Tyler Dawley discusses How to Raise Healthy Chickens with Dr. Ben Weitz.

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Podcast Highlights

3:54  Sustainable or regenerative agriculture does not have an exact definition, but Tyler understands it to be paying attention to the entire chain of our ecosystem.  If you are a conventional row cropper you might just grow corn, pour fertilizer on it, and expect a good harvest.  But as a sustainable rancher, you have to think about the mycorrhizal fungi, which are all the little fun things that grow in the soil.  You should worry about how much leaf cover there is and how much solar energy is being captured.  If you are a sustainable animal raiser, then you have to think about how to use these animals to graze the grass and brush without destroying it. If animal graze too long in the same area, they will degrade the land. In nature, the wildebeest get chased around by lions or coyotes, so they never graze too long in one area.  It is up to us to make sure they move around to different areas so the grass and brush can regrow. We want to pump more life into our soil, which is the foundation of all life on earth.

8:57  It is a benefit to have multiple animals on the farm and it would be more regenerative to have multiple animals and it is not in keeping with our climate for the meat case in California to look like the meat case in New York state or Florida.  All these meat cases have a lot of beef, a lot of chicken, a medium amount of pork, and no lamb or goat. In California, we have a Mediterranean climate, which means cool, wet winters and hot, dry summers. One of the reasons for some of the fires in California are that we don’t have goats and sheep that graze down the chaparral zone, so it becomes a bigger fire hazard.  Some are now bringing in goats to graze down brush and the blackberry bushes in the creeks.  People have not had good goat and lamb to eat and that’s the only reason why they don’t eat it because it’s delicious.

12:55  The way they raise chickens on Big Bluff Ranch is different from commercially raised chickens, where the chickens live in barns in controlled environments and never see the light of day. These regenerative chickens are out on the pasture from day one and they have no walls. They have complete access to the outside and they can go in and out as they please.  They are fed certified organic, locally grown, no corn, no soy ration.  The chicken manure helps to fertilize the grass. Such animals don’t need antibiotics because they are not crowded together and they are not stressed out.

18:56  Other chicken farmers also use antibiotics because they make the chickens grow faster.  The birds at Big Bluff grown slower but they are healthier.  Conventional chicken farmers often have birds that are called flippers because they grow so fast that their muscles grow faster than their organs and their heart can’t pump enough blood around and they die of a heart attack and flip onto their backs.  In Big Bluff they have no flipper deaths.

21:35  Some chickens are referred to as free range and this means that they live in a conventional, huge, crowded barn but they have pop out doors leading to a small patio area.  But chickens are very much creatures of habit, so once their habits are set and then you open those doors, they just don’t really go outside. However, pasture raised chickens are living on grass moving outside and inside as they wish from the beginning of their lives.

 

 



Tyler Dawley is an organic chicken farmer who also cares deeply about regenerative agriculture, animal welfare and sustainability. He lives at and runs Big Bluff Ranch, specializing in organic, pasture raised chicken.  The website is BigBluffRanch.com.  The phone is (530) 529-2291 and you can order the chicken directly from the ranch.

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. Hello, Rational Wellness podcasters. Today, we have an interview with Tyler Dolly on sustainable regenerative agriculture and farming practices and how to raise healthy chickens. Most of us have seen some of these horrible vegan documentaries that show factory farm chickens being raised in horrible conditions in cramped cages, all crowded together, given antibiotics, given feed with arsenic and other chemicals, and then eventually slaughtered in some horrific manner. It’s also claimed in a lot of these documentaries that the poultry industry has a negative impact on the environment. But we’ll be speaking with Tyler Dolly who is not only an organic chicken farmer, but he also cares deeply about regenerative agriculture, animal welfare and sustainability. Tyler, thank you so much for joining us.

Tyler:                   Thank you. I appreciate the intro. I feel pretty special and smart now.

Dr. Weitz:            So, how do you become interested in sustainable agriculture and farming practices?

Tyler:                   I won the genetic lottery, what it came down to… This is the family ranch, I was born and raised out here.

Dr. Weitz:            Okay.

Tyler:                   And in the early ’80s when I was still very short, my dad had to change the course of the ranch that we were not big enough to succeed in the conventional manner. So, he just started exploring stuff and he ran across a guy named Alan Savory, who is a… Depending on what world you live in, he is either a big celebrity or a minor celebrity, but he is a Rhodesian philosopher, wildlife biologist, who figured out… He’s a cool guy. Look him up, he has a TED Talk, had multiple millions of views, and his essential thesis is that animals should be moved just like the will to beast in the Serengeti would move. They would be chased by wolf or lions or whatever. And so, my dad started doing this, but we don’t have wolf. Well, we do have wolves now, but we used electric fences.  That’s how we control our animal’s grazing. So, we move our cattle at the time around on different pastures and be very aware of the regrowth of the plants and long fun story. But then that led us into taking care of our cows, changing the genetics of our cattle, that grass animal, very type animal. And for us, that meant a short, wide cow, which so happens to finish well on grass, which means that we had good genetics for grass-fed beef right around when I graduated college in 2000. So, we started going to farmer’s markets with our grass-fed beef and that led us to some lamb that led us to goat. And eventually threw a long series of unfortunate events, we ended up growing a lot of chicken. And now, we are one of the probably top one, two, three producers of pasture poultry here in California.

Dr. Weitz:            Cool. So, what does sustainable agriculture mean?

Tyler:                   Right. So, this is a new trend and people are, to some degree, defining it individually and they’re coming up with their own answers for it. So, I’ll share you with you my answers, but just understand that there’s no set definition. So, what I say is regenerative or sustainable, womeone else might say, “Oh, that’s complete BS. He’s wrong.”  But ultimately, producers who are in this space of regenerative or sustainable, what they’re really paying attention to is the entire chain of our ecosystem, that you can’t just pull out one aspect of it and only care about that.  So, if I were a row cropper, I can’t just grow corn, pour fertilizer on it and expect a good harvest.  No.  If I’m a sustainable rancher, I’m thinking about my mycorrhizal fungi, which are all the little fun things that grow in the soil. I’m worried about how much leaf cover I have, how much solar energy am I capturing?   And then if I’m an animal guy, I’m starting to worry… Not worry. I’m starting to think about, “Well, how am I going to use these animals to graze these plants?” Plants were evolved to be grazed by animals.  Animals were evolved to graze plants, but Mother Nature has her own process for doing this, and it’s a great process, but it’s a very hands-off process.  And when we get in there with our conventional thinking, we muck it all up and we have degradation of our range lands. So, regeneration or sustainability is really to understand Mother Nature’s process, which is what I talked about, the Serengeti and the wildebeest being chased around by lions that we want to take that sort of passive management that Mother Nature would use and then add our active management to it.

So, we don’t want to rely on just wolves chasing away or coyotes or whatever.   We have to actively move the cows and we’re moving them for a very specific reason. We’re paying attention to the grass and how it’s re-growing. The time of year, we’re looking at our rain forecast and we’re playing with all these factors that Mother Nature can passively do, and she does it really well. But because it’s passive, it’s slow. So, when we’re doing it actively, we’re getting in there and we’re being, “Okay. This grass, this pasture is recovered pretty well. Time to put cows in. Okay, we’re done with our growing season. How much grass do we have until our next rainfall? Oh, we have too many cows,” or, “We have not enough cows. Let’s change our animal herd size to fit what we actually grew.”  And so, my definition of regeneration is to pump as much life into our soil, the very foundation of all life on earth. If you ignore the oceans, of course.  All life on earth, and then draw forth what life you can and then just keep it growing and getting bigger and more synergistic that the fertility that used to exist in our landscape before European management processes came in is just it’s hard to imagine how fertile our landscape used to be.  And we can get back to it in decades, not thousands of years.  And we just need more and more people to be thinking about how to put life back into the soil.

Dr. Weitz:            And is that because-

Tyler:                   It’s not like-

Dr. Weitz:            … is that because when we farm, we grow the same crops over and over again until all the minerals and other nutrients are sucked out at that soil?

Tyler:                     Yeah, yeah. I mean, to some degree, think of your soil as a bank of fertility of life, and that in over thousands of years that Mother Nature’s put a lot of fertility in there and it grows with a compounding interest. So, if you come with your plow and you plow up 5,000, 10,000 years of fertility, you’re going to have an amazing crop of corn and you’ll probably have a pretty good crop of corn the next year and the next year. But what you’re doing is you’re basically drawing money out of your stock portfolio. You’re losing all of your compound interest and eventually you got nothing left. So, to some degree, it’s a tortured metaphor right now, but to some degree it’s the, the fertility in your soil is a stock market. You want to be living on the interest of your principle, not living off the principle itself. So, in our case, the principle that a farmer is trying to put into his landscape is vitality. And you do that through green leaves and all sorts of stuff like that.

Dr. Weitz:            Right. And, I guess, it could even be a benefit to have multiple animals on the farm at one time.

Tyler:                   Oh yeah.

Dr. Weitz:            I remember reading the Omnivore’s Dilemma and Michael Pollan talks about how one animal would do one thing and another animal would do another thing and-

Tyler:                   Oh, it’s a hundred percent true. So, one of the things that I am leaning into here on the ranch is, I don’t have a great term for it yet, but like a California meat case that when you go into your grocery store, you look at the meat case and it’s going to look exactly like the meat case in New York state or Florida, you’re going to have a lot of beef, a lot of chicken, a medium amount of pork, and no lamb or goat, and it’s the same everywhere. But then you step out of this mythical grocery store and you’re like, “Wait a second, it snows in New York City. In our part of California, it doesn’t snow.” I mean, just right there alone, why are we eating the exact same meat? So, getting back to Mother Nature and different species that here in our particular part of California, we’re in a Mediterranean climate, which means we have cool wet winters and hot dry summers.

Dr. Weitz:            Where are you guys located?

Tyler:                   We’re in Red Bluff. So, we’re in the Sacramento Valley, a couple hours north of Sacramento. Four hours-ish north of the Bay Area. And so, we have hot dry summers and there’s a lot of really fascinating stuff about it that I won’t bore you with, but if you want to know, just ask me because I will tell you. But what it comes down to is that we have hills and we have brush out on our ranch. Hills and brush are not what cows want to eat, but they’re exactly what goats and sheep want to eat. So, this is where it gets really exciting. You know what? California, we’ve been burning five of the biggest fires ever been in the last five year. Well, what are they burning? They’re burning brush. It’s brush.  Short shrubby stuff that’s burning. Well, ecosystem has been growing because through management we have removed fire. I mean, that’s a whole separate story, fire controlled burns. But also we’ve removed animals from that environment. There are no elk out there anymore grazing this stuff down. There’s not big huge herds of deer grazing this sort of forage down anymore. So, it just grows up. And the bigger and older it gets, the more flammable it comes and then, poof, it burns. So, what we’re doing, so in California, because we’re a Mediterranean climate that grows really good goat and sheep, we should be eating goat and sheep because those goat and sheep are going to graze down our chaparral zone. That’s a huge higher fire hazard. Even you’re seeing this now, there’s brushing crews, you see them all the time. It’s really fun.

                                People are bringing in 500 groats goats to graze down the fuel load around their housing community or blackberries in the creeks. I mean, there’s a booming industry. And so, all I’m saying is what we’re trying to do is take that idea of grazing with multiple species, because different species eat different things. There’s a specific set of species that we should have here on Big Bluff Ranch. So, with the right species, we’re taking care of our landscape, we’re making it better, we’re soaking in more rainfall. And then we’re also creating really delicious, nutritious, wholesome food at the end of the day that takes care of us so we can take care of them. And people just haven’t had good goat and lamb, that’s the only reason they don’t eat it because it’s delicious.

Dr. Weitz:            Oh, okay. So, tell us how the way you raise your chickens is different from the commercially raised chickens. And I’m sure most people have seen these videos where the chickens are crowded into these little tiny cages in horrible conditions.

Tyler:                     Right. Right. So, I’ve definitely talked a lot about ruminants, and grazing, and haven’t really talked about our chickens at all, but that’s what we specialize in right now. So, you’re exactly right that the conventional chickens live in barns. There’s a very extremely controlled environment and those birds really never see the light of day. Their airflow is regulated, their feet is regulated, their water is regulated, the square footage that they live in gets regulated, and it’s really designed to create cheap food, and it does a really good job at that. But there’s a lot more out there that should be done than just having sheep chicken. So, I’ve talked a lot about taking care of the soil and taking care of the animals. And one aspect of taking care of animals is to allow those animals to be their natural selves. So, for instance, we don’t feed our cows any sort of grain cows aren’t really meant to eat grain.  It actually messes up their gut. Chickens are not meant to be inside. It messes up all of their hormone system. They need the sun, they need vitamin D, they need to see the sun go down, they just need to see the sun come up, they need to eat grass, they need to eat bugs. So, that’s what we do.

So, our chickens are out on pasture from day one. So, they have no wall… Well, they have walls, but they have complete access to outside. They can run outside if they want to, they run inside if they want to. We feed them certified organic, locally grown, no corn, no soy ration, because that is a ration that California can grow well. And then they’re fertilizing the soil, the soil’s growing grass, the cow, chickens are eating it.  And then we harvest them from that spot, move them on to the next spot. And a new set of birds are on a new set of pasture. All that fertility that we left behind with the chicken manure, we let the plants and the soil microbes absorb it and lock it in and just keep that. It’s so fun when you get into it because if you really just start, it just… One thing gets better here, that means that thing gets better. If this is getting better than that’s getting better. It’s this huge ball of synergism. It’s fun. It’s really fun when it works.

Dr. Weitz:            So, chickens can pretty much be raised on grass?

Tyler:                   Well-

Dr. Weitz:            Is that what they eat or they [inaudible 00:15:43]?

Tyler:                   … they get a lot of nutrition from grass.

Dr. Weitz:            Okay.

Tyler:                   But chickens are not vegetarians. So, when you see vegetarian fed labels in the grocery store, that’s really not a diet. A chicken is meant to eat. They are omnivores and they are very happy to eat meat and high protein and you don’t really get that out of your pasture. It’s a salad. So, they need the protein portion of their big ass salads.

Dr. Weitz:            Which is wet bugs and-

Tyler:                   Bugs and stuff and like that. But, ultimately, we end up supplementing them with a no corn, no soy ration, just to make sure that they never hit any deficiencies from what our pasture would provide them. So, I can’t really give percentages, but they’re definitely out there on the pasture and they’re definitely eating some supplementation and it works out just fine. They’re very happy, very healthy birds.

Dr. Weitz:            Right. And then how do you avoid giving antibiotics and some of the other chemicals that are given commercially raised chickens?

Tyler:                   Right. Well, see, this is another part of that synergism that I got outside and then [inaudible 00:16:53].

Dr. Weitz:            Yeah. And/or any antibiotics given partially because they make them fatter?

Tyler:                   They’re phasing that out pretty aggressively now in the conventional industry, but until probably the last five to 10 years, that’s what they would do. Sub-therapeutic levels of antibiotics to grow the chickens faster, which is where people… You’re starting to hear about superbugs that there are some salmon-

Dr. Weitz:            Antibiotic resistant bacteria.

Tyler:                   Yep. Yep. And then a lot of people are pointing out the problems with this sub-therapeutic use of antibiotics for animal production. So, the thing is that they need those antibiotics because they are stressed out, a stressed animal, not living… Imagine yourself. If you are stressed, you’re inside too much or whatever, you can tell when you’re worn out, you tend to get sick, right? You’ve depressed your immune system because you’re not taking care of yourself. Well, just imagine yourself stuck in a football stadium with all those other people, but that’s what you do for your entire life, you’re going to have pretty high stress levels. You’re probably going to need some antibiotics to keep yourself going.  So, to take that metaphor, get out of that football stadium, and once you have space around, you have the sun, you have fresh air, you can engage with your friends on at the right level.  You’re back to a normal, happy, healthy thirst person and you’re not going to get sick. That’s the same thing with what we do with our chickens is that we provide the environment that they’re not going to get sicken. They get shade when they want it. They get shelter when they want it. They get the grass, they get the sun, they get all their friends. They have no pressure from predators because we have guard dogs out there with them. And if you’re a happy, well taken care of person, you don’t get sick. It’s the same thing for chickens. You give them the right environment and they’re good to go. You don’t need the antibiotics. It’s only when you stress them that you have to go to the pharmacy to make your living.

Dr. Weitz:            Right. And how do you get around the fact that they use the antibiotics to make them grow faster? You just take longer for the chicken to mature?

Tyler:                   Yeah, exactly. And then so, that is, yes. Our birds grow a little bit, grow out a little bit longer than conventional birds, which is really a good thing because not only does that mean we can avoid antibiotics and any other stuff like that. We raise a breed called Cornish Cross, which is the same genetics you’re going to buy from the grocery store and it’s really, actually, an amazing breeding. There’s no genetic modification, it’s just really strict controlled breeding for decades. And they’ve gotten these birds to grow so fast that it’s actually, they’ve been bred where their muscles can grow faster than their organs in an ideal situation.  So, the industry has a term they’re called flippers that basically the heart can’t pump enough blood around and they die of a heart attack and they flip right on their back. And what we do, we raise the exact same genetics, but we don’t have any flipper deaths, just doesn’t happen. And that’s because our birds grow a little bit slower. So, the organs develop in relation to the muscle and so, they’re just healthy, happy birds. So, some people have some issues with the Cornish cross and it’s not unguided, but that you give them the right environment and they don’t have issues. So, that’s-

Dr. Weitz:            Now, aren’t there commercially grown chickens where they say they’re grass fed, but really all that means is they let them out of the cages for a short period of time and they go back in,

Tyler:                   Right. Yep. Yep. So, the term for that, at least in the chicken world would be free range, free range chicken, free range eggs. And that is a-

Dr. Weitz:            Okay. So, if we see that term free range chicken, free range eggs, what does that mean?

Tyler:                   I’m just going to… Hey, George, I’m on the phone. I’ll be right back. Okay? Sorry about that. The kids just got back from school. Yeah. You ready?

Dr. Weitz:            Yeah, yeah. That’s fine.

Tyler:                   Okay. So, free range is a legally defined term. It’s like organic. There are a set of guidelines that you have to meet to qualify for free range. And depending on if you’re looking at meat birds or layers, they’re a little bit different. But, ultimately, it comes down to outdoor access is the term. And so, what that means is you have just the same exact conventional barn, it’s like a football field sized barn. But instead of being completely enclosed, like most conventional barns, they will have these little pop-out doors leading out to a little tiny patio area. And different free range certifiers have different requirements for the outdoor square footage, but it’s not very much. And the other thing is that chickens are creatures of habits. They do the same thing over and over and over again. You ever heard the saying, “Your chickens always come home to roost”?

Dr. Weitz:            Right.

Tyler:                   That’s a real thing. Chickens sleep in the exact same spot. They are creatures of habit. So, by the time they get around to opening those doors and those free range barns, their habits are set and they just don’t really go outside. So, it sounds good. So, if you talk to someone like me, I get this all the time like, “Oh, you’re a pasture-raised person or pasture-raised poultry.” You must be free range then. I’m like, “Well, yes, but we are so much more than free range because the image in people’s mind is free range, red barn farmer and overalls, green grass, a few chickens here and there.” That’s what free range conveys in the term, but the actual practices are very, very far from that. If you want that image, you need to be looking for a pasture raised chicken. That’s the only type of chicken that’s going to be out there on grass. The majority of its life.

Dr. Weitz:            So, if it says pasture raised, that means it’s got to be free to roam around, it’s pretty much its entire life till the end?

Tyler:                   Pretty much, yeah. There are different… Yes. The answer is, yes. If you see someone saying free or pasture raised, you’re going to be very happy with that chicken. There are some different styles of how you do pasture raised chicken, but I don’t want to split hairs. Go, go. If you see pasture raised that gets the stamp of approval.

Dr. Weitz:            And we’ve heard reports about chickens being feed with arsenic in it. And what was that about? Is that still being done?

Tyler:                   Well, I don’t know the exact arsenic story, at least I can’t recall it off the top of my head.

Dr. Weitz:            I’m trying to remember. It was some sort of arsenic related chemical that had to do with… I think it, once again, it was to somehow they would grow faster or something.

Tyler:                   Yeah. I Think it’s a growth promotion, that rings a bell. So, I don’t know that specifically, but I don’t think it’s been outlawed. So, there’s no reason that a conventional guy couldn’t be doing that. But I would just say that anyone who is taking care of animals, they are trying to do the best job they can. No, I don’t. I’m not pointing fingers at conventional farmers at all. They’re just doing the best they can with the systems and knowledge that they have. And that one of the things I like to tell people is that you get to vote for the future. Three times a day, you’re voting with your food dollars.  I know I’m stealing that quote from someone else, so I’m not that smart. But if you don’t like how those chickens are raised or how those farmers are treated, just buy some different style chicken. Buy an organic chicken. Is it as good as pasture raised? No, but it’s a lot better than a conventional chicken. And you will eventually, through your dollars and your food choices, create the food system that you want. That these big companies are not evil, they’re just profit driven. So, signal to them with your dollars that, “Hey, this is where I want to spend my money.” And they’ll turn as fast as they possibly can. And there’s actually-

Dr. Weitz:            Yeah. I-

Tyler:                   There’s a lot of examples of that happening.

