Kashif Khan discusses Functional Genomics with Dr. Ben Weitz.

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Podcast Highlights

4:12  Genetics vs Functional Genomics.  The difference between genetics and functional genomics is that genetics might tell us here’s what this gene does and we’ll speak about it independently.  For example, when it comes to methylation, you might say that you have the MTHFR gene and you need to take folate is genetics. Functional genomics looks at how the body actually works and recognizes that methylation is one part of phase two of detoxification. There is also glutathionization, glucuronidation, and antioxidation.  There’s all these detox functions happening in the body.  And if I don’t pair them, I haven’t understood the full cascade.  What does my body do from the point that a toxin enters to the point that it gets out?  So first understand that, and there’s not one gene that does every single step along the way.  There’s multiple processes.  When you connect them and you have your full functional answer, you can then solve the problem fully also. 

5:39  Kashif made an appearance on Ari Whitten’s Energy Blueprint and Ari asked if a woman has the BRCA gene should she have her breasts cut off?  The genetic answer is yes, but that is because pure genetics is pharma and disease backwards.  If you have the genetics and you ask why are you waiting to treat the disease, then you would remove the breasts.  If you ask the wrong question, you get the wrong answer.  But instead, if you ask why does the disease happen in the first place?  You understand that BRCA doesn’t cause cancer. BRCA is actually a tumor suppressor and when you have breast cancer, BRCA is supposed to come along and fix it.  And if you have the wrong version, you just have a bad repair tool. So you’re more likely to die from breast cancer because you can’t come back from it. So we’re solving the wrong problem once again. Why did the cancer happen to begin with?  That question is better answered by looking at if the woman is estrogen dominant and does she make a lot of estrogen?   Also, how does she metabolize her estrogen, which can be analyzed with DUTCH testing that measures which pathway the body uses to metabolize estrogen–the 2, the 4, or the 16 hydroxyestrogen pathway, with the 2 being healthiest and 4 and 16 being more toxic.  Bad genes do not equal disease. You also have to look at diet, lifestyle, and environmental exposures.  This woman’s bad choices may be that she goes on the birth control pill for 10 years that elevates her estrogen level.  Then she goes on Bioidentical Hormone Therapy (BHRT).  Not that you shouldn’t go on BHRT, but if you take the wrong form of estrogen and if you cook with a teflon pan and use conventional cleaning chemicals and get exposed to pesticides on her lawn that fuel the 4-hydroxy pathway.  Why do we see breast cancer more commonly around the menopause age?  It is because at that age, you no longer have a menstrual cycle and you no longer have the ability to get rid of this toxic load that you’re making every month. And your body stores it in fat, such as in your breasts, to protect you because it doesn’t want your organs and your vasculature getting damaged.  This reduces potential inflammation in the arteries, but it leads to inflammation in the breasts and you may get cellular degradation, mutation, and eventually cancer. And if you have the wrong version of BRCA, you’re not going to fight the cancer so well.

 

                            

                              



Kashif Khan is the Chief Executive Officer and Founder of The DNA Company, where personalized medicine is being pioneered through unique insights into the human genome. The website is TheDNAcompany.com. With a background in business, Kashif dove into healthcare and functional genomics and he has a successful podcast, The Unpilled podcast, and an upcoming book being released on May 16, The DNA Way.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also 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 speaking about personalized medicine based on your genetics. We’ll be speaking with Kashif Khan, who’s the chief executive officer and founder of The DNA Company, where personalized medicine is being pioneered through unique insights into the human genome. With a background in business, Kashif dove into healthcare and functional genomics. He also has a successful podcast, the Unpilled Podcast, and an upcoming book to be released on May 16th, The DNA Way.  Kashif, I recently heard you on Ari Whitten’s The Energy Blueprint, and I was blown away with the way you were able to couple explanations of various SNPs, DNA variants, and how they affected various metabolic pathways and how certain diet, lifestyle and supplement approaches might help to steer a patient towards greater health. Prior to this, I’ve spoken to other experts on genetics. And often, we get simplistic explanations like you have the C677T or the A1298C variant of the MTHFR gene, and therefore you need to take methylated folate and B12. And that’s pretty much the end of the story.

Kashif:                  Yeah. Something as complex and powerful as a human genome has been brought down to “Here’s a supplement you need because of one gene, and that’s all we’re going to talk about.” And I’m not saying that that’s not useful information, but the clinicians that are using these tools haven’t… So the tools are too difficult to use. Let’s start there. So when it’s too difficult to use, there’s one or two tricks up your sleeve that you stick to and that’s it because how much time do we have to reeducate ourselves? And so there is so much more, and that was part of our mission, is making it easy to use so it’s easy for people like yourself to implement. And there’s so much more we can do than just “Here’s your folate.” Right?

Dr. Weitz:            Right. And I just want to let you know that we have a fair number of healthcare practitioners and also educated consumers. So in our discussion, feel free to dive deep into the science if it’s appropriate.

Kashif:                 MTHFR.  Well, let’s use that as an example. You’re talking about a methylation gene. And just this morning, I was speaking to this influencer from the UK that calls herself the MTHFR guru or something. I said, “That in itself tells me you’re not a guru because you don’t understand methylation, that that’s one gene in a cascade that builds up a system.”  You have to first understand human biology, and this is where genetics is broken. A gene is not independent of the process happening in the body. It’s like looking at one link in a chain and then making a judgment on the whole chain, and they’re all different sizes and different qualities.  And so methylation is a cascade of a multitude of genes, six or seven of them. So if I tell you, “Your MTHFR is off. You’re not doing so well there,” you still don’t know where to intervene because it starts at B12 metabolic pathway B9. Is it folate or is it folinic acid? And what do you actually need? And if you know what part of the chain isn’t working, MTHFR means the cascade in itself is inefficient, but how and where do you intervene? So we can be a lot more precise and we can give someone exactly what they want. And then it’s no longer “This has a 80% chance of working.” It’s now “100% of the time, we’re going to get it right.”

Dr. Weitz:            And that’s an example of the difference between functional genomics and genetics.

Kashif:                 Exactly. Genetics is “Here’s what this gene does, and we’re going to speak about it independently.” Functional genomics is “Here’s how the body actually works, and let’s look at that first. And not only let’s look at the system, but let’s look at how several systems interlink.”  And I’ll use methylation as another example. Methylation is phase two of detox. If I only focus on that and don’t understand phase one first, methylation is like, “Here’s the door open to take the garbage out.” If I don’t understand who’s picking up the garbage and bringing it to the door, I’ve only solved half the problem, right?

Dr. Weitz:            Right.

Kashif:                 There’s glutathionization. There’s glucuronidation. There’s antioxidation.  There’s all these detox functions happening in the body.  And if I don’t pair them, I haven’t understood the full cascade.  What does my body do from the point that a toxin enters to the point that it gets out?  So first understand that, and there’s not one gene that does every single step along the way.  There’s multiple processes.  When you connect them and you have your full functional answer, you can then solve the problem fully also.

Dr. Weitz:            Yeah. Well, we don’t really need to do that because as soon as the person brings the garbage to the door, you just shoot them in the head. No, I’m just kidding.

Kashif:                 That works.

Dr. Weitz:            So when you were talking to Ari Whitten, Ari Whitten asked you a question about the BRCA gene. And I loved your answer, so I want to ask you the same question again. And he basically said, “If I’m a woman and I have the BRCA gene, should I have my breast cut off?”

Kashif:                  Yeah, so that’s exactly the… That paints a picture of genetics. So genetics is pharma and disease backwards. Here’s the disease, and how do we treat this disease? They’re asking the wrong question to begin with. If you have somebody’s DNA in hand, their human instruction manual that tells every cell in the body what to do, why are we waiting to treat a disease? Why don’t we ask, “Why does the disease happen in the first place?” and not have it? So when you ask the wrong question, you get the wrong answer.  And so the answer we now have is a certain version of BRCA means cancer risk. That in itself, by the way, is a false statement. BRCA doesn’t cause cancer. BRCA is a tumor suppressor. So when you have breast cancer, god forbid, BRCA’s supposed to come along and fix it. And if you have the wrong version, you just have a bad repair tool. So you’re more likely to die from breast cancer because you can’t come back from it. So we’re solving the wrong problem once again. Why did the cancer happen to begin with?   So I can give you one example, the same example I gave Ari, because I would say it’s the most prolific and easiest to deal with. Some women in their hormone pathway make a lot more estrogen. They’re estrogen dominant, and this is very easy to predict genetically the hormone cascade and how you go from progesterone to testosterone to estrogen. The genes that do each one of those steps, to what degree are they working efficiently or not efficiently? So some women just make a lot more estrogen. There’s a big pool of it every month. Step one of three.  Step two is when you have your monthly cycle, you’re not clearing estrogen. You’re clearing a metabolite. And there’s three options: 2, 4 or 16-hydroxy estrogen.

Dr. Weitz:            Right.

Kashif:                 Some clinicians listening here have done DUTCH testing and looked at these things, right?

Dr. Weitz:            Right.

Kashif:                 So 2 is the good, clean stuff you want. 4 and 16 are toxic. 4 has a lot of publications and education around its connection to breast cancer, but we still haven’t answered the full question as to why.  Then we look at functionally okay, I’m estrogen dominant. I make too much. The version that I make is a toxic version. I go down the four pathway. Well, let’s look at how well I detoxify it because again, how does the human body work? So you do look at glutathionization, antioxidation, COMT, which is the tail end of methylation, and you start to look at the jobs that your body does well or not so well. And you may understand that not only am I estrogen dominant, estrogen toxic, but I also don’t have the right detox genes kicking in to help me get rid of it.

                                So now you have the avatar, the profile of the woman who truly is at risk, but she still may not get sick. So what’s the difference between the woman at risk and the woman that gets sick is the epigenetics. You have to pair these two, and that’s another layer to functional genomics. It’s not just “Here’s your genes.” It’s also what are your habits? Because bad genes doesn’t equal disease. Bad genes equals elevated risk, right?

Dr. Weitz:            Right.

Kashif:                 You have to do something to create chronic disease. You’re not born with breast cancer or Alzheimer’s or diabetes. These things develop because of your choices that you make. One other thing…

Dr. Weitz:            Because of your diet, your lifestyle, et cetera.

Kashif:                 Exactly. And some of these things are obvious. Some of them are completely counterintuitive, that you would never think are related to the problem. So for this profile, now we say this woman’s bad choices may be that she goes on the birth control pill for 10 years and elevates that estrogen level. She goes on BHRT. Not that you shouldn’t take BHRT, but where do you intervene? What hormone are you taking? Is it estradiol? Is it estriol? Where do you actually plug in that hormone, and are you fueling that 4-hydroxy pathway or not? She may not understand the hormone disruption in her environment and what her Teflon-coated frying pan and her cleaning chemicals and her pesticides that make her lawn so beautiful are doing to her body.  So now, you have… The woman has a profile. She also has the wrong choices that are misaligned to that profile and what it’s capable of. And now, you get to the level where the genes can’t handle it anymore. There’s too much of that net 4-hydroxy causing too much inflammation.  So then last step, going back to biology, why is it that you typically see breast cancer around the menopause age?  It’s not because that’s when BRCA magically creates a problem. It’s because at that age, you no longer have a menstrual cycle and you no longer have the ability to get rid of this toxic load that you’re making every month.  And your body, to protect you because it doesn’t want your organs and your vasculature, your veins, getting damaged, will store it in fat.  It says, “Hey, I’m smart. I’m going to get rid of this stuff and not cause inflammation. Let’s put it in fat.” And women have fat in their breasts, and in the breasts you have all these glands and ducts for which the cellular structure was not designed to deal with that level of inflammatory insult. Then you get cellular degradation, mutation, eventually cancer. And then if you have the wrong version of BRCA, you’re not going to fight the cancer so well.

Dr. Weitz:            Right.

Kashif:                 Right? After all of that. So now you name a chronic condition. It can be laid out in this manner so that we can understand how to prevent it. Why would it happen to me? And my why might be different than somebody else’s why. That’s functional versus genetics.

Dr. Weitz:            What are some of the important genetics related to cardiovascular disease? We know about familial hypercholesterolemia.

Kashif:                 Yeah, so that’s a perfect example.  Cholesterolemia, to me, is a myth. It’s not a disease. It is the response to the true disease, which is endothelial inflammation.   So when we look at the genetics of heart disease, which is the number one killer, still number one drug prescribed is statins.  Why is that so?  Because most of us are not genetically designed for today’s reality.  What does that mean?  Our hardware, our endothelium, the actual inner lining of the blood vessel, most of us don’t have the best quality endothelium. We can actually predict that genetically. Is it stainless steel resilient or is it more paper thin, this papyrus that’s prone to inflammation, right?

Dr. Weitz:            Right.

Kashif:                 Most of us are walking around with that, the not so good stuff. So if that’s the case, and just like this breast cancer woman you happen to be breathing in the wrong stuff, eating the wrong stuff, having the wrong stress load, the wrong sleep load, et cetera, et cetera, et cetera, and you may also pair that with the wrong detox pathway or inefficient detox pathways that can’t support the inflammation being caused here, you’re going to get endothelial inflammation, which is the actual disease. Your body then responds with cholesterol as a hormone to reduce the inflammation. It acts like a Vaseline dealing with all these microabrasions and tears and inflammation and resolves them. The same oxidation and toxicity that caused the inflammation also oxidizes the cholesterol and causes it to harden and deposit because our body didn’t understand that our 200,000 years of caveman habits were going to be deposited in this industrial reality at some point. And so it hasn’t changed yet, and we still are not prepared for this.  So that’s the true why behind cholesterolemia. And if you understand this, not only can you predict it and prevent it, but if you have it, you can deal with the root cause and then prevent it. Or sorry, reverse it.

Dr. Weitz:            Right. Okay. How can our DNA blueprint help us to determine what type of diet might be best for each person?

Kashif:                 Yeah, there’s a lot that can be said there. Starting with the brain, and this is… What I’ll speak to is the unique things. There’s obvious things like there’s genes that tell you how you metabolize fats and starches. There’s genes that tell you how you break down chickpeas, lentils and “Should I actually be a vegan?” My primary protein sources, do I actually make the enzymes efficiently to digest them, or do I get bloated and not eat enough? Right?

Dr. Weitz:            Right.

Kashif:                  So those are the basics. Then there’s things that are a little more functional in nature. So how do we look at the human mind and determine why some people just perceive things differently? So do they not produce or bind enough dopamine, so it’s hard for them to experience pleasure? In which case, they may lean on food as a source of pleasure and overeat without even knowing it. Is their serotonin pathway dysregulated and they’re slightly more irritable?  It’s easy to dysregulate their mood because their serotonin receptors are a little too short and they can’t bind it efficiently. These people end up leaning on food as coping mechanisms because they’re constantly stressed.

                                There’s a gene called MC4R that determines the satiety of the palate. So as an ancestral trait, typically there wasn’t enough food. So we developed this desire to seek variety in our palate, a lot of us. And so it’s like, “Give me the crunchy. Give me the soupy. Give me the salty. Give me the sweet to make sure that I got enough nutrition.” And we’re still walking around with this trait and then going to the grocery store and filling our carts where it’s so convenient to overeat. And then when you get home and you have your meal, it’s not enough. You still need to graze to the pantry, the Doritos and the cookies, because you’re not satisfying the palate.  Same thing for the gut. There’s genes that determine how efficiently you feel full, that signal from the gut to the brain, and maybe your plate being appropriate just isn’t enough. You need to wait. Maybe you need a glass of water. So there’s a lot we can speak of these hidden areas when it comes to diet planning that go far beyond calories in and calories out.

Dr. Weitz:            Let’s talk about one particular gene, the APOE gene. And if a patient has one or two copies of the APOE4 variant, we know that they have an increased risk of Alzheimer’s. What does that tell us about what we can do about that?

Kashif:                  So another great example of how functional genomics can support that genetic question, so genetic… We do test for APOE and we do report on it, but there’s a lot more you need to know than just APOE. So APOE is how well do I, to keep it simple, transport lipids and more likely to develop amyloid plaque in the brain?

Dr. Weitz:            Okay.

Kashif:                  Which is highly connected to Alzheimer’s and dementia. So even then, people walk around with APOE34 and 44 don’t get sick. What’s the difference? Something has to trigger the inflammation.  Everything that we talk about that’s chronic in nature is typically rooted in inflammation. So if you do everything right, you could have the APOE 44 and have a better brain than somebody that has the APOE 33 that did everything wrong. All we’re saying is that this is a priority for you. This is a red flag. If you’re APOE34 or 44, you need to focus on this. What’s your health plan to make sure it doesn’t happen? What are the potential things you look at? Same thing as the breast cancer.   If you produce toxic estrogens, which is why, by the way, 80% of Alzheimer’s and dementia cases are in women. The vast majority are in women, and it’s much harder for women to reverse and deal with because they’re also dealing with the estrogen toxicity which leads to more inflammation.   A vast majority of today’s dementia is rooted in inhalation. What are we breathing? I spoke to a brilliant guy, Dr. Tom O’Bryan, that deals with a lot of [inaudible 00:17:39]-

Dr. Weitz:            Oh, yeah. I know Tom well.

Kashif:                 Yeah. So what he told me is that 66% today of what he sees is inhalation based, what we’re breathing.

Dr. Weitz:            Huh.

Kashif:                 One hour of LA traffic is equivalent to a pack of cigarettes.

Dr. Weitz:            Wow.

Kashif:                 So if that’s what you’re doing on your drive home every day and you’re creating that level of inflammation, if you have the APOE34, that may be the trigger that causes the inflammation for which you don’t transport the lipids that well. So again, go to the why. This is your… Genetics is red flag. You need to focus here. Functional genomics says, “Well, what do we do about it?”

Dr. Weitz:            Right.

Kashif:                 Right. “80% chance of Alzheimer’s. Good luck,” is not enough of an answer.

Dr. Weitz:            Do we know what kind of diet is going to be best for somebody who is APOE44?

Kashif:                 Well, it depends on what the actual trigger is. So if it’s-

Dr. Weitz:            Okay.

Kashif:                  So for example, if it is the inhalation-based, diet may not be their problem. Right?

Dr. Weitz:            Ah, okay.

Kashif:                  For a lot of people, it’s insulin based. So low insulin, low glycemic index. There’s some people that don’t metabolize fat so efficiently and [inaudible 00:18:50].

Dr. Weitz:            That’s exactly the question I was going to ask, because I know some people employing a keto diet to help reduce risk and other people are employing vegetarian, low-saturated fat diet to reduce risk. And you’re saying it depends on what other genes-

Kashif:                  Yes.

Dr. Weitz:            … are involved.

Kashif:                  There’s a lot of people we work with that got on to Keto and they felt amazing in the first three or four weeks. It’s impossible to not feel amazing because you start burning your fat as fuel and you get ketones firing in your brain. Everything feels good. But then you get five, six week in into it and you start feeling sluggish and like, “Well, what else do I need to change? There’s something…” Because you felt so good, you don’t blame it on the keto. But if your APOA2 gene, a different gene, is off, you don’t metabolize saturated fat so well. And five, six weeks into it, you’re going to feel horrible.  And that can actually drive an insulin response, by the way. We don’t think of fat driving an insulin response, but ultimately if you eat too much fat, it turns into glucose anyway and it can drive an insulin response. So yeah, we can be hyper precise on the exact plan.

