and people get flat and comfortable. This was very, very unusual to feel bloated. Anyhow, what we did, I stopped-

Dr. Weitz:                            Oh, somebody asked: why compounded nystatin versus conventional?

Dr. Rahbar:                         Well, I don’t like the ingredients of the generic nystatin. If you look at it, the tablet is sugar coated and it cannot guarantee that there’s no wheat or gluten or corn products in it, or somebody who is so sensitive to many things with this type of case complexity, I don’t usually use standard tablets.  Just ask your pharmacy to give you the excipients and other ingredients on the tablet, you will see what you get as a report is quite impressive.  Anyhow, what we did in this case, we stopped everything.  I speculated that the clinical picture is one of fungi, and I also speculated that the fungi was resistant to nystatin and fluconazole because we had used it before.  And what we did, we changed the treatment to itraconazole, and within few days the abdomen became flat and the patient reported that she has never felt this good ever.  We know a previous workup had revealed that there was evidence of mold exposure from maybe a residence that the person might have been in, and that might have been a trigger factor in the background, allowing fungal predominance here.  Now, please stay with the thought, there’s a lot to cover some of these concepts.  Most of us have heard of all of these SIBO, SIFO allergies, but what I’m trying to emphasize here is how these things they interact. In this particular instance, you just notice how the fungus can suddenly become the predominant picture.  It was probably there to begin with for a long time, and then suddenly it took over under the SIBO treatment.

The next case, there was a case of a young female with, I call it the mega gas, mega methane, or mega meth pattern with a peak of methane over 100. Patient was treated with Xifaxan and neomycin with good response, went over for a second course and a breath test that shows improvement by 80%, and patient says, “Well, I want to do a third round,” and this is the classical treatment pattern that it has been done outside. After the third course, the patient felt worse and the breath test was terribly abnormal. It was worse than the first one. So suddenly after two rounds of neomycin and Xifaxan that had given patient’s significant improvement, suddenly she got a very bad methane. We were back to square one. What do you want to do?

Dr. Weitz:                            Sam, how often do you end up prescribing two or three courses of Xifaxan?

Dr. Rahbar:                         Well, I used to do this more often.  This case is from few years ago.

Dr. Weitz:                            Okay.

Dr. Rahbar:                         Nowadays, I do take a little bit more precaution because of my understanding of how fungi might be a player into this, so please allow me to go through this. You will see, I’m trying to make a point from this presentation. In this case, I speculated, this is back about 2019, that the patient had a reason for immune dysregulation, allowing the archaea to produce methane. And when we checked the patient for tickborne diseases, Babesia duncani came back clearly positive. So the patient was treated with Malarone for six weeks, no other antibiotics, six weeks of Malarone. After two months, she walked into the office and said, “I feel good. I just want to repeat my breath test.” We did the breath test. The breath test was completely normal, completely. We did not use any more treatment for SIBO.  It was obvious that the treatment of the underlying problem might have altered the immune system in a way to allow clearance of this type of archaea. So the response was very remarkable. She even came back a few months later, did the same test again, it was consistent. It looks like the problem was addressed. The Babesia test later on turned to be negative. It was done through IGeneX. Another case is, what we call, incongruent pattern. Patient presented with very high hydrogen pattern, recurrent pattern of SIBO. You keep treating, response, but it keeps coming back. Eventually, we did some sort of urine organic acid and the markers for fungal dysbiosis were high. And I speculated that the fungi might be in the background leading to surface disruption and allowing crevices and cracks in the wall for the bacteria to persist in the mucosal layer.

Dr. Rahbar:                         I’m sorry, what is it?

Dr. Weitz:                            I think he just wasn’t muted. Somebody just came into the room. Sorry.