Dr. Weitz:            Okay. I eat purely organic pretty much 90% of the time, but then I read these reports about how these big companies have gotten into organic and then they get the rules changed so they can add this and add that, and it still qualify as organic.  So, my conclusion is organic is better than not organic, but it’d be even better if they weren’t allowed to get in and say, “Well, we can add this chemical and because that chemical originally comes from seaweed, then it’s okay, and this is okay.”

Tyler:                   Yeah, I totally agree. I mean, that always happens when you have a third party auditor, third party certifier, that all of a sudden you have standards and guidelines and then all of a sudden that means that there becomes loopholes. It’s a nature of the beast. And I totally agree with you that organic is better than not organic, but is organic as good as organic should be? No. No. But it’s directionally right. More and more people are buying organic, now you’re starting to see that higher level of organic. There are actually regeneratively certified organic products out there. It’s a standard we’re looking into, which again, is that as good as what we do? Are we getting all the credit for what we do? Not necessarily, but again, it’s another higher level and we can just keep moving the food system forward by voting with our dollars, taking the best step you possibly can.

                                I think that’s just really important. I mean, for us personally, when you buy a chicken from us, you’re keeping us in business and all the things that we’re doing for our landscape, it’s a very one-to-one exchange like, “Oh, you bought a chicken. Yay. I can go buy food now or whatever.” So, your dollars matter. I realize when you go to the grocery store, you’re like, “Eh, so what?” But actually it’s a very powerful thing. And if you buy straight from a farmer, like from us or from another farmer, local farmer, it’s dramatic. You’re like, “Wow, you are literally keeping people in business.” So, just to give you that sense of empowerment like, “You are really, really important. We love you.”

Dr. Weitz:            Right. Cool. So, what about the way your chickens are slaughtered, and what are the conditions, and then how are the chickens treated after they’re killed? We’ve heard reports about chickens being bleached, and put in all kinds of chemicals, and the processes that are used to end their lives are torturous and horrific.

Tyler:                   Right. Right. It’s definitely a conventional chicken houses process, something like 5,000 birds an hour. It’s insane how fast they do. And when you’re going that fast and that corners have to be cut. You just can’t do everything right. When they’re literally going so fast you can’t count them, it looks like a [inaudible 00:29:11]. It’s really, really fast. So, we don’t go to a processing plant like that. We go to a small processing plant not too far away from us. All of the slaughtering is done by hand, which means that mistakes don’t happen because it’s done by hand. Every single bird is hand slaughtered.

Dr. Weitz:            And are the birds slaughtered pretty quickly after they go there?

Tyler:                   Oh. Yeah. Yeah.

Dr. Weitz:            Okay.

Tyler:                   Yeah. So, for us, in particular, we catch our birds after the sun goes down, so chickens fall asleep hard, man. If it’s waking up a teenager, it doesn’t happen like, “Ugh.” And then we get them there before dawn. And then, so basically, they go to sleep and then they never wake up. So, for us, we have a really great way of getting this done. And our processing plant, they hold them in a right room with blue lights so they don’t wake up and they go into the kill room, which has red lights, so they don’t see all of the blood if they might even look around. And then they go and get plucked and gutted and it’s all done by hand, which is much cleaner and safer than these big automatic machines. It means, our processing costs are a lot higher, but it’s a lot better of a product.

                                And the real thing that we are super fortunate to have is that you are talking about the chlorine bath. So, in many, many, many chicken or processing operations, the way they chill the birds down, because you need to take that normal body temperature and get it down to a food safe 40 degrees pretty rapidly, I think you have four hours to do it. The most cost efficient way of doing that is to put it in water. You have a really good thermodynamic exchange, it draws down the temperature really quickly. Well, but as soon as you start doing that, you’re putting 5,000 birds an hour into the same puddle of water. If one bird is sick, all the other birds are going to have that salmonella or whatever. So, the way they get away or to stop that to mitigate that risk is they chlorinate the heck out of that water.  So, one of the things that happens as well, they’re in this heavily chlorinated water to keep them from cross contaminating each other. As the meat cools down, it actually absorbs in this chlorinated water. So, if you look on some chicken packages, you will see a little asterisk that’s talks about added water, that’s the added water that they’re talking about-

Dr. Weitz:            I see.

Tyler:                   … the chlorinated cooling water.

Dr. Weitz:            I see.

Tyler:                   So, we don’t do that. Our processor doesn’t do that. They do something called air chilling, which is much better. So, basically, it’s hang a chicken and it goes into a big old freezer and comes down to tap. So, never touches anyone else, it never touches water. So, to some degree it’s like dry aging of beef that you’re actually pulling moisture out. Water is wonderful, but it doesn’t have any flavor. So, you take the water out and you concentrate the flavor of the bird itself. Plus you’re not cost contamination, you’re not extra weight of water. And it’s an amazingly delicious way of processing your chicken. And then they come out of the chill chamber, hand packaged flash frozen, and then off to someone to eat it.

Dr. Weitz:            Cool. Do you have some reports from people telling you how much healthier they have, they feel, or even reports of health conditions improving from eating your quality chickens?

Tyler:                     Yeah. Yeah. I mean, that’s one of the best things about being a direct to consumer type operation, that if you ordered chicken from us, you’ll probably talk to me either on the phone or on email and I’ll be shipping it to you. I’m not like some corporate mucky muck and I have flunkies below me. I’d like to have flunkies, but I don’t, it’s me. You’ll be buying from me. And so, we’ll talk and it’ll be a lot of fun. And I get feedback all the time. My current favorite compliment is, “Tastes like grandma’s chicken.” Because chicken right now the joke is, “It tastes like chicken.” Means it tastes like nothing, it’s bland.

                                Well, the reality is the reason chicken tastes bland now is because it’s fed corn, it’s fed soy, man, and it’s literally watered down. Of course, it’s going to be bland. And they have no exercise. Our birds are outside in the sun, they’re hormones are working. They’re getting some exercise and then they’re treated really well through the processing process. And so, I mean, we raise grandma’s chicken. So, if you want to impress anyone with like, “Hey, this is how my grandma used to cut chicken. Her recipe is really good, don’t get me wrong.” But the real star ingredient was the fact that she had it in her backyard. So, if you want that style chicken, you look for us or look for someone else doing pasture race chicken.

Dr. Weitz:            Right. Cool. So, I think that’s the questions that I have. Anything else you want to tell us about?

Tyler:                   Oh. Well, I mean, we only have what? Another two hours now. I’m just joking.

Dr. Weitz:            No.

Tyler:                   No. We’ve covered a lot of stuff. I really appreciate the time. I mean, if anyone-

Dr. Weitz:            No. I mean, we’re fine with time if there’s anything else you wanted to tell us about what you’re doing.

Tyler:                   No, no.

Dr. Weitz:            Okay. Okay, good.

Tyler:                   I think that feels pretty good. I mean, if you have any more questions, I’ve got time. I don’t need to cut off, but we can start wrapping it up if you’d like.

Dr. Weitz:            Yeah. That sounds good. I don’t really have any other questions prepared. So, how can people listening or watching this podcast find out about ordering some chickens from you?

Tyler:                   Right. It’s pretty simple, bigbluffranch.com. There’ll be a big old shop now button and order some chicken. Shoot me an email if you want to ask any questions or want some more information.

Dr. Weitz:            And so, does the chicken come frozen?

Tyler:                   Oh. Yep, frozen. It’s frozen. So, it’ll be shipped frozen, it’ll be on in… Well, right now it’ll be in an insulated cooler. We hope to get a better packaging, but right now it’s a styrofoam cooler dry ice or gel ice, and we’ll ship it FedEx, and it just shows up right at your door. We’ll have tracking numbers on it so you can make sure that it is where it’s supposed to be. And, no, it works out great, especially in the winter shipping is no problem.

 


 

Dr. Weitz:            Right. Okay, cool. Big Bluff Ranch. Tyler Dawley, thank you for your time and look forward to talking to you again in the future. And thank you for making it all the way through this episode of the Rational Wellness Podcast. And for those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or Spotify and give us a five-star ratings and review. That way more people will be able to discover the Rational Wellness Podcast. And I wanted to say thank you to all the patients that we’ve been working with at our Weitz Sports Chiropractic Nutrition Clinic, most of whom we’ve been able to help with a range of various health conditions from various types of gut disorders to thyroid and hormonal issues, autoimmune diseases, and various other cardiometabolic conditions.  And so, I very much appreciate you and I’m excited about going forwards, helping you to improve your health on your journey towards optimal health. And I wanted to let everybody know that I do have a few openings now for new clients, and you can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition Santa Monica office at 310-395-3111. And we can set you up for a new consultation for functional medicine nutrition and we can get that going as early as the new year. So, give us a call and I’ll talk to you next week.

 

 

Dr. David Brady and Dr. Tom Fabian, PhD discuss Cytokine Testing 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

4:10  Cytokines are small proteins that are produced primarily by immune cells and their role is primarily in cell signalling and cellular communication.  Cytokines promote different aspects of immune cell development, immune cell function, and coordinate between the innate immune system and the adaptive immune system.  For example, if you ingest a pathogen though the digestive tract, there are certain receptors on cells that detect these pathogens and that leads to cytokines being produced that initiate an immune response.  This usually starts with the innate immune response.  Some of the classic cytokines that are involved in the inflammation response are IL-6, TNF alpha, IL-1 beta, and Interferon gamma

7:41  There are a number of difficulties in testing for cytokines, including that cytokines are very short lived and they tend to be unstable, so it is important that the sample arrives at the lab frozen, which is best accomplished by shipping with dry ice.

11:44  Cytokine level testing has been used in critical care medicine, such as analyzing patients with severe COVID-19 whether they are having a cytokine storm, which led to using certain interventions that modulate certain cytokines when used in patients with autoimmune diseases.  For Functional Medicine practitioners, cytokine testing can help to assess the immune system status, the level of inflammation, which can be re-assessed after using certain interventions to see how well we have been able to modulate the inflammatory process.

26:30  Cytokines and gut health.  It is recommended that patients that have cytokine testing also do the GI Map stool test, since the gut plays a big role in immune system function and in autoimmune diseases.  For example, Hashimoto’s hypothyroid has a significant gut component and certain bacteria like Yersinia have been associated with Hashimoto’s and there is a characteristic cytokine pattern for this.  We also know that 70-80% of the immune system is in the gut, so we know that, that’s really going to have a huge effect and it’s also a great place to intervene.   

 

 



Dr. David Brady is an internationally known speaker, Doctor of Chiropractic, and Naturopathic Physician. He’s also a Professor at the University of Bridgeport and the Chief Medical Officer for both Designs For Health, Inc. and Diagnostic Solutions Labs, LLC. Dr. Brady is a prolific writer, having published a number of scientific papers, contributed chapters to various textbooks, and he’s written several books, including his latest, The Fibro-Fix, published in 2016. His website is Dr.DavidBrady.com.  Patients seeking the Cytokine Test should contact a Functional Medicine practitioner and practitioners who would like to run the test should contact Diagnostic Solutions Lab at DiagnosticSolutionsLab.com or they can call 877-485-5336 to inquire about the CytoDx panel.

Dr. Tom Fabian, PhD has a PhD in Molecular, Cellular, and Developmental Biology and he is a certified Nutrition Therapy Practitioner.  Dr. Fabian specializes in the microbiome and how it relates to digestive, immune, brain, and metabolic health and he offers a Microbiome Mastery course through his website, Microbiomemastery.com. Dr. Fabian serves a consultant and science advisor with Diagnostic Solutions Laboratory, and he is also a Science Advisory Board member with Designs for Health.

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.

                                Hello, Rational Wellness Podcasters. Today, I’m excited to be talking about cytokine testing with doctors Dr. Fabian Fabian and Dr. David Brady.  I’ve certainly have known about cytokines, but since COVID, and we heard about the cytokine storm that played a role in a lot of people’s demise and made the symptoms more severe, cytokine have been talked about quite a bit. And Diagnostic Solutions offers a cytokine test, and I’m curious to learn more about how this may be a new tool for functional medicine practitioners to be able to help our patients. And my mission is to spread this information to practitioners, and also to the patients, so we can improve the overall health of our country, and the world, actually.

                                So, cytokines, what are cytokines? They’re a group of small proteins, peptides, and glycoproteins, and their main job is cell signaling, communication. Many of these cytokines are secreted by immune cells like macrophages, B and T lymphocytes, and mast cells.  Cytokines made by lymphocytes are known as interleukins. You may have heard the term IL-6, et cetera. These cytokines are very important for the immune system, and they modulate the balance between humeral and cell-based immune responses. They also regulate the maturation growth and responsiveness of particular cell populations. Cytokines are important in many responses in the body, including immune responses to infection, inflammation, trauma, sepsis, cancer, and reproduction.

                                Dr. Fabian is a PhD in molecular, cellular, and developmental biology, and he’s a certified nutrition therapy practitioner. Dr. Fabian specializes in the microbiome and how it relates to digestive, immune, brain, and metabolic health. Dr. Fabian offers a microbiome mastery course through his website, microbiomemastery.com. Dr. Fabian also works with Diagnostic Solutions, helping clinicians to interpret their various tests including the GI-MAP stool test, and the CytoDX test, which is known as the cytokine response profile.

                                Dr. David Brady is an internationally known speaker, doctor of chiropractic and naturopathic physician. He’s also a professor at the University of Bridgeport or, at least, I know he was at one time, and the chief medical officer for both Designs for Health and Diagnostic Solutions Labs, which makes the GI-MAP stool test, which is my favorite stool test. Dr. Brady is a prolific writer having published a number of scientific papers, contributed chapters to various textbooks, and he’s written several books. And his latest book is The Fibro Fix, which was published in 2016. I recently listened to Dr. Brady give a very helpful presentation on how to treat patients with long COVID at the CASI Conference in Orlando, Florida.  So, welcome, gentlemen, for a discussion on cytokines.

Dr. Brady:            Thanks, Ben. It’s good to be back on your podcast.

Dr. Weitz:            Absolutely. Thank you. I love having scientific discussions.  Dr. Fabian, maybe you could start by giving some little more information about what a cytokine is.  Why should we care about cytokines?

Dr. Fabian:          Absolutely. Yeah. I think you gave a great introduction overview. So, these are generally small proteins. We tend to think of them as produced primarily by immune cells, and that is essentially their main function overall, is to promote different aspects of immune cell development, immune cell function, coordinate between the innate immune system, the adaptive immune system, and on and on.  We all know that the immune system is fairly complex, and these play a really central role in essentially regulating those various functions of the immune system. I think another important aspect of cytokines for everyone to be aware of is, they’re not necessarily just produced by immune cells, they’re primarily produced by immune cells. But they can be produced by epithelial cells, for example, adipocytes, IE fat cells. And they can also influence these different cells. So, that’s a big part of this immune crosstalk…

Dr. Weitz:           Right.

Dr. Fabian:         With our whole system, really.   They generally also tend to be fairly short-lived, for the most part. So, they’re really meant to be a way for the immune system, initially, to kind of alert… Actually, for even the epithelium to alert the body to what’s going on. So, if you take a typical example in the gut and say a pathogen, you ingest a pathogen, there are certain receptors on cells that can detect these pathogens, and that sets in motion the production of cytokines that can initiate an immune response.  That often starts, of course, with the innate immune response, and then they play a role kind of in this cascade effect. Then, when those initial cells produce certain cytokines, that initiates a second set of responses, and that kind of gets the whole immune cycle going, and they play a role throughout the entire immune cycle. So, really, from inflammation through resolution of the inflammation, and then the healing process as well.

Dr. Weitz:            What are some of the more important cytokines that we should be aware of?

Dr. Fabian:          That’s a great question. Of course, as always, in research, we’re learning more and more about cytokines and some of them are starting to take center stage that we didn’t know that much about a few years ago.  But the classic ones that we think of is the key signs of what we call, classic inflammation. This is largely involving, at least, initially, the innate immune system, that would be… Cytokines like IL-6, which plays a really wide range of roles in terms of coordinating the immune system, initiating immune responses, something called tumor necrosis factor alpha or TNF alpha. Lot of these are produced, for example, by macrophages. Lot of these are sitting there in the mucosa, just monitoring what’s going on, produced by dendritic cells, also sitting kind of at these barrier sites, skin and mucosa. So, they’re really kind of these initial players in the immune response.  Third one would be, IL-1 beta, which is interleukin-1 beta, it’s another major inflammatory cytokine. Then, interferon gamma. So, those are kind of the big four, so it’s important to really understand what that means when you see those particularly elevated in a patient’s cytokine profile.

Dr. Weitz:            I read a bit about a bunch of issues related to the difficulty of testing for cytokines, so maybe you could talk about how we test for cytokines, and what are some of the issues related to trying to test for these?

Dr. Fabian:          Probably, nearly the top of the list is the fact that not only are they short-lived, for the most part, but also they tend to be unstable. So, it’s really important we have this release, spelled out in our instructions to make sure that they’re kept cold.   We specify that they need to stay frozen through the whole transit, so that they arrive at the lab frozen, because they’re very sensitive to room temperature.  So, if they arrive at the lab thawed, then obviously, that can affect the results of the test. So, that’s part of the picture, is a sort of technical-

Dr. Weitz:            So, after the blood is drawn, it should be put in a freezer for a period of time before it shipped?

Dr. Fabian:          Frozen. And then, ideally, sent, if at all, possible with dry ice.

Dr. Weitz:            Dry ice?

Dr. Fabian:          That will help keep them frozen.

Dr. Weitz:            Wow.

Dr. Fabian:          If they’re going to arrive at the lab really quickly, that may not be necessary. But these days, of course, we know there have been some issues with transports, et cetera. Things can get held up a bit, so dry ice really helps to ensure that they arrive at the lab. So, that’s more of just a technical issue to be aware of.

Dr. Weitz:            How would a practitioner actually get dry ice?  If I drew it on one of my patients here, we’d have to get dry ice to ship it?

Dr. Brady:            Ben, I’ll jump in.  The lab recommends you send it back on dry ice.  It could be sent back frozen with a conventional ice pack, but we do recommend for the best fidelity, dry ice.  And dry ice you can get at your local supermarket.

Dr. Weitz:            Oh, you can?

Dr. Brady:            So, if you’re going to be a practitioner that thinks they might be using these types of tests, it’s probably good just to find some dry ice at a supermarket, locally, and then just keep it in your office in the freezer, so that you have it available to send it back.  There are some cytokine tests out there that it just says, send it back, not frozen, just room temperature. And when you look at the range and the fidelity that they’re stating, they’re trying to achieve, which is a challenge in cytokine testing to… And we’ll talk about that to get down into the ranges where we would play clinically, because we’re not dealing necessarily in acute care medicine in overt cytokine storms, we’re looking for more subtleties.

Dr. Weitz:            Right.

Dr. Brady:            So, it’s half of the function-

Dr. Weitz:            [inaudible 00:10:18] of medicine community.

Dr. Brady:            Right. So, you have to get down to a level of fidelity. That makes sense for us trying to use these tests. And we think the best way, in fact, as far as our laboratory science, people that really control the quality control in the methodology and really, really understand how the sausage is made, basically, on how to make these lab tests very, very reliable. Suggests that, it’s just not virtually impossible when you’re sending it back at room temperature that they’re too fast to decay, they’re too unstable at those types of temperature.  So, while it is a bit of a hassle to do the whole dry ice thing, once you’re used to doing those tests and you find out where to get, it’s not a big deal. But there is a barrier of entry. And the other barrier of entry for functional and integrative providers a lot is simply that, it involves phlebotomy, it involves a blood draw, it’s serum tests, so you can’t do it in your end and you can’t do it in these non-invasive type of samples that people are used to.

Dr. Weitz:            Yeah. We usually bring a phlebotomist in to do functional medicine testing. I just didn’t know anything about dry ice. It sounds scary, maybe.

Dr. Brady:            Yeah, I know. I didn’t know much about it either until we were confronting this issue, and then it turns out it is very readily available because people are sending food stuffs and things like that all the time. So, it is more available than you would think.

Dr. Weitz:            Sounds good.   What does looking at cytokines tell us, specifically, about the immune system? And I guess, we can tie in the gut microbiome as well.

Dr. Fabian:           I was actually glad to stay there.  David, do you want to go first?

Dr. Brady:            Yeah. I’ll let Dr. Fabian dig into this. The real granular side of things in the science side, because he’s more knowledgeable than me about that kind of stuff. I’m just a clinician, but…   From a clinical standpoint, if you remember back… First, it was in chiropractic school, then it was in medical school. You learn immunology, you learn about all these cytokines, right?  And you learn everything that we said in the opening, and then you go into residency, you go practice, and you pretty much don’t use them, you forget it, you forget about them.  They’re not routinely ordered tests, but yet they’re so critical in our understanding of immunology.  Well, that’s not necessarily the case in critical care medicine, right? In critical care medicine, they’re dealing with life and death by the minute situations, and they have to utilize cytokine testing all the time. So, a lot of our understanding from a clinical utility standpoint with cytokine testing does come from critical care medicine with people, actually going into overt cytokine storms, whether it’s in multi-organ failure, whether it’s in sepsis, whatever it may be.