Dr. Weitz:            Interesting. So fats can drive an insulin response. I’ve not heard that before.

Kashif:                  And the reason you haven’t heard that, and I’m going to poke fun at you for some time right now.

Dr. Weitz:            That’s fine.

Kashif:                  Medical research is all done on Western European white males. It’s designed for you. It’s not designed for my pigmented skin. It’s also not designed for women. This is why dark people and women suffer more in our healthcare system than Western European white men. So the truth is that the genetics of South Asian people, brown people, we get an insulin response from fat.

Dr. Weitz:            Interesting.

Kashif:                  It’s not spoken of anywhere. And it’s not just South Asians. There’s other ethnicities as well. So we have a global medical model that was designed on one cohort of people, which great. You’re going to do well. But the uniqueness, the bioindividuality is there. We’re not all the same, and we’re starting to understand that. That’s part of what we’re pioneering, is how do we make this thing unique to the individual? It’s not about one set of research for everybody.

Dr. Weitz:            Right. And it’s not even about one set of research for a race either. We don’t want to just make a simplistic conclusion and say all Asians should follow this program or something like that.

Kashif:                  Yeah. So China is not Asian and it’s not Chinese. There’s two races that make up China, and they’re very different. So if you look and… Picture this. People from China either look like Bruce Lee or they’re big like [inaudible 00:21:41] the panda bear. And that’s what you get. There’s nothing in the middle. And there’s actually two major races that make up China, these highly androgenized, testosterone-dominant, rippled muscle 90-year-old grandma walking around doing her own groceries or these big, thick people that have a lot of fat on them and big heads. Those are the two races.  So even between those two races, it’s not the same answer. And we’ve learned this genetically that the uniqueness of how people… And why. These people are highly estrogen dominant. These people are highly androgen dominant. Eventually at some point, they came together and formed China. So you can’t give the same answer to those two people even though they both think they’re Chinese.

Dr. Weitz:            Huh. It’s all based on their genetic differences.

Kashif:                  Yep. Exactly.

Dr. Weitz:            What about the relationship between genes and mood?

Kashif:                  Oh, huge. So that’s the first place we always start. It’s very hard to support someone in their health journey if they don’t understand how they think.   So first of all, the way they think things are happening and their perception versus what’s really happening, and there’s no good or bad to that. There’s just always a gap. Everybody has some unique perspective.

                                Also, as a coach or a healthcare practitioner, how do you actually guide this person? So how do they seek reward? What motivates them? Do they burn out? Do they procrastinate? Do they have highly reward-seeking tendencies, the opposite, where they may overdo it? Are they highly skeptical, and then do they only learn experientially? They need to go through it. You can’t just tell them, “Go do this,” and they’ll do it.

                                So everything about if… Let’s just say this. If I had your DNA in hand, I don’t ever need to speak to you to understand your personality and habits to a T. I can describe you and who you are, whether you should be an accountant or whether you should be an entrepreneur to a T, and it’ll blow your mind. Why? Because we spent three years clinically studying 7,000 people.

                                So one by one by one, we interviewed 7,000 people, sometimes a single interview to many months of work depending what they were dealing with, and we understand how the neurochemicals drive behavior. And it’s indisputable, because this chemical causes you to feel like this. And this is how you make it. This is how you bind it. This is how you clear it, so this is how long it lasts. I can now predict how you deal with that. And there’s multiple things we look at. And now all of a sudden, here’s your personality map. I know it. It’s very, very clear.

Dr. Weitz:            That’s amazing. I saw somewhere where you said the COMT gene plays a role in altruism.

Kashif:                 Yeah, so the COMT gene clears-

Dr. Weitz:            Does altruism actually even exist? I have my undergraduate degree in philosophy.

Kashif:                 Well, here’s what I believe about all mood and behavior and behavior traits. They are based on your context. So we are all wired to do something. We’ve inherited our ancestral genetic legacy. Take me, for example. I have what we call warrior genetics. I need to be on the frontline fighting. Whatever I did yesterday is not good enough anymore. And if you look at my ancestral lineage, it comes from Afghanistan from some level of royalty, let’s call it, that were constantly fighting for the throne. Right?

Dr. Weitz:            Okay.

Kashif:                  So stress was just part of life. Fighting was part of life. The status quo is not good enough. That causes depression for me because I can’t experience pleasure like the average person. I need to fight.  So when it comes to COMT, COMT clears your neurochemicals. Not all of them, but a couple of key ones: dopamine and noradrenaline. And so your ability to experience emotional recall is based on noradrenaline. And if you clear it quickly, you may be a little bit confused about what things actually mean and then what they feel. Your recall may be a little off. But the opposite is also true. If you clear it very slowly, you’re really deeply connected to the impact or the emotion that you had in any given scenario, and you use that as a tool moving forward. And that’s your filter.

                                So now when you’re dealing with people, you may have more empathy. You may have more EQ. You may be able to read them and understand exactly what they need and want, and then they perceive you as that person. And it becomes a superpower. But put it in a different context where, god forbid, there’s a car accident, every time you go down that street it’s trauma because you’re remembering the feeling, not just the information.

                                So this innate understanding of how you’re wired, whether we use words like anxiety, depression, addiction, is based on what context you’re using that tool in. The same thing that can cause depression for me can also cause addiction because my baseline ability to feel pleasure and reward is very, very low. So if I just go do the average thing, I’m going to be depressed. If I find the thing that gives me pleasure, I’m going to be addicted. If I find the thing that gives me reward, because dopamine powers both pleasure and reward, I’m going to achieve. And guess what? I’ve experienced all three of these things. So context is key. Understanding who you are first and what the ideal context is and knowing what the more deleterious context is and what may cause you a problem, then you can choose how you feel.

Dr. Weitz:            Interesting. We screen for vitamin D quite often with our functional medicine clients. I find most people, we have a tough time actually getting the vitamin D up to a really target level. So depending upon the person, 50 to 70, 60 to 80. And then yet a few people, we give them a modest amount of vitamin D. What I consider a modest amount, 5,000. All of a sudden, it goes over 100. And I saw an article where you were talking about how genes control vitamin D metabolism and why most people are vitamin D wasters.

Kashif:                  Yeah. So what’s going on there, of all the micronutrients, vitamin D has the most complex metabolic pathway, the genes that drive it. Because again, ancestral traits, our ancestors weren’t indoors on Zoom calls. They were outdoors most of the day. Agricultural. They were outdoors doing stuff, which means that they were overexposed to vitamin D so their bodies had to learn how to mitigate that exposure.

                                And so what do we do? The first gene takes D2 from the sun and converts it into D3 and gets it into the blood. Step one, I need to metabolize it and turn it into the active form that I can use. Then once it’s in the blood… And this is why the measure of what’s in the blood is not enough of a measure. That’s only step one. That’s only telling you how much the person metabolized.

                                There’s a second gene that then takes that D3 and transports it to the cell. So picture these little taxi cabs that are moving it along and getting it to where it needs to be. Once it gets there, there’s a third gene that binds it and gets it into the cell. And any one of these can be off.

                                So you might have somebody that metabolizes vitamin D really well, but they don’t transport and bind it really well. So that person needs multiple doses because if you give them 5,000 IU, they will only use 1000 of it. They just can’t efficiently get it there and fast enough and bind it fast enough.

                                The opposite could be true. They may be really efficient at binding and transporting, but they don’t metabolize. So they might need 10,000 IU. They might need a lot more, especially in the winter, depending where they live.

                                So you can be really precise. And of all the micronutrients, the number one priority is vitamin D. That’s where you need to focus. Of the 22,000 genes that make up your genome, all of these little instructions in your cells, 2000, so almost 10% of your biochemistry, is dependent on vitamin D. So these genes don’t express if you don’t have the right vitamin D, which is why it affects-

Dr. Weitz:            Wow, wow.

Kashif:                  … anything from mood to skin, everything. So it’s really more so… And you know this. It acts more as a hormone than it does a vitamin.

Dr. Weitz:            Yeah.

Kashif:                  And so it’s key to be precise there, and this is why we built that specific pathway because it really… My niece is a perfect example. She was almost being prescribed a anxiety pill. She was getting anxiety attacks and couldn’t breathe, and I figured out all it was is because she was being homeschooled during COVID when schools were locked down and she got zero vitamin D. She hadn’t been outside in five months.

Dr. Weitz:            Oh, wow.

Kashif:                 And her vitamin D pathway is horrible. And she just needed more vitamin D and a little bit of L-theanine to boost her dopamine levels. That was it. And she was being prescribed an anxiety pill, which she would’ve probably still been on today.

Dr. Weitz:            Right. That’s awesome. Couple more questions. How do our genes tell us about our ability to fall asleep?

Kashif:                 Sleep is… That’s one question, how do I fall asleep, then there’s also how do I stay asleep? And there’s also how do I sleep through the night and actually feel rested? [inaudible 00:31:23]-

Dr. Weitz:            How do I get quality sleep? How do I get good deep sleep? How do I get good REM sleep?

Kashif:                 And those are all different things genetically. So the first one is based on circadian rhythm. So how efficiently does my clock work? So if my clock… There’s two genes. There’s literally a gene called CLOCK, which makes a CLOCK protein which allows your body to understand what time it is. And then there’s BDNF, brain-derived neurotropic factor, which also heavily regulates circadian rhythm. And so if you’re not doing well there, then your body is going to need a very strict routine to be able to fall asleep on time, which means waking up at the right time, getting sunlight and vitamin D at the right time, pausing to breathe a few times during the day, some kind of light sauna or stretching type activity in the evening, no blue light, turning off the TV a couple hours before. We can be very precise about your sleep problem and why you can’t fall asleep, but that same problem doesn’t affect why you can’t stay asleep. That’s a different problem which is more based on serotonin and cortisol.

                                Those are very different problems where if your serotonin is dysregulated, which means your brain is more sensitive to stimulus, it notices everything. And you make your serotonin in the second half of the night in your gut, and your body uses serotonin to wake you up. And it’s literally waiting for sunlight to say, “Okay, time to get up. Let’s bind that serotonin.” But if your brain can’t prioritize stimulus because your serotonin pathway is off, then it’s responding to everything in that second half of night. When the temperature changes, when there’s a smell, when the hubby pulls on the blanket and it touches your skin, every little stimulus in that second half of the night your brain confuses for the sunlight coming through the window and you get up, go to sleep. Get up, go to sleep. Get up, go… So it’s a different problem to solve.

Dr. Weitz:            Right. Interesting. What are some of the strategies to combat some of those?

Kashif:                  Well, for the second one, so this is actually… All of these things that we see as problems are actually our ancestral superpower. So think about the caveman who had to not be eaten by a wolf while he was sleeping.

Dr. Weitz:            Right.

Kashif:                  Right? So the person who was able to have that hypersensitivity to stimulus would survive because they would hear that branch breaking far before the wolf arrived, right?

Dr. Weitz:            Right.

Kashif:                  So that trait is designed to wake you up, but our context is not aligned to the sleep cocoon we actually need, which means heavy weighted blankets so that your body feels safe. Head to toe, the skin is signaled. There’s this weight on me. It is sleep time right now.        Cooling of the mattress. So there’s mattress coolers you can actually get that mimic what it meant to sleep on a cave floor, right?

Dr. Weitz:            Yeah. We use one.

Kashif:                  You use one? Yeah. So it’s an amazing hack that completely changes your sleep because if you have the heavy blanket, a couple hours in you’re going to overheat. How do you mitigate that? You get the cooler, right?

Dr. Weitz:            Yeah.

Kashif:                  Zero light leakage. If there’s light, that’s signaling serotonin to bind. And depending where you live, the light may start at 4:30 AM, which is not the right time. So zero, zero light leakage, potentially an eye mask.  You potentially may have a separate blanket from your spouse. You cannot have that stimulus. So those are the things to consider. How do you make that sleep cocoon?   And now if we know that serotonin is the gene pathway is off, you can also modulate serotonin with the right supplements. So 5-HTTLPR is the gene. There’s a supplement called 5-HTP which helps regulate your serotonin level so you can take one before going to sleep. You know?

Dr. Weitz:            Right.

Kashif:                  There’s things you can do, these adaptogen type things that help you get into a deeper sleep state. So there’s a lot of things available. You just need to know, again, what your body needs. Where do I start?

Dr. Weitz:            Right. Let’s see. One more question. What about our genetics and weight control?

Kashif:                  There’s so much. We need an hour just for that.

Dr. Weitz:            And obviously, obesity is such a big, big risk factor for chronic diseases, or maybe is a chronic disease itself.

Kashif:                  Yeah. So let me give you the fast bullets.

Dr. Weitz:            Okay.

Kashif:                  Hormones is one of the areas that is where people get stuck. So I’m going to the gym. I eat properly. Why can I not lose these last 20 pounds? Hormones. Are you estrogen dominant? Are you androgen dominant? Maybe you don’t have enough fat or enough muscle. You can’t get bigger. You can’t put on the muscle. Maybe not enough of the estrogens. So hormones is a first area, and it’s very easy to use basic supplements to change these gene pathways and change your body.

                                Second one is your brain perception and what you think you’re eating versus what you’re actually eating. Your addictive tendencies, your binging tendencies, your emotional eating tendencies, and these things that never get counted in your calorie count. So that’s another big one.

                                Then there’s actual gut and mouth brain connection, which we talked about a little bit earlier, and understanding your ability to actually feel satisfied and how to hack that. So if you are the person that has the palate need of variety, you have to create it. Give yourself a little bit of cheese, dark chocolate, nut, grape, all the textures and varieties right when you’re with done your meal so that you hack your brain to get the variety it’s desiring. Another big one that nobody looks at is-

Dr. Weitz:            Or you just take Ozempic.

Kashif:                  Or you take Ozempic. Yeah, that’s another way around. And then you get off Ozempic and you balloon up like never before. Yeah. And-

Dr. Weitz:            We’ll call that the Ozempic balloon.

Kashif:                  Yeah. It’s sad, but the federal government went on 60 Minutes and said like a week before Ozempic was released, coincidentally, that 80% of obesity is genetic.

Dr. Weitz:            Wow.

Kashif:                  That’s what they said. They said it’s not lifestyle. This was on 60 Minutes. I don’t remember the name of the person, but it was some health advisor for the Biden Administration went on and said that “We believe that obesity is 80% genetic. It’s not lifestyle or nutrition based.”

Dr. Weitz:            Pharmaceuticals will solve all our problems.

Kashif:                  Yes. A week later, Ozempic gets released. Pure coincidence.

Dr. Weitz:            Yeah.

Kashif:                  Right? So now, yes it’s true that 80% of it is genetically driven if you’re making all the wrong choices, but it’s absolutely false that you don’t have control and that it’s going to happen, that it’s innate. There are genetic conditions like sickle cell syndrome. There’s a gene that’s broken, and you have it-

Dr. Weitz:            Right.

Kashif:                  … [inaudible 00:38:25]. Obesity is not something that you have. It’s something that’s caused. There are some people that have genetic obesity. That’s a tiny fraction of the people that are actually obese.  So the other big one, sorry, I was going to say is environmental toxins. So we’re so overburdened by environmental toxins, what we breathe constantly, that our body is storing fat as a place to deposit the toxins. So if somebody that goes for a run every day in Manhattan that can’t understand why they can’t lose that little bit, because you’re running and breathing in pollution every day and you might not have the right detox pathways to deal with that. And so your body’s trying to protect you by storing fat to deposit that toxin to keep it away from your organs.

Dr. Weitz:            Interesting.

Kashif:                  And that may be your number one thing. That could just be the one thing you have to work on.

Dr. Weitz:            Right. Great. So how can patients get your DNA test done? Is there an option for practitioners to become providers or is this a direct to consumer, or are both options available?

Kashif:                  Yeah, for sure both. So we do work with functional medicine, chiropractors, naturopaths, everybody in that sort of wellness space that thinks the way we think, and a few MDs that have learned about life and what they need to change. So we do work with practitioners. It’s very easy. You open an account. We send you some kits. There’s training if you want. There’s free training. There’s paid training, depending how deep you want to dive.   And then for consumers, it’s thednacompany.com. You simply go there. The test is called the 360. The way it works is you get shipped a kit. You spit in a tube. You ship it back to the lab. We extract your DNA. A few weeks later, you’re going to get an email to access your reports, and the reports are very, very easy to use rather than “Hey, you have this gene, the MTHFR CC.” Nobody knows what that means. It’s more like, “Here’s how your body deals with cholesterol and inflammation. Here’s how you deal with anxiety. Let’s speak in the context you actually can apply this stuff.” And there’s recommendations built right in. So where do you actually supplement? What do you actually change in your diet, et cetera?  Beyond that, there’s some people that have the need for clinical support. I have breast cancer and how do I deal with this? So we do have functional genomic-certified coaches that can take on patients and help them through programs, and we can also train practitioners to do the same. So all of the above.  So it’s thednacompany.com, the 360 test. And to work with us as a practitioner, you can also send us an email through there. You can find us on Instagram if you’d like. It’s my… K-A-S-H-K-H-A-N official. A lot of news and stuff that we put out there. Think about things like Ozempic. So you can keep learning. Yeah, but all of the above. We’re here to support.

Dr. Weitz:            What if the patient already has their DNA run by 23andMe or Ancestry? Can they send that in, or are your tests more extensive or different?

Kashif:                  We would love to be able to do that because there’s 80 million people out there that have done those tests, and business wise it would make a lot of sense. The challenge is that they don’t test for what we test for.

Dr. Weitz:            Oh, okay.

Kashif:                  So remember, these are data collection companies. Their business is sell something on the front end that’s infotainment and then sell the data on the back end to a pharma company. That’s where they make their real money. So they have to build the product in a way that serves that customer, the real customer which is a mass data dump, a bunch of SNPs for the practitioners that are on here. It’s the spelling mistakes in genes.  When it comes to the major pathways that we need to understand, there’s things called copy number variations, where it’s far more complex than a SNP. It’s like, “Do I even have the gene? Am I completely missing it?” You have to test for that separately.

                                When it comes to things like APOE, I can’t tell you how many customers have called us and complain and said, “I have my 23andMe done, and your APOE result is different. And you guys are a scam.” And then we have to explain to them that APOE, we sequence the entire gene. We treat it as an independent test because it’s so complex. So there’s one thing to look for a SNP, and there’s one thing to look for all 20,000 letters in that gene. We test for a lot less, but we are going a lot deeper in those genes that actually are meaningful, the functional genes that drive the main pathways.

Dr. Weitz:            I don’t quite get that one on the APOE. So aren’t you just either an APOE34 or 33 or 44? What else is there?

Kashif:                 The way you determine that is not as simple as it seems.

Dr. Weitz:            Oh, okay.