Dr. Rahbar:                         That’s nice. Okay. Yeah. So how do you manage a case like this? In this instance, what we did? We stopped focusing on the SIBO and we focused on the managing the fungi. The question was that why a patient would have persistent fungal scenario, and when we checked it, there was evidence of environmental toxins, BPA and glyphosate, and some mycotoxins. It was hard to say which one is the player. I basically treated the patient with a variety of binders for several months and concurrent antifungal therapy, and eventually we went back and treated the SIBO and the SIBO this time cleared, and it appeared that they stayed under control. The patient felt better and eventually decided to pursue pregnancy. These three cases they could be… I presume, other physicians would see difficult patterns to control, and I think it is good to keep these in mind.  Based on these presentations, I want to come back and show you one of the pictures we clearly refer to is this one here. In this case, if you… This is published in an article, looking at some of the patients with celiac disease, that they may still have symptoms and they’re gluten free, that you may be dealing with a scenario of celiac. However, I use this slide as an example to show that if the mucus layer is disrupted, if the epithelial, the enterocytes are disrupted, you can allow, or one can allow the fungi to change shape from yeast format to hyphae. And these hyphae, they can have arms and leg. This is like an Eiffel tower. This is like a jackhammer, and they can actually crack the wall and affect the tight junctions. This will cause aggravation of the mucus layer and aggravation of the mast cells and release of histamine and other inflammatory chemicals.

This will lead to patients sometimes showing up with allergies, nasal congestion, seasonal allergies, and dermographism, mast cell activation, so the whole chain of events can take place by doing this. However, if you do, you see evidence of mast cell activation. Even by a simple physical exam, looking at dermographism, it suggests that the mast cells are turned on. And in many cases, one must think of this fungal element. I don’t believe we have appreciated the fungal kingdom adequately. These are different than bacteria. Bacteria, they can stick together and could be subtle, and they produce a little biofilm. This thing can actually mechanically disrupt the tissue. By mechanically disrupting the tissue, you can produce crevices and cracks and that will allow bacteria to stay here. And I believe, this is one of the reasons you see SIBO, SIBO, SIBO keep coming back because of the mechanical disruption.  Now, we have seen this in our practice, many women with recurrent urinary tract infections, men or women with recurrent sinus infections. And every time you give antibiotics, you basically feed this creature again and we basically fall into a vicious cycle or, what they call, like a domino effect. This pattern actually has been described with fungi and C. difficile. And once I understood this concept, I said, “Look, is it possible C. difficile, that is recurrent, might be doing the same thing?” And when I searched, the article easily came up. This was published in 2019 and talks about this unappreciated feature, so it’s not just about UTI and sinusitis, C. difficile. In our patients that we treat with treat for C. difficile, I generally incorporate an antifungal program with it, both as far as the dietary and maybe adding nystatin to the regimen.

This is not a standard of care written everywhere, but considering these concepts, if I feel it’s appropriate, I make a clinical judgment and I incorporate antifungal treatments in the treatment of C. difficile in the hopes of preventing that recurrent pattern, spore formation and so forth. Again, my theory behind this would be that’s probably some mechanical disruption of the surface that allows the spores or the bacteria to hang around longer, and then after your first course of treatment, you end up another one. Now you add immune dysregulation, weakness, and clinical picture of malnutrition to some of these cases that even [inaudible 00:29:01] further to recurrent C. difficile. Now, this particular article talks about intestinal mucus barrier, the missing piece in the puzzle of food allergy. Let me see if I have this, actually. You see my screen? Let me just put that here.

Okay. So this is the article that was published and it really nicely goes into the details of this that we need to appreciate further the glycoprotein that it creates the mucus layer of the gut. And there’s a mucus layer in the stomach, small bowel, and colon, and obviously, the stomach has its own version of the mucus layer, small bowel has its own version, and the colon has its own. There are two layers with this that they describe. One is tight and is attached to the very surface, and there’s a looser mucus layer from glycoproteins that is sitting on top of it. What these mucus layers do? They create a smooth and sliding layer. It’s like ice skating. These bacteria can float on them and through the gut movement, they can be pushed out. When the mucus layer is damaged, then you’re going to have a rough surface and that creates for these additional opportunistic bacteria and fungi to further lodge into this.  Now, the relationship of the mucus layer with Akkermansia is very, very important, because as you might know, Akkermansia that recently became available as a probiotic is Akkermansia muciniphilia. And this particular bacteria for most part is supposed to be a good bacteria, because what it does, muciniphilia means it likes mucin, it eats off the mucin. And by doing this, if you have a thick mucin, it makes it… kind of loosens it up. It almost keeps the mucin in good shape. In scenarios of fungus, from what we have seen, and I’m sure many of your patients have shown you rope forms by passing thick mucus layers from rectum means that mucus becomes very thick and abnormal, and that makes it very easy for this thick biofilm to allow many bacteria and fungi to lodge in there.  Presence of Akkermansia is very, very important to be able to keep a healthier and this article, they do talk a little bit about the Akkermansia muciniphilia, a commensal bacterial member of the human and non-human gut microbiota and a mucin-degrading specialist that has been associated in human with both beneficial and harmful effects in multiple disorders. Obviously, if your mucus is thin and abnormal and this thing comes and eats the rest of the mucus, you’re going to have more problems. But in the setting of fungus, in my experience, if the Akkermansia is depleted, and many of your labs will show you if you have adequate Akkermansia or not, it might be beneficial to incorporate Akkermansia as part of your therapeutic protocol [inaudible 00:32:57]. Intestinal mucus layer-