                                When it came down to COVID, COVID is one of these, in certain people, in susceptible people, and have the right set of circumstances. As we know, it can progress very rapidly. And end up in this cytokine storm, that can be, actually, the thing that takes you out, that drowns you in your own lung fluids and so forth.  So, they figured that out right away. And of course, they turned to some of the agents and the different types of interventions that they had used successfully in other reasons for cytokine storms, including non-infectious reasons. Some of them worked, some of them didn’t. And when they worked, they only worked to a degree, and they often only work to a degree.  But what we were able to learn from that experience is that, listen, if they can use them when the fire alarm’s screaming, and it’s really, really a serious situation, maybe we can use those in another way in chronic care medicine or in ambulatory care medicine, even, to try to fundamentally determine where does someone’s immune system, where’s it sitting from the standpoint of how inflammatory is it, how activated is it, how imbalanced is it? And what the cytokine testing can tell you, particularly, if you get away from just looking at one cytokine in isolation, when you look at sort of groupings of them, there’s sort of a bucket of what we would consider pro-inflammatory cytokines, and a bucket of cytokines that we would considered anti-inflammatory calming cytokines.  And we actually grouped them in that way, in our tests, so you can see, “Hey, I got a whole cluster of inflammatory ones that are above the normal situation you see in a normal person, right, person without overt disease or any obvious reason that would be driving cytokines to be elevated.” And then, you can look at what is their status in the ones on the opposite side of the seesaw, and you can start getting a picture in a more objective way of your patients. In addition to what they come in and tell you, “All my joints are inflamed” or “My ulcerative colitis is flared up” or “I have long-haul COVID symptoms.”   Well, that’s very valuable information, but wouldn’t it be nice to be able to actually baseline them and get where they are on this seesaw of inflammatory, anti-inflammatory immune balance, and then be able to, from there, figure out what you’re going to try to do to help them. And you intervene in whatever way, whatever your therapeutics may be. And then, serially assess them downstream, so you can monitor, “Hey, are their symptoms getting better? Are they saying they’re feeling better?” Or other maybe standard laboratory serum markers, functional markers, metabolomics, things like that. Are they changing in a positive direction or not? But you can also come back to cytokine testing and see, are they indeed now less inflammatory and less of an inflammatory stance than they were before I started. That’s the goal of it.

Dr. Weitz:            Right. Okay. Interesting. I’ve done a couple of the… Dr. Vojdani developed this lymphocyte MAP test, and that’s a way to map out the various parts of the immune system. And I was trying to figure out what the cytokine testing tells us compared to that. And I was thinking, in my mind, maybe we’re investigating a crime, and then we go to the scene, and we see who’s there, and then we want to hear the conversations between who’s there, intercept those phone calls, and the cytokine testing is telling us what’s going on, the communication, right? Is that a way to think about it?

Dr. Fabian:           Yeah.

Dr. Brady:            It’s actually a good analogy. I think I’ll let Dr. Fabian follow up. But basically, knowing what population of cells and their relative abundance and the things is an important thing to know, it’s a good thing to know. But those cells have the ability to do different things in different scenarios.   So, the fact that certain cell populations in different variations or different iterations in different relative levels can be important, but it’s nice to also know, functionally, what are they doing?    So, the cytokines and the things that they’re releasing in their chatter, like you said, in their conversation, contextualizes, not only who’s there but what they’re doing while they’re there, right?  Dr. Fabian, you can maybe expound upon that, in a better way.

Dr. Fabian:           Yeah. I do think that’s a great analogy, because different cell types, immune cell types, as David noted, can perform a bit differently in different contexts. Kind of the class example, sort of an extreme example would be, like macrophages. We know there’s pro-inflammatory and anti-inflammatory macrophages that have totally different roles, even though it’s the same cell type. So, they’re going to produce different types of cytokines under those circumstances.  You can think, overall, of the cytokine profiling approach. It’s kind of almost like a tiered view of the immune system. Your first question is, do we see a systemic, elevated systemic immune response? That’s important to know because sometimes, you can just have a local issue, local infection that’s not really at the level that’s going to impact things systemically. So, you’re not going to necessarily see a significant signature in serum. But if you have a big enough immune response, say in an autoimmune flare, for example. We see this all the time in various autoimmune diseases, infections, et cetera, inflammatory scenarios. You can certainly often see a pro-inflammatory response.

                                So, that’s kind of the next level is, do you see a generally pro-inflammatory response? And then, what are you seeing with this compensatory anti-inflammatory response? And we know from research, and we see this clinically, that you can have an extensive pro-inflammatory response, but not a sufficient anti-inflammatory response to bring that back down. That’s really the idea. You think of the classic infection, you want that immune response to ramp up, deal with the infection, and then you want the anti-inflammatory part to kick in and help bring things back down to homeostasis. So, that’s a big part of it.

                                And then, the next level down, which I think speaks to some of the information in this other test is, we often characterize immune responses based on these T-cell types. You’ll hear Th1, Th2. We think of Th1 with antiviral chronic inflammatory scenarios, autoimmune conditions. Th2 is more the allergic type scenario, typically, although there’s some nuances there.  You can often see a characteristic pattern with that. We definitely see that with, for example, type 1, type 2 diabetes, inflammatory bowel disease. You’re going to see, oftentimes, those predicted patterns that we know from research.  So, it helps you sort out what the details of that response is, especially important for patients that have multiple things going on. A review cases for patients that had multiple conditions. Sometimes, it’s a little bit hard to understand what’s going on. You look at these cytokines, you can see what’s the overall picture here. What’s elevated is that, they’re innate, immune response elevated, as if they’re adaptive, and then you can start to piece it out from there. From there-

Dr. Brady:            I’ll follow up on just what Dr. Fabian said in that, you have these two sides. And in looking at both sides is often important and not just looking at, “Hey, are the inflammatory cytokines high?” Well, that’s good to know. But also, are the anti-inflammatory cytokines kicking in as a compensatory reaction? So, when you look at some of the data coming out on trying to build an immune profile or an immune signature in something like long-haul COVID, which is a very complicated thing that unfolds over a long period of time.  Various studies have come out. There was just one I presented at CASI, Ben, was from mucosal immunology, and it was looking at, truly, a sticky imprinting of an aberrant immune response or an immune signature, five months, six months, eight months after you had acute COVID. And this is multiple papers showing this. And they didn’t only show upregulation of pro-inflammatory cytokines and eicosanoids, 5-lipoxygenase, and things like that. But they also concomitantly showed a downregulation of the production of pro-resolving factors and anti-inflammatory cytokines.

                                As they build these signatures, they’re using these things. And they’re not just actually looking at a PDF of lab results, I’m talking about studies where they’re looking at hundreds of biomarkers, whether they’re serological markers, whether they’re cytokines, whether they’re other types of compounds. And they’re using non-biased, naive, computers machine learning to try to figure out, what are the patterns you see in this constellation of results in people that meet the clinical criteria or have the clinical presentation of someone having a long-haul syndrome versus people who are normal, versus what it looked like in acute COVID, or what did it look like if they had immune dysregulation that, apparently, was from having COVID itself, versus having an immunization to COVID, let’s say.  So, they can pick this apart and at pretty high levels of detail. And actually, they’re starting to use this kind of machine learning with cytokines and other testing, metabolomics and so forth, to actually finally be able to pick apart, what is the signature of chronic fatigue in me? What is the signature of long-haul COVID from the virus? What’s the signature of long-haul COVID from a vaccine? What’s the signature of, I don’t know, fibromyalgia? Right?  So, they’re trying to build these with very complex digital modeling, but you can do that on a little bit more of a simplistic level. But still, really good way to do it with objective information by looking at a cytokine panel.

Dr. Weitz:            Is it the case… And this might be an oversimplification, that if we look at a cytokine panel, that if we see certain inflammatory cytokines high, or certain anti-inflammatory cytokines low, or maybe just a pattern that we have specific diet lifestyle supplement interventions, that can modulate those?

Dr. Brady:            Well, they’ve looked at some of these advanced models, like I was telling you. If you look at Pat Bruce Patterson’s work and in other groups. In other groups, there’s group at Yale, there’s groups looking at these signatures. And they’re not only looking at these cytokine signatures and other types of biomarkers from the standpoint of who has it? Do they have it or not? From a diagnostic standpoint.  But what drives a lot of their work is trying to figure out, “Okay, let’s answer if they have it.” Number one. But let’s say, they have this pattern that seems to correlate with, I don’t know, let’s pick one long-haul COVID.

Dr. Weitz:            Okay.

Dr. Brady:            What are, then, the therapeutic approaches that we’re going to take, that’s informed by this laboratory data?   If you look at groups, like Patterson’s group, many people may be aware of some of the different approaches being used in, let’s say, long-haul syndrome. One of them is this combination of a low-dose statin and maraviroc, which is an antiviral part of an HIV cocktail, but it’s used in an off-label way, and it’s a combination of a low-dose statin and maraviroc.  They didn’t just pick those agents out of thin air, they pick those agents because they have specific modulating effects on the precise cytokines that they found elevated in the signature of those patients. Maraviroc, for instance, is a will downregulate CCL5 or RANTES, and that’s one of the cytokines that has been most correlated. Not the most correlated one when you look across the broad literature, but it’s the one that, for instance, Patterson, really, honed in on early that this RANTES CCL5 was elevated. I believe it is an HIV, and he comes out of HIV research world. So, it makes sense. He applied an agent he knew from the HIV work to downregulate RANTES or CCL5. And it has some value in long-haul COVID.  It’s not a panacea, it doesn’t just fix everything. But they’re not only trying to figure out, what kind of testing can we do to answer the question, do you have disease A, B, or C or not? But then, what do we need to do to try to treat it?

Dr. Weitz:            Okay. Why don’t we go into a little bit about how cytokines can help us to better understand the gut, and how it might correlate with, say, stool testing.

Dr. Fabian:                      Yeah. We actually do strongly recommend, if at all possible, to try to do a stool testing in conjunction, really, for two reasons. Because of course, as we all know, the gut certainly plays a big role in influencing the immune system, and it’s often thought to be involved in a variety of different chronic conditions. Even if those diseases are primarily take place elsewhere. For example, hypothyroidism or Hashimoto’s affecting the thyroid, we know that there’s a significant gut component there, based on the research.   You often see a characteristic cytokine pattern. It is always one of the things to keep in mind when you’re looking at… And learning the cytokine pattern and combining that with gut testing is really understanding those general patterns. Is it a Th1 dominant scenario? Which is what you’d expect in an autoimmune condition? Do you see a lack of the compensatory anti-inflammatory response, which is, again, pretty common?

                                It’s actually often driven in part or influenced strongly by, what’s going on in the gut? For example, we know your commensal bacteria, your normal beneficial bacteria produce a whole range of factors. Probably, the best known would be short-chain fatty acids. Butyrate is obviously the most famous of those. Butyrate is known to have an anti-inflammatory effect. Pretty significant studies show that it can actually kind of downregulate the activity of many different types of immune cells, and shift that profile, like we talked about, more towards an anti-inflammatory type pattern.

                                So, we often see a deficiency for patients in their normal bacteria. That can mean that they don’t have this stimulus to produce enough of these anti-inflammatory factors. And that’s actually widely characterized in a very long list of diseases and conditions. Everything from autoimmune disease, chronic inflammatory disease, allergic disease, et cetera. So, you can kind of [inaudible 00:28:41] this balance, so you need to have a sufficient amount of these normal bacteria cranking out these homeostatic molecules that keep the immune system from overreacting.  But also, at the same time, you’ll often see overgrowth of some of these opportunistic bacteria. Commonly, the more ones. So, things like Klebsiella, Citrobacter, that many of you may be familiar with, Proteus, Fusobacterium. A lot of these are implicated in chronic diseases, autoimmune disease, et cetera.

                                We see those same types of imbalances noted now in long COVID studies. For example, low butyrate producers, especially low faecalibacterium is probably the most commonly noted factor in these various studies. So, that basically says that, that could be a contributor to these chronic inflammatory scenarios that you see associated with long COVID, because you don’t have that ability to bring those cytokines and those immune cells back down. So, very, very important connections there.   There’s a lot of details we could get into, in terms of specific microbes. Microbes that produce LPS, et cetera. But that’s kind of the general idea is, this balance in the gut. We know that 70-80% of the immune system is in the gut, so we know that, that’s really going to have a huge effect. So, it’s a great place to intervene as well.

Dr. Weitz:            Now, one of the things I always find fascinating on the GI-MAP test is the potential autoimmune triggers, and managing a lot of patients with autoimmune diseases. We’d also like to try to prevent them. It’s fascinating to consider that some of these gut bugs can play a role in becoming triggers for autoimmunity.  And I wonder if there’s a correlation like, if you see an elevation of a potential autoimmune trigger bacteria, and we see a certain cytokine pattern cannot reinforce the potential or the relationship with some autoimmune disease that’s either existing or might exist in the future.

Dr. Brady:            There’s different levels of linkage in some of these organisms. If you look on a GI-MAP, you’ll see there’s a section, I think, on the latest revision of the test. Well, I have one here. What do we call it? It’s like, autoimmune inflammatory triggers. And it’s in the opportunistic organism section. I thought I had one here somewhere, but… Anyway. But as Dr. Fabian mentioned, you see things like Citrobacter, and we’ll look at the species level or the genus level, and sometimes down to the species. Klebsiella, in general. But Klebsiella pneumoniae, for instance, is not only linked from an association standpoint. An association relationship, as you know, means if you take… Let’s say, people with rheumatoid arthritis, and then you test subjects without rheumatoid arthritis, and you do microbiome analysis, you have a higher prevalence of finding Klebsiella in those with rheumatoid arthritis.  And you can spin it around the other way. People with elevated Klebsiella have a higher propensity of having rheumatoid arthritis. It doesn’t mean if you find Klebsiella pneumoniae or if you find Citrobacter freundii, that the person will get rheumatoid arthritis. Other things have to line up, genetics and other factors and so forth. But there is this association.

                                Now, in some organisms, there’s actually beyond association data. With prevalence, there’s actually causal understandings of how this can actually cause an autoimmune response. Some of these organisms, like Dr. Fabian mentioned, Hashimoto’s, right? Above Yersinia enterocolitica, it has been shown to have proteins expressed on its surface that look structurally very similar to TSH receptors on the thyroid. As your immune system says, “Hey, this Yersinia shouldn’t be there, I’m going to attack it.” It can get confused and latch onto to TSH receptors, and you get a inflammatory immune erosive thing going on against your thyroid, and inflames your temporarily hyperthyroid, you eventually go hypothyroid. And that’s when you usually get diagnosed, right?  But that’s an actual cause of relationship. In that case, it’s molecular mimicry. In other cases, some of these organisms produce enzymes which modify host proteins, turn them into a hapten, and then you’re off to the races because now it’s an abnormal protein. So, the immune system goes at it.  There’s multiple ways by which this can happen, but the dominoes, really, often, do start to fall in immune dysfunction systemically in the gut, in mucosal immunology. And some of it is mediated through these responses of these organisms, whether it’s structurally or whether it’s through messaging molecules.

                                There was a paper that came out post-COVID on the microbiota regulation of viral infections through interferon signaling, so we know that different microbes can actually alter interferon responses, and how you produce interferons, and how you’re able to fight viruses or not. And you saw during COVID, that the status of the microbiota in the gut was one of the predictive factors on whether you did well or did not do well or you actually perished from it.  The paper I was talking about, in particular, also looks at important commensals, Bacteroides fragilis, certain clostridia, bacillus species, lactic acid producing bacteria, including lactobacillus and strep, promoting the production of antiviral interferon, including interferon beta, specifically, and bolstering that antiviral defenses of the host. And if you were devoid of those things or you had lower levels, you didn’t have that protection.  So, we’re still just trying to unravel all this, and you were probably just scratching the surface on it, right? In 50 years, we’re probably… If someone watches this podcast, I’ll probably bust out laughing, right? Because they’ll know a whole lot more. But it is interesting stuff. But the connections are just wild. They’re just wild.

Dr. Weitz:            Are there certain cytokine patterns that, if we see that and we see that they have these potential autoimmune triggers, would that change our clinical strategies?

Dr. Brady:            I think if you actually have cytokine expression leaning toward the inflammatory side, that is a functional marker telling you, there is an upregulated immune response, and there is inflammation. There’s got to be a reason for it. It doesn’t tell you it’s from rheumatoid arthritis or it’s from this or that, but there’s something going on.  It’s like, getting an ANA, right? Unfortunately, you have doctors now telling females, mainly females, “Oh, ANA. But everything else is negative. That’s normal.” It’s not normal, it’s common. It’s not normal. It’s not normal to make antibodies against nuclear, right?  Same thing here with the microbiota. You can have someone that comes back and they have higher DNA catch for Klebsiella or Citrobacter, or Prevotella, or Proteus or what have you. But clinically, they have no signs or symptoms of an autoimmune disorder. It may, though, mean that, if that is left there to fester, eventually, with other things combined in the whole ball of wax, they would be more likely to progress to eventually end up with an autoimmune disease.

                                But if the cytokines are already raging, something’s already going on. So, it’s almost like our conversation about the cell test versus the cytokine test. It’s almost like, what is potentially going to happen, and then what’s actually being expressed? Another analogy is, when you do genomics and you look at snips, it’s predilections toward things. It’s not anything is necessarily happening or not, but when you do things like metabolomics organic acid, proteomics, you’re actually measuring something that’s functionally occurring, you’re me measuring the downstream effects of actual biochemistry and metabolism. So, they make great one two punches, for sure.

Dr. Weitz:            So, you mentioned thyroid issues, Yersinia, et cetera. Let’s say, we’re managing a patient with Hashimoto’s thyroiditis, which is an autoimmune condition that leads to a decreased function of the thyroid.  From a conventional perspective, even though, sometimes, thyroid antibodies are measured, conventional endocrinologists and physicians don’t really pay any attention to that because there’s really no strategies to do anything about it, so they basically just forget about it. But from a functional medicine perspective, we’re measuring thyroid peroxidase antibodies and thyroid globulin antibodies. And we’re trying to see, what are some of the underlying triggers that might be leading to this hypothyroid, Hashimoto’s, and those could be gut dysbiosis, and they could be food sensitivities, and they could be chemical toxins.   Let’s try to get a little more clinical here. We have a patient who has Hashimoto’s, they have elevated TPO antibodies of 500, and we also see a cytokine test that indicates a more pro-inflammatory profile. How can that help us? How can that, potentially, change our clinical judgment?

Dr. Brady:            Well, it’s a multifactorial thing. In autoimmune thyroiditis, you bring up a particularly interesting one because we see it all the time. Number one. It’s extremely prevalent.  And you’re right. I mean, the medical management is, well, let’s just watch it until it gets out of… They may look at antibody levels, but they do them to figure out, when do we need to oblate the thyroid and get it out of the picture and use HRT? We’re looking at them often more serially to figure out, how autoimmune active in this patient? Are they trending better or worse, or what have you? And you got to take some of that with a grain of salt on minor changes, because these antibodies are variable, but you can see big changes in trends over time.  But in something like autoimmune thyroiditis, we know about these hooks to changes in the gut ecology, so we’re going to look for things like Yersinia, we’re going to look for things like Citrobacter, Klebsiella, all the inflammatory things. But just general dysbiotic state, leaky gut, barrier function problems, digestive problems. I mean, because you mentioned foods, we know certain foods are correlated with autoimmunity, including autoimmunity to thyroid.

                                Great people with Graves and Hashimoto’s have about 20 times the rate of… Or I should say, the other way around. For instance, celiac disease patients who clearly have a problem with gluten, a major food peptide, have 20 times the rate of autoimmune thyroiditis than non-celiac patients. So, we know that people don’t have celiac disease, but they have non-celiac gluten sensitivity, also have a higher propensity of having autoimmunity.  Some of that might be permeability of the gut, not digesting it, so we look at markers like elastase-1 and make sure… We need to get them digesting their proteins. We need to get their barrier function better. We need to treat dysbiosis, if it’s there, particularly if there’s these autoimmune inflammatory ones.   Then, your job’s not done because you mentioned other great stuff. Environmental stuff, a lot of these pesticides and flame retardants and all of that, they glob on thyroid receptors.

Dr. Weitz:            Bisphenol A, et cetera, et cetera, and Teflon.

Dr. Brady:            And then, viruses, I mean, probably, the most common triggers, Epstein-Barr, reactivation with long-haul COVID, tons and tons of thyroid autoimmunity that crops up because one of the biggest things it does… And multiple speakers talked about this at CASI, CASI reactivates EBV, right? So, if your EBV is reactivated or CMV or any of those ubiquitous stealth viruses, it can drive an autoimmune response.   They’d love to hang out in the thyroid, and it’s called the bystander effect. They go to the thyroid to hide out, and then the immune system attacks them there, and the thyroid gets obliterated because it’s the battlefield, essentially.  So, it’s interesting, but the more ways you have to triangulate on this and look at objective markers, it can push you toward the right types of therapeutics.

Dr. Weitz:            Let me bring up another case on the same thyroid topic. Let’s say, we have a patient who has, what some people call, subclinical hypothyroid. Meaning, the person has an elevated TSH, maybe they’re T3 and T4, within range, and they have elevated antibodies.  And the question is, is this somebody who should have an intervention? Does this person need to take thyroid hormone? And let’s say, we see a pro-inflammatory cytokine pattern. Does that change the way we might handle this patient?

Dr. Brady:            Dr. Fabian, do you want to go first, or me? I can give you my clinician’s perspective on that. But if you have [inaudible 00:42:58] first.

Dr. Fabian:           Just because we do see that gut immune connections so often… If they’re not quite at the point where they necessarily need the typical clinical treatment, they don’t have the outright meet the criteria for the outright disease, obviously you can often still see some of the underlying causes starting to trend out of balance.  That really is where focusing on the gut is very helpful, because you can typically see in many of these scenarios. And a lot of people run GI-MAP, just from more of a preventative standpoint. So, you can start to see some imbalances already in people that may be preclinical, subclinical, et cetera.  So, I think it can give you really valuable information and specific targets that you can act on, particularly based on the gut testing.