Kashif:                 And have you heard of Dale Bredeson?

Dr. Weitz:            Yeah, of course.

Kashif:                 [inaudible 00:43:30].

Dr. Weitz:            I’ve had him on the podcast.

Kashif:                 Yeah. So in his book on reversing Alzheimer’s, he says something like, “23andme is something like 65 or 70% accurate,” and that’s why he refuses to use genetics, because genetics isn’t as simple as run a test and get a result. There’s a lot of science behind what that result actually means, and that’s why you see variability between different testing companies.  So what we do, again, we test for less. We’re not looking for thousands and thousands of genes. We’re looking for the 100 that actually matter that are functional, but we go a lot deeper on each gene to make sure it’s accurate and that we inform more. It’s not just a SNP. It’s a copy number variation. It’s also the indel. An indel means that a whole paragraph might be missing or there’s a extra paragraph, not just a letter or a variant. We’re deeper on what matters, and APOE’s a perfect example. You can assume by looking at certain markers or you can sequence the entire gene from beginning to end and be certain, and that’s what we do.

Dr. Weitz:            Fascinating.

Kashif:                 Yeah.

Dr. Weitz:            Awesome. Okay, thank you very much.

Kashif:                 Oh, It’s a pleasure. Good talking to you, man.

 


 

Dr. Weitz:      Nice talking to you. 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 Podcasts or Spotify and give us a five-star ratings and review. That way, more people will discover the Rational Wellness Podcast.   And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

 

Dr. Terry Wahls discusses how to Reverse Multiple Sclerosis with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 

 

Podcast Highlights

2:00  Dr. Wahls was diagnosed with Multiple Sclerosis 23 years ago, so she went to the best MS center in the country and saw their best physician and took the recommended latest drugs. Three years later she was going downhill and she was in a tilt, recline wheelchair despite taking the newest, disease modifying drugs, including Tysabri and Novantrone.  For her, these drugs did not help. She continued to worsen, as did the electrical face pains that she had.  She decided to dive deep into the research on her condition and she concluded that the mitochondria are the drivers of disability and she created a supplement cocktail for her mitochondria.  She changed her diet from vegan to paleo to provide protein and additional nutrients. She also discovered a study using electrical stimulation of muscles and added that to her physical therapy.  She then discovered the Institute of Functional Medicine and took their course on neuroprotection and developed a longer list of supplements.  Her condition was improving but she was not where she wanted to be. She then had an aha moment and decided to redesign her paleo diet to be able to get all of these nutrients in the supplements from her food. She did more research and then figured out the Wahls Paleo diet by December. At that point, she was so weak that she could only sit up for about 10 minutes in a regular chair before she had to be either in bed or a zero gravity chair and she could only take a few steps with walking sticks.  Her electrical face pain was much worse and she was beginning to have trouble with brain fog.  She started eating this way on December 26th. By the end of January, her pain is less, her brain fog is less, and her fatigue is also less. By the end of February, her physical therapist noticed that she was getting stronger, so he advanced her exercise. By the end of March, she was walking with walking sticks. And by the end of April, she wanted to try riding her bike and she had an emergency family meeting with her wife Jackie and her two children.  Her 13 year old daughter and her 16 year old son jogged along side on either side of her bike and she rides around the block on her bike and they are all crying.  And then every day she rides her bike more and more.  And in October, Jackie signs her up for the Courage Ride, 18.5 miles, which she completed.  This fundamentally changed how Dr. Wahls thinks about disease and health and it changes the way she practices medicine and it will change the focus of her clinical research.  She has now conducted seven clinical trials and is now starting her eighth clinical trial on multiple sclerosis. She’s published over 70 peer reviewed posters, abstracts, scientific papers and nearly 30 of them on multiple sclerosis. And she has really made it her mission to let people know there is so much that we can do that can change the course of this disease.

6:50  Dr. Wahls was able to regain her health using a Functional Medicine approach focused on diet, lifestyle, and physical therapy.  Dr. Wahls noted that she is an academic doctor who believes in the best and newest drugs, technology, and devices. And she treated her disease very aggressively because she did not want to become a burden, but she continued to go downhill. When she read the package insert in the drugs she was taking, it said that she had a 2% risk of getting leukemia each time she took the drug.  She took Tysabri and it did not help, but her program of diet, targeted supplements, and electrical stimulation of muscles enabled her to achieve a remarkable level of function.  With the guidance of her neurologist, she was weaned off the drugs and has been off these disease modifying drugs since the spring of 2008.  She has continued to get stronger and she now jogs on her treadmill for 20 minutes a couple of times per week.

8:48  The mitochondria. Dr. Wahls explained that most of her colleagues in the MS world focus on the immune function and the relapses and exacerbations. But the slow, relentless loss of brain volume and loss of spinal cord volume is what drives neurodegeneration. Her interpretation of the basic science literature is that the driver of that disability is probably mitochondria.  The mitochondria are not generating enough ATP for the robust energy needs of the axons, of the myelin of the neurons. And that’s driving cognitive decline for dementia, for Alzheimer’s, in Parkinson’s.  She figured out that her mitochondrial supplements were making her feel better and when she didn’t take her supplements, she couldn’t get out of bed and go to work.  While they were helping her a lot, they weren’t getting her out of her wheelchair.  The magic really happened when she  redesigned her food around her supplements.

15:05  The most important nutrients. Low vitamin D is associated with more relapses and disability and worse quality of life.  Dr. Wahls recommends an ideal vitamin D levels of 60-80 ng/mL.  Omega 3 fatty acids important and low omega-3 fatty acids are associated with more relapses and more disease progression.  We do also need omega 6 fatty acids and arachidonic acid, but most of us do not get enough omega 3. We should have an omega 6:3 ratio of 4:1 and 3:1 is also good, but 2:1 may be too low.  But most Americans are at 20:1 or 30:1 or even 45:1. That level is very inflammatory.  We would like to see homocysteine levels between 4 and 7.5 and most people are much higher than that.  This is lowered by taking the right forms of B vitamins. With homocysteine above 10 there are higher rates of neurodegeneration as well as higher rates of heart disease.  We want to get plenty of carotenoids, including zeaxanthin, meso-zeaxanthin, and lutein that are present in green leafy and colored veggies.  There are many beneficial compounds in mushrooms that help to lower rates of anxiety, depression, and cognitive decline.  Both greens and beets can raise nitric oxide levels, which is really good both for blood vessel health, for cardiac health, and also for neurologic health.  Fermented vegetables like Kimchi and sauerkraut are also beneficial.  She also recommends nut milk and coconut milk kefirs.

20:45  Dr. Wahls prefers the paleo diet for neurodegenerative conditions.  She explained that while there are many diets out there: vegan, vegetarian, keto, paleo, fasting mimicking diet, fasting strategies and there are a variety of clinical trials testing these diets, a consistent finding is when you put people on a intervention diet compared to the usual diet, the dietary intervention always improves.  One of the reasons for that is when you have less sugar and less added processed foods, the quality of the diet improves. Dr. Wahls was a vegetarian following a low fat diet for about 20 years prior to her MS diagnosis and for her this was not the right diet. She had her remarkable health transformation following the change to the paleo diet and she has been using the paleo diet in her clinical trials and has been achieving remarkable success.  To follow the paleo diet means to try to emulate what our ancestors might have eaten in the region of the world where we live, which means to eat meat, poultry, fish, nuts, seeds, greens, tubers, berries and fruits.  It also means not to eat sugar, grains, legumes, and dairy because those foods were foods that humans added eight to 10,000 years ago.  While we do not have enough research to prove what the best diet is for humans or for each person, Dr. Wahls recommends to patients to pick a diet that speaks to your heart and give it at least three months.  If Dr. Wahls puts a patient on a paleo diet and their cholesterol goes too high, she may make it a lower fat version or she may put them on a Mediterranean diet.  If they are developing insulin resistance, then she may lower the carbs or use a ketogenic diet.

25:27  Insulin resistance.  Insulin resistance is an important for multiple sclerosis, just as it is with Alzheimer’s and Parkinson’s.  If Dr. Wahls has patients with insulin resistance, she may put them on a lower carb diet and she may even put them on a ketogenic diet. She may recommend intermittent fasting and she may use Prolon kits for 5 days per month. 

26:31  Protein.  The muscles are a vital endocrine organ for maintaining good blood sugar and good blood lipids. It’s really important to maintain muscle mass when facing a neuroimmune condition like MS.  You need to do strength training and building muscle requires protein and our protein requirement goes up as you get older.  Dr. Wahls said that she is eating more meat and more fish in order to hang onto her muscles.  Organ meat, such as heart, liver or tongue, is an incredible source of vitamin A, B vitamins, and minerals and Dr. Wahls recommends eating 4-8 oz. of organ meat per week.

30:00  Toxins.  Toxins can play a role in neurological and autoimmune diseases and flouride is one example of that that can play a role in demyelinating nerves.  There are 80,000 plus synthetic chemicals that are in our environment, and it would be very difficult for any of us to not have an abundant number of toxins, heavy metals, solvents, plastics, the forever chemicals stored in our fat.  The fatty guts of meat are likely to have the most stored toxins, so you should make sure to eat organ meat from an organic animal and not to overdo it.  Rather than routinely screening patients for toxins, Dr. Wahls assumes all of her patients are toxic, though she will sometimes test them for mold toxins.  To facilitate detoxification, she will recommend eating greens, cabbage family vegetables, and onion family vegetables to stimulate the production of glutathione and she may recommend taking glutathione or NAC and lipoic acid, which are glutathione precursors.

33:31  Dr. Wahls recommends 9 cups of vegetables per day: 3 cups of greens, three cups of sulfur containing vegetables in the cabbage, onion, mushroom family, three cups of deeply pigmented carrots, beets, berries, peppers, tomatoes.  This is for men and tall women. If you are smaller, then 6 cups might be appropriate. There is no reason to overeat beyond what your appetite will tolerate.  You should not be hungry. If you’re hungry, then eat more protein.  If you’re full, as long as you’ve had your 6 to 12 oz of meat and you’ve got proportionately the greens, sulfur and color veggies, then you’re fine. 

34:48  Exercise. Strength training is very important for MS and it should be hard enough that you can’t do 3 sets of 12 reps of an exercise.  You need to progressively increase the resistance either with more weight or more bands or it is with bodyweight, then doing it slower. You want to rotate which parts of the body you work on on different days. You should also do balance exercises so you decrease the likelihood of falling. Dr. Wahls said that when she showers she will stand on one leg and count to 50 and then do the other leg.  If you want to live to 120, then you need to have great balance in your 70s, 80s, and 90s.

37:17  Electrical Stimulation.  Dr. Wahls finds that electrical stimulation is very helpful for patients with MS to help regenerate the muscles. It makes recovering your strength easier and it also helped her mood and her mental clarity.  We now know from animal model studies and human studies that when you add electrostimulation to exercise, you make more nerve growth factors and muscle growth factors locally for your muscles, but you also make more nerve growth factors in your brain and you make more endorphins in your brain.  Dr. Wahls uses a 10 seconds on, 20 seconds off protocol for the electrical stimulation and she co-contracts her muscles at the same time.  The muscle contractions need to be really forceful to get results. 

42:58  Nutritional Supplements.  Dr. Wahls also takes some nutritional supplements and is constantly keeping up with the research and tinkering with different supplements and she reads about 200 scientific papers per week.  She takes vitamin D with K, fish oil, a variety of mushroom supplements, and she has recently added urolithin A.  She is taking bergamot, which she really likes. She takes lipoic acid, NAC, beet root, and curcumin.  She makes a smoothie with phosphatidylcholine, plasmalogen, omega-3s, omega-6s and a cocktail of spices, which she will rotate that may include beet root, inulin, curcumin, and ginger. 

46:10  Clinical Research.  Dr. Wahls has so far completed 7 clinical trials and these have shown that the diet, exercise, and lifestyle  approaches that she recommends are helpful for patients with MS.  She is now recruiting volunteers for a new trial that compares a ketogenic diet with a paleo diet and a usual diet.  They are looking at changes in fatigue and quality of life, but also at changes in walking function, hand function, vision function, and how well we think.  They are also looking at brain volume over time because patients with MS experience brain shrinking at 3 times the rate of other patients.  They will also be looking to see if there are reductions in brain fog, anxiety, and depression.  participants will need to come to Iowa at month zero, month three, and month 24.  She has already recruited 83 people but they still have room for 72 additional volunteers.  Dr. Wahl’s team has published about 70 abstracts and posters and 45 peer reviewed scientific papers of which 26 are related to the multiple sclerosis research.  Those interested should go to TerryWahls.com/MSStudy.

                               



Dr. Terry Wahls is a clinical professor medicine at the University of Iowa Carver College of Medicine where she teaches medical residents and does clinical research and she has published over 60 papers.  She conducts clinical trials that test the effect of nutrition and lifestyle interventions to treat MS and other progressive health problems.  She is the author of The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles and the cookbook The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions.

Dr. Wahls was a patient with relapsing remitting Multiple Sclerosis in 2000 and by 2003 she had progressed to secondary progressive multiple sclerosis.  She was in a wheelchair because her back muscles were too weak to hold her up. She was taking the standard of care medication, which included chemotherapy, and yet she continued to go downhill until she took matters into her own hands and started researching MS and she looked for vitamins and minerals that might help.  She created a list of nutrients for brain health and began taking them, which slowed her decline.  In 2007 she discovered the Institute of Functional Medicine and she developed a longer list of nutrients and then she redesigned her diet so that she could get these nutrients from food rather than just from supplements.  She also started to use electrical stimulation to help strengthen her muscles.  She restored her health and vitality and she now rides her bike to work and teaches and researches at the University of Iowa.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure.  Dr. Weitz has also successfully helped many patients with managing their weight and improving their 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. Our topic for today is multiple sclerosis with Dr. Terry Wahls. Dr. Wahls is a clinical professor of medicine at the University of Iowa Carver College of Medicine, where she teaches and does clinical research, and she’s published over 60 papers. She’s currently conducting clinical trials that test the effect of nutrition and lifestyle interventions to treat multiple sclerosis and other progressive health problems. She’s the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, the Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles, and the cookbook, the Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. Dr. Wahls herself was a patient with multiple sclerosis, first diagnosed in 2000, and by 2003, she was in a wheelchair and going downhill until she took matters into her own hands and started to employ a functional medicine approach to healing herself. I’ll stop there because I’d like to let Dr. Wahls tell us about her story herself. Dr. Wahls, thank you so much for joining us today.

Dr. Wahls:           Hey, thank you, Dr. Ben. It’s a privilege to be here.

Dr. Weitz:            Absolutely. Please tell us about your personal journey.

Dr. Wahls:           Yeah. I’ll tell it in real time. 23 years ago, out walking with my wife Jackie, a half mile from home, my left leg grows weak. Dragging it home. I see the neurologist. And while I’m going through the workup for the next three weeks, I think about the 20 years of worsening electrical face pain that I have, and I’m praying secretly for a fatal diagnosis. Now, three weeks later, I hear multiple sclerosis. Being a physician, I do my research, find the best MS center in the country, see their best physician, take the newest drugs. Three years later, I hear the words tilt, recline wheelchair.

Dr. Weitz:            Wow.

Dr. Wahls:           I take Tysabri, I take Novantrone. None of these drugs help. I continue to worsen. My electrical face pains continue to worsen. My 10 year old daughter hugs me as tears streamed down my face. And that’s when I asked myself am I doing all that I can. I go back to reading the basic science. I’m studying in PubMed night after night. I decide that mitochondria are the driver of disability and I begin creating a supplement cocktail for my mitochondria. I discover a study using electrical stimulation of muscles. I ask my physical therapist can I add that, and we add that to my physical therapy. And then I discovered the Institute for Functional Medicine. I take their course on Neuroprotection. I have a longer list of supplements. I add all of them.

                                And not a lot’s happened yet. Then I have a really big aha. And actually, Ben, I’m sort of embarrassed now about how long this took me to have this because I’d already been doing a paleo diet for five years. But now I think what if I redesign my paleo diet based on the supplement cocktail. If I get my nutrients from the food as opposed to from supplements. And so that’s more research. And in December, I redesigned my paleo diet. Now, at that time, I am so weak I cannot sit up in a regular chair like I am now. I can only sit up for about 10 minutes. I can take just a couple of steps using two walking sticks. Otherwise, I’m either in bed or in a zero gravity chair with my knees higher than my nose. My electrical face pain is much worse and I’m beginning to have trouble with brain fog.

                                Start this new way of eating December 26th. By the end of January, it’s clear that my pain is less, my brain fog is less, my fatigue is also less. By the end of February, my physical therapist is saying, “You know what, Terry, you’re definitely stronger.” And he advances my exercise. And by the end of March, I’m beginning to walk with walking sticks. And by the end of April, I’m telling my family I really want to try riding my bike. Now, I haven’t ridden my bike in six years. We have an emergency family meeting because on Mother’s Day, two weeks later, I really want to ride my bike and Jackie tells my son, who’s 6’5″, “Zach, you jog alongside on the left,” my daughter Zeb, who’s 13, “You jog alongside on the right,” and she’ll follow. And we all get in a position, we push off and I bike around the block. And that big 16 year old boy, he’s crying. The 13 year old, she’s crying. Jackie’s crying. And when I talk about that now, I begin crying. And then every day I bike a little bit more. And in October, Jackie signs me up for the Courage Ride, 18.5 miles.

                                And once again, when I cross that finish line, my family’s crying, Jackie’s crying, and I’m crying. And this fundamentally changes how I think about disease and health and it will change the way I practice medicine and it will change the focus of my clinical research. And now we’ve conducted seven clinical trials. We’re doing our eighth clinical trial. We’ve published over 70 peer reviewed posters, abstracts, scientific papers. Nearly 30 of them in multiple sclerosis. And I’ve really made it my mission to let people know there is so much that we can do that can change the course of our disease.

Dr. Weitz:            That’s amazing. Able to regain your health without really drugs, using a functional medicine approach, diet and lifestyle. It’s amazing.

Dr. Wahls:           And I’m a academic doc. I certainly believe in the best technology, the best drugs, the newest devices, the newest technologies. And I treated my disease very, very aggressively because I didn’t want to become a burden. And despite that, I continued to go downhill. And I was taking drugs that when I read the package, insert 2% risk of getting acute leukemia each time I took the drug. So I was all in. I treated my disease very aggressively, but it didn’t help. I even took Tysabri. Did not help. And then what was remarkable, I used my diet, targeted supplements, electrical stimulation of muscles, and I recovered a remarkable level of function. And when I walked into my neurologist’s office, he was very excited and I said, “I really would like to go off my disease modifying drug treatment.” He goes, “Yes, I think that’d be fine. We need to taper you off because you have made this dramatic recovery. The toxicity of the drugs are substantial.” And with his blessing then in the spring of 2008, he weaned me off my disease modifying drugs, and I’ve been off disease modifying drugs since. I continue to get stronger and in fact, I now jog on my treadmill 20 minutes a couple times a week.