Dr. Weitz:                            For those who don’t know, there is a commercially available Akkermansia muciniphilia product available from Pendulum Therapeutics.

Dr. Rahbar:                         Right. You should invite them the next time to support this program. Okay. Anyhow, stomach produce this mucin 5AC, MUC5 I call it, and then the gut has the MUC2s, and again, each of these are two layers and then they have subclassification. It goes into a lot of biochemistry, and just for you to know that amino acids are commonly used in this mucus production, threonine, serine, and glutamine during necessary for production of this mucus layer. And the glucose is attached to the protein by, what they call, O-glycosylation. It attaches itself to the oxygen molecule and it is a form of a glycated protein, basically that is created here. In addition, the protein [inaudible 00:34:12] mucins O-glycosylation is an important feature that contributes to the viscoelasticity of the mucus, thus promoting activity as a lubricant to help expel particles and parasites.

Now, I gave a new language we don’t hear is mechanical disruption of the surface. Previously, we talked about leaky gut. Leaky gut could be loss of those tight junctions. Leaky gut could be loss of a cell that it dropouts or extrusion. But now we should also think about leaky gut as mucus layer being damaged, either too thick or too thin, and this can happen. Now, this article talks about environmental chemicals, which is fascinating because many of the environmental chemicals, they work as a detergent, like a soap, and they can actually damage the mucus layer. And I believe many of these syndromes that we’re seeing that I call the syndrome of FODMAP intolerance is because of exposure to this environmental chemical that they’re showing up in our food chain and in the urine. As we speak, we are currently working with Vibrant laboratory. We have already started a research project to look at digestive manifestations and other manifestations in patients with abnormal urine outputs having these type of chemicals.

As you might already know, back in 2021, in January, we published digestive and non-digestive manifestations of patients with vector-borne disease that was published in journal of patient-centered reviews by University of Wisconsin and Aurora Health. And that our article is already available online. Our next focus is going to be looking at the correlation or the association of presenting symptoms, whether it’s digestive or non-digestive, with abnormal urine chemicals including toxins of mold, environmental chemicals, that would be 36 of them would be studying, and metals in the urine. We will see what the update would be in the [inaudible 00:36:50]. I’m going to close this article here. Okay. And then going back to… So that reference is also available. I’m sure if you look it up, it’s going to come up easily. It is free online.

Dr. Weitz:                            And Sam, I just put a reference for your article in the chat box. Can I ask you, should we think of the mucus layer as crucial for both the health of the intestine and to allow the healthy bacteria to grow, but at times can’t it also become a biofilm to protect the problematic organisms?

Dr. Rahbar:                         Exactly. And I think that’s where we need more research to understand how do you delineate what is normal and what is abnormal and how much is too much. I can tell you that there was an article published in traditional journal of gastroenterology describing biofilms. If phenomenon that I could never really understand that why when I do colonoscopy in the area of cecum, occasionally we see a layer of biofilm stained green, but it is so sticky that if I use high pressure water, I would still have difficulty getting it off. And then you have another patient that comes for colonoscopy and the colon is completely clean, the mucosa is shiny, and I don’t have such a biofilm. And somebody published this in last couple of years, and then I realized that when I looked back in our patients who have this type of biofilm, the majority of them were patients with Lyme disease and other problem that they had received a variety of antibiotics, that probably created a very dysbiotic flora as a consequence of ongoing antibiotic use.  And now, I hypothesize personally that persistence of this bacteria, it requires a rough surface that most likely it is fed or sustained by this fungal interaction, and that’s what I call, the interplay. And so, when I see recurrent bacterial infections, either sinus, urinary tract, or even gut, then we realize that this may have a fungal component under it, and I think that also has to be addressed. So that’s one of the take home messages I try to emphasize. The other thing is-

Dr. Weitz:                            Sam, let me just stop you for a second. Guy Citrin asked: what products have you seen or utilized that have successfully helped to repair the mucosal barrier?