Dr. Brady:            Yeah. I think you got to clean up all the stuff we already talked about in that scenario. If they don’t have overt, medically, defined primary hypothyroidism, so-

Dr. Weitz:            Yeah. Let’s say, they don’t have fatigue, they don’t have weight gains-

Dr. Brady:            [inaudible 00:44:01] aren’t overtly low, their TSH isn’t above the normal. But we know those are wide ranges, right? You got to be pretty screaming hypothyroid of your TSH go above the range now.  But we see them up in the threes and in the fours. T4s hanging in the normal range are usually midpoint or lower, but then the T3 levels are way lower. So, the total T3 and the free T3s are often right at the rock botDr. Fabian of the normal range or even reported overtly low. And-

Dr. Weitz:            I have patients who are men where the TSH, maybe they’re in their sixties or seventies, and the TSH is even seven or eight. And they’re still there. T3 and T4 is in a normal range.

Dr. Brady:            Yeah. Well, in those cases, if their TSH is really high, but all their hormone fractions are within the normal range, find out where they are in the range. Or usually, in the lower end of the range. And I would look at their autoantibodies. This is a phenomena you see much more in females, biological females, than males.  And there’s various hypotheses why that is, that involve estrogen receptors, that involve a lot of other things. The differences in the immune response of females versus males, because they have potential to carry the fetus, and they have to have a more dynamic immune system. But in the end, you clean up all those things. And we all know the things from clinical nutrition on trying to promote the 5 crime deiodinase enzyme is what converts T4 to active T3, and its sister enzyme, the 5-deiodinase will convert it to reverse T3. You can look at those balances and so forth.

                                And we know that certain things suppress the deiodinase enzymes and imbalance them, cortisol, stress, steroids, things like that. But lots of environmental toxins. So, you clean up everything you can, you do the best you can, you serially assess them. But if you have someone who clinically is hypothyroid, they’re tired all the time, they’re slow bowels or constipated, hair falling out, all that kind of stuff, body composition changing, you do everything you can to rebalance it itself.   But usually, if they’re past a certain point, particularly if there’s autoimmunity and they’ve had destruction of enough of the thyroid gland itself, therefore it’s functionality. Usually, we’re talking, usually a female, usually in that forties and up, particularly if they’re postpartum, they’ve had a couple of kids, all of a sudden, boom, this thyroid immunity hits like crazy, autoimmunity.

                                Oftentimes, they do need to optimize their metabolism, and get them to feel like they didn’t get hit by a truck. I think, top them off on the T3 side with something with T3 or a combo T4, T3 kind of compound it, HRT, just to optimize them in the normal range, never to make them too hyperthyroid. But you don’t want them hanging right down on the bottom of the ranges, if they really feel bad.  Caveat to that is, do all everything you can to self-correct them. But oftentimes, you’re dealing with someone that’s tipped over that line, where you’re never going to get their metabolism optimized if you don’t backfill the thyroid a little bit directly.

Dr. Weitz:            Just to hit on the cytokine thing, again, let’s say we get a pro-inflammatory cytokine pattern. We take some interventions from a functional medicine perspective, we take out gluten and dairy and soy, et cetera, we clean up the gut, we create some of the dysbiosis that we saw there on a GI-MAP, maybe we give them some antimicrobials, some other nutrients, et cetera. And then, we see the pro-inflammatory pattern on a cytokine test, become less inflammatory. Does that tell us, for example, that we are potentially on the right pattern at helping the-

Dr. Brady:            Yeah, it’s-

Dr. Weitz:            … underlying-

Dr. Brady:            Yeah, it’s really good assessment. If you change your diet, now you’re using curcumin or… Whatever you’re doing, whatever your interventions, we all know a million natural anti-inflammatories and how to have a less inflammatory, less autoimmune stimulating diet and so forth. Yeah. You should serially assess and see those things coming down, just like you would look at a A1C or a blood glucose in other circumstances where you’re trying to improve their glucose tolerance. Yeah, exactly. That’s the exact intention.

Dr. Weitz:            How about with autoimmune gut conditions like Crohn’s and ulcerative colitis? Can cytokine testing give us an idea of what’s going on, as to the state of their autoimmune condition?

Dr. Fabian:          Yeah, absolutely. I’ve seen a number of cases of both Crohn’s and ulcerative colitis. We know, in research, that they’re a little bit different, in terms of their cytokine profile. Crohn’s tends to be generally more sort of Th1 dominant, some Th17. Ulcerative colitis, actually, has a bit of a Th2 component to it, which we normally associate with allergies and things like that.  So, there’s a bit of a different immune response that you may see there. And same with what’s going on in the gut. I mean, you can connect those dots, if you have that data, and you can see how they correlate on this.  One thing I would note is, it’s can get a little complicated in terms of correlating what we know by the immune system with the gut. And I would just certainly advise everyone who is trying this, initially, Diagnostic Solutions Lab does have these 30-minute consultations which, when you’re first getting going, can be really invaluable to help understand and help you connect those dots, because it can be a little daunting. I think that’s one of the barriers, for some clinicians, in adopting this type of testing is, they see this panel of 18 cytokines. They’re not used to working with those cytokines. So, it can be a little challenging at first, and that’s really where our resources and our consultations can be so helpful.

Dr. Weitz:            Does that different cytokine pattern, in ulcerative colitis versus Crohn’s, does that give us any ideas about clinical treatment strategies?

Dr. Fabian:           It can, yeah. I mean, the classic picture is, with Crohn’s, you tend to have more in the guts of a inflammatory microbiome dysbiosis pattern. Actually, we often do see. Ulcerative colitis can have a combination of an overgrowth of normal commensals. Long-

Dr. Weitz:            So, how might we treat those differently? What does this tell us that clinicians can use, practically?

Dr. Fabian:           I think, to David’s point, certainly, when it comes to the gut, I mean, having that comprehensive picture, we know that there are all these upstream factors that can contribute to downstream displaces [inaudible 00:51:12] that sort of downstream. In optimizing digestion, for example, can be very important, especially for addressing that overgrowth type of pattern.

Dr. Weitz:            What do you mean by optimizing digestion? What does that mean?

Dr. Fabian:           Of course, when we think of digestion, the common pieces would be sDr. Fabianach acid, hypochlorhydria is pretty common. We know that H. pylori, for example, is one of the contributors to low stomach acid. So, C high H. pylori patient also has some symptoms of hypochlorhydria, not only can improve their hypochlorhydria, also improve some of that downstream dysbiosis.  Optimizing pancreatic function-

Dr. Weitz:            Let me just stop you, real quick. So, you’re saying, if you see H. pylori, maybe use herbs that we know can reduce H. pylori. If you don’t, maybe supplement with HCL.

Dr. Fabian:           Certainly, the herbal approach is the most common, especially mastic gum. Based formulas, those are really popular, and those seem to work quite well.  Typically, they’ll do that in conjunction with some other things like [inaudible 00:52:18], for example. And then, the use of HCL with H. pylori is kind of controversial. Certainly, with significant gastritis, you wouldn’t necessarily want to go that route. When it’s kind of a low level infection, some clinicians… It’s really a clinician judgment. Some clinicians do use HCL supplementation, others may just strictly avoid it until they have already eliminated a reduced HCL.

Dr. Brady:            Well, I mean, we use a full digestive enzyme complex, a full pancreatic enzyme that mirrors what the exocrine output of the pancreas. And oftentimes, those products, some have, some don’t. And you can make that differentiation in your recommendation, whether they have any hydrochloric acid or not.    Some of them have enough to activate the enzymes, but not like a super heavy payload, like if you were taking a separate betaine HCL.

Dr. Fabian:           Right.

Dr. Brady:            And I think some of the decision comes down to, if they have frank ulcers, if they have frank gastritis, duodenitis, you’re probably not going to use hydrochloric acid. But if you find H. pylori, that’s sort of a resident population’s been around a long time… I know, way, way back, when this H. pylori thing first emerged, I was in school, right? And the thought was, the H. pylori dig in, they make you overproduce all this stomach acid, and it rips your stomach apart, and can cause… Oh.   And what Dr. Fabian said is right. Actually, the story is unfolded very different than that. A longer term chronic H. pylori infection can actually down-regulate the production of your endogenous hydrochloric acid, so you end up in a hypochlorhydric place. And if you give a little stomach acid, as long as there’s not exposed tissue, it can improve everything about the digestion, it can kind of treat that upper dysbiosis, if you want to call it SIBO or whatever you want to call it. A lot of that is a function of pH not being right. And a lot of that is a function of not enough hydrochloric acid.

Dr. Weitz:            Okay. Let’s get back to, where were we. We were talking about how… I forgot what we were talking about. Ulcerative colitis or Crohn’s, right now.

Dr. Brady:            Exactly. Yeah. We were talking about H. pylori.

Dr. Weitz:            Right.

Dr. Brady:            And then, you were asking, does testing the cytokines change what you’re doing clinically?

Dr. Weitz:            Right. Right

Dr. Brady:            Sometimes, it does. Sometimes, it doesn’t. To me, it’s just more objective evidence that I have someone that’s in an inflammatory posture, immunologically, and I need to take action steps to reverse that.  And some of those action steps will be determined by, what I figure out, is the driver of their inflammatory status in the gut, right? I’m going to treat them different, if they’re long-haul COVID, versus if they’re ulcerative colitis, or if they’re… It’s not just an easy O. When that cytokine is high, give this, it’s not that linear. Right?

Dr. Weitz:            Right.

Dr. Brady:            But it’s just another tool to serially assess, am I really getting this person better or not, objectively? Versus just them saying, “Oh, yeah. Well, I’m having less flares or… I’m a little less fatigued.” I mean, that’s fuzzy around the edges, right? It’s hard for us.

Dr. Weitz:            For sure. Yeah. Maybe you can talk a little more about long COVID and how cytokine testing can help us to assess, what’s going on and what we can do about it? And I guess, the new term that I’ve seen in some of these studies is post-acute sequelae of COVID 19-

Dr. Brady:            That PASC-

Dr. Weitz:            … PASC. Yeah.

Dr. Brady:            Post-acute sequela of COVID-19 infection or of SARS-CoV-2 infection. Yeah, that’s the fancy medical term for long-haul COVID. They couldn’t name it the same thing as the patient’s name. They have to have some fancy acronym that no one understands. That’s just medical ego at play, but it is what it’s… Right. So, PASC is long-haul COVID.  And I mentioned some of this research that has been done by multiple investigative groups at CASI. We had Bruce Patterson, his group is one of the ones who’ve done that, that have tried to typify these changes that occur in long-haul COVID patients. And actually, even different variants of long-haul COVID patients. And they found typical suspects, inflammatory cytokines like IL-10 and IL-6, TNF alpha, TNF gamma. VEGF is another big one that they find the RANTES or CCL5 that I talked about.  And then, that paper in mucosal immunology, I reference… I have it here, actually. They show elevated expression of interferon beta, interferon gamma, IL-6, and various other cytokines. But the biggest thing that popped out most for them in this study was pretty big group was, IFN beta or interferon beta. So, they’re still working on it and figuring it out, but there’s definitely patterns that are associated with long-haul.

                                Actually, Patterson’s group have… I think they have IP on an algorithm, that they use a computer model to look at cytokine testing, and come up what’s called, a long-haul or index. And that’s a mathematical calculation using things like CCL5 or RANTES and VEGF, and some of these other cytokines.  I can say, clinically, I’ve had patients with long-haul syndrome, no doubt. I mean, it’s just in your face, the definite long-haul COVID syndrome. No other thing it can be. And it’s hit or miss, whether they hit on that long-haul index or not. So, I don’t use it as a binary, “Yes, they have it. No, they don’t,” kind of thing. It’s not there.   But certainly, they generally have a more than one, a multitude of these inflammatory cytokines high when you cytokine test them.

Dr. Weitz:            And is that a questionnaire?

Dr. Brady:            What? The long-hauler index?

Dr. Weitz:            Yeah.

Dr. Brady:            No, it’s-

Dr. Weitz:            Oh, it’s a computer.

Dr. Brady:            … it’s a computer algorithmic output based on the laboratory assessment behind the scenes. You know what I mean?

Dr. Weitz:            I see. Okay. Okay, good. Yeah. All right. Any other things we want to talk about, how cytokine testing can help clinicians?

Dr. Brady:            Well, I mean, a big part of the understanding of cytokine testing and what ended up turning into these commercial cytokine analysis and testing… A lot of it came out of, like I said, critical care medicine, but also out of cancer research. Because with precision personalized medicine in cancer therapeutics, where they’re trying to phenotype the cancer, and then give very specific agents that modulate the immune system in very specific ways based on the person’s genetics and the cell line’s genetics, all those drugs were pretty much proved out with very advanced cytokine analysis, all the way through the process. It was part of the drug approval process. In fact, one of our main science brainiacs at DSL, actually ran the largest CRO lab that did a lot of the cytokine testing for the approval of a lot of these different biologicals, if you will, right? Response modifiers.  So, when they’re considering using PD-1 checkpoint inhibitors and things like that, they’re using cytokine analysis to make those calls in a lot of different situations. So, there’s a lot of use for this throughout many different phases of medicine, especially at the highest levels of precision medicine and cancer therapeutics.  But I think there’s definitely a role for it in functional integrative medicine, because when it’s all said and done, as you know, we’re dealing with all these complicated downstream issues that are fundamentally creating very common, a common set of physiological responses. And usually, it evolves around inflammatory and immune responses.

Dr. Weitz:            Okay. Great. Any final thoughts, Dr. Fabian?

Dr. Fabian:           Yeah. I would say, the clinical utility, to me, has been pretty phenomenal in many ways, for a lot of patient cases. So, you can really zero in on what’s going on in the immune system for certain patients. And again, especially if you combine that with gut testing… I’ll just give you a couple of quick examples. One would be, patient that had a chronic Bartonella infection. It was really just not doing well, pretty sympathatic. I’m certainly not a Bartonella expert, so I can’t comment…

Dr. Weitz:            By the way, for those who don’t know, Bartonella is a common co-infection often related to Lyme disease.

Dr. Brady:            Also, very commonly flared up in long-haul patients.

Dr. Fabian:           Yeah. And so, one of the things that you can potentially see is this classic ideas. You might have an overactivity of the pro-inflammatory side and insufficient anti-inflammatory. But in some cases, you have the opposite. So, you have a chronic viral infection, and ideally your immune system wants to try to deal with that.  But on some of these patients, I’ve seen patterns where they don’t have a detectable pro-inflammatory pattern, and they have elevated IL-10, interleukin 10, which is a really well-known anti-inflammatory cytokine. And I looked in the research on that when I reviewed that patient’s case, and there’s a fair amount of research on these various chronic bacterial viral infections that many of them can actually cause an upregulation of your anti-inflammatory response, that then kind of blocks this antiviral function.   So, that gives you some key information, because normally, what comes from the gut standpoint, you might want to work on an inflammatory scenario, increasing those beneficial bacteria, trying to increase that IL-10. But there may be cases where that may not be the best strategy. So, this really speaks to precision medicine. And knowing these details can really help influence your overall strategy. One other quick case would be-

Dr. Weitz:            Hang on. Just one quick second. Let me just give a little extra information to those listening, who aren’t familiar with what we’re talking about is, you’re pointing out something which is really important which is there’s a tendency to think of inflammation as all bad, and the more anti-inflammation you can get is better.  But inflammation is also a marker of immune system function, and we need a certain level of inflammation to fight off microbes and help us heal from injuries, et cetera. So, it’s not as simple as inflammation is bad.

Dr. Brady:            It’s how much how long what’s causing it, and is the response in appropriate for what’s going on. And is it becoming too persistent in locked loop.  And even what Dr. Fabian just pointed out was interesting. One of the things you do see a lot on, let’s say, a long-hauler population is IL-10 being elevated. And you might go, “Well, hey, that’s anti-inflammatory.” Right? Well, sometimes, it’s… When you look at a cytokine test, it’s not only important to see that someone has upregulated inflammatory cytokines. Sometimes, upregulation of anti-inflammatory cytokines is telling you, they’re trying to react to it, they’re trying to fight something. So, you need to look at it from both directions.  And so, again, it’s not as draw this line linear, as you think. You got to kind of think your way through it a bit.

Dr. Fabian:                      Yeah. And I’d say, just to kind of add to that picture a bit more, and again, really, the precision medicine approach and parsing out what’s going on, I’ve seen a number of cases where patients with autoimmune conditions that are on biologics, they are highly targeted to suppressing certain inflammatory cytokines.  So, anti-IL-6 is a pretty common class. Anti-TNF alpha is another common class. Remember one particular case where this patient is on the biologic. We looked at the cytokine profile results, and that particular cytokine was not detected. So, that’s telling us the biologic. It did appear to be working. Patient was still very sympomatic. We saw all kinds of other pro-inflammatory cytokines lighting up. So, that’s telling us that, that was effective in a narrow way, but not really effective in generally suppressing that overactive immune response.  So, that gave the practitioner digital information that there’s more work to do, to try to find out, what’s causing this inflammation, and what can they do to compliment this biological therapy.

Dr. Brady:            Or they might need an entirely different response modifying medication, because it’s just not hitting the optimal target.

Dr. Weitz:            This brings up a really interesting example. Imagine that you’re managing a patient with autoimmune disease, who’s on one of these biologics and you do a cytokine test. It may be that, immune modulating drug is actually not working. Maybe that cytokine that’s supposed to be suppressing is elevated, and you might actually be able to interact with their rheumatologist and say, “Hey, look, this interleukin-6 suppressing drug, actually their interleukin is elevated. They probably need a higher dosage of that. Or maybe the opposite. Maybe they’re taking-

Dr. Brady:            Or they’re using IL-6 targeted drug, and they’d be better off with a TNF alpha. And you can show that on the cytokine analysis.   And while they may use this kind of testing in a very precise way, in many cancer therapeutic situations, generally, I don’t find that’s the case in standard rheumatology. I think they’re just clinically working up a patient, maybe doing rheumatoid panel or what have you, but not advanced cytokine testing. And then, saying, “Well, we’re just going to use the drugs we use, so we’re going to try a TNF alpha or we’re going to try in IL-6.” Well, they’re not testing it to that level, they’re just not doing it.

Dr. Weitz:            Yeah, that’s really insane. Imagine that you were going to put a patient on a drug for diabetes, and you don’t test his blood sugar to see if it’s working or not.  So, I think we just pointed out something that’s really, really crucial for managing autoimmune patients.

Dr. Brady:            Yeah.

Dr. Weitz:            Okay, great. Thank you so much, guys.  Dr. Fabian, why don’t you tell us how clinicians can… These tests are available for clinicians, right?

Dr. Fabian:          Correct. Yes.

Dr. Weitz:            Right. So, you can either contact a functional medicine practitioner, like myself, you can go to find a practitioner from the Institute of Functional Medicine. Or if you’re a clinician, you’re a practitioner, to tell us how we can order the cytokine test and the GI-MAP stool test.

Dr. Fabian:          So, you can either call our customer service. Just go to our website to get the contact information. You can either fill out the form, call customer service. If you want, just more information about these tests, we have a lot of great information on our website about the test and specific information there on how to order.   And if you’re just kind of wanting to know a little bit more before you do place an order, we do have a lot of educational information that can help you better understand utility of these tests, clinically.

Dr. Brady:            All of that is on the website at diagnosticsolutionslab.com. So, Diagnostic Solutions Lab. Or again, just Google Diagnostic Solutions Laboratory and you’ll find it.  And the tests are orderable, also, through a lot of the big lab distributors, whether it’s Rupa or Evexia, or any of those as well. So, it depends how the clinicians order their diagnostic testing, but if they have the authority for ordering diagnostic laboratory testing, they can come right to DSL as well.

Dr. Weitz:            Great. Thank you, guys.

 


 

Dr. Weitz:     And thank you for making it all the way through this episode of the Rational Wellness Podcast.  And for those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or Spotify, and give us a five-star ratings and review. That way, more people will be able to discover the Rational Wellness Podcast.

                                And I wanted to say, thank you to all the patients that we’ve been working with us at our Weitz Sports Chiropractic and Nutrition clinic who, most of whom, we’ve been able to help with a range of various health conditions from various types of gut disorders to thyroid and hormonal issues, autoimmune diseases, and various other cardiometabolic conditions.  And so, I very much appreciate you, and I’m excited about going forwards helping you to improve your health on your journey towards optimal health. And I wanted to let everybody know that I do have a few openings now for new clients, and you can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition, Santa Monica office at 310-395-3111, and we can set you up for a new consultation for functional medicine nutrition, and we can get that going as early as the new year. So, give us a call and I’ll talk to you next week.

 

Dr. Anna-Marie Wynsyski discusses the use of Bioidentical Hormone Replacement Therapy in Women 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

4:03  We learned from the 2001 Women’s Health Initiative that the use of synthetic hormones including estrogen made from horse’s urine and synthetic progestins might increase the risk of heart disease by forming clots that can block the arteries in the heart. In particular, it is the synthetic progestins that are dangerous, since in the estrogen only arm, there was no increased risk.

9:10  The Benefits of Bioidentical Hormones, in contrast to synthetic hormones, are that they significantly reduce all cause mortality, which means the risk of dying from any cause, in both men and women when used at the appropriate time.