Dr. Weitz:            That’s awesome.

Dr. Wahls:           It’s been a journey. Absolutely. A big journey.

Dr. Weitz:            So why is the mitochondria so important for understanding autoimmune diseases like MS?

Dr. Wahls:           Well, most of my colleagues really focus on the immune function and the relapses and the exacerbations, but you have a relapse and you recover function. Most of it. That slow, relentless loss of brain volume, loss of spinal cord volume is what drives neurodegeneration. My interpretation of the basic science literature is that the driver of that disability is probably mitochondria. The mitochondria are not generating enough ATP for the robust energy needs of the axons, of the myelin of the neurons. And that’s driving cognitive decline for dementia, for Alzheimer’s, in Parkinson’s. And when I was reading the basic science early in my MS journey, I had very few relapses. It really had a degenerative process, and so I was like mitochondria are key. And I did figure out early on with my mitochondrial supplements that I felt a little bit better taking my supplements. When I didn’t take my supplements, I really couldn’t get out of bed and go to work. So they weren’t getting me out of my wheelchair, but clearly they were doing a lot for me. And then it is pretty interesting when I redesigned my food around my supplements, that is when the magic happened.

Dr. Weitz:            And do you think that’s because you got additional phytonutrients that maybe we haven’t even figured out what the benefits are that are present in the fruits and vegetables that-

Dr. Wahls:           Absolutely.

Dr. Weitz:            Aren’t necessarily present in the capsules?

Dr. Wahls:           I think if you focus just on what’s in the capsules … And it’s a great way to do animal model studies. It’s a great way to do basic science and to move our understanding forward. So they’re very helpful. But food is very, very complex. We have easily 80,000 food molecules that are really important to our health, probably many more than that. And so all of those molecules have a role to play in my chemistry, in your chemistry. And so I think it’s very hard to create a molecule by molecule nutrient program that’s good for us. But our ancestors over the 200,000 years that we’ve been homo sapiens and over the 150,000 years that we’ve been out of Africa, humans have been eating a wide variety of food stuffs as we go into all these different ecological spaces. So anyone says there’s only one food that is correct or one nutrient that is correct is wrong. Our evolutionary history would say there are a lot of foods that work, there are a lot of different foods that work, and so there’s only one food that we know is really terrible for us and that’s the standard Westernized diet.

Dr. Weitz:            Correct. And then we are certainly not going on the right path when it comes to pharmaceuticals for treating these neurodegenerative diseases. I’m sure you’ve probably seen the recent research that came out, I think last week, that the leading drugs that shrink the amyloid plaque for Alzheimer’s actually lead to a shrinkage of the brain. So not only are-

Dr. Wahls:           I saw that.

Dr. Weitz:            They not making people better, they’re making them worse.

Dr. Wahls:           Correct. An amyloid is sort of like the sticky fly paper. So I think there’s some protection for amyloid and I’m not sure that we’re going to find these dementia treating drugs in the end to be very useful.

Dr. Weitz:            It may be, and Dr. Bredesen has mentioned, is that maybe if we do all the functional medicine stuff first, if you eliminate the reasons why the brain is laying down the amyloid plaque and you get rid of the inflammation, the toxins, you balance the nutrients, you do all the other things to improve the health of the brain, maybe at that point if you were to remove the amyloid, it might be beneficial, but not until you’ve done all that.

Dr. Wahls:           Correct. And we don’t know. We don’t know. And I have variations of this debate for MS. We have 20 different drugs that are really great and they have to be great at reducing the number of enhancing lesions, therefore also they often reduce the number of relapses and that’s how you get FDA approval. So they’re very good at that, but they’re not at all good at slowing the rate of brain volume loss. They aren’t really good at reducing anxiety, depression or fatigue. And I think that yes, we absolutely want people to stop having the enhancing lesions, the relapses, I agree, but you have to do all of the diet and lifestyle stuff so you can address brain volume loss, address anxiety, address depression, address fatigue. And that’s what our programs have been very good at.

Dr. Weitz:            So what do you think are some of the most important nutrients, vitamins, minerals, phytonutrients for brain and nervous system health?

Dr. Wahls:           I think the research is really excellent. When we do network meta-analysis in terms of combining multiple studies, we see consistently that low vitamin D is associated with more relapses, more disability, worse quality of life. So making sure your vitamin D is certainly above 40, and in my clinical practice, I want to see that in the top half of the reference range.

Dr. Weitz:            So you’re talking about 50 to 100? Is there an ideal target?

Dr. Wahls:           50 to a 100 and 60 to 80 would be my ideal.

Dr. Weitz:            60 to 80. Okay.

Dr. Wahls:           But 50 to 100 I think is certainly acceptable. Below 30, that’s definitely a big problem. And below 20, that’s a severe problem. Then the next nutrient that I’m thinking a lot about is the omega-3 fatty acids. Again, low omega-3 fatty acids are associated with more relapses, more disease progression. And people want a badmouth arachidonic acid and omega-6 fatty acids. However, if your arachidonic acid and omega-6 acids are low, that’s a problem too because we also have a lot of arachidonic acid and omega-6 fatty acids in our brain as well. They are also important in myelin formation. So you need both omega-3 and omega-6, but you want them in about the same ratio, or I should say a ratio of four to one. Four omega-6 to one omega-3. Three to one is okay, two to one is getting a little bit low. But many of us, because we have so much fast food that is deep fried-

Dr. Weitz:            We’re at 20 to one or 30 to one.

Dr. Wahls:           20 to one, 30 to one, 40 to one, 45 to one. That is definitely very inflammatory.

Dr. Weitz:            Do you like to see a higher DHA omega-3 for neurological?

Dr. Wahls:           Yeah, I’d rather see a little higher DHA. Although interestingly, some of my psychiatrists would rather see more EPA. So it may depend on what conditions you’re trying to treat.

Dr. Weitz:            Okay.

Dr. Wahls:           Then I’m thinking about homocysteine levels and I’d like to see that homocysteine between four and 7.5.

Dr. Weitz:            Wow, that’s really low.

Dr. Wahls:           Yeah. I’d rather have it in that range. Now, some people may go up to nine, may go up to 10. Ten’s, I think, high. Certainly above 10, you’re going to have higher rates of neurodegeneration, higher rates of heart disease. And I want to have plenty of carotenoids, total carotenoids. Zeaxanthin, meso-zeaxanthin, lutein. These are the greens in green leafy vegetables. And we know in my retina, those are the compounds that protect me from the ultraviolet light that is coming into my eyes when I’m out in daylight. And it turns out that those same compounds are really good at protecting me from cognitive decline. So green leafy vegetables, really good. Then there’s all these compounds in culinary mushrooms and those are the mushrooms we can eat without being poisoned by eating poisonous mushrooms. So those things we’re beginning to understand a little bit more what are some of these molecules. From a epidemiologic basis, we know the more mushrooms you eat, the lower the rates of anxiety, depression, cognitive decline.

Dr. Weitz:            I picked up some lion’s mane mushroom just today at the co-op to add to my eggs tomorrow.

Dr. Wahls:           Oh my God, they are so tasty. And then having more greens, having more beets. We’re beginning to realize that that stimulates my nitric oxide, which is really great for blood vessel health. We’ve known that is really good for blood vessel health, cardiac health. Now we’re beginning to realize that nitric oxide is very important for neurologic health as well. So I think that’s another reason why greens and beets are so good for us. Fermented vegetables. Kimchi, sauerkraut. We’ve known for some time that if you eat more fermented vegetables, you have less influenza, you have less pneumonia, you have fewer colds, and you’re less likely to be hospitalized during this coronavirus pandemic. So I like to have people eat fermented vegetables, and I also encourage fermented keifers and yogurts, preferably nut milk and coconut milk keifers and yogurts.

Dr. Weitz:            Okay. So you like the paleo diet for neurodegenerative diseases. Why the paleo diet? Some would say why not the vegan diet?

Dr. Wahls:           Oh, yeah. There are many diets out there, vegan, vegetarian, keto, paleo, fasting mimicking diet, fasting strategies, and there are a variety of clinical trials testing all of these diets in a wide variety of clinical studies. I think a very consistent finding is that when you put people on a intervention diet compared to the usual diet, the dietary intervention always improves. I think some of the reasons for that is when you have less sugar, less added processed foods, the quality of the diet improves. Historically, I have my own personal health transformation using the paleo diet. I’d been a vegetarian 20 years. I followed a low fat diet for that, and so this would’ve been considered a really phenomenally great diet. For me, it obviously was not good for me. I had a remarkable transformation. It’s the diet I’ve used in my clinical trials and we’ve had remarkable success.

                                From an evolutionary standpoint what the paleo diet does is it says, given your locale where you are in the world, we want you to try and emulate what our ancestors would’ve been eating in your region. So eat meat. Poultry, fish, nuts, seeds, greens, tubers, berries and fruit that’s in your area. Don’t eat sugar, grains, legumes, and dairy because those foods were foods that humans added eight to 10,000 years ago. And from our evolutionary history when we separated from primates six million years ago, when we became a distinct species 250,000 years ago, and when we got out of Africa about 150,000 years ago, those were the kinds of foods that we ate. We didn’t start adding grain, legumes or dairy until recently. Now, I think there are many, many versions of the paleo diet that you can find in Europe, Scandinavia, in Asia, in Africa, in the US, that will all be a little bit different because hopefully we’re all adapting that to our local region.

Dr. Weitz:            Yeah. I guess one of the typical arguments I hear against the paleo diet is even though that’s the way humans ate for hundreds of thousands or millions of years, that doesn’t necessarily mean it’s the best diet for long-term health.

Dr. Wahls:           Well, that’s true, and we have no idea what is the best diet, and nor do we have any idea what’s the best diet for Ben Weitz or for Terry Wahls. What I counsel everyone to do is pick a diet that speaks to your heart, paleo diet, vegan diet, vegetarian diet, a ketogenic diet, and try it out and see how you feel. If you feel like your health is improving, that’s fine. Stay with it. If your health is not improving, then I invite you to give it at least three months, but do it really well. Then talk to your physician, talk to your family, and decide, okay, I tried the paleo diet, it’s not really working for me. I want to try a ketogenic diet, or I want to try a Mediterranean diet. Then go ahead and try that.  There will not be one diet that is great for everyone. In my clinical practice sometimes I will recommend a paleo diet. Their cholesterol is going up too high. We make modifications to make it a lower fat diet, and I may make further changes. So I may even put them on a Mediterranean diet in response to what I see happening to their lab values if I’m not pleased. Or I may put them on a ketogenic diet because I’m worried about them developing insulin resistance. You want to have a starting point, assess their response, follow the labs, and make adjustments.

Dr. Weitz:            I know how important insulin resistance is for working with patients with Alzheimer’s and Parkinson’s. How about for MS?

Dr. Wahls:           It’s very important. People with MS and other neuroimmune conditions, we have higher rates of insulin resistance than the general public at the same weight. And so is that part of the same disease processes?  Likely yes.  And so I want all of my MS patients to have a blood sugar and an insulin level, so I can see are they developing insulin resistance?  If they are, I put them on a lower carb diet and we continue to monitor things. And I may in fact put them on a ketogenic diet. I may put them on a program of intermittent fasting. I may even use Prolon kits, one kit every month to try and improve their insulin sensitivity.

Dr. Weitz:            How important is it to have high quality sources of protein like animal protein and organ meats for maintaining and regenerating neurological tissue?

Dr. Wahls:           Well, let me come back a couple things. My muscles are really a vital endocrine organ for maintaining good blood sugar and good blood lipids. And so it’s really important to maintain muscle mass. So please do strength training even if you have MS or a neuroimmune condition to maintain those muscles. And the more strength training you do and the more male you are, the more protein you’re going to need in your diet than a female who’s not strength training or a petite individual. As you get older, and you see I have some gray hair, I’m now over 65, my protein requirement has gone up, and so I’m eating more meat and more fish, because I really want to hang on to my muscles. I’m spending more time strength training. I mentioned earlier that I’m jogging just twice a week because I’m strength training more because I so value those muscles.

Dr. Weitz:            That’s great. And how about organ meat?

Dr. Wahls:           Organ meat. Our ancestors valued organ meat as the highest, much more valuable than the steaks and the muscle meat. Brains were the most valuable, then bone marrow, then heart, liver, testicles, kidneys, lungs, and then muscles. So if there was a lot of meat around, a lot of carcasses, they would take the organs and leave the muscle meat behind. And they’d take the long bones. So traditionally, about a third of the animal carcass is what we’d consider organ meat. And when we do an analysis of the nutrients of the B vitamins, the minerals, its highest in the heart, liver and organ meat, higher than in the muscle meat. Having said that, as much as I love liver, I think it’s a delicious meat, I still want you to have only, me, about six ounces of liver a week. You can have about eight ounces a week.  A petite person would be maybe four ounces a week. Because it has so much vitamin A in it. Super good for you. Heart, tongue, also super good for you and super, super delicious. Brains used to be a delicacy that was tremendously valued. I have my great-grandmother’s Compendium of Cookery and Modern Book of Knowledge from 1889, and she’s got recipes in there for brains and eggs that look like that would’ve been really quite delicious. But I can’t tolerate eggs because it triggers my face pain. And of course, no one’s going to feel comfortable eating brains anymore because of some of the prion diseases in brains.

Dr. Weitz:            Jakob Creutzfeldt’s disease. Mad Cow disease. So a liver contains a lot of toxins, and we know toxins can play a role in neurological and autoimmune diseases. Dr. Perlmutter had a dentist on, and he was mentioning how fluoride can actually play a role in demyelinating neurons, and demyelinating nerves. And-

Dr. Wahls:           Yeah, fluoride is not good.

Dr. Weitz:            So I’m sure there’s got to be a lot of toxins in everyday life that are playing a role.

Dr. Wahls:           There are 80,000 plus synthetic chemicals that are in our environment, and it would be very difficult for any of us to not have an abundant number of toxins, heavy metals, solvents, plastics, the forever chemicals stored in our fat. And I want to correct something. Your liver processes through phase one, phase two reactions, the synthetic chemicals that we have, and then excretes it into the bile. It goes into the gallbladder. And then as we eat fat, the gallbladder releases bile into the small intestine. We absorb, digest the fat and recycle the bile. So eating liver isn’t going to give you a higher toxin load. Eating your bacon, however, might because the fat is in the bacon and if you fry things in lard and duck fat, the toxins are really in the fat much more so than in the liver.

Dr. Weitz:            I see. So good to eat liver from a healthy animal, not-

Dr. Wahls:           From a healthy animal.

Dr. Weitz:            Maybe to eat a liver from a standard American diet eating person with fatty liver.

Dr. Wahls:           Correct. So I certainly want you to have liver from an organic animal. I don’t think you have to be afraid of liver. Six to eight ounces is okay. The fatty cuts of meat, the bacon, it’s the fat that has the toxins. So you have to be worried about the fat.

Dr. Weitz:            Right. Do you screen patients for toxins?

Dr. Wahls:           Well, I assume everyone is toxic. So in my VA clinics, we assumed everybody was toxic. I put them all on a protocol to reduce their toxin exposure and to make it easier to excrete their toxins. In my clinics, again, I assume everyone is toxic and we do the same. Now, depending on their clinical circumstances, I may screen them for mold toxins, for-

Dr. Weitz:            Heavy metals.

Dr. Wahls:           Heavy metals. And we may have a more specific program for them.

Dr. Weitz:            What about incorporating glutathione to help with detoxification?

Dr. Wahls:           Well, certainly you would like to make sure they have plenty of sulfur containing amino acids, such as NAC, N acetyl-cysteine, lipoic acid. You may give them some glutathione. You could also stimulate the production of glutathione by eating these radical things known as the greens, the cabbage family vegetables, the onion family vegetables, because those foods will up-regulate my glutathione synthetase.

Dr. Weitz:            Now your recommendations for diet, I believe include nine cups of vegetables a day.

Dr. Wahls:           Nine cups of vegetables a day. So it’s three cups of greens, three cups of sulfur containing vegetables in the cabbage, onion, mushroom family, three cups of deeply pigmented carrots, beets, berries, peppers, tomatoes. And the way you can think about that is if you take your dinner plate and you cover it so you can’t see the bottom, that’s three cups of vegetables.

Dr. Weitz:            Okay. And that’s for the average weight person?

Dr. Wahls:           And you might think about that. That’s for men, tall women. I’m six foot tall. If you’re a petite woman or a petite man, then maybe six cups would be appropriate. There’s no need to over consume beyond what your appetite will tolerate so I just want to be sure that you’re not hungry. If you’re hungry, eat more protein in those greens, sulfur and colors. And if you’re full, as long as you’ve had your six to 12 ounces of meat and you’ve got proportionately the greens, sulfur and color, then you’re fine.

Dr. Weitz:            Okay. So which forms of exercise are most beneficial? You mentioned strength training and there’s particular recommendations, parameters for strength training?

Dr. Wahls:           So ideally you want to have things be hard. Hard enough so that you can’t do three sets of 12 of that exercise times three. If you could do that, then you could advance the rigor of that exercise. Either more resistant bands, more weights, slower version if it’s a body weight exercise. And you want to do your arms, your core, and your walking muscles. And ideally I rotate so I’m doing arms one day, core one day, legs another day so that I’m getting my whole body trained. I’m also doing balance exercise. Because as we age, our balance declines. And so I don’t want to fall. So I’m doing exercises and I teach people how to maintain balance. And you might start, get my hands out there, so that your feet are wide apart and you gradually get them closer and closer. Then you gradually get so you’re standing on one foot and toes down, then eventually just on one foot.  And when you can do that, then you turn your head side to side. And then when you can do that, then you can close your eyes. In that way you can gradually improve your balance. So routinely when I shower, I’ll do standing on one leg counting to 50, and then I do the other leg counting to 50, and I take turns drip drying so I can maintain my balance. Because falling becomes increasing hazard the older we become. And my goal is to be 120 and thriving so I want to have great balance in my 70s, 80s, 90s, and 100 plus.

Dr. Weitz:            That’s great. Great job of multitasking, getting your shower in, your balance training. Put the cold water on, you can get your cold water immersion at the same time.

Dr. Wahls:           Absolutely.

Dr. Weitz:            So how important is electrical stimulation? It sounds like it was very important for you to help regenerate some of those muscles.

Dr. Wahls:           It was super helpful. Fortunately, I had gone to a physical therapist who had an athletic practice and physical therapists who treat athletes have been using electrical stimulation for decades to help their athletes recover from injury more quickly. And at that time, remember, I could not sit up more than 10 minutes. I could do just a 10 minute very basic mat exercise program. We added electrostimulation to my mat exercise program and gradually increase that and that let me grow muscles more quickly. We now know from animal model studies and human studies that when you add electrostimulation to exercise, you make more nerve growth factors and muscle growth factors locally for your muscles, but you also make more nerve growth factors in your brain and you make more endorphins in your brain. And I could certainly tell very early on that the electro stimulation did great things for my mood and my mental clarity, and it I’m sure accelerated my recovery. It’s not a requirement. It’s simply a way of accelerating the speed of recovery, particularly for people who have severe disability. So people who need a cane, a walker or walking sticks, or in my case, the tilt, recline wheelchair.