Dr. Rahbar:                         Well, I use a variety of products for that, but this probably would be better to do it in a Q and A, so I don’t get disrupted in my thought process.

Dr. Weitz:                            Oh, okay. I’m sorry. I’m sorry.

Dr. Rahbar:                         Just hang in there with me. I can tell you what we do and what’s available out there, but-

Dr. Weitz:                            Okay.

Dr. Rahbar:                         … and then, we can go from there. There’s a few take home messages that I like to cover. Another take home message here is the correlation between methane and fungus. Now, for those of you that you treat SIBO, the methane SIBO, it does not have the same character as the hydrogen. Methane generates very low, less than three. They say, if you get to methane level of 10 is abnormal, but I think even that might be too high, but to produce methane, you need archaea. Archaea are bugs that they don’t like oxygen. They don’t survive in an environment that is oxygen. On the other hand, fungi, they like oxygen. That’s why, if you put a piece of fruit outside for a few days, you’re going to see becoming a little moldy outside. You can actually see it sometimes visibly.

Based on this concept, I said, “Let me do a search and see how do they grow archaea or methane producing bugs in the laboratory.” I found a nice article. It is not listed here, but is available online that… This was done by microbiologists, how to grow methanogens in laboratory. So I went to the methodology and they said, “Okay, this is your Petri dish and you put A, B, C, D like a kitchen,” and they were putting a little fungi in it. Wow, why they put fungi into that? And partly because fungi can produce nitrogen just like the way we make beer, and nitrogen is going to replace the hydrogen, so you create an anaerobic environment. I say, “Well, maybe the same phenomena is happening in the gut.” New genome showing a high level of methane, like the case I just presented to you that to have a high methane, it appears to me that you need to have fungi around.

So we started to look at the fungal markers for our patients with high methane. Nearly 90% of patients with high methane. They had markers for fungi positive. Either the stool had fungal growth or the organic acid showed it, or the antibody to fungi were showing up in the blood. There were reasons for us to believe that the fungus might have been a player. Obviously, fungus scenario and fungus dysbiosis, it has no discussion currently in classical textbooks of medicine. Unless it’s invasive, when you’re in the intensive care unit, having with fever and invasion, or you’re dealing with oral thrush, esophageal candidiasis or vaginal yeast, there is no discussion beyond these areas of the role of fungi. And I think it needs to be further research.

If you look at the references I’ve given you, the same language is used by the authors as how unappreciated this scenario could be. And because of its ability to disrupt the microbiome, disrupt the mucus layer, disrupt the enterocyte layer, crack the wall and create a mechanical disruption that produce crevices for the box to grow. This is what I call cracks in the wall, and it may be another concept to keep in mind when we’re trying to deal with this. With that scenario, I can give you a summary what I like to be the take home message, and I’m happy to answer any questions. I put your concepts to consider. Methane SIBO indicates possibility of underlying fungal dysbiosis, recurrent C. diff may be facilitated by fungal dysbiosis. Surface disruption, that’s something I put there as a possibility.

Underlying fungal dysbiosis indicated possibility of immune dysregulation directing in two directions, Th2 dominance and allergies. Food sensitivities and/or immune weakness align fungal persistence, as if you took steroids, you took chemotherapy or antibiotics, so it looks… That’s now, you have a vicious cycle. Fungal persistence may increase the likelihood of bacterial infections, such as recurrent sinusitis, UTIs, and the need for antibiotics; hence, the domino effect. Immune weakness can originate from microbiome disruptors, particularly mold exposure and environmental chemical exposure. Such conditions make coexist with vector-borne diseases. Clinical experience and therapeutics trial are needed to understand as what might be the major player in symptom presentation. A vicious cycle may follow. More emphasis need to be placed on understanding lubricant mucus layer and ecology of fungal kingdom. That’s the take home message. So I’m ready for any questions if you have.

Dr. Weitz:                            Okay. So one of the questions is: what’s the best way to repair the mucus layer?

Dr. Rahbar:                         Well, I mean, one of the first thing we do is we understand if there’s bacterial or fungal scenario, we need to identify that. I don’t always start to mobilize toxins, because if you bring them into the gut and the gut is dysbiotic, you may actually make the dysbiosis worse. If I feel there’s a fungal elements, I usually use antifungals. Then, you need to think about what does the mucus layer need to repair itself. Now, there are some elements that I use routinely is glutamine, for sure, and then there are other amino acids are usually given, array of all amino acids. But again, some of the main ones that are part of glycoprotein, like thionine, threonine, serine, and glutamine. You can find these in a product, for example, such as the MegaMucosa from the Microbiome Lab, I think, it has some of those elements.