10:19  Dr. Wysynski prefers to prescribe estrogen creams rather than oral estrogen or in other forms.  She prefers not to use oral estrogen, since it tends to raise LDL cholesterol, but she will sometimes use it if the other forms don’t work for that woman.  She prefers the Biest cream that contains both estradiol and estriol.  She will sometimes use a vaginal route. She is looking into bringing pellet therapy into her clinic, but the difficulty with pellets is that you can’t easily adjust the dose.  With Biest cream it is easy to adjust the dose.  There are patches that are bioidentical, but they are synthetic rather than natural.  Dr. Wysynski prefers to use the Biest creams, which mimic the fact that the naturally occurring forms of estrogen are estriol and estradiol in an 80:20 ratio.  Sometimes a higher amount of estradiol, such as 50:50 is necessary to calm down perimenopausal or menopausal symptoms. 

15:27  Some doctors in the hormone replacement field feel that estradiol is the preferred hormone to recommend and that estriol is the hormone that predominates in pregnancy and it does not provide the benefits of estradiol.  In allopathic, conventional medicine, we give women estrogen in the form of estrogen patches or EstroGel as hormone replacement and if a woman does not have a uterus, we do not offer any form of progesterone or progestin.  But that doesn’t make any sense to Dr. Wysynski, since when women are in their 20s, progesterone is typically a hundred or more times higher than estrogen. In perimenopause, progesterone falls faster and greater than estrogen.  Progesterone falls about 70-75% whereas estrogen only falls by about 30%.  When estrogen levels are higher than progesterone, this is referred to as estrogen dominance and this estrogen dominance leads to the typical symptoms of menopause.  If you give estrogen only, this exacerbates estrogen dominance and high levels of unopposed estrogen can makes things grow.  It is not physiologically correct to give estrogen without progesterone. And in terms of the form of estrogen, a woman naturally produces 80% estriol and 20% estradiol, so using a 80:20 Biest cream is physiological.

18:34  Dr. Wysnyski likes to recommend slow release oral progesterone compounded, though some women prefer topical creams.  She customizes each patient’s hormone recommendations for each woman depending upon her presentation, her needs, and her hormone testing, such as saliva testing.

19:49  Dr. Wysynski leaves it up to her patients if they would like to have their cycle return, then she will cycle the progesterone. If not, she will have them take it daily and perhaps take it 6 days per week and skip one day or perhaps take a lower dose on day six or seven.  Progesterone is a brain chemical, a natural antidepressant, helps with water bloat, it’s a diuretic and it is an anti-anxiety hormone as well as a sleep hormone, so it is very beneficial for women. 

23:14  Testosterone for women.  While Dr. Wysynski will recommend testosterone for women if they need it, she feels that it is not so much a driver of libido in women as it is commonly thought.  She feels that when you restore the estrogen/progesterone balance, women’s libido usually comes back without needing additional testosterone.

 

 



Dr. Anna-Marie Wysnyski is the Medical Director of her clinic, Dr. Wysynski Bespoke Functional Medicine in Burlington, Ontario. She is certified in Functional Medicine from the Institute For Functional Medicine and she has completed a post graduated fellowship in Anti-Aging Functional and Regenerative medicine from the American Academy of Anti-Aging Medicine.  She is a hormone expert and has provided bioidentical hormone replacement therapy for peri-menopausal and menopausal women since 2006, which is our topic for today.  Her website is TorontoBioidenticalHormones.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, and let’s jump into the podcast.

                                                Hello, Rational Wellness podcasters. Today we will be discussing the use of hormone replacement therapy in postmenopausal women with Dr. Annmarie Wysysnki. Today we’ll be discussing the potential benefits and drawbacks of recommending hormone replacement therapy in postmenopausal women. After menopause, women often experience a number of symptoms including hot flashes, night sweats, sleep problems, vaginal dryness and atrophy. Post postmenopausal women also have an increased risk of heart disease and osteoporosis. It was common for MDs to prescribe hormone replacement therapy prior to the Women’s Health Initiative, which in 2001 reported that postmenopausal women who take hormone replacement therapy have an increased risk of heart attack, stroke, and breast cancer.  After the WHI study was published, many MDs stopped prescribing hormones to postmenopausal women. However, additional analysis of this study has led quite a number of doctors and researchers to conclude that these results may only apply to women who take estrogen derived from horse urine and synthetic progestins, and who don’t start taking hormones until an average of 10 years after menopause. The American College of Obstetricians and Gynecologists, I went to their website, and so they currently recommend that taking unopposed estrogen increases the risk of endometrial cancer while taking combined therapy estrogen plus progestins slightly increases the risk of breast cancer. They also state that combined hormone therapy may reduce the risk of colon cancer. On their website, The American Collagen of Obstetrics and Gynecologist’s website also states that combined hormone therapy is associated with a small increased risk of heart attack for older women.

                                                Now, they also state that this risk may be related to age, existing medical conditions, and when a woman starts taking hormone therapy. Some research suggests that combined hormone therapy may actually protect against heart attacks in women who start combined therapy within 10 years of menopause and who are younger than 60 years, and this benefit may be even greater for women taking estrogen alone. However, I will say that I’ve seen guidelines from other nations, other countries, and they come to different conclusions. Anyway, we’re going to discuss all this. Dr. Annmarie Wysysnki is the medical director of Dr. Wysysnki Bespoke Functional Medicine, formerly Vitality Anti-Aging Center in Burlington, Ontario. She’s certified in functional medicine from the Institute for Functional Medicine, and she’s completed a postgraduate fellowship in anti-aging, functional and regenerative medicine from the American Academy of Anti-Aging Medicine. She’s a hormone expert and has provided bioidentical hormone replacement therapy for perimenopausal and menopausal women since 2006. Dr. Wysysnki, thank you for joining us today

Dr. Wysysnki:                     Ben, it’s my pleasure. Thank you very much for hosting me.

Dr. Weitz:                           Absolutely. What did we learn from the 2001 Women’s Health Initiative?  Did it tell us that hormone replacement therapy increases the risk of breast cancer and heart disease in menopausal women?

Dr. Wysysnki:                     It did tell us that, Ben. In fact, we know that when there are different hormones used, specifically the synthetic hormones as you spoke about, it can increase risk of heart disease by you forming clots that block the arteries in the heart, and it could increase the risk of stroke as well. What we learned, and this is very difficult in the literature, is that we’re very inaccurate when we talk about hormones. When we talk about bioidentical hormones, for example, we know that those are identical chemically to the body hormones that are made when we go into reproduction starting in puberty. However, the studies have been used with pharmaceutical drugs that are made from synthetic chemicals and specifically, as you said, estrogen from horse urine.  Over 50% of that estrogen is not identical to what we make, and we know that that may or may not propose problems. But where the biggest issue came with the WHI study, the Women’s Health Initiative, or the WHI study, is we know that there are synthetic progesterone-like compounds called progestins. This is where the greatest issue came. When the study was stopped because of increased risk of heart attack, stroke, and breast cancer, the arm of estrogen only continued, and they found that that was not as egregiously dangerous and not dangerous at all, frankly, compared to when we combined estrogen with synthetic progestins. This is a really key important point when we’re reading the literature as healthcare providers to differentiate between progesterone and progestins, but it’s not always clear.  If we’re not clear what’s happened in a study, how do our patients differentiate what they’re getting versus what they are reading in the common literature and what they’re hearing from their doctors?

Dr. Weitz:                            I think another important factor is that on the average, these women didn’t start taking hormones until an average of 10 years after menopause. If estrogen is protective against heart disease and these women go 10 years without estrogen, which means during that period of time they’re at increased risk of heart disease and then you incorporate the hormones, well, obviously they’re liable to have more of a risk of heart disease because they went for 10 years without that protection.

Dr. Wysysnki:                     Absolutely. One of the points that’s really salient here is that when women are at 40 years old and not in any menopausal state yet, because menopause can start as early as 35, but as an example, as a cohort, when we look at women who are at 40 years old who still cycle and have their natural hormones being made, compared to men at 40 years old, women enjoy 10 year protection against heart disease. However, when we go to 50 and within the one year when a woman’s menstrual cycles wind down and she ends up losing her menstrual cycles, by the time that year anniversary of no period, which is called the date of menopause, when that happens, she catches up to her male 50-year-old cohort equivalence.  We already enjoy extra protection when we’re cycling and you’re right, that 10 years is usually the time period in which we start seeing things happen like plaquing, early heart disease symptoms, angina, et cetera. When we try and reestablish these hormones and then add a progestin that is synthetic that is known to be embolic, meaning it causes clots, in a population that’s already lost their hormones, lost their protection and has accelerated disease over 10 years, of course we see increased risk.

Dr. Weitz:                            This whole risk of women and heart disease is kind of an interesting topic because I think in general, women tend to get undertreated for heart disease and under screened for it.

Dr. Wysysnki:                     I agree with you in the heart disease, but in general, women’s health still is not well addressed. This is why I become passionate about helping women worldwide deal with menopause and their longevity protection. Because typically when we look at studies, and previous to medical school, I was a PhD researcher where I did these types of studies. I was in pharmacology where we would do drug development and typically because we want to keep all these factors controlled, so what that means is we have identical animals with identical genes with identical daylight cycles, et cetera, we don’t want to have female animals in that experiment because when they get their estro cycles, which is the equivalent in animals of the period for women, it confounds or it creates an unknown factor in the studies. Typically all research is done or almost exclusively done on male animals or men when we do human population studies, and then we just extrapolate to women. Not only is heart disease underrepresented, women’s reproductive health and everything about women’s health is underrepresented in the literature.

Dr. Weitz:                            Right, absolutely. Let’s talk about hormones. What are some of the benefits of taking bioidentical hormones? Then also tell us what types of bioidentical hormones you prefer to use.

Dr. Wysysnki:                     Absolutely. The advantage summed up in a sentence is when men and women replace their hormones at an appropriate age or developmental reproductive stage, they statistically significantly reduce all cause mortality. That means any disease that we could think about acquiring and dying from or causing disease and leading to earlier death is reduced not only just experientially, but in the literature that real key word of statistically significant. When I use bioidentical hormones, I like to use natural hormones. Most of them are derived from wild yam. Stabilized in the lab, they look identical to what our body makes. There’s no additional groups added to it. There’s no additional chemistry or different picture. If we took our natural hormones and our bioidentical ones that we replace, they marry each other in chemical structure and function.

Dr. Weitz:                            Let’s start with estrogen. Do you prefer creams, patches, pellets? Some women are still taking oral estrogen.

Dr. Wysysnki:                     Right. Thank you for that. I prefer creams for estrogen for a variety of reasons. We know that oral estrogen does increase certain risk factors for heart disease. For example, it will actually increase the bad cholesterol or the LDL that we try and control in people to produce heart attacks and strokes. Oral estrogen would not be off the table, but it would certainly not be my first choice. In fact, it would sort of be my I have nothing else to offer a woman and that’s all she could take. I believe it was 2018, there was a great book called Estrogen Matters that was written by a radiation oncologist in California. His name is Avrum Bluming. So Estrogen Matters by Avrum Bluming and he went back to the ’40s when synthetic oral estrogen was discovered. In his meta analysis or grouping together of all these studies and looking at the literature, he actually showed that it’s quite protective to still just have oral estrogen. So that wouldn’t be my choice.

                                                I really prefer to have compounded two estrogens, estradiol and estriol called Biest. We can achieve bioidentical estrogen replacement with patches or EstroGel, but again, those are synthetic. From a chemical point of view, they’re made in the lab from chemicals. They don’t have the same energetic potential, if you might, as natural hormones. I tend to go with natural hormones. Sometimes we’ll use a vaginal route. Oftentimes we can use the topicals, as I said, and then pellets are just coming into fashion here in Canada, quite popular in the United States, and I’m actually looking to bring that into my clinic shortly. I will be an independent provider of pellet therapy soon.  The difficulty with pellets is it’s hard to adjust dose. With the creams, we can actually adjust doses. For example, if I give somebody, let’s say, 0.4 milligrams of estrogen and it’s not doing well for them, I can actually have them double the dose by giving more than one or two pumps or turns of a container. Or if it’s too much, I can actually have her alternate one pump and two pumps every alternate day, for example, and that would actually give me an average dose over 10 days that would be in between the dose that I’ve prescribed. They’re very flexible. Custom compounds unfortunately are not covered on most drug plans, which is a drawback, however.

Dr. Weitz:                            Now, aren’t there prescription patches that are bioidentical?

Dr. Wysysnki:                     They are bioidentical but not natural. They are synthetic. For example, patches EstroGel are created in the lab from synthetic chemicals. They are not derived from yam.

Dr. Weitz:                            How much does that matter?

Dr. Wysysnki:                     I think it matters a lot. If you take a vitamin pill, for example, a vitamin C tablet, and you take one that’s made from synthetic hormone, it will fit into the receptors, so that’s like putting your key into a lock. However, from a natural point of view, if you were to take natural vitamin C, there’s actually energetic auras, if you might, or energetic potential. I would rather eat a natural orange than to take a vitamin C synthetic tablet. For me, it is more dogmatic than it is scientific, but certainly I would rather go with a fully naturally derived hormone rather than a synthetic one.

Dr. Weitz:                            Then explain why you like the Biest cream, which is a combination of two different forms of estrogen, estradiol and estriol, and what percentage of each do you prefer?

Dr. Wysysnki:                     Thank you. I prefer to combine the estrogens because when we talk about estrogen, we talk about it as if it’s one hormone in the body and it’s not. It’s a group of hormones. We know specifically the most information about three: estrone, estradiol and estriol. Why I like to balance the estradiol in the estriol is that that’s how it naturally occurs, usually in an 80:20 percentage. So 80% estriol, 20% estradiol. However, it depends on the patient and their situation. I can custom compound that percentage to be anything I want. I’ve done 70/30, I’ve done 60/40. My greatest success is with 50/50 because we know that there’s a little bit of bioconversion between estriol and estradiol and it keeps the percentages healthy.  Estrogens make things grow, but estradiol is actually extremely healthy and safe, so much so that in Europe, estriol is given to women to treat breast cancer. We know, again, as you said, different countries have different consensus guidelines and there’s different uses for these. When I look at the biochemistry of a woman and how she produces her estrogens and what proportions, I’d like to replace a mere identically to our natural levels. Although when women are having symptoms in perimenopause, sometimes a little bit more estradiol to tone down the receptors actually works better.

Dr. Weitz:                            Let me just bring up a challenge from another doctor who I’ve spoken to a number of times who’s a big proponent of estradiol, and she argues that estriol is really the hormone that’s secreted during pregnancy and is not really … it doesn’t really provide all the benefits that estradiol does, so that’s really not the natural way to do it.

Dr. Wysysnki:                     Two things I’m going to comment on. In allopathic medicine, which is non-functional medicine, as you know, it’s pharmaceutical oriented medicine, we give women estrogen in the form of estrogen patches or EstroGel as a hormone replacement. Specifically if one does not have a uterus, we do not offer any form of progesterone or progestin. That doesn’t make sense to me because, and I’m just going to use my hands, I don’t have a chart. When we’re 25, progesterone is typically a hundred or more times higher than estrogen. In perimenopause, as things decline, this is what happens. Progesterone falls faster and greater than estrogen. Progesterone falls about 70, 75%. Estrogen only falls about 30%.   By definition, estrogen is higher in menopause than progesterone, a state that we call estrogen dominance. If the natural hormones are progesterone higher than estrogen at our peak reproductive ages and our peak wellness ages, why would we give more estrogen to a woman who’s in estrogen dominance and that estrogen dominance is what leads to the typical symptoms of menopause? What happens in allopathic medicine, as I was trained, you give a woman estradiol and it forces that estrogen higher and higher and higher. Why don’t they get more symptoms?  Because we have locks and keys. The hormones are the key, the receptors are the lock.  When we have too much signaling, it’s too much noise. The body doesn’t want to hear the noise, so eventually the receptors come out of circulation, and now you have unopposed high estrogen.  Estrogen makes things grow.  It is not correct physiologically if we’re going to create a balanced hormone picture to give estrogen. If we look at resources like standard gynecological and physiological textbooks or resources in the medical literature, we know that a woman naturally produces 80% estriol and 20% estradiol. Why is that? Estroiol is very weak. It’s produced in large quantities. Estradiol is produced intermediate quantities, and it is higher potency. We don’t need that much estradiol to balance the system.

Dr. Weitz:                           Sounds good. In what form of progesterone do you like to recommend?

Dr. Wysysnki:                     It depends on the woman and what her situation is. Particularly if women are having mental health issues, mostly anxiety or sleeplessness, I often prefer to have slow release oral progesterone compounded. But some women prefer to have topical creams. Many women are under the impression based on what they read in the popular literature that if you put creams on, it doesn’t go through your liver. We call this first past metabolism where things go through your liver. Anything oral goes through the liver. Sometimes I want to capitalize on that because with an oral progesterone, I can get metabolites formed in a woman’s body that crosses a blood-brain barrier, gives her a sense of a calgon moment or a wusha, reduces daytime anxiety, helps her sleep better, where some women who don’t have those sleep or anxiety provoking or mental health symptoms may not need oral estrogen. When I rebranded the clinic, we called it Bespoke Functional Medicine for a reason, because every treatment is customized specifically to the woman, her presentation and her needs, as well as her biochemical tests, like her saliva testing for example.

Dr. Weitz:                           Do you like to cycle the progesterone or give it every day of the month?

Dr. Wysysnki:                     It depends on the woman. Most of my women almost exclusively do not want to cycle. I have one woman in my practice who’s over 70 who wants to cycle.

Dr. Weitz:                           By the way, for those who are listening who aren’t aware of what we’re talking about, some doctors recommend giving progesterone in a similar way as your normal menstrual cycle. By giving it for a period of time and then not giving it, women may start bleeding and getting their menstrual cycle back.

Dr. Wysysnki:                     There are different philosophies and different approaches how we do this.  One of my women wanted her menstrual cycle back, and she’s still in her ’70s, has a five-day light period requiring light protection, feels fantastic on it.  Most women don’t want the bother. Oftentimes what I will do is if the woman wants … and again, depending on her symptoms, if she responds well and if she sees me in perimenopause where there are still periods, I will cycle the progesterone in various doses at different times of the cycle in order to support her periods.  If we see women who are starting to get scanty, irregular periods or flooding periods, let’s say at age 52, we know the literature shows that if women’s cycle naturally or with hormone support till 55, it is very protective.  I will push that envelope for a woman trying to keep her cycling as long as possible without having side effects.  If a woman’s very symptomatic, sometimes we need standard dose progesterone, and sometimes that looks like days three to 28, sometimes that looks like day one to 25. I don’t like that cycle because I think if you go to day 25, give them five days off, they get too much instability. As well, I may actually give them progesterone six days a week with one day off. Sometimes my approach will actually help to keep sensitized receptors so they don’t get used to the dose. Sometimes they need a break because they, I don’t know, work shift work or they have other needs. Progesterone actually sensitizes the estrogen receptor as well. It needs to be there even in a hysterectomized woman who’s lost her uterus. Progesterone is in all of our tissues. It is a brain chemical, a natural antidepressant, helps with water bloat, it’s a diuretic and it is an anti-anxiety hormone as well as a sleep hormone. We need that and the women’s needs will tell me how they want to be cycling.

Dr. Weitz:                            That’s interesting you mentioning six days a week and one day off on the progesterone. That’s the first time I heard that recommendation.

Dr. Wysysnki:                     I use that very often. This is called a combined continuous dosing schedule and giving a break in the cycle or sometimes if a woman finds that she can’t sleep on that one day off, or often what happens is, let’s say she takes a break on a Saturday night and has to be back in the office on Monday, because she’s not slept Saturday, it will actually catch up with her about 24 to 48 hours later, and she may go into the boardroom or into the office or into the hospital, wherever she works, not be very functional in terms of word recall, et cetera, et cetera. We will actually give her a lower dose on day six or seven rather than no dose. Again, very customized dosing for the woman.

Dr. Weitz:                           Interesting. Do you often recommend testosterone for women as well.

Dr. Wysysnki:                     If they need it, absolutely. Interestingly, Ben-

Dr. Weitz:                           How do you decide if they need it?

Dr. Wysysnki:                     Through their testing and their symptoms. It’s interesting that, for example, we think that women need testosterone because they have low libido or desire, and I sort of separate libido is up in here and libido down there, right? Desire and libido. To tease it out because sometimes the dysfunction is a desired dysfunction, libido is fine, sexual arousal is fine. Sometimes sexual arousal is difficult, but they desire intercourse. It’s kind of interesting. Again, here’s where that gender bias comes in. Men make all three hormones too, progesterone, estrogen, testosterone, but their main hormone is testosterone in high levels. Testosterone drives the sexual function of men, but not so much in women. In my clinical experience of now over 17 years, I have found that once we restore the estrogen progesterone balance to that 25-year-old level or close to at least 10 years earlier, women’s libido comes back very nicely.

Dr. Weitz:                            Interesting, interesting. I thought it was pretty much accepted that testosterone was a big factor in women’s sex drive.

Dr. Wysysnki:                     I think it’s overstated.

Dr. Weitz:                            Do you ever recommend pregnenolone?