Dr. Weitz:            Now I’m very familiar with the electrical stimulation. As a sports chiropractor, we use electrical stimulation in the care of the patients. Specifically for neurological diseases like MS, can you talk about particulars? What is the protocol? How many seconds of contraction? How many seconds of rest? How many reps? Do you use contraction by moving the joint at the same time?

Dr. Wahls:           So when you’re using electrical simulation, one of the things that it will do is you’re going to get current going through the pads into the motor nerve, into the muscle driving contraction. And it was used originally for people with spinal cord injury who were never going to walk. And it was a great tool to reduce the harm of inactivity. To improve blood sugar control and blood lipid metabolism. And then we did it on me and my athletic physical therapist said, “Terry, we don’t know if your brain’s going to be able to talk to this muscle so you have really got to build this connection. When that current is going, you contract your muscle as hard as you can. It’s going to be 10 seconds on, 20 seconds off. You got a two second ramp up and ramp down and dial it up to as much pain as you can tolerate.” I’m a former athlete. By God, I was going to leave nothing on the table, so I would dial it up. I would be in a sweat from the intensity of the current.

                                And I was doing all this, Ben, not to get better because I knew I couldn’t get better. I knew I had progressive MS, that functions once lost were never coming back. I was doing all this to slow my decline. But I was getting stronger. And they said, “Okay, 10 minutes, twice a day. 15 minutes, twice a day, 20 minutes twice a day, 30 minutes twice a day.” And then he goes, “Well, Terry, it’s 45 minutes a day to build stronger muscle. You’ve got a lot of weak muscles. How much time you have in the day, go ahead and stimulate.”

Dr. Weitz:            So 10 seconds contraction, 10 seconds rest you said?

Dr. Wahls:           No, 10 contraction, 20-

Dr. Weitz:            20 rest. Okay. And then for what? 10 reps?

Dr. Wahls:           Well, I can’t remember. He gave me a set of exercises to do. It was 10 minutes. And I don’t remember what we started with at that time because I did belly, then I did back and butt. So there was three sets of muscles that I did at first. And so it was probably just 10 reps at first. And then it was 10 reps times two, then 10 reps times three. And then I am like, okay, if I’m going to get my electrodes here and here, so I had a two channel machine, I’m going to do isometrics for 30 minutes. So 10 second isometric on, 20 second off. And so I’d have my machine with me at work and I’d have 10 seconds of … Okay, I can work now for 20 seconds. 10 seconds of …

Dr. Weitz:            Hard to record a podcast like that.

Dr. Wahls:           And so if I was staffing residents, I had to dial the current back so I could have a conversation and no one would know that I was stimming. But if I wasn’t staffing residents, then I could dial it all the way up.

Dr. Weitz:            Cool. Now, I know you’ve tried to get everything you can from food, but do you still employ some nutritional supplements?

Dr. Wahls:           Yeah. Actually I take a bunch of supplements. I feel better when I’m taking my supplements. And then I continue to read the basic science and I tinker. I see a new interesting study and I’m like, okay, what would that do? And plus, it’s interesting, I probably go through about 200 different papers every week, maybe 250 to scan, see what looks interesting to try out.

Dr. Weitz:            So what nutritional supplements are you taking right now?

Dr. Wahls:           Well, I’m certainly taking vitamin D, fish oil.

Dr. Weitz:            You take D with K?

Dr. Wahls:           Yeah. I always take D plus K. I’m taking a variety of mushroom supplements. I’ve recently added urolithin A. That’s been very interesting. And then I-

Dr. Weitz:            Are you doing NR or NMN?

Dr. Wahls:           I am not.

Dr. Weitz:            You chose not to or?

Dr. Wahls:           It’s not hit the top of my list yet of things to try.

Dr. Weitz:            Okay. Okay.

Dr. Wahls:           I’m taking bergamot. I like that a lot. I like lipoic acid.

Dr. Weitz:            NAC?

Dr. Wahls:           Oh, we take lots of NAC.

Dr. Weitz:            Tocotrienols?

Dr. Wahls:           I have in the past. I’m not currently.

Dr. Weitz:            Okay. Other antioxidants, polyphenols?

Dr. Wahls:           Well, I certainly am taking beet root. I’m taking a variety of mushroom products. I am taking curcumin and I take a-

Dr. Weitz:            What’s your favorite form of curcumin? Because that constantly changes. Which one is best or the latest?

Dr. Wahls:           Well, what I do is I’ll make a phosphatidylcholine, plasmalogen, and a omega-3, omega-6 fatty acid smoothie. Then I’m adding curcumin in a cocktail of my favorite spices and I just rotate through which spices I’m adding. I’ll add beet root and some inulin, curcumin, ginger, and I’ll make that into a smoothie. Then I’ll add chia seed, and I will have that in a quart jar. And I will have that once a day. And I eat every other day. I’ll have my PC smoothie blend every day. And I’m not calculating how many calories are in that. And then-

Dr. Weitz:            What’s the PC smoothie?

Dr. Wahls:           Oh, that’s the phosphatidylcholine, plasmalogen, essential fatty acids. The various spice blend, curcumin, ginger. I’ll put together.

Dr. Weitz:            Can you tell us about some of the ongoing research you’re doing about MS?

Dr. Wahls:           Okay. We’ve done seven clinical trials and so far they’ve all consistently show that people can implement the diet and the study protocols that we use. That if you’re overweight, you lose weight generally without being hungry, getting back to a healthy weight. Fatigue is reduced. Quality of life is improved in 75 to 80% of the individuals. Now think about that. That is really remarkably effective. Even the very best drugs for everything, including infections, generally don’t have 70 to 80% rates of helping people. We have a new study that I’m super excited about. The efficacy of diet on quality of life. We’ll be comparing a ketogenic diet, a paleo diet to usual diet. And we’ll look at changes in fatigue, quality of life. And those are our primary outcomes. But we’re also looking at changes in walking function, hand function, vision function, and how well we think. And what I think will be the most interesting part of this study, Ben, is we’re looking at brain volume over time. Because people with MS, our brains as a group are shrinking three times as fast as what happens in healthy aging. So it’s about 1% per year, which is why we have much higher rates of anxiety, depression, cognitive decline, early frailty, early need to quit our jobs, go to assisted living and nursing home care. Even as very young people.

                                And because clinically we’re so effective at reducing brain fog, reducing anxiety, depression, I’m very optimistic that we’ll be able to get a significant number of our folks back into the healthy rates of brain aging. And although it’s not the primary outcome, so it’ll be one of those other manuscripts that we add, but I predict it’ll be groundbreaking. It’ll be very, very exciting. Because while disease-modifying drug therapies have to show that they can reduce the number of new enhancing lesions compared to control, and therefore they often reduce relapses compared to control. And so they’re very good at inflammation, but they don’t address neurodegeneration. They don’t address mitochondria. And therefore they don’t have much impact on anxiety, depression, cognitive decline, or brain fog.

                                So I don’t know what we’ll find, but I am super excited. People need to come to Iowa at month zero, month three, and month 24. We have 83 people that we’ve consented and are in the process. That means I have room for 72 more. And I expect that we’ll finish that recruitment in the next 12 months. And so really it’s three more years of steady activities to get all this stuff going. And so it’s ’23, that means in 2026, we’ll be wrapping things up at the end of the year. In 2027, we’ll be analyzing the data and presenting it at the MS Scientific meetings. And then the papers will start coming out. Now, in the meantime, my team has published about 70 abstracts, posters. We have 45 peer reviewed scientific papers of which 26 are related to the multiple sclerosis research.

                                And I’m really a unique, Ben, because I do the research to change the standard of care, but I know what it’s like to be facing terrible prognosis, terrible disability, and I am committed to at the same time that I’m doing the research to change the standard of care, to teach other clinicians how to think the way I think, and to teach other patients like me that there’s a whole lot you can do that can change your disease course. And yes, talk to your physician about how disease-modifying drugs fit into your care plan. But whatever you decide, we should all be working to improve our diet, asking for physical therapy, asking for stress reducing practice, making sure we’re sleeping well and being connected with our friends and family.

Dr. Weitz:            And what’s even more remarkable is that the disease modifying drugs that are available don’t reverse the condition, don’t actually make people better. At best, people get worse at a slower rate.

Dr. Wahls:           Exactly. At best, all they need to show is they have fewer lesions in the MRI. They don’t really have to show any change on anxiety, depression, mood, clinical function. And it’s wonderful that they’ve done this. They’ve taken the time from diagnosis to wheelchair and have moved it out five years. And for everyone with MS, those five years … It’s great to get five more years away from the wheelchair. But wouldn’t it be even better to never have to need the wheelchair? Wouldn’t it be even better to have no anxiety, no depression, no cognitive decline? I can now jog on my treadmill.

Dr. Weitz:            Right. That’s one of the amazing things is none of these disease modifying drugs can actually give you any hope of going from a wheelchair to not being in a wheelchair and yet the functional medicine approach that you’re pioneering has that potential.

Dr. Wahls:           And so we see people. I think it’s really important to stop the decline, use the functional medicine approach to stop the decline, and then find a practitioner who has a very close relationship with a rehab center, rehab minded physical therapist who will work on that rehab potential. I have close relationships with folks who are big champions of electrical stimulation of muscles. They treat our patients like athletes, recovering athletes. We work hard, we have big goals, and we realize this is going to be a several year process for those people who are like me, profoundly disabled and wheelchair dependent. But we have other wonderful stories. It’s not just me getting out of the wheelchair. But the people who are most successful are the former athletes and the people who are willing to say, “I’ll treat this athletic training. That I realize this is a long row that I’m going to be hoeing and I’ll be doing it the rest of my life. And I am down for that journey.”

Dr. Weitz:            That’s awesome. And so how do they contact you to find out about the getting involved with the study?

Dr. Wahls:           The simplest way to do this is go to terrywahls, that’s T-E-R-R-Y, Wahls, W-A-H-L-S.com/msstudy. There’ll be more information about the study, a short little video. There’ll be a yellow box. Click there to take the survey. You’ll put in your contact information, answer a few questions, and then we will begin the process of confirming your diagnosis, putting you in our patient registry. Because we’ll have more studies that we want everyone to hear about. And then for those who are eligible for the study, we will contact you and begin the process of confirming the diagnosis, telling you in more detail what’s involved in the study in getting you enrolled. So 72 folks. We’d love to help get you in the study and help transform your life.

Dr. Weitz:            And I understand that all your studies are privately funded. You’ve yet to have the National Institute of Health provide funding.

Dr. Wahls:           Correct. We’ve been funded by individuals, by family foundations, the MS Society, which is a nonprofit. They have funded us. And so we’re very grateful for them. A grateful patient whose life we transformed is funding the really big study, the Carter Chapman Shreve Family Foundation. And my university, which at first thought I was a bit eccentric, a bit odd, now they’re like, “Dr. Wahls is a rockstar.” Because I’m getting funded through the grateful patients at a level that is really quite extraordinary.

Dr. Weitz:            That’s awesome. Thank you for the work you’re doing, Dr. Wahls.

Dr. Wahls:           Well, I am so grateful. In 2007, I had such a terrible future. Bedridden, demented, in continuous electrical pain. That was the future that I thought I was facing. Now I’m pain free. I consider my trigeminal neuralgia a gift because I know if my brain’s inflamed moment to moment. I don’t have fatigue, I don’t have mental clarity. I’m traveling the world. And I just am so grateful that I have this amazing future.

Dr. Weitz:            That’s awesome. And others can potentially have that future too, if they make the right diet, lifestyle changes as well as doing the standard of care.

Dr. Wahls:           Correct. Correct. So we’re not anti-drug. That’s a great conversation to have with your treating specialist. We just want to be sure that you have support to do all that you can of the things that we control. Our actions, our diet, our self-care routine.

Dr. Weitz:            Do you have training programs available for practitioners who want to-

Dr. Wahls:           Yeah, we certainly do. We train physicians, chiropractors, physical therapists, registered dieticians, health coaches. Anyone with a health related license or certificate. The training is online. We also have sessions via Zoom. Once you’re trained, it’s about 20 hours worth of training, there’s a test that you’ll have to pass. And then we have monthly calls with me discussing cases. Sometimes I bring in a guest lecturer as well. And we have people, I believe, in 24 different countries around the world. And because we do this online, my mission, we want to train as many clinicians as I can so we can make this way of taking care of people more readily available around the world.

Dr. Weitz:            And do we go to terrywahls.com to find that practitioner training?

Dr. Wahls:           To find that you go to terrywahls.com/certification.

Dr. Weitz:            Okay. That’s great. Thank you so much, Dr. Wahls.

Dr. Wahls:           And thank you for all that you are doing.


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 Podcasts or Spotify and give us a five star ratings and review. That way more people will discover the Rational Wellness Podcast.  And I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardio metabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

Dr. Izabella Wentz discusses her Adrenal Transformation Protocol 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

0:37  Adrenal fatigue as a concept was first proposed by Dr. James Wilson in 1998 in his book of the same name.  This concept was dismissed by the medical world but embraced by the Functional Medicine community, but now it has been discredited and seen as invalid even in the Functional Medicine world since the adrenals never lose the ability to secrete cortisol.  On the other hand, there are many patients with symptoms like fatigue, brain fog, intolerance to exercise, feeling overwhelmed, etc. and salivary cortisol testing often shows reduced cortisol levels or cortisol not being released at the proper time, which we will call adrenal dysfunction

3:15  Dr. Wentz suffered with Hashimoto’s thyroiditis and she got off gluten and dairy and started taking thyroid medications T4 and T3.  This made her feel better, but she still struggled with brain fog, fatigue and anxiety, and unrefreshing sleep even though I was sleeping a lot after having made these changes.  She had heard about adrenal fatigue and had heard that it didn’t exist as a condition.  Eventually she tried the recommendations for adrenal fatigue and they helped her to feel better.  Her brain fog and fatigue improved and she started to have refreshing sleep. Her anxiety also improved due to balancing her adrenals. Most patients with Hashimoto’s (hypothyroid) have some degree of adrenal dysfunction where they either have too much cortisol, cortisol at the wrong times of day or not enough cortisol.

8:12  The adrenal/thyroid connection.  Patients with hypothyroidism will generally break down their cortisol slower.  Cortisol may supply some of the energy that the body lacks from the lower thyroid hormone levels.  Or patients who get put on thyroid meds may feel better at first but then may crash and this may be because they start clearing their cortisol quicker and now they have too little cortisol.  Dr. Wentz noted that about 60% of those tested for adrenals with Hashimoto’s have a low cortisol level all day long.  You should also measure reverse T3, since higher levels of stress and cortisol can lead to T4 being converted into reverse T3 instead of into T3.  Some of these patients will do better with a natural desiccated thyroid that contains some T3 as well as T4.   

18:18  Recommendations for adrenal dysfunction.  Patients should follow a paleo-like diet by getting rid of the most common inflammatory foods, including gluten, dairy, soy, as well as grains.  This diet should be higher in protein and fat and perhaps a few more carbs at night to help lower cortisol to help with sleep.

19:25 Nutritional Supplements.  Dr. Wentz offers a minimalist approach to help patients with adrenal problems turn their health around in a short period of time.  To help with digestion, she sometimes recommends sea salt to stimulate digestive enzyme production or thiamine to stimulate digestion and hydrochloric acid production.  Dr. Wentz does recommend adrenal adaptogens, magnesium citrate, saccharomyces boulardii, and myo-inositol. As far as adrenal adaptogenic herbs, the ones she likes the most are Ashwaganda and Rhodiola. Ashwaganda can also help normalize thyroid hormone.  Maca and Shatavari are two herbs that can help with libido. She also recommends B complex and vitamin C.  Dr. Wentz also recommends magnesium citrate, which can help with anxiety, with sleep, for pain, and for constipation.  Magnesium can also help us to produce GABA.  Dr. Wentz also recommends saccharomyces boulardii as a probiotic to improve gut health and improve our natural defenses and help to clear out candida, protozoans, and some pathogenic bacteria.  Myo-inositol is another important supplement that Dr. Wentz recommends for adrenal issues at a dosage of 600 mg. and it can also help with thyroid, blood sugar, anxiety, and obsessive compulsive disorder.  The final supplement that Dr. Wentz recommends for patients with adrenal problems is L-carnitine at a dosage of 2000 mg per day and this helps to relieve brain fog. It can also help to remove ammonia from the body.  

 

                               



Dr. Izabella Wentz has a Doctor’s of Pharmacy degree and she is an internationally acclaimed thyroid specialist.  She has dedicated her career to addressing the root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s thyroiditis in 2009. She is the author of three books on Hashimoto’s: Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, Hashimoto’s Food Pharmacology, and Hashimoto’s Protocol, which became a #1 New York Times bestseller. Today we’ll be discussing her new book, ADRENAL TRANSFORMATION PROTOCOL.  Her website is Thyroidpharmacist.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. Welcome to our podcast interview today with Dr. Izabella Wentz, where we’ll be discussing her new book on adrenal dysfunction.

                                This is a topic that has been much debated within the medical community for some time. The idea of adrenal fatigue was first proposed by Dr. James Wilson in his book of the same name in 1998. However, the concept was initially dismissed by traditional medical doctors who said that if you had low functioning adrenals and low cortisol levels, you had Addison’s disease. And if your adrenal glands produced too much cortisol, then you had Cushing’s syndrome, and there was nothing in between.  This concept of slightly underperforming adrenal glands, which Wilson discussed, was taken up by functional medicine practitioners. And then in recent years, the idea of adrenal fatigue has been widely discredited as an invalid concept since the exception of Addison’s disease, which is rare. The adrenal glands never truly lose the ability to secrete cortisol.  Despite this, many patients continue to experience fatigue, brain fog, intolerance to exercise, feeling overwhelmed, and other symptoms, ensure reduce cortisol levels or cortisol not being released at the proper time on saliva testing. That is typically performed a number of times a day.  Today, we’ll be diving into this topic with Dr. Wentz and exploring the nuances of what we call adrenal dysfunction and its impact on our health.

                                Dr. Izabella Wentz has a doctor’s pharmacy degree, and she’s an internationally acclaimed thyroid specialist. She has dedicated her career to addressing the root causes of autoimmune thyroid disease after being diagnosed with Hashimoto’s thyroiditis in 2009.  She’s the author of three books on Hashimoto’s, Hashimoto’s Thyroiditis: Lifestyle Interventions for Finding and Treating the Root Cause, which by the way is the most incredible book on thyroid and I’ve got it underlined and highlighted, and I’ve referred to that book so many times. Hashimoto’s Food Pharmacology and Hashimoto’s Protocol, which became a number one New York Times Bestseller. Today, we’ll be discussing her new book, Adrenal Transformation Protocol. Dr. Wentz, thank you so much for joining us.

Dr. Wentz:          Thank you so much for having me, Dr. Ben. It’s a pleasure to be here with you.