Most of the time, what concerns me with these blended products is the excipients that they put in their colors, sugars, stuff that they put. I don’t personally like those things, so when I see those things, then I may start to use the elements individually as opposed to using it as a blended. The more blended the stuff you use, more chance patients may have a reaction and it would be hard to know what’s going on. But amino acid replacement, including glutamine. Omega-3s are very important. Omega-3 actually helps to promote the growth of Akkermansia, which as we said, is helps keeping a healthy mucus layer to the best of our understanding. And I use a variety of high quality multivitamins, including the Bs to make sure that those elements are there.

And if the patient is going on a carbohydrate-limited diet, I use short-chain fatty acids and butyrate as a replacement, so to make sure the enterocytes have adequate amount of energy available to them. I also include zinc carnosine. And then, we go from this replacement phase into attack phase. And if necessary, I add some microbiome disruptors, such as [inaudible 00:48:21] or sometimes lauric acid, Lauricidin, monolaurin, as a measure to help to disrupt the microbiome. NAC is another one I use, but again, sometimes I use a combination, sometimes I use one at a time to make sure the patient can tolerate it, and we go from there.

Dr. Weitz:                            I think one of the issues with fungal overgrowth, Candida, et cetera, is the difficulty in having a definitive test for it. For example, there’s no breath test for fungal overgrowth. What do you find is the best way to test for the presence of fungus?

Dr. Rahbar:                         Well, the honest answer is that I first use my clinical judgment, and in clinical judgment, we look for potential risk factors that allow that. I do remember one case that I told the patient, “Look, I really believe you have a fungal clinical picture, you have taken antibiotics, you have been under stress, your cortisol is high, and you were on birth control pills,” but all the tests I did, came back negative. And I just said, “Please, I want you to take a leap of faith and just do the antifungal treatment.  I’m going to put you on this regimen with nystatin and a dietary change,” and she dramatically improved.  So most of the time, I think clinical judgment is important, but to support it and maybe put the patient’s mind at ease, I use antifungal antibodies. Vibrant has a nice expanded panel of antifungal antibodies, and is more than what you can get from a Quest Lab because they only do Candida albicans antibodies.

The other one is that I heavily rely on is urine organic acids, the microbial organic acids, but we have numerous cases where the tests or organic acid was normal, and I could see fungal growth in the stool. One example was today, a man with history of inflammatory bowel disease, 2 plus Candida glabrata, which is a relatively aggressive fungi in the stool showing up, but urine organic acid was negative. But the antibody test was also positive, so there was still supportive evidence that this patient might be suffering from a clinical picture of yeast, if you will.

Dr. Weitz:                            When it comes to treatment for fungus, number one, when do you use nystatin versus other antifungals? And then, how long do you think it’s safe to treat with nystatin?

Dr. Rahbar:                         Well, I didn’t know the answer until we kind of evolved into this, and I don’t think you’re going to find literature on this one, but I’ve talked to other colleagues as well. We have patients now on antifungal regimen sometimes over a year. If I ask them to come off, they won’t. Okay. I mean, they know that they’re going to have trouble. Now why the immune system has a problem? My theory is the chemicals, especially exposure to mold, toxins. Especially, if somebody has the HLA profile that Dr. Shoemaker had described that they’re multi-susceptible or more susceptible, they hold onto this. It is almost a hundred percent guaranteed I’m going to see this pattern if somebody has persistent scenario, that genetically they’re susceptible to the mold and they may have a slower mechanism in getting rid of the toxins there.  So going back, I think, as for how long? We have used it long. I just monitored the liver, the kidney function and I just look that I have the patients follow up with me periodically to make sure we’re not making a microbiome switch going to bacterial, to fungi, and the liver and kidney functions and blood counts are normal. I mean, in our patient practice, I can tell you, I have not seen a single case of liver enzymes going up with Diflucan.