Dr. Wysysnki:                     100%. Pregnenolone is a hormone that I’ve used of late in my practice in the later years. As my population and my patient population has evolved, so have their needs. Pregnenolone can be really, really helpful in cases of head injury, for example, past traumatic brain injury, for weight shifting, sometimes we could get really nice effect. But when I am working up a woman for menopause, I’m also looking at their cortisol and adrenal function and oftentimes we need those upstream chemicals of pregnenolone and/or DHEA in order to cause effect with the adrenals. Because when a woman stops menstruating, the majority of her hormones that are still produced in low quantities come from the adrenal glands, which also produce our stress hormones.  If we live in the world, period, I used to stay in North America, but if you live in this world and you’re a woman or a man, you have stress. The bottom line is we all think that we handle it well, but chronic stress is a really good indication. When I’m seeing those DHEA levels or those cortisol levels being depleted or over overstimulated, I may use pregnenolone specifically to help those downstream chemicals replete.

Dr. Weitz:                            I want to ask you about one or two other hormones, but let’s go into testing since that seems like that would make sense right now.

Dr. Wysysnki:                     Sure.

Dr. Weitz:                            What’s the best way to measure and monitor hormone levels in women? Do you prefer serum, saliva, urine?

Dr. Wysysnki:                     That’s a great question, and I think that qualifies with depends what you are looking for. When I was a bench scientist, I was taught very keenly if you want to prove your hypothesis, if you want the answer to your question, ask the right question.

Dr. Weitz:                            Of course.

Dr. Wysysnki:                     I extrapolate that into my medical practice. If I want to know what the hormones are doing, look in the right compartment. If I want to know what’s available, I will look in the blood. Now, blood is still standardized because it is in the literature. Most of the studies are done on blood. However, various factors will affect blood hormones including the way that they’re carried through the body, whether they’re free or bound, et cetera. It’s not always a clear picture and here’s why. Many, many women worldwide have gone to their doctor and said, “I think I’m in menopause. I have hot flashes. I’m disinterested in sex. I’m yelling and screaming all the time. I feel like I’m going out of my mind. My vagina is dry, sex hurts. I can’t sleep. I’m having hot flashes, night sweats,” et cetera and they’ll do a battery of blood work and hold up the paper and go, “No, you’re fine.”  Well, you can’t be fine if you’re symptomatic. Right? If we had somebody with cancer who came in and said, “I’m fatigued all the time, I’m losing weight involuntarily. I have profused night sweats,” which is classic symptoms of potential cancer and we just said to somebody, “You’re fine,” you’re not fine. When we look in the blood, it can be beneficial to see certain aspects of the hormonal cycle. For certain protocols, for example, the one where a woman will choose to use different doses to produce and keep her cycle going, that often tests better on blood. However, the reason a woman is symptomatic is that the tissues are not being bathed in the right amount of hormone. When we use saliva testing, the blood bathes the salivary gland, the hormones go into the salivary gland and are secreted through the salivary gland into the saliva, similar to what’s going on in our bone, our brain, our breast, our uterus, our ovaries, our heart.

                                                This becomes a proxy measure for what we term intracellular or in the cell levels. That’s what I want. I want to know what the end target is doing. Some people like to dose on urine. For me, when I use urine, I see the potential for dosing on urine. I’ve had a great success record with using saliva to guide my dosing. I prefer to look at urine when I need metabolites. What’s coming through the kidneys? How is it metabolized? For example, we talked about the two estrogens, estradiol and estriol. We haven’t really talked much about estrone. Estrone is very important. How it breaks down in is metabolized in the body to different pathways, metabolic pathways, the urine sample for me is ideal for that ideal. Ideal.  When I’m worried about somebody potentially having breast cancer or family history, breast cancer, estrone has been implicated in breast and uterine cancer in susceptible individuals. When we look at the pathways of how that estrone is broken down, I could see if a woman needs metabolic support or biochemical support to enhance or tune down different pathways that may or may not be favorable in terms of producing her metabolite outcomes from estrone.

Dr. Weitz:                           We’re talking about the 2, 4, 16 estrogen pathways, right?

Dr. Wysysnki:                     Exactly. The methoxy and the hydroxy pathways of 2, 4, 16 metabolites.

Dr. Weitz:                           You’ll do a urine test like a DUTCH test or something like that?

Dr. Wysysnki:                     Exactly. I would look at a urine metabolite test, such as DUTCH or other companies out there do provide those tests as well. If a woman’s history, again, a bespoke approach depending on her family history or she’s highly concerned about breast cancer, then I will offer a DUTCH test or a similar test, a urinary metabolite test to see how she’s breaking down her estrone. It does not predict breast cancer. It does not predict who’s at higher risk. When we look at the ratios of how the metabolites of estrone are broken down, as you said in those 2, 4, 16 pathways, there were a few small studies, particularly off an isle of France called Guernsey where they noted that women with certain patterns of estrone breakdown or metabolism had up to 30% protection against developing breast cancer. I can’t say a woman won’t get breast cancer. I can’t say she will. All I could say is that her ratios are or are not favorable based on these studies out of Guernsey and if we optimize her pathways, it appears to confer some protection.

Dr. Weitz:                            For those of us who are familiar with this in working with women, there’s a lot of controversy over which pathway is most important and we used to look at the 2 to 16 and now some people place a lot more importance on 4 pathway. What do you consider the most significant pathways and what do you like to see, and then what sort of nutritional strategies do you use to optimize things?

Dr. Wysysnki:                     Absolutely. The 2/16 ratio I still look at specifically. When you ask me what pathway, they’re all important to me. Because just like when I’m looking at my salivary tests, I’m looking for not only absolute numbers, I’m looking for relative ratios. When I’m looking at the urinary metabolite tests for estrone, I’m looking at relative ratios like the 2/16 pathway where the methoxy metabolites are, because those are known to be unstable and to cause DNA adducts. I’m looking at their COMT profile, I’m looking at their methylation profile to see exactly what is going on in her body.

                                                Then depending on what pathways I’ve used, and in men as well, I’ve used grapefruit to bring up some pathways and increase enzymatic reactions, cruciferous vegetables, diindolylmethol or methane or DIM or I3C, indole-3-carbinol, those are all part of the pathways that are derived from cruciferous vegetables and those are provided as supplements. Sometimes I will recommend those. Sometimes it’s as easy as having somebody stop smoking or decrease their alcohol intake, increase flaxseed. There’s multiple pathways and multiple mechanisms and again, it depends if somebody doesn’t like to take pills, which most of us don’t, even though they are supplements, a woman won’t adhere to that therapy. But if she will add a tablespoon of flaxseed to her diet and incorporate a cup of green cruciferous vegetables, then that’s the way we’ll go.

Dr. Weitz:                            Do you ever use iodine as something that might be protective?

Dr. Wysysnki:                     Absolutely. Iodine is a nutrient, I think, that is very misunderstood and underutilized. We know that table salt had been iodized because of goiter, but we also know that iodine is useful in conditions like polycystic ovarian syndrome and in fibrocystic breast disease. I just recently had a patient who did not have optimized thyroid levels, and so I added a little bit of iodine to her diet through a supplement, liquid supplement, and to optimize her deiodination of her T4, really her less active thyroid hormone, but also because she had lumpy painful breasts and I had her taking a little bit by mouth and then also applying it to the breast tissue works beautifully to relieve fibrocystic breast pain.

Dr. Weitz:                            Interesting. Applying it directly to the breast tissue?

Dr. Wysysnki:                     Yes. Of course, it’s going to be messy and stain that iodine brownish color. She wasn’t concerned about that because her breasts were so tender, she didn’t care.

Dr. Weitz:                            Now what about calcium DG gluconate?

Dr. Wysysnki:                     Calcium DG gluconate is great for getting rid of some of those estrogen metabolites and lowering estrogen levels. I can use it if I need to. Oftentimes women don’t need a whole bunch of estrogen. Typically, my doses are not high. We see women getting six, 12 milligrams of estradiol. Mine are not near that high, and I get great outcomes with the women.

Dr. Weitz:                            Cool. You mentioned DHEA. When you do a serum lab test, what level of DHEA do you like to see in women?

Dr. Wysysnki:                     I don’t do serum. I collect that on their salivary tests. I can test it on serum and actually my preference, and not all labs offer this, is to do the DHEAS. We could do both. DHEA is great as an anti-aging hormone, the higher the level, the better, but DHEAS also tells me a lot about the cortisol response and what’s going on with their adrenals. I like the DHEAS from a stress response. Again, if you want the answer to your question, ask the right question. What DHEA form are you using? How are you testing it? What are you looking for? If I’m looking for adrenal health, I will look for it in the saliva, ideally as DHEAS, although DHEAS and DHEA levels in saliva tend to be parallel as they do in blood. If DHEAS or DHEA were robust, the other one will be as well and you can almost use that as a assumption that the other is just as robust.

Dr. Weitz:                            Are you typically doing the adrenal cortisol stress test where you measure the saliva at different points during the day?

Dr. Wysysnki:                     Correct. Okay. I don’t really like people to wake up in the middle of the night to take a test because, of course, that pops their cortisol up, it breaks their melatonin cycling, but we will do at least a four point cortisol. For monitoring, when I know my patients are stable, I’ll look at least at the morning cortisol because things change.

Dr. Weitz:                            Right. We’ve been having a bit of an issue trying to get women to do the CAR part, the first two parts, especially if they have to fill up this tube with saliva and they’ve just woken up and they haven’t drunk any water and it’s really hard to fill that thing up.

Dr. Wysysnki:                     I know. I know. Not only from a patient point of view, but from a personal point of view. I know.

Dr. Weitz:                            It’s interesting that you like to use saliva, and I know a number of functional medicine doctors who do, but there are a number of doctors who say, “Well, look, saliva’s just not accurate. It really hasn’t been standardized.” What do you say to that?

Dr. Wysysnki:                     NASA uses saliva testing for its astronauts. If it’s good enough for astronauts, it’s probably good enough for us docs and our patients.

Dr. Weitz:                            There you go. That’s a good one. I hadn’t heard that before.

Dr. Wysysnki:                     But again, if you want the answer to the question, ask the right question. We tend to overdose our patients in blood because it’s just an available level at the time. There are diurnal variations and we know that. Especially when people are on hormones, if I ask them to put hormones on their skin and go down to the lab and get a blood draw, I’m probably getting a whole whack of hormones that are residual on the skin or that are in those skin cells as the needle goes through and the circulating levels are not necessarily as accurate as I would like them to be. I’m using more blood now than I ever have, which is a teeny minuscule amount of serum testing for various reasons. Sometimes when women aren’t getting the response that they want, or if I’m finding that saliva levels are just astronomically off the charts, I’ll check again in blood. You can’t always compare them and almost never do I see them correlate.

Dr. Weitz:                            Interesting. One more hormone. It’s a minor hormone, but I’ve read a little bit about it recently, is oxytocin.

Dr. Wysysnki:                     Oxytocin is amazing. One of the things for oxytocin, there is a rule for oxytocin in functional medicine. The difficulty with oxytocin, it’s about $600 a month. It is very, very expensive, at least here in Canada and probably in the US it’s a lot more. Oxytocin is the hormone that’s released from the pituitary gland, typically when a woman is going into labor. That’s what increases the onset of labor, that rhythmic contraction of the uterus, et cetera, et cetera, and primes the cervix for delivery. But we can use oxytocin in many instances. Oxytocin can be very, very effective for chronic pain, fibromyalgia type pain, arthritic pain. Also, I have prescribed oxytocin when somebody was in a situation where desired human interaction and human affection, but were very shy and withdrawn from being in that human interaction to get the emotional support that this patient wanted.

                                                Unfortunately, one of my patients with pain used oxytocin and has a very complex pain situation. As a single approach, she did not find it overly beneficial and my other patient with the emotional disconnection from humans but desiring human affection was not able to afford oxytocin. But yes, oxytocin is a pretty interesting hormone.

Dr. Weitz:                           You get it compounded, is that the form?

Dr. Wysysnki:                     It actually comes in as Pitocin. It is synthetic.

Dr. Weitz:                           Oh, so you use it as synthetic pitocin?

Dr. Wysysnki:                     Right. I don’t know that there is any actual raw material. That’s a great question because I haven’t needed to look at that. But the Pitocin itself is what we would’ve used as a sublingual spray or other methods, and it can work just beautifully.

Dr. Weitz:                           Right. Great. Let’s see. Those are the questions that I had prepared. Is there any other things that you would like to cover?

Dr. Wysysnki:                     I think women need to be knowledgeable and know that there are options out there. It’s not the standard one size fits all approach. At least that’s the approach that my clinic takes and I think many functional medicine doctors do. Just because your doctor may want to do a saliva kit doesn’t make them wrong or if they want to do serum analysis, it doesn’t make them wrong. What it means is that that’s their comfort level in the art of medicine. Remember we say the science and art of medicine. I’ve had great success with saliva testing. Also understanding the role of adrenals helps me use that saliva test to the patient’s benefit because I really do want to know what’s going on with the adrenals. In allopathic medicine, we don’t pay any attention to the adrenals unless they’re not functioning at all or over functioning to create disease, and there’s a whole spectrum in between them.

                                                So if a physician or practitioner, functional or not, doesn’t know how to deal with adrenal dysfunction well, then it may not be beneficial. Yes, things are costly, but the cost of not being well and functioning well and being at our best is also very expensive. It doesn’t count in dollars and cents, but our ability to stay well, avoid diseases, we know that through functional medicine and hormone replacement as well as other modalities and functional, we know that we could keep patients well. We know we can reverse disease and continue to longevity, whatever our natural lifespan is, without illness and disability. That’s really important to me is to support women in that. I also treat men, but my ability to support women because this is such an under-recognized and undertreated area of medical science for women is really important.

Dr. Weitz:                           That’s great. For those who are listening, who would like to seek you out to possibly have you help them or find out more about you, where would they go?

Dr. Wysysnki:                     Right now the best place to go is by email at info@drwizz.com. It’s I-N-F-O @ D-R-W-I-Z-Z for those south of the border or D-R-W-I-Z-Z for those of us north of the border dot com. Our website is currently under construction, so that should be coming soon, probably launching in the new year. Also, Ben, for those women who can’t afford or are in countries where bioidenticals are not available, I have written a 12-week menopause 911 coaching program that will also launch early in the new year so people can look forward to seeing that as well.

Dr. Weitz:                            Okay, that’d be great. Do you see patients remotely as well?

Dr. Wysysnki:                     I do. I am also licensed in one state in the United States, but across Canada, certainly I do telemedicine and can see patients coast to coast.

Dr. Weitz:                            That’s great. Awesome. Dr. Wysysnki.

Dr. Wysysnki:                     Thank you so much, Ben.

 


 

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcast or Spotify and give us a five-star ratings and review. That way more people will be able to discover the Rational Wellness Podcast. I wanted to say thank you to all the patients that we’ve been working with at our Weitz Sports Chiropractic Nutrition Clinic, most of whom we’ve been able to help with a range of various health conditions from various types of gut disorders to thyroid and hormonal issues, autoimmune diseases and various other cardiometabolic conditions.  I very much appreciate you and I’m excited about going forwards, helping you to improve your health on your journey towards optimal health and I wanted to let everybody know that I do have a few openings now for new clients, and you can take advantage of that by calling my Weitz Sports Chiropractic and Nutrition Santa Monica office at 310-395-3111, and we can set you up for a new consultation for functional medicine nutrition, and we can get that going as early as the new year. Give us a call and I’ll talk to you next week.

 

Patricia Lemer discusses a Functional Medicine Approach to Autism 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

4:05  The rates of autism are rising rapidly.  Some of the experts claim that we are just diagnosing autism more frequently, but today everyone knows someone with autism and when I was growing up, we never heard of anyone with autism.  According to Patricia, “Did those people used to hide in the attic and in the basement so we didn’t see them? Or didn’t they exist? And are we just more aware?” And those of us who are in the field don’t believe that’s true, though this is a new phenomenon as kids in our world get sicker and sicker.  In the 1980s we were seeing one kid in 10,000 with autism, while today the rate is one in 23 children.  And kids with autism could not have been confused with kids who simply failed to develop normally and are mentally handicapped, since kids with autism typically are seen to be developing normally until one and half years or two and then in a matter of a few days undergo a radical transformation and stop communicating, sit in one place, and bang their head against the wall and perform other repetitive actions.

9:53  Patricia explains autism with the total load theory that she borrows from engineering that explains why a bridge collapses.  When a bridge collapses, we seek to find out who’s to blame.  Was it the engineer who designed the bridge?  Was it our terrible weather that rusted out the moorings of the bridge?  Rather, it is a combination of things over time that overload the tensile strength of the bridge.  Kids with autism have a threshold of health they hover under and different load factors are added to the child until they go over their threshold and then start getting sicker and sicker.  Children used to be born with a lot of room under the threshold, so they could be exposed to a few toxins, such as painting the room or spraying for termites and they would be fine. But today because families are having kids later in life, the mother carries a bigger toxic load, and we have all these other chemicals and toxins that are bombarding our baby and lead to them overloading their threshold till they start experiencing symptoms such as autism.

And so kids used to be born and way, way, way down here and we could have a few toxins. We could paint the room. We could spray for termites. And the kids still had a lot of wiggle room there. But because of a couple of factors, like families having babies later, the mother carries a bigger toxic load herself, which nature has her dump into her unborn baby. And then we have all these other chemicals and toxins and environmental things that are bombarding our baby, that are adding up, adding up, adding up to where the bridge collapses.  Along with this autism epidemic, we also have an epidemic of infertility and miscarriages.  We need to start working with the parents for a good year prior to conceiving to get them healthy, so they can have healthier kids. 

14:05  Environmental Toxins.  One environmental toxin to avoid is antimony, which is contained in the flame retardant chemicals that are sprayed on most mattresses, furniture, and even clothing.  You should buy all natural, toxin-free bedding, since we spend a third of our life in bed.  The bedroom should be for sleep and sex and nothing else.  And we want to avoid EMFs, which are more pervasive since 5G.  Patricia has a canopy over her bed to repel EMFs.

17:10  Heavy Metals.  Mercury is commonly associated with autism.  Mercury can come from amalgam fillings and from coal fired power plants, which spew mercury into the atmosphere and that falls into the oceans and gets into the fish.  The big ocean fish like tuna have the highest levels of mercury. The best fish to eat are the smaller fish like sardines and anchovies and high fat fish like salmon.  Aluminum is latest metal that many are concerned with from cooking in aluminum pans, to using aluminum foil on our food, to aluminum in the air from chemtrails.  One person with autism that Patricia knows who when he was a kid had pica syndrome where he kept eating dirt and he was poisoned by arsenic from the playground that was built out of railroad ties that have arsenic in them.  Arsenic can also be found in well water and rice and sometimes in chicken.

27:30  Cerebral folate deficiency can be a factor in autism and antibodies to dairy can block the absorption of folate.  Unfortunately, kids with autism tend to eat mostly foods with wheat and dairy like macaroni and cheese, pizza, cereal with milk, bagels and cream cheese, and pizza.  Most kids with autism are reactive to both casein and gluten and an elimination diet can help show this.  We need to have kids with autism to eat real food like fruits and vegetables, animal products and fish, beans, and good quality fats. Cheez doodles and Goldfish crackers are not real food.

 

 



Patricia Lemer is a Licensed Professional Counselor (LPC), and practiced as an educational diagnostician for over 40 years. Patricia wrote several books, including her most recent, which is Outsmarting Autism, Updated and Expanded: Build Healthy Foundations for Communication, Socialization, and Behavior at All Ages (2019).   Patricia was co-founder and Executive Director of Developmental Delay Resources (DDR), an international, non-profit organization for 20 years which merged with Epidemic Answers in 2013.  Patricia’s books on Outsmarting Autism are a part of the curriculum for the Epidemic Answers Health Coach Training Program, in which she delivers 3 modules.  She also has a podcast, Autism Detective.

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.

                                Hello, Rational Wellness podcasters. Today we’re going to have a discussion about how to outsmart autism with Patricia Lemer. Autism or autistic spectrum disorder is a developmental disability marked by deficits in social communication and restricted repetitive behaviors. Autism typically begins before the age of three years. While there is a range of levels of severity, people with autism tend to behave, communicate, interact, and learn in ways that are different than most other people. Some patients with autism experience an improvement in their symptoms over time, while some never improve. Some of the most common symptoms include reduced eye contact, differences in body language, lack of facial expressions, not engaging in imaginative play, and repetitive gestures or sounds among others.   Rates of autism are increasing rapidly with levels reported by the CDC of autism in the year 2000 being one in 150 children. And one in 44 in 2018, according to the CDC. And one in 23, according to the National Institute of Mental Health. Autism is four times more common in boys than in girls. Clearly, autism incidence has been increasing, though it appears that the consensus in the conventional medical mental health and medical community is that autism is not more prevalent, but that it’s simply being diagnosed more often, especially with patients who might have previously been diagnosed with other mental disorders, which also corresponds with the societal trend to stop institutionalizing people with mental disorders. And then there’s another factor, which is that if a child gets diagnosed with autism, then insurance coverage might kick in, that will pay for behavioral and other therapies that can be quite costly.

                                Patricia Lemer is a licensed professional counselor and she practiced as an educational diagnostician for over 40 years. Patricia wrote several books including her most recent, which is Outsmarting Autism, Updated and Expanded: Build Healthy Foundations for Communication, Socialization, and Behavior at All Ages, published in 2019. And I read it and there is just a ton of great information there. A great reference for anybody who wants to know more about autism. And it’s available through Amazon and I’m sure other book sellers.  Patricia was a co-founder and executive director of Developmental Delay Resources, an international non-profit organization for 20 years, which merged with Epidemic Answers in 2013. Patricia’s books on outsmarting autism are a part of the curriculum for the Epidemic Answers Health Coach Training Program in which she delivers three of the modules. She also has a podcast, Autism Detective. Patricia, thank you so much for joining us.