Dr. Weitz:            Great. So since so much of your professional focus was on thyroid, why did you decide to focus on the adrenals in this new book in your new program?

Dr. Wentz:          I felt called to really focus on adrenal health because healing my adrenals was part of my thyroid journey. I initially got on thyroid meds, which were helpful, so we want to make sure we’re optimized on T4, T3. That’s a big game changer for people. I got off of gluten and dairy, which was life-changing for me as well, and I recommend that for others with Hashimoto’s and hypothyroidism. Sometimes the condition can go completely into remission when we just do these things, but I still struggled with brain fog, fatigue and anxiety, and unrefreshing sleep even though I was sleeping a lot after having made these changes, right?

Dr. Weitz:            Right.

Dr. Wentz:          So I kept hearing the term adrenal fatigue, adrenal fatigue, and being like a skeptical pharmacist, I looked up the term and then I saw that it didn’t exist. It doesn’t exist, and I was like, “Okay, so I don’t have this.” I went about, tried other things, and finally it was like the 15th person that mentioned adrenal fatigue to me and I was like, “Okay, I will give this a try.” And sure enough, I tried the interventions for it and they helped. So I had this thing that didn’t exist and nothing was going to help, even if it did exist. And then the things that these crazy people were recommending. And then I felt so much better.   So the brain fog improved. The fatigue was so much better. I could wake up in the morning and be full of energy, and I also had refreshing sleep, and I didn’t need to sleep so much. My anxiety was gone. Haven’t had a panic attack in 10 years, and they used to be a very frequent, unwanted part of my life prior to balancing my adrenals. And it’s like, “I can’t believe it’s been 25 years since Dr. James Wilson was talking about this condition.” And people are still saying, “It doesn’t exist. It doesn’t exist.”

                                I’m like, “Can we please just stop gaslighting the people that are going through these very real symptoms and help them get the help that they need?” In my experience, just about everybody that I’ve worked with, with Hashimoto’s has some degree of adrenal dysfunction where they might have too much cortisol, cortisol at the wrong times of day or not enough cortisol produced. And there’s a way to get into balance from that.  It’s not Addison’s disease. It’s not Cushings. It’s not a disease per se. This is a very predictable way that the body responds to stress. And not just people with thyroid issues, but other people who are struggling with all these symptoms. They’re presenting with this as well, and they’re walking around without a diagnosis. They think they’re crazy or lazy or just really anxious, edgy people.

Dr. Weitz:            It sort of reminds me of the issue with diabetes, where medical doctors, your blood sugar could go from 80 to 90 to a hundred to 110. Everything is fine. Everything is fine. All of a sudden it hits 125, now you got diabetes. Maybe it was a gradual process where you weren’t handling glucose quite as well as you should have. And if you had recognized it earlier, you could have helped some of these people not end up with frank diabetes.

Dr. Wentz:          I mean, yes. And it’s like the same with the thyroid gland. It’s like sometimes the person will have the reference range is 4.5 for TSH, and they’ll have a 4.4. Your thyroid is fine, right?

Dr. Weitz:            Right.

Dr. Wentz:          With really a healthy person should have a TSH somewhere around 0.5 to two if they don’t have a thyroid condition. And with the adrenal glands, it’s the same thing. So you don’t manifest with Addison’s disease until 90% of your adrenal glands have been destroyed. And you can also have other reasons for inadequate cortisol production, and part of it could just be this stress adaptation. So your adrenals may be perfectly healthy. You may not have an autoimmune response against your adrenals, but because your body is overwhelmed by stress, there’s going to be a disconnect between the hypothalamus and the pituitary and the adrenal glands and the hormones they secrete.  It’s like the boy who cried wolf. You go enough times and say, “Okay, we’re stressed, we’re stressed, and more cortisol please, more cortisol, please.” Eventually the body is going to adapt and say, “We just can’t have this much cortisol produced at this high level all day every day. We really need to start shutting down production. And this is what happens with receptors when they get overwhelmed by certain messaging, they become desensitized to the message.

Dr. Weitz:            Absolutely. So let’s talk a little more about the connections between thyroid and adrenals and how adrenals affect thyroid and thyroid affects adrenals.

Dr. Wentz:          It’s definitely a two-way street. So in my experience, people who have hypothyroidism will generally break down their cortisol slower. So they end up with more cortisol in their body and more cortisol metabolites. It’s a protective mechanism. So the body is like, “Oh, you’re not making enough thyroid hormone? Let’s help you out by keeping cortisol around a little bit more.” And then you end up feeling more edgy and wired, but you get your cortisol kick from the adrenals, which isn’t the best type of energy, but it’s energy, right?

Dr. Weitz:            Right.

Dr. Wentz:          And end up getting a diagnosis of maybe hypothyroidism. You get put on thyroid meds, which can be incredibly helpful if you’re hypothyroid, but they can also uncover a low cortisol issue that maybe you didn’t know when your body was compensating because then your cortisol clearance normalizes. So that means it increases if you had been hypothyroid.  And then a person will say, “I felt better at first with the thyroid meds, but then all of a sudden I crashed.” And I’m like, brain fog fatigue, all of that got worse. What is happening? And many times it’s like this uncovered low cortisol state. About 60% of the people that I’ve tested with Hashimoto’s that were symptomatic were actually in the low cortisol state where they had low cortisol all day long, and most of them were on thyroid meds.  In this situation, it’s not more thyroid to overcome the fatigue, it’s less support to your adrenals to get back into balance. Now, the other part of the pathway, and I always ask people, what was going on in your life before you got sick? And usually they’ll say, “I was on a period of a lot of stress.” Stress can make us produce a type of thyroid hormone we don’t want. It’s known as reverse T3. Again, this is the body’s feedback loop where. The body is like, “There’s too much of this. We need to slow down this.”

                                Reverse T3 is the inactive thyroid hormone where that will sit inside of our thyroid receptors and block them instead of activating them. And then this usually goes along with low levels of active T3. And so people will say, “I take thyroid medications that are supposed to be converted to T3. The active hormone, levothyroxine is T4 and the less active thyroid hormone that normally should get converted into T3 in the body, but it doesn’t for a variety of reasons.   So people will say, “I’m taking this medication, but it’s just not working.” And sometimes they do better on a natural desiccated thyroid that contains some of the three directly, and that’s because of that stress and cortisol component that drives up the reverse T3 production. This can even happen in people without a thyroid issue. So you can have a perfectly healthy thyroid without the immune system messing with it, but you just have all this cortisol and stress on board, and you’re going to end up with hypothyroid symptoms because of that reverse T3 blocking your thyroid receptors.

                                This has been a subset of my clients as well as as some friends reaching out to me that said, “Izabella, I have all these symptoms. I know you help people with Hashimoto’s that have these symptoms. I don’t have Hashimoto’s. Right?” But they can definitely have these symptoms and this is where something like a reverse T3 test or testing free T3 would be-

Dr. Weitz:            And most of them probably haven’t had a reverse T3 test because that’s not a test that’s typically done.

Dr. Wentz:          It’s not typically done. And if a person comes to me with Hashimoto’s, I’m not necessarily going to do it because I’m like, “I already know you have a thyroid problem and I already know you have an adrenal problem,” so let’s not-

Dr. Weitz:            Get right to the treatment.

Dr. Wentz:          Yeah. Let’s go right to the treatment options. We don’t need to feed the vampires with all this blood, but with a person who maybe has these symptoms, then I’m really looking at what’s going on in your body. And if they were open to doing testing, I would do something like an adrenal saliva test or maybe a Dutch test and some reverse T3. But also in my book, I just talk about the symptoms people can utilize to assess themselves because the testing is not always accessible. Sometimes the functional test can take weeks to get back. And by that time you could have really worked on your health.

Dr. Weitz:           Typically, a couple of weeks to get test results back for functional medicine testing.

Dr. Wentz:          Right. And the protocol can work in four weeks where within a… I’ve had patients and clients, and I’m sure you’ve had them too, where you give them a test and they’re like, “Yes, I’ll take this test.” And then three months go by and it’s like the test is still sitting at home and it’s collecting dust on a shelf.

Dr. Weitz:           For sure. We make those calls all the time. You got to do the test.

Dr. Wentz:          Yeah, absolutely. So I wanted to give people more of a streamlined approach where they can really get to know their symptoms and learn about what their body is trying to tell them and how to care for themselves to get themselves in the best state. So whether they’re working with a practitioner, hopefully they are, they found somebody really good to work with that can support them. Or even if they’re trying to do things on their own for their own health, a lot of the strategies are safe and effective. We’re not talking about using hormones in my book, we’re really focusing on solid lifestyle things people can do.

Dr. Weitz:           Right. I noticed in your book you talk about the relationship between cholesterol and adrenal function. And right now in health, we seem to be focused on trying to drive cholesterol levels as low as possible to stop heart disease and we’re constantly being told that, “That’s fine. There’s not going to be a problem with the brain function or anything else because all those other tissues make whatever cholesterol they need.”

Dr. Wentz:          So cholesterol is responsible for making our hormones. And from a pharmacist perspective, it is a category X for women who are pregnant because their body is needing to have hormones, and it can be associated with a lot of damaging effects when we suppress what the cholesterol lowering drugs are. So when we suppress cortisol… Sorry, I’ve been talking about cortisol all day. When we suppress cholesterol production too much, we can potentially suppress the production of other hormones.   And it doesn’t happen to everybody, but it can be something to be on the lookout for.  The other thing to consider is cholesterol, high cholesterol actually can be a symptom of hypothyroidism and even low T3. So part of how we make hormones out of cholesterol is utilizing thyroid hormones, specifically T3.  So getting your thyroid hormone in check and your adrenal glands in check can be a way to optimize your cholesterol levels. It’s like your body can drive up… Your body is like, “Okay, we’re under stress. We need to make more cortisol.” So cholesterol sits at the top of the pyramid and it turns into pregnenolone which is our mother hormone that gets turned into progesterone and cortisol and DHEA and our sex hormones and all these beautiful hormones downstream. But if the body’s like, “I need more cortisol because I’m in a lot of stress,” cholesterol can be gone up.  And when we balance that stress response, that need for cortisol, that need for these other hormones, then we can actually help with balancing cholesterol levels as well.

Dr. Weitz:            Cool. You talk a lot about helping your body to feel safe in order to heal and how to send safety signals to your body. What’s the importance of this concept?

Dr. Wentz:          One of the reasons why people get stuck in this adrenal dysfunction is because their body gets the message that we’re under stress or we’re in the presence of a threat right now. We have these beautiful ancient bodies that respond to modern signs of normal life and they’re still interpreted by our caveman, cavewoman genes. So if we’re doing things like over exercising or overworking to a caveman or a cavewoman, they wouldn’t be doing that. Right? So it gets interpreted as in some cases, as stress. And if we get too many of these stress and threat signals, we shift into that survival mode.  We shift into our sympathetic mode where we are in our fight or flight system. We’re in a catabolic state where the body is breaking itself down for fuel rather than being in our parasympathetic state where we are resting, digesting, healing, and thriving. We do need a balance of both. I’m not saying one is good and bad. We do need to spend time in both of these systems, but what can happen when people with adrenal dysfunction, they’re spending more time in that catabolic fight or flight state, rather than having a good balance of breaking your body down and building it back up.

Dr. Weitz:            Right. Because the adrenal gland is our major stress gland, and that’s where adrenaline and cortisol comes into play that are secreted by the adrenals?

Dr. Wentz:          Exactly.

Dr. Weitz:            So let’s talk about the recommendations for how to feel better with adrenal dysfunction. Let’s start with diet. What’s the best nutritional approach?

Dr. Wentz:          I really love focusing on a paleo-like diet. So we’re getting rid of the most common inflammatory foods, gluten, dairy, soy, as well as grains because they can be problematic for blood sugar issues. This is a 30-day plan and generally people can introduce some of the foods if they feel okay with it, such as the grains after a time period. But a lot of people do find that they feel significantly better. We’re generally going to be doing more protein and fat than the average person, a bit lower carb throughout the day, maybe some more carbs at night.   Carbs can lower cortisol, so that can be helpful for people to getting to sleep. And then we’re also utilizing a lot of nutrient dense foods. One of the issues people can have when they’re in that stress response is they can have trouble digesting foods. So I utilize a lot of smoothies in the morning.

Dr. Weitz:            Okay. What about digestive enzymes? I guess that’d be another way to get around that.

Dr. Wentz:          Absolutely. It’s a four-week plan that really focuses on kind of a minimalist approach to get the maximum dose of improvement. And that’s those four short weeks. I use sea salt as a way to stimulate digestive enzyme production. But the back of the book also has advanced strategies such as using digestive enzymes or using thiamine to help drive energy production as well as hydrochloric acid production. It depends on the person. There’s so many options for ways to heal the body, and I didn’t want to give people sure too many choices at first, because I know one of the main symptoms of adrenal dysfunction is overwhelm. So I wanted to create a very straightforward and easy to do plan.

Dr. Weitz:            Sure.

Dr. Wentz:          And the whole second part of the book-

Dr. Weitz:            You don’t want to overwhelm them with 20 supplements to take.

Dr. Wentz:          Exactly. But I do have a section in the third part of the book on additional things to consider, such as doing more testing or additional deficiencies in what symptoms may indicate that you may need additional support.

Dr. Weitz:            Right. You talk about targeted supplements and the supplements that you focus on are adrenal adaptogens, magnesium citrate, saccharomyces boulardii, myo-inositol. There’s adrenal adaptogens are these herbs that can help modulate adrenal and other function in the body, but there are a lot of them. Which ones do you think are the most important?

Dr. Wentz:          I list out a few of them in the book, and some of my favorites are Ashwaganda. They can be very, very helpful for people with thyroid issues. They can actually normalize TSH in some cases. So I always recommend checking your thyroid hormone when taking that one. Rhodiola is another one of my favorites. It’s been studied in anxiety and depression.   Then there are ones that such as Maca and Shatavari that may be especially helpful for libido issues. So I would say those are some of the more common ones I use. I really like Reishi for people, especially in the evenings. It can be very helpful for giving people a little bit more energy, but also for helping them sleep well at night.

Dr. Weitz:            I’m assuming you’re using some formula that contains a combination of these?

Dr. Wentz:          Generally, for the average person that’s not sensitive to supplements, I may recommend something that contains adaptogens, B vitamins, and vitamin C in it so that they can have a really kind of just one supplement to take. For nursing moms or people that tend to be more sensitive to supplements, then I might recommend utilizing one adaptogen at a time like Holy Basal or Tulsi tea is a really fantastic adaptogenic herb that can be utilized by nursing moms. Although I always recommend checking in with a midwife or a lactation consultant.

Dr. Weitz:            And mag citrate?

Dr. Wentz:          This is going to be something that can be incredibly helpful for anxiety, for trouble sleeping at night, for pain in the body, for constipation. And generally, magnesium is involved in so many processes in our body, and it can be helpful for producing neurotransmitters for helping us produce GABA, which is our internal chill pill for helping us produce L-tryptophan so we can rest and sleep better at night. It is something that works so well for attention and cramps in the body.

Dr. Weitz:            And then saccharomyces boulardii, so this is a healthy yeast probiotic product.

Dr. Wentz:          This is one of my tweaks because a lot of times one of the triggers for getting in that stress response, not a lot of people are aware of, but it’s actually having gut infections. Whenever we’re stressed out, our secretory IGA in our gut is lowered. This is our natural defense layer in the gut. So saccharomyces boulardii helps to raise that natural defense naturally.   So then we can overcome these infections that are there. We can become less sensitive to the foods that we’re eating. We’re not as likely to catch infections. It’s helpful for candida. It’s helpful for various protozoa. It’s helpful for clearing out mold out of the body as well, and some pathogenic bacteria.

Dr. Weitz:            And then myo-inositol.

Dr. Wentz:          Myo-inositol is something that’s been really making the headlines in the last few years.

Dr. Weitz:            I typically have always thought of it as something for PCOS.

Dr. Wentz:          It has been used in PCOS, and it can be very helpful for that. In recent years, it’s been studied for people with thyroid issues as well. So it’s been shown to normalize TSH levels and get Hashimoto’s antibodies into remission. Now, not everybody, and it’s not going to happen for everybody, but it is such a profound effect that I always recommend testing if you are already taking thyroid meds. Because in some cases, especially in the early cases of hypothyroidism, this can help with normalizing that TSH.  It is something that can balance blood sugar, and that’s why it’s so helpful for adrenal issues, which are oftentimes correlated with blood sugar swings. It’s helpful for anxiety. It’s helpful for obsessive compulsive disorder as well. Generally, people will say they take it and they sleep better throughout the night because they’re not having as many blood sugar swings. So this is something that it’s become a recent favorite of mine. And there’s been a lot of incredible studies with all the benefits of this nutrient.

Dr. Weitz:            What is the dosage that you like for myo-inositol?

Dr. Wentz:          Around 600 milligrams for the adrenal purposes. There’s been doses higher than that, that have been used for things like obsessive compulsive disorder. For the purposes of the program, I’ll use about 600 milligrams. And that’s the dose. 600 to 700 milligrams has been studied in hypothyroidism.

Dr. Weitz:            Okay. I know for PCOS, a lot of products have a combination of myo-inositol and D-chiro-inositol.

Dr. Wentz:          Absolutely. I have a little bit of a note in my book that talks about utilizing that for PCOS too.

Dr. Weitz:            Oh, okay. Let’s see. You also mentioned L-carnitine.

Dr. Wentz:          Yes. Yes. So L-carnitine is a mitochondrial supporting supplement. It is incredibly helpful for people who have brain fog. It’s been studied in thyroid fatigue, about 2,000 milligrams per day or so is what we’re dosing it at. A lot of the people in my program, I’ve had about 3,500 people go through it. We have about a 92% relief improvement in brain fog in just those few-

Dr. Weitz:            That’s fantastic.

Dr. Wentz:          A lot of people do credit the carnitine for that because what it does, it does a lot of things, but it helps to move fatty acids into our mitochondria. So the mitochondria can produce energy. It helps us remove ammonia from the body. A lot of times we can have ammonia buildup from gut infections, from constipation, from gut dysbiosis, certain gene variations. And ammonia can be incredibly neurotoxic and cause brain fog. Carnitine can help with clearing that out of our bodies.

Dr. Weitz:            I listened to your interview with Hyman and that’s the first time I heard about ammonia as being an issue. That’s interesting. In Los Angeles, we not only have chlorine in our water, we have ammonia. It’s chloramine. If we’re drinking tap water and not purifying it like I do, we’re actually drinking ammonia. So I wonder if that could be a big issue as well.

Dr. Wentz:          Oh my gosh, I had no idea. I’ll have to look into that. I know it can be generally definitely produced internally, but potentially external sources. I always do recommend filtering water because you never know what’s going to be in your water supply.

Dr. Weitz:            You’re right. All the stuff we don’t know about, but that’s when they actually tell us they put in. You talked about mitochondrial support, and I noticed that the acronym of your book is ATP, which I’m sure is not by accident.