Now having said that, it may be, I may be too naive or too inexperienced that have not seen it. Maybe, time eventually will show a case. Have not seen any problem with long-term use of nystatin. In one case, the creatinine went up a little bit, but I was not sure if that was nystatin or not. Anyhow, we stopped it and we changed it to something else. If you do use long-term use of these medications, it’s obviously appropriate to monitor the labs. I know one thing for sure, that dealing with the fungus, this is not a strep throat to take a 10-day course of penicillin. And this creature, it has its own behavior. It is capable of penetrating its arms into the mucosa. And that hyphae pattern, it may take it months to years to [inaudible 00:53:42] to clear.

Dr. Weitz:                            What are the most effective natural products for antifungal?

Dr. Rahbar:                         I’m not going to give you one single item, because there’s no research to use say, “Oh, this versus the other one.” You have garlic, from [inaudible 00:54:00] from oil of oregano, from pau d’arco, all these things have been studied. Please bear in mind that when you use an herb, which in my experience, the herbs are not as powerful in dealing with the fungus clinical picture, especially if it’s an advanced form. now, I may be seeing a skewed population in my practice, and many people may just get away by an herbal product. In our patient population, I cannot completely rely on herbs as an antifungal. However, I use them maybe more so for maintenance, maybe an adjunct.

But I want to give you an example of a quick patient where a patient came and I saw evidence of fungi and SIBO, both of them. I said, “Look, I’m not sure which one to treat. Shall I treat your fungus first? Shall I treat…?” And she said, “Well, can you just give something to cover both?” So I came up with a five-herb program. I used five different herbs, okay? Herbal products from Biotech Research, from ADP, Dysbiocide, and [inaudible 00:55:21] and this other one… Anyhow, five of them we put together. And within three days, patients said, “Look, I am more bloated on five different herbal products.” I speculated that the herbs basically lowered the bacterial component more preferentially than the fungal component. I immediately stopped the herbs, put the patient on nystatin alone. Within a week, the bloating and discomfort subsided. So when you use herbs, the herbs are good, but they’re not as specific just for fungi. They’re also for bacteria. And case by case may vary because we don’t know to what preference they may actually suppress that particular kingdom, if you will. Are you with me on this one? It’s very important to understand because-

Dr. Weitz:                            Yeah.

Dr. Rahbar:                         … you can create a microbiome switch with this. And this type of language comes from having encountered patients with this scenario we had to deal with, but it’s not something one would forget.

Dr. Weitz:                            Somebody asked a question about colon hydrotherapy.

Dr. Rahbar:                         And what about it?

Dr. Weitz:                            Is that ever something you might use, say with a patient with chronic constipation or…?

Dr. Rahbar:                         I do. If somebody has constipated. We have [inaudible 00:56:50] recommended coffee enemas and colon hydrotherapy, especially if they’re constipated. It may help to remove some of the thick microbiome and fungal elements, but it’s not going to be adequate because you’re not completely addressing the small bowel. And I usually tell the patients, “If you do it, how do you feel?” People say, “I feel good. I feel refreshed. I feel energized.” I say, “Okay, do it. If it didn’t make any difference, please don’t do it.”

Dr. Weitz:                            So what are the particular dietary factors that you think are most beneficial for patients with fungal problems? Are you putting them on low sugar carb approach, Like an anti-candida diet? Are you avoiding things like mushrooms and other sources of fungus, peanuts, et cetera?

Dr. Rahbar:                         Well, I definitely do not recommend peanuts, especially you get the [inaudible 00:57:55] you don’t know what they crushed in there. Okay. Okay. Look, I’m not the one who does the dietary counseling directly, which I give the principles, but people say, “Why shall I follow an antifungal diet?” I said, “There are three reasons to follow an antifungal diet.” You don’t want to take the sugary stuff either with this juice or fruits or stuff like cookies or chocolate or ice cream that directly feeds the fungus. The second principle is that you want to make sure that the product that you eat doesn’t have ochratoxin or other mycotoxins in it, because if you swallow it, you’re going to add to the problem. And the third scenario is you want to make sure that, that particular product is not actually a fermented product from yeast, such as kimchi or sauerkraut or some of these things that are really more fungal fermented.

We don’t really know what is going to do. I am not in favor completely in using S. boulardii. In this scenario, you got to be very careful. If the patient has immune suppression, S. boulardii can sometimes take over. This is part of their actually… their precaution when you look at the… Like the use of this in patients with chemotherapy, patients who have a line, the beneficial bug can become sometimes a pathogen. Now having said that, I’ve had many patients who say, “Look, I took S. boulardii and I feel my fungal clinical picture is behaving better with me.” I don’t argue with them. If you tried it and it was beneficial, but if you try it, make sure the patient is not immune compromised because it could go other way for you.