Patricia:                Thank you, Ben, so much for having me. That was a long introduction. And I appreciate you covering so much of the history of autism, and what’s going on in today’s world. Because no matter where I am, and if I’m meeting new people and they say, “Well, what do you do, and what is your field?” When I say I work with kids with autism, people with autism, inevitably someone says, “I have a family member with autism.” My grandchild, my brother’s child, my next door neighbor’s child. Everybody knows somebody today with autism. And we didn’t growing up.

Dr. Weitz:            Right. Yeah. I don’t recall knowing anybody with autism.

Patricia:                And so what you said is, “Did those people used to hide in the attic and in the basement so we didn’t see them? Or didn’t they exist? And are we just more aware?” And those of us who are in the field don’t believe that’s true, though this is a new phenomenon as kids in our world get sicker and sicker. This is what’s happening. You see more and more autism diagnoses.

Dr. Weitz:            It’s shocking though, the rapid increase in rates. My understanding is, is back in the 1980s, we’re talking about one in thousands.

Patricia:                Yes, like 10,000.

Dr. Weitz:            Right. Wow.

Patricia:                And I’ve been in this field, not the autism field, but the field of children with disabilities since the late ’60s. And because I was working with kids with other disabilities, when autism reared its ugly head in the late ’80s, I was an instant expert because I’d seen one kid with autism and nobody else had seen any. So that’s how I fell down the autism rabbit hole. And because I was always a questioner with, “Well, why does my child have a learning disability? Why does my child have ADHD?” I could apply those out-of-the-box thinking ideas to this new phenomenon called autism.

Dr. Weitz:            What I’ve heard from other doctors is some people feel that there were kids with mental disabilities. We used to call them something else, retards or whatever terminology they used to use. And some people feel that we’re just reclassifying them now as autism. But it sounds like you feel that was something different, a different form of mental disability.

Patricia:                It was. Those kids who… And I did diagnostic testing on those kids and we had horrible categories like imbecile. And it just was horrible how we labeled those children. But they presented differently. First of all, they were kids who many of them had birth injuries. Second of all, they were kids who had classifiable syndromes that we could identify. And most importantly, those kids were not developing normally and typically and looking like they were doing well for a period of time before they regressed. And not all kids with autism have a history of regression, but many do. And because today’s parents have video cameras and cell phones, they can document this. They can show that this kid waved “Hi, mommy” at this first birthday party. And by his second birthday, he’s kind of sitting there not even noticing the candles on the cake. And so it is documented. And so that’s very different from those kids who were cognitively impaired in the past.

Dr. Weitz:            And it’s quite shocking for parents showing these videos and to see a kid that seems by all measures to be completely normal, communicating, developing, learning, acting normal, going through normal developmental stages, and then all of a sudden over a day or a few days or weekend does stop talking, sits in one place and bangs its head against the wall. I mean, it’s just unbelievable how this sudden change can happen.

Patricia:                Right.

Dr. Weitz:            Now I do recall, I either read an article, was speaking to or maybe listened to a podcast where some doctor claimed that there’s no way all these environmental things that happen are really causative factors because we can actually see something going on in the brain during in utero, even though you don’t notice it until age one and a half or two or something like that.

Patricia:                I don’t think so.

Dr. Weitz:            You don’t think so?

Patricia:                And the theory that I borrowed from engineering was something called total load theory. And total load is an engineering term that explains why a bridge collapses. And I live in Pittsburgh where we have over 400 bridges and one of them just ended up in the park. And when that bridge collapsed, we said, “Well, who’s to blame? Was it the engineer who designed the bridge? Or was it our just terrible weather that rusted out the moorings of the bridge?” But kids with autism are similar. I think we all have a threshold of health and we hover under that threshold. And when we add different load factors, we get sicker and sicker. And at some point when you add too many, you go over your threshold and all a sudden the grandma says, “What happened to my grandbaby?” “Oh mom, he has ADHD or he has a learning problem, or he has autism.”

                                And so kids used to be born and way, way, way down here and we could have a few toxins. We could paint the room. We could spray for termites. And the kids still had a lot of wiggle room there. But because of a couple of factors, like families having babies later, the mother carries a bigger toxic load herself, which nature has her dump into her unborn baby. And then we have all this other chemicals and toxins and environmental things that are bombarding our baby, that are adding up, adding up, adding up to where the bridge collapses.

Dr. Weitz:            Right. And we use the same analogy all the time when we’re talking about a functional medicine approach to analyzing autoimmune diseases.

Patricia:                Exactly.

Dr. Weitz:            And you have food sensitivities and toxins and all these things that add to immunological insult. And once you get to a certain level, you end up having problems.

Patricia:                Right, right. And that’s what we’re seeing with our kids. And so for those who are listening and thinking about having a baby, I want to get with a young couple a good year out because healthy parents have healthy kids. And work with moms and dads with allergies and moms with low thyroid and looking at their environment and saying, “What are the toxic products around here that you need to remove?” And clean up this environment, get some sleep, get rid of the computer in the bedroom. There’s all kinds of things we can do to get these moms healthy so that they can carry a healthy baby. And along with this autism epidemic, we have an epidemic of infertility and miscarriages.

Dr. Weitz:            Yes.

Patricia:                And these are not viable pregnancies that of course we mourn, but they are nature’s way of saying, “Honey, this isn’t a healthy environment. Your womb cannot grow a healthy baby.” This is the way nature works. And so clean it up and then we can have a nice healthy baby.

Dr. Weitz:            Right. Absolutely. And a lot of the toxic chemicals are endocrine-disrupting chemicals. And this is one of the reasons why we’re seeing lower levels of testosterone and sperm counts, and it’s playing a role in fertility and also in autism.

Patricia:                Right, right.

Dr. Weitz:            So let’s go into some of these environmental toxins that you mentioned in your book. One that I had not heard about before that you mentioned in your book is antimony which is often contained in flame retardant chemicals, which if most people are not aware are most mattresses, furniture, even clothing, sleeping gowns are sprayed with flame retarding chemicals.

Patricia:                Right. So we want to buy all natural bedding. We spend a third of our life in bed. And we want that bedding to be as natural and toxin-free as possible. And that bedroom to be a sleep sanctuary. It is for sleep, period. It is not for reading your book. It is not for watching television. It is not for being on the computer. It’s not for talking on a wireless phone. It’s for procreating, having sex, making babies, and sleep. And it has to be toxin-free for us to get good quality sleep. And the latest boogeyman are these 5G towers that are sprouting up everywhere and bombarding our homes, from the church down the street, that got paid to put up a cell phone tower. And so I now have a canopy over my bed that gets rid of, that repels some of these electromagnetic frequencies.

Dr. Weitz:            Interesting.

Patricia:                So this is so important. And it’s especially important if you want to get pregnant and if you want to have a healthy baby.

Dr. Weitz:            Yeah, yeah. It’s probably a good idea to use an environmental expert to come and inspect your home and see where the EMFs and other electrical fields are that may be affecting your bedroom and your home.

Patricia:                I had somebody come to my home, he has a little Geiger counter. When he got near the bed, it went… and said, “How old’s that clock radio?” And he said, “You don’t want that next to your head.”

Dr. Weitz:            Right. Even the wiring in the walls can be…

Patricia:                Exactly.

Dr. Weitz:            … discharging electrical signals.

Patricia:                Right.

Dr. Weitz:            So let’s go into some of the other chemicals. Let’s go through some of the heavy metals. We’ve got mercury, lead, aluminum, arsenic.

Patricia:                Yeah. Well, mercury is the big bad metal of autism. And of course lead was the metal that most people know about. And lead is old news. Then mercury is newer news. And how do our kids get mercury? Well, the first way they get it is a mother who has silver amalgams in her teeth, which off-gas into her unborn baby. And so that’s one of the things that we want to do is to have the mother remove those amalgams safely prior to getting pregnant if she has some. There’s also mercury in power plants and we can’t do a lot about those.

Dr. Weitz:            Yeah, basically coal fired power plants are spewing hundreds of tons of mercury into the atmosphere and that’s what eventually falls into the oceans and gets into the fish.

Patricia:                Right, right. And so that’s the next thing is our food. And so the rule to follow is that the larger the fish, the more mercury it has. It’s the top of the food chain. So medium-sized fish eat baby fish and big fish eat medium-sized fish. So our big fish like tuna fish, which could weigh hundreds of pounds, are probably the least desirable fish for our diet. And I can’t tell you how many mothers of kids with autism tell me, “Oh, I ate tuna fish every day in my pregnancy because I heard fish was good for you.” So the choice should not be tuna.  And so we want smaller fish, these little babies like sardines and anchovies, and fish that is high fat. Because even if it has a little bit of mercury, the higher fat content is protective because our nervous system is myelinated in this fatty sheath, which is like the protective cover on an electrical cord. And that protects our nervous system from all kinds of attacks. So we want to eat good quality fat, and the best omega-3 fats come from fish.

Dr. Weitz:            Right. And then we have all these other chemicals like PCBs and bisphenol A.

Patricia:               Right. Yeah. Well, let’s go. Let’s finish… I can do a little more on the metals.

Dr. Weitz:            Okay, let’s finish with the metals.

Patricia:               Yeah, because aluminum is the newest boogeyman. So we went from lead, and everybody knows about lead testing, mercury, and now aluminum. And aluminum is… We’re cooking with aluminum pans and there’s aluminum in the air from the chemtrails. And so we’ve got to protect ourselves from aluminum.

Dr. Weitz:            Some people use aluminum to cover their food. They make a turkey and they cover it with aluminum foil.

Patricia:               You’re right, you’re right. And so that gets in…

Dr. Weitz:            The holidays are coming. They have those aluminum pans that you throw away that a lot of people use for cooking your Thanksgiving meal.

Patricia:               So people say, “Well, what am I going to use?” Well, the best thing to use is parchment paper. Parchment paper’s very, very benign. So that’s not a problem. But we want to avoid aluminum. And aluminum has been implicated in Alzheimer’s and dementia too, not just in autism. And then the arsenic. I know one child who’s now… He’s not a child. He’s 30 years old with severe autism who was poisoned by arsenic from the playground where they built the playground out of railroad ties.

Dr. Weitz:            Oh, yes.

Patricia:               And he had pica, which is eating dirt. And kids who have pica are looking for minerals. Their bodies are craving minerals, but he got the wrong one. He got arsenic. And there are common signs of arsenic poisoning that I put in my book that most people don’t know, like calluses on your hands. And the mother of this young man often said to the pediatrician, “He has these giant calluses. What is that?” And this doctor said to the mother that this autistic boy, “Maybe he’s playing too much basketball.” She said, “I don’t think so.”

Dr. Weitz:            Interesting. I’d never heard that about the calluses. How does arsenic lead to calluses?

Patricia:               I don’t know what the phenomenon is. But he also had rainbow-like skin, sort of iridescent skin on his back. And that was another sign of arsenic poisoning.

Dr. Weitz:            And arsenic can be found in chicken. It can be found in rice.

Patricia:               Rice. And that’s where this boy also got it. They were macrobiotic at the time, eating a lot of rice. And rice from China is particularly heavy in arsenic. So you just have to be really careful about food in particular. And our food is… When we talk about GMO foods and glyphosate, Roundup being used to grow our wheat and our corn and our soybeans. If you don’t buy organic, you’re getting a taste of glyphosate or this Roundup in every bite of food. So that’s really important to watch for too.

Dr. Weitz:            So what do we do about all these heavy metals?

Patricia:               Well, there are ways of getting them out of the body. There’s a process called chelation that is used in Europe a lot.

Dr. Weitz:            You’re talking about intravenous or are using oral chelators?

Patricia:               You can do it with a doctor, with IVs and specific oral chelators. But one of the things that Dr. Dietrich Klinghardt, who I have followed for years, recommends is a substance called chlorella. And chlorella is a natural seaweed that is very, very high in minerals and is able to chelate naturally. And it comes in little pellets that look like M&M’s. And he likes people, pregnant mothers to chew on chlorella. He likes kids to chew on chlorella. I don’t know how you feel about that as kind of a natural chelator.

Dr. Weitz:            Mm-hmm. Interesting. What about using liposomal glutathione and other binders?

Patricia:               Yep, yep. So glutathione is really important because it’s our natural substance that we have that can chelate out the toxic metals. And if you’ve depleted your glutathione by using too much Tylenol, then you can use liposomal, which means it’s carried by fat and you use it through your skin. So there’s lots of products that you can buy that can help get rid of some of the metals. But if you’re seriously mercury toxic or aluminum toxic, you have to work with a doctor to do proper chelation.

Dr. Weitz:            Right. So glutathione is actually one of the nutrients that kids with autism are often deficient in. And deficiency or insufficiency of specific nutrients can be a major factor in autism. Isn’t that correct?

Patricia:               Absolutely correct. And one of the autism world’s heroes, Dr. Bernie Rimland, who founded the Autism Research Institute, was one of the first people to discover these nutrients and minerals that kids are deficient in. And he has a son, Bernie’s gone, but his son Mark is still alive. I think he’s in his 60s now. Bernie started supplementing Mark with vitamin B6 and magnesium with terrific results. And he did studies with families with autism and found that magnesium was just a marvelous benefit to many, many of our kids.

Dr. Weitz:            Right. And I understand that cerebral folate deficiency can be a factor. And I understand that sometimes antibodies to dairy can block the absorption of folate.

Patricia:               That’s correct. And so if you look at the diet of so many of our kids with autism, it’s almost like they’re colluding. Like they’re getting on the internet and say, “Let’s only eat foods that have wheat and dairy in them, okay?” And so they live on macaroni and cheese, pizza, cereal with milk, bagels and cream cheese, and pizza. And even though these have different names, then they’re basically the same thing. They’re combinations of wheat and dairy and wheat and dairy. And our kids are reactive to the casein, which is the protein in the dairy, and gluten, which is the protein in the wheat.  And if we put them on an elimination diet that takes away these products, some of them improve markedly. And you can test for it to see if they have gluten sensitivity or casein sensitivity. And sometimes doctors are willing to do that and sometimes not. But if you can just do it by elimination and then have for two weeks or so, and then have kind of a glutton day where you eat nothing but these combinations, you’ll see your kid could have this going on.

Dr. Weitz:            Yes. So when you recommend an elimination diet, what foods particularly do you take out? Do you just take out gluten and dairy? Do you also take out other foods, peanuts? How do you do your elimination diet?

Patricia:                Well, first and foremost, you only want to do one thing at a time. If you do more than one thing at a time, you don’t know what the problem is.

Dr. Weitz:            Well, typically what people in the functional medicine world do is they pick six foods or eight foods or something. They take them all out and then they test [inaudible 00:30:00] one at a time.

Patricia:                That’s a good way to do it too. Yeah, yeah. But something like peanuts, if a child has a peanut allergy. Most parents are pretty aware of peanuts because their child has anaphylactic type, life-threatening maybe, reaction.

Dr. Weitz:            Right. But we’re really talking about sensitivities, not…

Patricia:               Correct, correct, correct. So those six foods are dairy products, wheat products, soy products, corn products, eggs. What’s your sixth?

Dr. Weitz:            It all depends. Some people would take out seafood. Some people would take out soy. They would take out…

Patricia:               So my clue is always what the child’s eating the most of.

Dr. Weitz:            Right, right.

Patricia:               And then the mother goes, “Ah! He’s going to starve to death.”

Dr. Weitz:            Right.

Patricia:               So I will tell you, I’ve never seen a child starve.

Dr. Weitz:            Here’s the pizza food group and here’s the McNuggets food group.

Patricia:               Right. So kids do not starve, but parents have to be stalwart. They have to be a Nazi and say, “I’m sorry, you can’t have that today.” And I tell them to blame me. “I met this crazy lady who told me, ‘You might do better if you didn’t drink four glasses of milk every meal.'” And for the older kids, I would bribe them. I would pay them not to eat those products.

Dr. Weitz:            There you go. A number of people have proposed specific diets for autism. I went through your book, and in there you mentioned the low oxalate diet, the yeast-free diet, the low glutamate diet, the Feingold diet, the REID diet.

Patricia:                Yep, there’s a huge chapter on dietary dos and don’ts. And these are down the line. You start with eating real food. If you eat fruits and vegetables and animal products and beans and fish and good quality fats, you don’t need a special diet because you’re not eating processed food. You’re eating real food. And real food is very rarely the problem.

Dr. Weitz:            Right.

Patricia:               And so that’s really hard from families today who don’t cook, who are in a hurry, who eat out, who order in. They drive-through. You want to eat real food. And those are the diets that kids prosper on. And occasionally we will find a child who’s allergic to garlic. But the garlic or the onion or the egg isn’t making him autistic. It’s these additives, this processing, the way the food’s grown, that is the problem.

Dr. Weitz:            The pesticides, the…

Patricia:               Oh my God, yeah.

Dr. Weitz:            … toxins, the herbicides, the fungicides, the way we grow our fruits and vegetables. And then when they get made into processed food, all the chemicals that are added, it’s just unbelievable. It’s not relieving food at that point.

Patricia:               It’s not. And I have a slide when I present this, that the heading says, “Are Goldfish crackers food?” And the answer is no.

Dr. Weitz:            Right.

Patricia:               And shame on you if you buy them, because you can’t live on Cheez Doodles and Goldfish crackers because they aren’t food. And this chapter of my book, the Dietary Dos and Don’ts, has just been republished as a standalone booklet in Greek, Spanish, German, and I think French. No, in Italian. And so they’re also available as e-books. I don’t know if you have an international audience or not, but those are available if you need something not in English.

Dr. Weitz:            Yeah, we do have people from other parts of the world. I get that little map showing and it’s like, “Oh, 14 people in Iceland have listened to my podcast.”

Patricia:               Oh, that’s great. So this is the number one thing is the lifestyle issues. Before you go on and do expensive therapies and pay out of pocket or ask your insurance, this is in your hands what you’re feeding your children, what they’re eating, what they’re drinking, what they’re breathing. This is necessary to do prior to any kinds of other therapies. And we can get in about 80% by changing the diet, by making it more nutritious, by adding in good fats, by taking away some of these potentially problematic food sensitivity foods. We can get better behavior, better eye contact, better learning, better sleep, better everything.

Dr. Weitz:            Right. And eat organic and start to work on reducing your exposure to some of these toxic chemicals…

Patricia:               Absolutely.

Dr. Weitz:            … the metals, the other… And maybe do some testing and find out what chemicals you are getting exposed to. Are there mycotoxins in your home?

Patricia:               Right, right. And some of the tests are fascinating. For instance, some doctors… I don’t know if you use a hair test. There’s some very interesting hair tests that we look at what metals are coming out in the hair. And they did this with kids with autism, and they found that many of them weren’t showing mercury and aluminum in their hair. And the first conclusion was that they didn’t have any. But then they did a challenge test with a chelator and the mercury poured out into the hair. So it wasn’t that it wasn’t in there, it was that the kids were not detoxifying it.

Dr. Weitz:            Right. That’s one of the tricky parts about testing for some of these toxins, like some of these heavy metals, is if you look at… The typical physician is going to order a serum mercury test, but that’s only going to discover the mercury that’s floating around the bloodstream. If it’s stored in some of the organs or in the bones or the fat, it’s not going to be circulating around. There’s not going to be high levels in the serum necessarily, so.

Patricia:               Right, right. And so you have to be a good detective. And that’s why I named my radio show The Autism Detective. And it’s so much fun to interview these parents who had to be a detective, what happened to their child, to these therapists, to the functional medicine doctors. I have several functional medicine doctors who I have interviewed who talk about, well, like you, where do you start? What do you start looking at when you have a child with autism? How do you peel that onion to figure out what is the most important thing that is affecting this child? And my old Autism Detective episodes, about 65 of them now are on Spotify. So you can go there and find them.

Dr. Weitz:            Cool. Yeah. Well, one of my favorite tests these days is this urine test from Vibrant called the Total Tox-Burden. And you can do 20 different heavy metals, a bunch of different environmental toxins and mycotoxins. And so…

Patricia:                Interesting.

Dr. Weitz:            … it’s a really good initial screen for toxins.

Patricia:               Who makes that test?

Dr. Weitz:            Vibrant America. Are you familiar with them?

Patricia:               I’m not.

Dr. Weitz:            Oh yeah, check out Vibrant America. It’s a premiere testing for functional medicine practitioners in particular.

Patricia:               That’s great.

Dr. Weitz:            Yeah. So another type of toxin is endotoxins. And these are often coming from bacteria that are found in the gut. And we know that gut health has a major factor in autism. So maybe…

Patricia:               Absolutely.

Dr. Weitz:            … you can talk about that.

Patricia:               Yep. Well, the word microbiome, which is who we are living with, because we’re only 10% human, it’s all the gut bugs that live in our intestines and in our belly button and on our skin. And those critters that we share our body with can be friendly and helpful, or they can be problematic. And one of the reasons I had to revise my Outsmarting Autism book was because of the research that was done on the microbiome. And that’s a brand-new word, only a little over than 10 years old. And it’s just we have ways of now evaluating our microbiome through a stool test or a urine test, and we can look at what our ratio of good bugs to bad bugs is. And we know that we need a balance. We have to have the proper balance. And our kids with autism have an imbalance, which is called dysbiosis. That’s just a fancy word that means they have more bad guys than good guys, right?