Dr. Wentz:          Oh yes, absolutely. So ATP is our body’s energy source, body’s energy exchange, how our mitochondria makes energy. Right? So this book is all about transforming your energy, all about transforming your life, creating vitality in your life. It’s a new take on adrenal. So I really focus on a lot of the nutritional aspects, some of the foundations that I’ve taken from old adrenal protocols, but I also have a big piece of mitochondrial support that I utilize.  And then transformational, personal growth techniques that really help us rewire that stress response. So we can take all the supplements we want and we can eat a super healthy diet, but if our mind is still stuck in survival mode because of past trauma or some of our wiring then we’re just-

Dr. Weitz:            Or if you spend all day on Twitter or in social media.

Dr. Wentz:          Or watching the news, right?

Dr. Weitz:            Right.

Dr. Wentz:          You’re going to be constantly getting this source of stress and danger, and that can be just from your own mind or from your own habits. So I really wanted to have a comprehensive plan for people to truly transform their stress response. So I have had adrenal dysfunction three times myself and I don’t want to have it again. A big part part of that has been really transforming my brain function and supporting my body and my mind.

Dr. Weitz:            That’s great. How can listeners find out more about you, your book, and your programs?

Dr. Wentz:          My books are available on Amazon, and Barnes & Noble, wherever fine books are sold. And then my website is thyroidpharmacist.com. I have a ABC’s guide for adrenals guide if people go to thyroidpharmacist.com/abc that I’d be happy to share with everybody.

Dr. Weitz:            That’s great. Thank you so much, Izabella.

Dr. Wentz:          Thank you so much for having me, Dr. 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 Podcasts or Spotify and give us a five-star ratings and review. That way more people will discover the Rational Wellness Podcast.  I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So if you’re interested, please call my Santa Monica White Sports Chiropractic and Nutrition office at 310-395-3111 and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.

 

Dr. Fiona McCulloch discusses Managing a Healthy Menopause at the Functional Medicine Discussion Group meeting on April 27, 2023 with moderator 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

5:35  Perimenopause usually starts around age 39 till 55 or so and this is when we start seeing irregular cycles and lots of symptoms and increases in chronic health risks.  Perimenopause is a time of fluctuation.  Women are born with all of the follicles in their ovaries for their entire life. the follicles house the eggs and each egg is housed by cells that make hormones.  Over the lifespan the pool of follicles decrease and when you get to the end of the reproductive years, there are far fewer follicles and hormones are released abnormally and inconsistently.  During a normal menstrual cycle the granulosis cells in the inner follicle make estrogen and when the egg comes out, it ovulated and the shell of the egg makes progesterone for two weeks.  During perimenopause we have follicles on their last legs and they make estrogen all the time but not in a normal pattern and there is almost no progesterone.  The adrenals do make small amounts of progesterone but the ovaries make massive amounts of progesterone.  Perimenopause is marked by wildly fluctuating wild estrogen levels up and down and pretty much no progesterone for the majority of the time.

10:37  Diagnosis of Perimenopause. The pituitary gland is involved with the complex control of ovulation.  When estrogen levels start to drop, the pituitary senses that and then sends FSH down to the ovary to make an egg and then you get increased estrogen.  When estrogen levels get irregular but generally higher, the brain will stop making FSH, so some measure FSH as a way to diagnose perimenopause. But FSH is not consistently low, so it is not a good way to diagnose perimenopause. The best way to diagnose perimenopause is not to test hormones but based on age and that the menstrual cycle gets shorter, irregular. Women will get insomnia, have mood changes, etc.  Testing can be useful for treatment but not for diagnosis.  Menopause is easy to diagnose, since it is diagnosed when it has been 12 months since the last period. 

14:32  Stages of Perimenopause.  During the first stage of perimenopause, the cycles become shorter because there are less follicles and they make less anti-müllerian hormone, which slows them down from ovulating too early.  In the later stages of perimenopause we see highly unpredictable cycles and lots of heavy, long bleeding. Some of the common symptoms that may occur in menopause include hot flashes, insomnia, anxiety, depression, low libido, vaginal dryness, autoimmunity, insulin resistance, loss of bone density, increased cardiovascular risk, and increased Alzheimer’s risk.   

20:12  Hormone testing.  Different modalities of testing are more or less effective for different reasons. Serum or blood spot is the most common form of hormones testing and it is good at picking up topical estrogen, oral and vaginal hormones.  Topical progesterone is not seen very well in a serum test, but it is seen in a blood spot or in saliva testing.  Urine testing is good to look at the metabolites of estrogen and cortisol and Dr. McCulloch will typically use DUTCH testing.  But urine testing is not as good to monitor topical hormone replacement therapy or vaginal HRT, since this can end up in the urine directly.  Saliva is helpful to look at the diurnal rhythm of free cortisol and is good for picking up topical progesterone.  For saliva and blood spot testing she will use ZRT Labs.

24:28  Other labs that Dr. McCulloch will often order besides hormones include the following: 1. Lipids, 2. ApoB, 3. Homocysteine, 4. HOMA-IR, 5. HBA1C, 6. Glucose, 7. OGTT with insulin, 8. Liver: AST, ALT, GGT, 9. CBC, 10. Ferritin, 11. Iron panel, 12. Thyroid, 13. Cortisol, 14. AMH may be useful in differentiating irregular cycles from PCOS, 15. FSH and LH.

28:33  Diet.  Dr. McCulloch often recommends a low glycemic Mediterranean diet with lots of cruciferous vegetables that helps with estrogen metabolism and preventing breast cancer. They also contain antioxidants like sulforaphane that helps with CVD, insulin resistance, cellular overgrowth, and cancer prevention. Lignans and flax seeds and sesame seeds can mimic estrogen and have other benefits. Women should avoid processed foods, alcohol, and high glycemic carbs.  Calcium, magnesium, vitamin K2, and boron can help to prevent osteoporosis. 

29:51  Dr. McCulloch feels that soy is healthy as along as it is organic and non-GMO and the person is not sensitive to it. 

30:25  The Women’s Health Initiative study, which was first published in 2002, Risks and Benefits of Estrogen Plus Progestin in Healthy Postmenopausal WomenPrincipal Results From the Women’s Health Initiative Randomized Controlled Trial.  When this study was published it pretty much scared all women and doctors from using Hormone Replacement Therapy because it increased the risk of heart attacks, blood clots, and cancer.  One of the problems with this study is that they used oral, conjugated equine estrogen and synthetic progestins.   Another problem is that the average age that these women started to take it the hormones was 63 years of age.  Another issue is that 50% were current and past smokers, 35% with hypertension, 70% were obese, and there was no control for atherosclerosis.  And the group of women who took this dangerous kind of estrogen–the conjugated equine estrogen–without the synthetic progestins had no increased risk.  It’s the synthetic progestins that really increase the clot risk and these are in birth control pills, Provera and Depo-provera. They are orders stronger than natural progesterone and they don’t act like progesterone anyway. We are not sure why initiating hormones 10 years after menopause, but it may be because such women will tend to develop plaques once the estrogen drops and then when they start taking hormones, estrogen may soften some of these plaques and increase the risk of an event.

33:12  What we know now from research is the following:

1. Topical estrogens (patches, gels, creams) are safer than oral estrogen. We have known for years that oral estrogens cause blood clots. 

2. Topical estrogen and progesterone (even synthetic progestins) do not increase breast cancer risk up till 5 years after the last menstrual period.

3. While synthetic progestins increase the risk of clotting, this does not occur with micronized bioidentical progesterone.

4. While starting hormones more than 10 years after menopause may increase the risk of cardiovascular disease (CVD), especially in those who are obese, smokers, or have high blood pressure, initiating topical estrogen and natural progesterone within the first 10 years after menopause  is protective against CVD.

41:33  Topical estrogen. Many doctors recommend a compounded form of topical estrogen called Biest that includes both estrodial and estriol, with the thought that estriol is a weaker but safer form of estrogen.   The trend used to be to recommend 80/20 with 80% being estriol, but then you have to give higher dosages to control symptoms, so 50/50 Biest is best.  Dr. McCulloch will titrate the dosage to the amount of estradiol being absorbed, since that is the estrogen that modulates the symptoms, while estriol is essentially there to possibly mitigate risk.

43:15  Vaginal hormones.  For women who may be at increased risk for breast cancer or who are afraid of that possible risk, but who would like to improve vaginal dryness and atrophy, is it best to use vaginal estrogen or can vaginal DHEA work as well or even vaginal testosterone?  Vaginal DHEA has been shown to work really well. In the US, the Bezwecken DHEA Cubes work really well and these are over the counter, though they are not available in Canada. The other option is to use vaginal estriol plus hyaluranic acid, which also retains water and helps to lubricate the vagina. 

45:50  The clinical differences between estrogen and progesterone. 

 

Benefits of bioidentical estrodial: 

1. Very effective at reducing hot flashes, while progesterone can help with hot flashes, but not that much.

2. Estrogen has the most effect on vaginal dryness and atrophy.  If vaginal estriol with hyaluranic acid or DHEA don’t work, low dose estradiol vaginally works amazingly.

3. Improves bone density.

4. Promotes better mood/less depression.

5. Libido is primarily driven by estrogen and not by testosterone, as is commonly thought. 

6. Cognition.

Over replacement.

Taking too much estrogen or having too much estrogen because the ovaries are still putting out some can result in breast tenderness, mood swings, sadness, crying, irritability, acne, spotting, bleeding, weight gain around the waist and hips.  Using Canadian units at the beginning of the cycle, the estrogen’s about 100 and at ovulation it’s about 800.  In the Luteal phase, it’s about 400.  When we use topical bioidentical estradiol we are putting women’s estrogen somewhere around 150-250.  But if they are in perimenopause, sometimes their ovaries will bust out an egg and estrogen levels might surge to 1500, which will cause overreplacement symptoms.

 

Benefits of Bioidentical Progesterone: 

1. It opposes estrogen and it thins the lining of the uterus and prevents endometrial cancer. You don’t need to use progesterone if they don’t have a uterus.

2. Menorrhagia. Progesterone is amazing at reducing heavy menstrual bleeding. 

3. Sleep. It improves the depth of sleep, though it doesn’t help with the hot flashes that can wake women up as much as estrogen does. Progesterone turns into allopregnanolone, which crosses the blood brain barrier and it improves calmness, stimulates GABA production, and promotes sleep. This is also why oral progesterone should be given at night.

4. It also improves bone formation.

5. It improves cardiovascular disease and promotes the health of the arterial endothelium. It is anti-inflammatory and reduces coronary artery disease.  

Over replacement.

Too much bioidentical progesterone can make women feel groggy, drowsy and retain water. 

 

52:58  Synthetic Progestins, like MedroxyProgesterone, Norgestrel, and Norethindrone, are not Bioidentical Progesterone.  Synthetic progestins all behave differently but some can cause clotting and proliferation of breast tissue, while bioidentical progesterone does not cause these.

53:52  Androgens.  Menopausal women may have a relative increase in androgens because while androgens will slowly decline with age, estrogen and progesterone levels will drop drastically.  Thus the androgens tend to become more dominant and they can cause hair loss on the head and hair growth in other areas and exacerbate symptoms for patients with PCOS.  Progesterone is actually anti-DHT, so it is an anti-androgen. It can lower LH, so this will tend to lower androgens.  There are also some herbs like saw palmetto that can help.  On the other hand, some patients can benefit from taking testosterone or DHEA, esp. if their levels are really low.

55:41  Herbs.  The first category of herbs are the Endocrine Adaptogens.  These herbs help the endocrine system to adapt to change. Some herbs are androgenic herbs, including maca, tribulus, Panax ginseng, damiana, epimedium, bacopa and Gotu kola.  These herbs tend to help with low libido, fatigue, and energy and they tend to stimulate testosterone. There are other herbs that are estrogen and progesterone types of herbs, including Shativari, black cohosh, wild yam, siberian rhubarb, red clover, Vitex agnus castus, kudzu, Dong quai, and hops. Shativari is an Ayurvedic herb that is helpful during perimenopause for mood, skin, hair, hot flashes, and for energy. Black cohosh is famous for both perimenopause and menopause. It used to be thought of as being a phytoestrogen, but now we believe it works in the brain. We often think of wild yam as mimicking progesterone, but it has to be converted into progesterone in a lab, so just taking the ground herb will not convert and it actually has more estrogenic effects in the body.  Siberian rhubarb, Estrovera from Metagenics, is the top recommendation for hot flashes besides taking estrogen.  Red clover is another phystoestrogen.  Vitex is often thought to be progesteronic, but it is not, though it can encourage ovulation in certain situations, which increases progesterone. Vitex actually acts on dopamine and prolactin in the brain. Vitex can be especially helpful if the patient has amenorrhea and stress, which is usually related to high prolactin. Kudzu is another phytoestrogen that is quite strong and can also help with hot flashes. Hops is also a phytoestrogen. Dong quai is from traditional Chinese medicine and it is a tonic that is similar to shatavari.

1:01:00  Adrenal Adaptogenic Herbs.  Adrenal adaptogenic herbs include Ashwaganda, (Withania somnifera), Holy basil, Eleutherococcus, Rhodiola, Panax ginseng, and sage.  Ashwaganda is a good herb to be given in the daytime for anxiety and irritability. It is also a very calming herb that can be given at bedtime to keep people from waking at night from a cortisol spike.  Holy basil is a good mood booster in perimenopause and it also has nice effects on skin and hair.  Eleutherococcus is an adaptogen that helps to manage stress and it helps energize patients. Rhodiola is a very uplifting herb that can help with low cortisol or depression or fatigue, dopamine problems.  It can also help with attention, brain fog. Panax ginseng actually is quite similar as it is an uplifting, stimulating herb.  Sage is really good for mood, energy, and overall cortisol balance.

1:02:55  Sleep and Mood. Supplements that can help with sleep in perimenopausal and menopausal patients include magnesium, melatonin, valerian, skull cap, passionflower, Zizyphus, and ashwaganda.  Dr. McCulloch likes the Ayur-Ashwaganda from Douglas labs 2 caps before bed is really helpful for preventing the 3:00 AM wake up.  For mood, esp. for anxiety and irritability, GABA, threonine, phosphatidylserine, taurine, Ashwaganda, St. John’s wort, and Vitex can all be very helpful.  It should be pointed out that you can’t combine St. John’s wort with SSRIs.

 



Dr. Fiona McCulloch is a board certified Naturopathic Doctor and founder of White Lotus Integrative Medicine in Toronto Canada, serving thousands of women with hormonal conditions since 2001. Dr. Fiona’s best selling book 8 Steps To Reverse Your PCOS, offers well-researched methods for the natural treatment of Polycystic Ovary Syndrome. Fiona is also a medical advisor to and developed the nutrition methodology for the OpenSourceHealth PCOS project which analyzes molecular, genetic, metabolic and hormonal markers in women with PCOS. As a woman with PCOS herself, Dr. Fiona feels fortunate to serve as a guide, providing trusted information that empowers women to manage their own health.  Her website is DrFionaND.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:                            Okay. Hello, everybody. I’m Dr. Ben Weitz and welcome to the Functional Medicine Discussion Group Meeting tonight. We’ll be discussing the health challenges and successful strategies and treatments that functional medicine practitioners like us can employ to help women with women’s health expert, Dr. Fiona McCulloch. I want this meeting to be interactive, so please participate by typing your questions into the chat box, and then I’ll either call on you or ask Dr. McCulloch your question when it’s appropriate. May 25th, we have Dr. Mark Pimentel and we’ll be discussing SIBO and IBS. I’m working on June 22nd. I’m thinking about possibly doing one in person. Details still to come on that, probably on adrenal.

                                                July 27th, we have Dr. Dale Bredesen on Alzheimer’s disease. If you’re not aware, we have a closed Facebook page, which is for practitioners only, the Functional Medicine Discussion Group of Santa Monica that you should join so we can continue the conversation when the evening’s over. I’m recording this event and I’ll include it in my weekly Rational Wellness Podcast, which you can subscribe to on Apple Podcast, Spotify, or YouTube. If you enjoy listening to the Rational Wellness Podcast on Apple Podcasts or Spotify, please give me a five-star ratings and review. The latest podcast is an awesome interview with Jeffrey Smith on the dangers of GMO foods and glyphosate and it’ll really blow your mind, so you got to listen to that one. That’s out now.

                                                I want to thank our sponsor for this evening, Integrative Therapeutics. Usually, Steve Snyder’s able to join us, but he’s not able to. He’s attending a naturopathic conference, so I want to tell you about a few Integrative products. Integrative offers several products that help with estrogen metabolism, including Indolplex, which is an enhanced absorption form of DIM. They also have a very good formulation of calcium D-glucarate. They also have a very good quality and reasonably priced Vitex Extract. Finally, Integrative now has an even more advanced form of curcumin with even greater absorption than their Theracurmin, which is currently my favorite form of curcumin. This new product is called Curalieve, and it is an amorphous, solid dispersion of curcumin.   Apparently, curcumin forms crystals, and that’s one of the reasons why it’s difficult to get absorbed. So, this is a solid, amorphous form. I’m not even sure what that is and apparently has way higher absorption rates.

Dr. Fiona McCulloch is a naturopathic doctor and founder of White Lotus Integrative Medicine in Toronto, Canada, serving thousands of women with hormonal conditions since 2001. Dr. Fiona’s best-selling book, Eight Steps to Reverse Your PCOS, offers well-researched methods for the natural treatment of polycystic ovary syndrome.  I’ve referred to that book a lot when dealing with patients with PCOS. It’s really an awesome book. Dr. Fiona is also a medical advisor too and developed a nutritional methodology for the Open Source Health PCOS Project, which is a women’s health technology platform. All the way from Canada, Dr. Fiona McCulloch.  Thank you so much for joining us.

Dr. McCulloch:                   Thanks so much for having me. I always love being on your podcast and presenting. Of course, I love everything about hormones, so I’m really excited to present on this topic.

Dr. Weitz:                          That’s great.

Dr. McCulloch:                   Yeah, so I’m just going to start off talking about perimenopause and menopause. I always find it very hopeful to differentiate between these two, because they’re actually quite different and they need different support, but they both cause lots of different issues. Sometimes perimenopause is actually worse and is often missed altogether. So, yeah, I am Dr. Fiona McCulloch. I’ve been practicing in the area of hormonal health for 22 years in Toronto. I’m a naturopathic doctor and I’m a board member of the Endocrinology Association of Naturopathic Doctors. So, I’ve prescribed lots of hormones. The majority of my practice is polycystic ovary syndrome, menopause, thyroid, adrenals. So, yeah, I really love this topic.

                                                So, first, I just want to talk about the different stages that we see in the lifespan in women. So, the first stage is premenopausal. This is when patients are having regular cycles. It’s generally from the time they have their first period up until usually around 40 or so. Some people have this a little earlier, but for the most part, it’s around this age that we see perimenopause happening. So, around age 39 to 55 is usually perimenopause. We start seeing irregular cycles, changes in cycles, and that’s when lots of symptoms begin as well. Menopause is defined as 12 months past the last menstrual period, and this is where we see a lot of the chronic health risks rising. So, they’re both very important times. They have different sets of problems to deal with.