Dr. Weitz:                            Now, medicinal mushrooms are commonly used in many functional medicine practices to strengthen immune system, for brain function. Should they be avoided while treating a patient for fungal overgrowth?

Dr. Rahbar:                         Well, are you using a crushed mushroom or you’re using an extract of mushroom? I don’t have a problem with an extract. Okay.

Dr. Weitz:                            Okay.

Dr. Rahbar:                         I don’t have a problem. Like, there are products that we use for that [inaudible 01:00:08] T-cell. They support the T-cell function. And if somebody actually has a Th2 dominance, it may be beneficial to use something like that, but to get mushroom and crush them and eat them that way is a little tricky. You have to look at the clinical outcome. If they said, [inaudible 01:00:29] I got to say, “Look, you got to try and see what happens. It’s not something I’m going to rush into recommending somebody.”

Dr. Weitz:                            What are some of the most common symptoms that alert you to the idea that they might be having a fungal problem?

Dr. Rahbar:                         Generally speaking, first of all, we see it more in female gender. And I just think that… I always say to my patient, “It looks like fungus loves women and they loves estrogen.” And so, anytime there’s hormone replacement, particularly birth control, stress, high cortisol, it give me clues that this could be the problem. Also ask your patients if they have had athlete’s foot or toenail fungus, or they have dandruff, these may be almost tell tales that there may be a fungal clinical picture going on in that scenario.

Dr. Weitz:                            Do you worry about resistance using antifungals for so long and…?

Dr. Rahbar:                         I do. I do. That’s why I just gave you the… My first case was an example of that. We don’t even have a way to check for that. I cannot see what is their sensitive tool, what is their… You got to use a lot of clinical judgment in this. That case probably would’ve puzzled many people with bloating, because I personally had never seen it before. Most people would say “My stomach is flat.” So this was quite unusual. I knew that we were dealing with a major fungal scenario as soon as I heard that.

Dr. Weitz:                            Have you ever had your patients get fecal microbial transplant? Is that a treatment option for some of these cases?

Dr. Rahbar:                         Patients have done it on their own, overall with some good success. We obviously need more data on that. I actually made a trip to Taymount Clinic in UK, Dr. Erdman. We went to city of Letchworth next to close to London. And we looked at how they do. They use actually aggressive colon hydrotherapy to clean up the colon before they do FMT. I think part of it might be because they’re trying to clear some of the thick biofilm that might be there. I think, the FMT has some role. We tried to actually see if we create a protocol, but when we got to the IRB, we got stuck with them. They couldn’t understand what we were doing. And then, right after that, COVID pandemic came in March 2020 and $20,000 worth of trying to do IRB work got wasted.

Dr. Weitz:                            Oh, bummer. Is there an issue using antifungals with patients with Crohn’s or ulcerative colitis?

Dr. Rahbar:                         I don’t know if there’s an issue, you need to monitor, but certainly, in my practice, if I see evidence of that, I use it. I mean, if you look at cases of pouchitis… Many cases of pouchitis, I may treat not only with mesalamine to block hydrogen sulfide, I sometimes use Xifaxan also in addition. But if I see any fungal scenarios, I add nystatin, preferably a compounded version that is pure to that. They may be resistant, but we’ll see. Today… Indeed, as we speak today, we did see one patient who came with history of Crohn’s and history of pouchitis after colon was removed and basically an ileal pouch was made. But the question was that: why there was pouchitis? And pouch inflammation was driven by what? Now, obviously traditional medical model uses TNF-alpha blockers and IL-23 blockers, Stelara, to control this type of inflammation, but I don’t believe it really addresses what drives the fire.

When we looked at these patients, most of these patients have exposure to mold or environmental toxins that has led to fungal overgrowth, and it becomes a vicious cycle. You don’t know what came first. However, to recover is conceivable to me to use antifungals in this scenario. Most of the time, I use nystatin, and so far, I have not had any problem with that. However, you need to use clinical judgment and see if that would be appropriate for your patient.

Dr. Weitz:                            Now, we know Candida can colonize all throughout the GI track and in different parts of the body and other mucus membranes. Do you ever have to treat the nose or other areas?