Dr. Weitz:            Yeah.

Patricia:               Yeah. And so by using probiotics and some supplements, which we know the good guys like to eat, and then they can proliferate, we can change the balance in the gut. And by doing that, we miraculously change the behavior and the focus and the ability of this child to be present and learn.

Dr. Weitz:            Great. So gut health is super important.

Patricia:               Absolutely.

Dr. Weitz:            And we do stool testing all the time. And then when we see an excess of fungus or pathogenic bacteria. Or sometimes you just have bacteria that are supposed to be there, but they’re overgrown so it throws things out of balance. One of the things that we’ll use are particular herbal antimicrobials.

Patricia:               That’s great. So people say, “Well, how did we get so much fungus in the gut?” And typically these are kids who’ve had a lot of infections. And the infections in the first two years of life were treated with antibiotics. And we know now that antibiotics have gotten stronger and stronger and stronger, and they wipe out everything. And they wipe out the good guys and the bad guys, except that the fungus are hardy and they hang around.

Dr. Weitz:            And some antibiotics like penicillin are actually fungi themselves.

Patricia:               That’s true. That’s true. And so we need to use some counteractions to these antibiotics and be more vigilant about when we use antibiotics. And most women who’ve had a yeast infection know what that’s like. It’s not good. And it often happens after you’ve taken antibiotic.

Dr. Weitz:            Right. So what about the V word?

Patricia:               What about it?

Dr. Weitz:            Is that playing a role in autism?

Patricia:               Probably, and in most kids. And I didn’t know how much you wanted to talk about that.

Dr. Weitz:            I’m not sure how much I want to talk about it either, but.

Patricia:               How safe it was to talk about it, so you can lead me.

Dr. Weitz:            I’ve been very vociferously avoiding that word.

Patricia:               Okay. So the V word is important because of what’s happened between my generation and your generation and today’s generation. And we are much more heavy-handed than we used to be.

Dr. Weitz:            Yes.

Patricia:               And so our kids today are heavily inoculated. And we don’t know what this is doing to their systems. And the inoculations also by necessity have what’s called adjuvants or additives in them, which are put there on purpose to stimulate the immune system so that they don’t have to put so much of the pathogen in. And those adjuvants are just as bad as the chemicals in our food, in our personal care products, on our furniture, because they are the same ones. They used to be mercury and that’s gone, but then they added more alumina and propylene glycol. And if you’re a kid who can’t detoxify those things, your body has to deal with them and has maybe an autoimmune reaction. But if the V word was implicated in as the number one cause of autism, every kid in America would have autism. So we know that some kids are higher risk than others. And we just want to be cautious about how we use those Vs. We don’t want to ever do it with a kid who is sick or on antibiotics because that kid is vulnerable.

Dr. Weitz:            Absolutely.

Patricia:               Yep. And we don’t want to do too many at a time.

Dr. Weitz:            Exactly. Now that’s more convenient for the doctor and big pharma if we can load up three, four, five at one shot. But that’s a lot for a kid’s immune system to deal with.

Patricia:               It is. It is.

Dr. Weitz:            And then if they have side effects, what do we do? Give them some Tylenol, which further decreases your detoxification abilities.

Patricia:               Right. So this is very hard to discuss with the mainstream. And there’s not allowed to be any controversy anymore. And it’s really important, I think, that parents educate themselves, that they read both sides, they understand what they’re doing so they can make educated, informed decisions.

Dr. Weitz:            Right. And I don’t think you have to be for or against. I think you can recognize the benefits of some of these, but yet do it in a manner that might be more safe for your particular kid.

Patricia:               Right, right. Every kid is different. And we don’t want a one-size-fits-all schedule.

Dr. Weitz:            Right.

Patricia:               Yeah.

Dr. Weitz:            So let’s talk about some of the beneficial nutritional supplements that kids with autism might be on.

Patricia:               Well, the B6 and magnesium are really important. My number one supplement for everybody, autistic or not, is vitamin D.

Dr. Weitz:            Yes. And now vitamin D with K?

Patricia:               Now vitamin D with K. I live in Pittsburgh. We have 50 days of sun. That’s not very many.

Dr. Weitz:            No.

Patricia:               And the way your body makes D is through sunlight. So if you can’t make it, you’ve got to take it. And there are lots of ways of taking it. And you want to take a high-quality pharmaceutical grade vitamin D with K, so it’s absorbed. And so you want to get your numbers up so that… It’s very protective. And from the reading I’ve been doing, I believe that it is very protective in COVID [inaudible 00:48:55].

Dr. Weitz:            Oh, a hundred percent. Not even controversial, in my mind.

Patricia:               Yeah, mine either. And those people who go down with COVID are the ones with the lowest vitamin D levels.

Dr. Weitz:            Right.

Patricia:               So I think the FDA or CDC says that a level of 25 is adequate. You want twice that. You want a good 50 or 60, would you agree?

Dr. Weitz:            Oh yeah, absolutely. 50 to 70. Yes, absolutely. Yeah. I mean, there’s plenty of data now. I know there’s still controversy. But there was a really good paper that came out a few years ago showing that women, if their level is 60 or above, their risk of breast cancer is reduced by 30%. I mean, there’s very few…

Patricia:               And colon cancer.

Dr. Weitz:            Yes.

Patricia:               And colon cancer.

Dr. Weitz:            Right.

Patricia:               Very, very protective of all kinds of things. So the best way of course is to live in Florida or Arizona.

Dr. Weitz:            I just got back from Florida. Not a big fan of living in Florida. It’s a big old swamp.

Patricia:               Right. So that’s why we have to take it.

Dr. Weitz:            Yep.

Patricia:               And again, because D is a fat-soluble vitamin, you want it with fat. So liposomal D.

Dr. Weitz:            By the way, I apologize to anybody who lives in Florida. It’s just not the place for me.

Patricia:               Yeah, nor me.

Dr. Weitz:            Yes, absolutely. Take your vitamin D when you consume fat. So you’ll have those fat enzymes that will help you to absorb it at a higher rate. And then we got the B vitamins.

Patricia:               All the B vitamins, especially B12. And James Neubrander has helped so many kids with IV vitamin B12. Very, very important with our kids. And then the B6 I mentioned earlier, the B vitamins. And it’s important to look at the B vitamins separately. They make these B50, B100 compounds, but they’re not in the ratio of what your body needs.

Dr. Weitz:            Right. And somebody else who’s an expert on autism, Greer McGuinness, who I interviewed a number of months ago. She pointed out that some of these kids can’t properly metabolize the methyl B12. And so in some kids, if that’s the case, the methyl B12, which is now the preferred form, will actually over excite these kids. And so those kids are actually going to do better on the [inaudible 00:51:54] or the hydroxycobalamin.

Patricia:               Very interesting.

Dr. Weitz:            Yeah, based on some of those methylation genes. So we also have acetyl-L-carnitine, which is kind of an interesting compound for brain health.

Patricia:               I’m not so up on that to be able to talk about that.

Dr. Weitz:            Okay, okay. So you have a chapter in your book on hormones, and I thought that chapter was really interesting because you talk about some hormones that most people don’t talk about. And you talk about oxytocin, which is generally only talked about as the hormone that’s involved in orgasm. But it has a number of other important roles in the body that you talk about and may play a role here in autism.

Patricia:               It’s the bonding hormone. It is what allows a child to bond with a mother. And with our hormone disruption, with our pesticides in our foods, we are seeing many, many, many kids who are hormonally disrupted and autistic. And that was the hardest chapter in the book for me to write. It is the cascade of hormones of how one turns into another, which begets just a couple of others is so complicated that I needed several people to help me write that chapter. It actually was the last chapter that I wrote. But oxytocin is a big one. And if you can stay away from these hormone-disrupting foods, that’s really important.

                            But the one hormone that is often seen as deficient is the thyroid hormone. And the thyroid is the master gland. And many of these kids are born to low thyroid mothers. So back to healthy parents have healthy kids. I want a mother to have her thyroid tested and balanced and made sure that it is strong enough and efficient enough to get her through the pregnancy and to have a child with adequate thyroid hormone. And you’re the doctor, you know about thyroid testing. Our typical thyroid testing isn’t complete enough.

Dr. Weitz:            No, of course not. Typically, all they do is TSH.

Patricia:               Right.

Dr. Weitz:            Nobody’s looking at the free T3 and the free T4. Occasionally they do. And then nobody looks at the antibodies, whether you have antibodies to your thyroid.

Patricia:               So if you’re thinking about getting pregnant, if you have one child with autism, you want to be sure that you get a good thyroid test from somebody who really understands all the different aspects of thyroid.

Dr. Weitz:            Yeah, you need to go to a functional medicine doctor because…

Patricia:               Absolutely. Yes.

Dr. Weitz:            Unfortunately, insurance doesn’t really want to cover that. Vasopressin was another interesting hormone that people don’t talk about that you also mention is a factor. You write in your book that it enhances muscle tone, peer bonding, and even plays a role in brain function.

Patricia:               So many of these kids have low tone. And I just had the privilege of observing twin girls. And they’re fraternal twins. They look very different. And one is like a little fire plug, and the other, I tried to pick her up, it was like picking up a noodle. And low tone is a big problem. We have to have good tone in our face to be able to talk. We have to have good tone in our hands to be able to pick things up and later to write. But the biggest area regarding tone is our digestive system. Our intestines are just one giant muscle.

Dr. Weitz:            Absolutely. Gut motility is a key factor. Alterations and gut motility is a major cause of IBS, which is the most common gastrointestinal condition.

Patricia:               And our kids are notoriously constipated or they have diarrhea, or they alternate constipation and diarrhea. And so part of it, not all of it, part of it’s what they’re eating, part of it’s that they’re not moving. But part of it is that this muscle tone in their gut is weak. And so that’s something that needs to be looked at thoroughly.

Dr. Weitz:            Another thing that I saw in new chapter on hormones, which I thought was kind of an interesting clinical pearl is you mentioned DHEA, which is another hormone that typically is not measured by doctors. And that low DHEA leads to low tryptophan, which leads to low serotonin, which we know is one of the essential neurotransmitters in the brain that can lead to depression and anxiety and all sorts of other brain issues.

Patricia:                And guess where they’re made, in the gut. And so you have a damaged gut, you’re not going to be able to produce those, and absorb your food properly, and then your hormones are off. So we’re back. We’ve gone full circle now. The proof is in the gut. We’ve got to be able to heal the gut. And functional medicine doctors are really the best at doing that work.

Dr. Weitz:            Right. Now, we just talked about oxytocin, and I just found this discussion of oxytocin so interesting. You also go into the book how it’s very common during the birthing process for women to be supplemented with Pitocin in order to induce labor, which is a synthetic oxytocin. And this may actually turn off the oxytocin production in your baby.

Patricia:               That’s right. And who thunk it?

Dr. Weitz:            Here we are injecting all these hormones going, “Oh yeah, it’ll be fine.”

Patricia:               Right. It’ll be fine. And doing these birthing procedures that do not enhance later development and post-birthing procedures. I have a whole chapter on reflexes and the importance of primitive reflexes and how our body is like a computer that’s programmed with over a hundred different reflexes. But if the baby isn’t come down through the birth canal and is taken by C-section, that is a bad situation for future reflex development, which is the pattern for talking, for looking, for reading, for standing and sitting and rolling over, all these things. So the reflex integration has been affected by the hormones…

Dr. Weitz:            Fascinating.

Patricia:                … by the birthing process.

Dr. Weitz:            Wow.

Patricia:               It’s all interrelated.

Dr. Weitz:            One more reason to avoid a C-section if at all possible.

Patricia:               Absolutely.

Dr. Weitz:            Not only is there increased risk to the mother, increased risk to the baby, increased cost, but you lose out on the development of the microbiome because the baby develops the bacteria from the mother’s womb as it’s passing through. But it also affects the primitive reflexes.

Patricia:               Right. And we’re now, thank goodness, we’re swabbing babies with mother’s vaginal fluids if they’re born by C-section. So that’s a good thing. But the better thing would’ve been to be born that way. But then we have this back to sleep movement where we’re putting babies on their backs to sleep when they’re neurologically upside down. When a baby’s on his back, his eyes are up there somewhere. When he is on his tummy, he sees his hands and he can move and he can look left and look right and look up and lift his head and use the strongest muscle in his neck to lift his head. When he is on his back, he’s like a beach whale.

Dr. Weitz:            Well, this is all an attempt to try to stop sudden infant death syndrome, that’s why.

Patricia:               Yes. Yeah. Well, guess what, we’re back to that V word where many people can correlate the timing of that sudden infant death syndrome to 24 hours prior a baby having some kind of inoculation.

Dr. Weitz:            Wow.

Patricia:                And what is sudden infant death syndrome, really? It’s probably a V reaction. And in Japan where they stopped doing that with young babies, there is no sudden infant death syndrome. And I quote that research in my book.

Dr. Weitz:            Interesting, interesting. So what do you think about using… You mentioned using the oxytocin supplementation for kids with autism. And I guess there’s also a homeopathic version.

Patricia:                There’s a homeopathic version of everything. There’s even a homeopathic version of some of the pathogens that we inoculate against. And so for those who know about homeopathy, it’s an energetic version of animal, vegetable or mineral. And so when you energetically introduce it into the body, when the pathogen comes along, the body… It’s not a foreign substance to the body. So the body says, “I know this, I can deal with this.” And that’s what homeopathy does. And for some kids, homeopathic oxytocin is enough to get their bodies awake, just as it is for some of the other things that we do use homeopathy for. And homeopathic detoxification, I talk about in the book. And that is one of the most exciting ways of getting kids back to themselves in a very gentle, sequential fashion.

Dr. Weitz:            Cool. Another hormone you mentioned is that some of these kids may have high testosterone, and that can result in aggression and some of the other symptoms.

Patricia:                Right. And testosterone…

Dr. Weitz:            And that could be…

Patricia:                What?

Dr. Weitz:            Yeah. That maybe is one of the reasons why it’s more common in boys.

Patricia:                That’s what I was just going to say. That testosterone and mercury are a bad combination because it potentiates the problem and that’s what looks like aggression. And so the doctors, Geier, G-E-I-E-R, Mark, and can’t remember the other one’s name, they were using Lupron to lower the testosterone in boys. And they were accused of castrating their autistic patients. But they were very, very successful by lowering the testosterone and chelating the mercury to bring down the aggressive behavior. And the girls with autism typically have high testosterone levels…

Dr. Weitz:            Interesting.

Patricia:                … which is fascinating. They’re more masculine in their features and their levels are too high. And estrogen is protective from some of the metals and from some of the chemicals and the viruses. So we want to, again, and this requires very careful management. This is not something you go and do yourself. This requires a doctor who really understands these hormones.  This chapter that you have focused on doesn’t happen to be my area of most expertise, but I’m glad you did it because it’s really, really important for parents to understand how complicated this autism picture is. It’s not just about one thing. It’s not about poor speech and not having friends and not having eye contact. It is biological. And the biology of autism is where our important functional medicine doctors are going. And this started with Martha Herbert. She would be a great one for you to have on your show. Martha Herbert wrote the book The Autism Revolution. And she was one of the first doctors to talk about, “This is a biomedical problem. This is not a psychiatric disorder.”

Dr. Weitz:            Right. You have a chapter in there about structural work, and you mentioned chiropractic, and I’m a chiropractor, so I thought that was kind of interesting.

Patricia:                Right. And you know that the birth process causes all kinds of issues if it’s not clean and easy. And so many of our kids with autism have a history of traumatic birth. And many chiropractors want to be present at birth. They want to catch that baby. They want to do teeny-tiny little manipulations to balance out anything that might have gone wrong during that birth process if there was use of vacuum aspiration or forceps. Those are absolute necessities to have a good chiropractor on your team.  And there are so many other methods that chiropractors use, like craniosacral techniques or myofascial techniques that some of them are done just by chiropractors. Some of them are tools in the tool chest, say, of occupational therapists or physical therapists or other medical practitioners who can help balance this out, some structural issues. And some of them may be obvious, like a head tilt or a child who is walking crooked. But some of them may not be obvious to a parent or a teacher. And it’s important that you have a good structural evaluation of a child with autism.

                                And some of them, some of chiropractors work with optometrists. And I have gotten particularly interested in vision on my website, which is my name, patricialemer.com. There are several long interviews like this about vision, and I’ve titled most of them, Vision Is More Than Meets The Eye. And what happens if the two eyes are not working together, if the brain and the eyes don’t work together, if a child is having double vision or is not using the eyes well together, it may not be obvious. And a good developmental optometrist can work collaboratively with a chiropractor to do therapy that can help this child use vision more efficiently. And I don’t mean eyesight, I don’t mean the clarity. I mean something conceptual, organizational. When you say someone has vision, you’re not talking about the prescription in their glasses. You’re talking about something, about thinking, that is missing in many of our kids with autism.

Dr. Weitz:            Cool.

Patricia:                Yeah.

Dr. Weitz:            There were a couple of other things when we spoke before we started that you wanted to make sure we covered.

Patricia:                Besides vision and other sensory areas. Many kids with autism see occupational therapists. And the occupational therapist works on sensory issues. Temple Grandin, who’s probably the most famous adult autistic, she talks about her sensory issues, her tactile, her olfactory, her auditory sensitivities. But vision gets its own chapter. And again, an OT and an optometrist should collaborate.  And the other area that this book has, that my book Outsmarting Autism has that is often neglected, is the dental area. If you look at kids with autism, many of them have overbites. They have very narrow and high-arched palate and they’re not getting good breathing and good oxygen to the brain. So a good functional, holistic dentist who doesn’t use fluoride, who understands why our palate should be wide, is an important member of the autism team because they can put expanders in the jaw and open it up, which will help breathing, will help speech, which will help get more oxygen to the brain for thinking. And so I have a whole chapter on that, which is another really important piece of the autism puzzle.

Dr. Weitz:            Yeah, that’s super important. And proper breathing techniques like learning how to breathe through the nose and not through the mouth, and maybe even using mouth taping or other techniques.

Patricia:                Yep, the mouth is for eating, the nose is for breathing.

Dr. Weitz:            Excellent. Excellent, Patricia. So we’ve covered a lot of great information. So any final thoughts? And then let people know how they can find out about your book and get in touch with you.

Patricia:                So as a final thought, I told you early on, where I really have made a difference is helping people understand the sequence of working with a child and why sequence matters. And my book is written in sequence with five steps of how to get your child better functioning. And it has to start with the biology of autism. It has to start with lifestyle, with diet, with sleep, with hydration, and with movement. Those are the way we function best when all of those are on par. And people don’t want to start there. They come to you or me and they say, “My child’s not talking.” Well, I can’t get him to talk if he’s living on Twinkies and Coke. It just doesn’t work that way. He has to have good gas for his car to be able to talk. And he’s not going to talk if the muscles of his tongue and his lips and his cheeks aren’t working, and if those mouth and eye and facial reflexes aren’t working. So you’ve got to be patient for talking.

                                “And he doesn’t have any friends.” Well, socialization is the end product of all these things coming together. And that’s why the subtitle of my book, Outsmarting Autism, is so important. Build Healthy Foundations for Communication, Socialization, and Behavior at All Ages. And we didn’t talk about ages, but it’s never too late. It’s never too late for some of these young adults today to start using communication skills. Some to be able to be more independent, to eat better. Their lifespan is… we’re getting it to be longer and longer by helping them eat better, sleep better, and have better health.

                                And so all of this is in my book, Outsmarting Autism, which is available, as you said, on Amazon. It’s in a 600-page paperback with the world’s best index and also comes as a Kindle that you can read on a tablet. And there’s also an audiobook, which I do not read. They hired a professional actress to read the book. And you can go also, I have two websites. I have patricialemer.com, and my last name is spelled L-E-M-E-R, one M. And I have outsmartingautism.com. And both of them have lots and lots and lots of information on them.

                                And then I’m on Facebook, Patricia Spear Lemer, S-P-E-A-R. And Outsmarting Autism also has its own Facebook page. And you’ll see that I travel all over the world and I like posting on Facebook. And I often post what I’m doing related to autism. And that my Autism Detectives podcast is… I post every time. I have a new podcast, which is the second and fourth Tuesday of the month at 1:00 PM Eastern, 10:00 AM Pacific. And it’s on something called healthylife.net, which is a web streaming radio station. So you can listen live. But the best way is to find it on Spotify and I post it like a day or two after I’ve done it live. So there’s tons of those to keep you busy if you want to know everything there is to know about autism.

Dr. Weitz:            There you go. Excellent, Patricia. And are you still working with clients?

Patricia:                No, I’ve retired about 15 times. If you have questions though, I’m happy to answer them. My email address is developdelay@gmail. And that’s D-E-V-E-L-O-P-D-E-L-A-Y, developdelay@gmail.com. And that’s the way I work with clients. It’s best for me if I don’t have to go through what’s in my book. And I realize that every parent has a great story. I’m gotten too old to listen to the long story, so I’m not a good listener. But I sure would be happy to help you find resources and figure out the best sequence to helping your child if you want to email me.

Dr. Weitz:            Excellent. Thank you so much, Patricia. Fact-filled podcast.

Patricia:               Well, Ben, this has been fun. I really appreciate the opportunity to be on your show.

Dr. Weitz:            You got it.

Patricia:               Thanks so much.

Dr. Weitz:            Thank you. Thank you.

Patricia:               Okay.

 


 

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 White 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.