Dr. Rahbar:                         I mean, for patients who have nose problems or congestion, I usually get a culture and see if it actually show fungus in that area. Many of them, they do have MRCoNs. I personally don’t use the antibiotic regimen for the MRCoNs. I try to use nasal irrigation and sometimes silver, maybe sometimes xylitol to make it uncomfortable for this bacteria or the biofilm to stay there. To get rid of the MRCoNs is very difficult, and if you introduce antibiotics and if the patient has a gut problem with fungus, any of that stuff gets into the gut, you can actually make the fungal dysbiosis worse. So I’m a little bit more conservative when it comes to nose treatments.

Dr. Weitz:                            Do patients who have fungal problems in the gut, do they also tend to have fungus in their nails?

Dr. Rahbar:                         It’s a common question for me to ask. It’s not a common occurrence, but it’s a common question. I would say probably about one or two out of 10 patients will tell you they have toenail fungus. The fascinating part is this that you will not believe it, several of our patients where we only treated them with nystatin, which is nonabsorbable, they reported to me that the toenail fungus was completely clear. I give them nothing but [inaudible 01:07:20]. So it is obvious that when you manage the immune system and you allow it to recover, it takes care of itself.

Dr. Weitz:                            Given the fact that a lot of these patients have compromised immune systems. Besides treating the fungus, what are the most effective ways to treat the immune system?

Dr. Rahbar:                         That’s a broad question. And I’m not sure if I can give you a quick answer to that. Okay. I mean-

Dr. Weitz:                            Well, let’s say you get a stool test and they have a low secretory IgA. What-

Dr. Rahbar:                         That’s not… I mean, we’re not talking about gamma globulin deficiency and other things. I mean, if I see…

Dr. Weitz:                            Right.

Dr. Rahbar:                         Okay. Many of your T-cell… If you have a T-cell function that is low, like a CD57, one of your T-markers are low, you may have used nutritional replacement. Some of this could be malnutrition. And so, by providing the nutrient replacements, many times you can actually support the immune system. If the immunoglobulin is low, then we just use either colostrum, or better the serum-derived bovine immunoglobulin, which is a favorite one. It is part of one of the proteins that we use for the leaky gut, and I think somebody asked that earlier, what you do for that, this is also one of the things we add to it.

Dr. Weitz:                            You’re talking about [inaudible 01:08:47]

Dr. Rahbar:                         Something like that.

Dr. Weitz:                            Something like that. Yeah. Okay. Any other questions? Do you like BPC-157? Do you use peptides?

Dr. Rahbar:                         I do. We frequently use the BPC-157 as part of our leaky gut protocols.

Dr. Weitz:                            And what dosage do you use for that?

Dr. Rahbar:                         Most common dose is the 500 mcg once a day, because it’s also a little bit pricey. Occasionally, at first, especially if somebody has, let’s say, a lot of hives and rashes, I make for maybe two, three months [inaudible 01:09:25] two a day, like one twice a day.

Dr. Weitz:                            Oh. And then, in terms of the compounded nystatin, what is the dosage you’re typically using?

Dr. Rahbar:                         The maximum dose is usually 3 million units a day. In one case, the patient requested for me to go higher because she tried it on her own and said, “Look, I did better on 4 million units.” It was actually a patient with celiac disease, and I showed her the article that how the fungus can interact and she was having symptoms, so we went up to four, but unfortunately she was living in a moldy home and she couldn’t get out. And that I believe continued to allow persistence of a fungal clinical scenario, because the mycotoxins are immune suppressants, like the mycophenolic acid, that’s like CellCept that they use in chemotherapy and in transplant medicine. So many of these are immune suppressants and they allow growth of micellar form of the fungi. So 4 million, I have one case we went. Most of the time three, and I usually start very slow maybe at 500,000 once a day and just ask them to add maybe by one pill every five days to get to the maximum dose.

Dr. Weitz:                            Great. Awesome. Dr. Rahbar, thank you so much for an excellent, excellent presentation on a fascinating complex topic. And for those who want to find out… who want to get a hold of you, to contact you, where should they go?

Dr. Rahbar:                         Well, our website is probably the best place to refer to the laintegrativegi.com and our contact information and email is on the website.

Dr. Weitz:                            Great. Excellent. And thank you everybody for joining us and we’ll see you next month.

Dr. Rahbar:                         Thank you. Have a good night.

 


 

Dr. 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 and 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.