                                                So, the first thing to know is that perimenopause is a time of fluctuation. So, its very nature is change. It is very chaotic hormonally. I’ll show you what goes on there and why it is so challenging. A lot of the time patients will come in unaware that their symptoms are from perimenopause, because they’re still having periods. A lot of patients believe that until they actually stop having periods that it can’t be related. So, this is something that can be missed a lot of the time. A lot of these patients are diagnosed with anxiety, depression, and things like that. Meanwhile, they’re actually in perimenopause. So, it’s really important to be able to figure out if that’s what’s going on here. So, what is it that causes that to happen hormonally?

                                                So the first thing is that women are born with all of the follicles in their ovaries for their entire life, and the follicles basically house eggs. So, each egg is housed by different cells that make hormones, and these follicles basically are ovulated. There’s an ovulation that occurs every month from one of the follicles. Over the lifespan, the pool of follicles decreases. As you get to the end of the reproductive years, there are far less follicles. When that happens, we start seeing some irregularities. These follicles don’t behave normally. There’s less of them. They release hormones abnormally, and many times they don’t ovulate. So, these are basically the end of the road of the ovulation process, and we’re seeing a lot of inconsistent hormone production as a result of that.

                                                So, if we look at what actually happens on the left side in a reproductive cycle, on the left, this is a normal healthy menstrual cycle where we’re seeing the very beginning of the cycle. A lot of people are not that aware that the estrogen is actually made from the follicle during the process of ovulation. So, at the very beginning of the cycle, over on the left side here, there are these very tiny follicles and they’re not really active. They’re sitting there quite mostly dormant, and the brain will then start to grow a follicle to get ready for ovulation. The inner part of this follicle makes estrogen. That’s called the granulosis cells, and the outer part actually makes estrogen and the estrogen actually will spike up quite high as the follicle enlarges.   So, it makes a lot of estrogen that stimulates the process of ovulation. The egg comes out, it’s ovulated, and then the shell of the egg makes progesterone for two weeks. This is where the vast majority of our progesterone comes from. If you look at the beginning of the cycle there, see how there’s so little? That’s the amount that comes from your adrenal glands. It’s almost nothing compared to how much comes from the ovary. The ovary makes massive amounts of progesterone. The adrenal makes tiny amounts of progesterone. So, throughout the reproductive lifespan, we have large amounts of progesterone for two weeks, very little progesterone for two weeks, but then estrogen goes through this lovely pattern where it’s up and goes up in that pattern to ovulation and then another little bump around the gluteal phase.

                                                Perimenopause, what we see over here is that we have all these follicles. They’re not really functioning normally because they’re old. They’re on their last legs and they’re about to sputter out. So, basically, they just randomly make estrogen. They make estrogen all the time, but they don’t make it in a normal way. Sometimes they make a lot, sometimes they make none. It’s up and down and all over the place. Progesterone only happens when you ovulate. So, you have this little bit from the adrenals, but then that large amount is just not there most of the time. Only when ovulation occurs, two weeks of progesterone are made. That’s random in perimenopause and when it does happen, sometimes it’s way less than you would see. So, you’ve got all this estrogen, almost no progesterone, definitely not that normal half and half pattern that we’re used to having. So, that’s a huge change that we see in perimenopause. So, the two big things are really fluctuating wild estrogen levels up and down and pretty much no progesterone for the majority of the time. We do get some sometimes, but unpredictable.

So, let’s talk about why these wild fluctuations happen in the first place. If we look at what the pituitary gland does, the pituitary gland is involved in very complex control of ovulation.  Whenever your estrogen levels are very low, the brain sees that and says, “Oh, we need to make an egg. Let’s grow an egg.”   It basically sends FSH right down to the ovary, starts to grow the egg, and that’s what makes the estrogen. So, basically the stimulus to grow an egg is low estrogen. Whenever estrogen’s low, the brain’s like, “Push an egg.” So as you can imagine, that drop will make the brain push out an egg. Then we get a big burst, and then maybe that exporters out drops. So, now we get this back and forth, up and down between the brain and the ovaries. So, once the estrogen goes up to the brain, then it stops making FSH. So, sometimes the FSH will be low, sometimes it will be high depending on what’s happening at the time. So, it’s quite random. This shows you what happens when there’s high estrogen. So, high estrogen, the pituitary gland will shut down FSH.  Basically, we don’t need to make an egg. We already have one. The times that that occurs are really right around ovulation. We wouldn’t be growing an egg at that time because we’re already ovulating. We wouldn’t be doing that in the luteal phase, second part of the cycle, it’s already lots of estrogen. So, at those times, we don’t want to grow an egg and that’s totally normal. If someone is pregnant, also, high estrogen, don’t need to grow an egg. In perimenopause though, it’s high randomly all the time. So, basically it’s up, the brain is like, “No FSH,” then it’s down, and then the brain’s like, “Yes, FSH.” So it’s basically up, down, all because of these eggs that are really burning out and not able to do their normal function of ovulation.  So, this is basically this back and forth process, up and down estrogen. Basically, it’s a very bumpy ride. It’s very unpredictable. The reason I’m showing you that is sometimes people test FSH to diagnose perimenopause. That often can be very misleading, because sometimes it’s high, sometimes it’s normal, sometimes it’s low. It’s just all over the place. It’s totally random. So, it’s something to consider, but I certainly wouldn’t say, “Oh, that person has normal FSH, they’re not in perimenopause.” So these are really important things just to understand diagnostically. So, yeah, perimenopause, we see this up, down of these hormones, very random, up and down of FSH, up and down of estrogen.

                                                So, how do we actually diagnose perimenopause given that we can’t actually test these hormones and know if that’s the cause? Really, it’s very easy to tell. So, you use clinical case taking basically if a patient is between 40 and 55 years old and they’re really having persistent changes to their menstrual cycle. So, they’ve always had a 28-day cycle. Now they’ve got a 25-day cycle. Now it’s a 24-day cycle. They have insomnia, they feel different, they feel weird, they’re having mood changes. This is perimenopause. That’s really all you need to know. There’s no test that will tell you more than that. It’s the age range and these symptoms and these changes to the cycle. Menopause is very easy as well. It’s 12 months since the last period.  But in menopause, we do have a very consistent testing to look at. So, the FSH knowledge are extremely high, usually over 30 for FSH.  Estrogen, progesterone will be very, very low. So, yeah, in menopause, you can use these tests. However, it’s also very obvious because the person’s not having periods. So, testing is useful for treatment, but not for diagnosis, because you can diagnose it just by talking to somebody and figuring out what’s happening.

The next thing is that there are different stages of perimenopause to know about, and the first stage can be a little bit subtle. What usually happens is the cycles become a little closer together. So, if somebody had a 28-day cycle, now it’s 25, 24, 23 days, that often goes on for a few years before the next stage of perimenopause.  This whole thing can last around 10 years, but the first stage can be quite long actually, where those cycles are shorter. Then ovulation is occurring early in that first stage. The reason for that is when there’s less follicles, they make less of a hormone called anti-müllerian hormone, which is basically something that slows them down from ovulating too early. So, you just start ovulating earlier and earlier and there’s just less regulation inside the ovary. It just starts pumping out eggs that are maybe working sometimes, maybe not at other times. We also in the later stages, start seeing highly unpredictable cycles. So, the cycles might be months apart. They might be two in a month. They might be bleeding for three weeks straight.  It’s just so unpredictable and chaotic, but definitely, we see a lot of the heavy, heavy long bleeding in this stage and that can be very problematic. That’s where a lot of patients in the old days would be given a hysterectomy, second stage of perimenopause, because unfortunately, they didn’t have treatments for that which we have now. Sometimes it’s still done, but there’s so much more that can be done now. So, we don’t have to have a hysterectomy just because of this last stage of perimenopause. So, the symptoms in perimenopause, if we think about perimenopause as the left side of this graph where the right side is menopause, perimenopause still has estrogen. So, you’re not going to have constant estrogen deficiency symptoms.

                                                They’re going to be fluctuating, but you’re also going to have a bit of chaos and mayhem in how people feel. They feel up and down, mood swings, insomnia. It comes and goes. We see lots of autoimmunity happening here, because the immune system has to respond all the time to these up and downs of hormones, especially estrogen really causes a lot of changes to the immune system. So, migraines, it’s almost like PMS times a million all the time. It’s just up and down, all over the place. So, yeah, a lot of patients come in this stage and they’re like, “I just feel really tired. I have anxiety, I have depression. Something is wrong.” Then nobody ever brings up that they might be in perimenopause. So, this is often misdiagnosis, something else in this stage.

                                                But just to keep an eye out for these imbalance symptoms where heavier periods, irregular cycles, mood changes, sleep changes, a general change in how people feel. It’s all very common. I am sorry, I don’t know why it has gone back there. One second. The menopause stages are really estrogen deficiency symptoms. So, this is where if we’re looking at that right side. There’s really no more estrogen. That’s where you really start seeing things like hot flash. I mean you can have them in the first stage, but in the second stage, the hot flash is really stark, because there’s no more estrogen, insomnia, anxiety, irritability, depression. But these symptoms tend to improve gradually, those top three a little bit as time goes on.

                                                They find in menopause, women, generally, their mood gets better if they’re given a little bit of time compared to perimenopause. But some of the symptoms and risks actually start accumulating from the lack of estrogen. So, that would be things like cognition, cardiovascular risk, insulin resistance, bone density. So, all of those things just continue and get worse over the years, and those are really caused by estrogen deficiency. We also sometimes see androgen excess symptoms like hair growth on the face, hair loss from the scalp. I’ll show you why that happens, because a lot of people are confused in that the testosterone’s actually quite low. So, why is this happening? There’s actually some reasons for that and everyone’s a little different. It depends on their predisposition there.

Dr. Weitz:                          Can I ask, do we understand why hot flashes occur from low estrogen?

Dr. McCulloch:                   So they don’t 100%, but some of the thinking or the newer information is suggesting that people who have high estrogen previously have more hot flash and they don’t 100% understand why that is.

Dr. Weitz:                          I mean, what is the body trying to do or compensate for?

Dr. McCulloch:                   They don’t actually know unfortunately. Yeah, it’s neurological in some way and there’s some pre-programming related to estrogen, but they haven’t been able to figure it out. It’s like a neurological circulatory element. Yeah, there isn’t really good answers on that unfortunately, because some people just have them like their whole life and it’s interesting. But I definitely see it in the patients that have high estrogen. Once they go through the final stages, they often have bad hot flash. It’s a different treatment process to go through those stages. The types of hormone testing that we can do. So, in perimenopause, although we cannot really diagnose it with testing, we certainly want to do testing to understand how we can help these patients because everyone’s a little bit different.  Everybody has different aggravating factors and I find that people’s predispositions are always worse in this phase. So, whatever they have already, it just gets worse.

So, there are different types of testing. I just want to briefly review them. There’s all different possibilities for tests. I mean some of them have pros and cons and it really depends. Sometimes it’s convenience. Sometimes it’s a combination of different tests that will make you choose between one or the other, but blood spot and serum testing is definitely probably the most common type of testing that’s done. It is really good at picking up endogenous hormones.  So, hormones that we make in the body naturally. It is also good at picking up topical estrogen, oral and vaginal hormones. We just have a lot of data on that and what those levels look like in serum. Topical progesterone is not seen very well in a serum test, but it is seen in a blood spot test, because it’s found in capillary blood more so. If you ever do progesterone cream and you run a blood test, you’re not going to see it much there at all. You’re going to see a tiny bit, but if you do capillary blood spot or saliva, you’ll see the progesterone cream.

Dr. Weitz:                          Wow, that’s an interesting pearl right there.

Dr. McCulloch:                   Yeah, it’s one of those things that they don’t actually know how it’s actually absorbed, but they believe might be lymphatic and that’s why it’s showing up that way. But nobody’s actually studied that properly to find out because they believe the progesterone cream isn’t absorbed. So, they won’t study it, but it is. You can pick it up in these tests. So, it is observed and I see that it is different. They’re just different forms. I think in the future, hopefully, that will be studied more so, but urinary metabolites are also very useful. Those show something a little bit different. So, those are going to pick up excretion and break down products of hormones. It can help us understand metabolites.

                                                So, if somebody has a risk of breast cancer, we can understand, “Do they make harmful metabolites of estrogen?” It’s not as good for a topical HRT assessment, because it is excretion and vaginal HRT, it can actually land in the urine. So, those are not really good. It’s not really a good way to assess how is the level in the person’s system, but it’s extremely helpful for adrenal issues because you can understand metabolites of cortisol, total cortisol free. You can do diurnal rhythm. So, it’s a great test for cortisol really, and saliva. So, saliva is interesting in that it’s very good at picking up topical progesterone. It can give you an instant measurement of adrenal free cortisol. It’s easy to do at home, so you can do diurnal. So, yeah, so that is basically saliva.

Dr. Weitz:                          For urinary, do you have a preference for dried urine versus 24-hour urine?

Dr. McCulloch:                   Yeah, I usually do dried urine. Yeah, I usually do that, but I have done 24-hour, just like if some patients don’t want to do the whole dried urine thing. I’ve done that, but I just find that’s good for just total cortisol.

Dr. Weitz:                          In Canada, do you have some of the same testing companies that we have here?

Dr. McCulloch:                   We do.

Dr. Weitz:                          You have the DUTCH testing. Okay.

Dr. McCulloch:                   Yeah, that’s what we use for, this is primarily the DUTCH test. We use ZRT also, but mostly the DUTCH test for the urinary metabolites.

Dr. Weitz:                          Okay. What about for saliva and bloodspot?

Dr. McCulloch:                   For saliva and bloodspot, I use ZRT. They have great tests actually. I really like ZRT. So, yeah, they have a lot. They’re adding more and more too. So, really good company.

Dr. Weitz:                          Cool.

Dr. McCulloch:                   Yeah. So, yeah, it really depends on what you want to know, which tests to do. There’s just many different reasons to choose each one. Lab panels, so these also would be selected for the patient and their risks. So, basically whatever you’re seeing here, don’t get too stuck on it. I see sometimes people doing the DUTCH test and they’re like, “Oh, you have no estrogen,” and then the person’s having periods not regularly, but they are. So, obviously, they have estrogen, but then it has to be understood that these hormones change all the time and that’s normal.  If it’s low, it’s low, but that tells you that sometimes it’s low. That’s all tells you. Other times, it might be high. If they’re having periods, they have estrogen. So, it’s really this understanding, you can look at it under, get a snapshot, but knowing that it changes is very important.

Dr. Weitz:                          Have you used the cycle testing where you test it every day of the month using DUTCH?

Dr. McCulloch:                   I have. I also have the fortune of working with a lot of fertility patients who go through cycle monitoring at fertility clinics. So, I get that, which is really cool, because then it’s repetitive. They’ll do a bunch of them, so I get to see that too. We do the cycle testing, so it just depends, but a single cycle’s really only a single cycle too. So, sometimes it just depends on what I’m trying to learn from that. Sometimes it is useful to figure out what’s going on. So, yeah, the estrogens, progesterone. So, the strong estrogen is estradiol. The other estrogens are estrone and estriol, and then there’s progesterone. So, all of these can be measured in blood spot and metabolites. The androgens can be measured.  I often do that in patients who have PCOS, because there’s a group of patients with PCOS whose androgens actually go up in perimenopause. Their DHEA shoots up through the roof and they get high testosterone and then they have all kinds of problems. They’ll lose all their hair or something like that very suddenly. So, those patients, I always test their androgens. Other patients, usually they’re going to be low, but there’s this category of PCOS patients where it goes up quite high actually, which is not fun for them, because they’ve gone through their whole time and now again, they have to deal with this problem. So, it’s good to make sure that’s what’s happening.

                                           The cardiovascular elements, I always test that, lipids, ApoB, CRP, homocysteine, insulin resistance, so HOMA-IR, A1C, glucose. Oral glucose tolerance test with insulin or even just fasting insulin can be really helpful. Liver enzymes to look for fatty liver, especially ALT, can be quite sensitive for that. Iron panels can be really helpful too in understanding fatty liver and then iron deficiencies in perimenopause are very common with the heavy periods and a full thyroid panel because a lot of people develop Hashimoto’s in this phase. Cortisol is really important. I really do like to do the diurnal cortisol whenever possible. Sometimes I’ll just screen it if the patient doesn’t want to pay for that test, but I’ll screen it with serum.

                                                Metabolites are really useful for someone with a complex condition. Other considerations, anti-müllerian hormones. So, sometimes say if a patient’s 36 years old, they’re too young for menopause, but they’ve had regular cycles, now of a sudden they’re irregular. If you want to find out, “Are they in perimenopause early?”, you can run AMH and that will tell you they have a very low egg reserve. They’re probably having those symptoms from perimenopause. FSH and LH, again, they’re high in menopause. In peri, they’re up and down all the time. Sometimes they look totally normal and sometimes they look really high, but they just move around. So, yeah, the labs are all very individual.

So, nutrition generally, of course like anything, a lot of different nutrition plans can work.  I don’t believe in any particular nutrition plan. I’m like, “What works for this patient that’s the healthiest way that they can eat according to their lifestyle?” But a Mediterranean low GI diet or an adaptation of that is often very helpful in this category for cardiovascular disease. Cruciferous vegetables, lots of those will help with estrogen metabolism, preventing breast cancer, but also antioxidants with sulforaphane, that really helps with cardiovascular disease, insulin resistance, cellular overgrowth and cancer prevention. Lignans and flax seeds, sesame seeds, they mimic estrogen.  They can have some really good benefits. CalMag mineral formulas are really critical. So, many patients will start to develop osteopenia as soon as their estrogen starts dropping. So, these are really important. Usually, they should have all the minerals and vitamins that go along with calcium and magnesium, like vitamin K2, boron. So, all of these micronutrients are really important.

Dr. Weitz:                          Steve asked about soy. What do you think about soy? Soy?

Dr. McCulloch:                   So soy, if it’s non-GMO and organic and the person doesn’t react negatively to it, is not sensitive, I’m actually fine with it. I think what the research shows is it’s beneficial. As long as it’s not GMO and not sprayed with tons of glyphosate. If it is, you don’t need it. Yeah, it’s sprayed with a lot of glyphosate, conventional soy. Still controversial though, right?

So the next thing I’m going to talk about is this study, the WHI 2002 study. Probably everybody remembers this study because they ring the alarm bells. They stopped this study. It was all over the news. HRT’s going to kill you, give you a heart attack and give you breast cancer and we need to stop it right away. I remember that very well. I remember being afraid of it and being shocked, because I had just graduated school at that time.  “Oh, wow, this is really dangerous” was my thought at the time. That thought has persisted. So, basically, it was the oral estrogen and synthetic progestins were reported to increase the risk of clot and cancer. However, what they said was HRT will give you heart disease and cancer. What we know now is that the statistical analysis and breakdown of that and the updated research has showed us that that was quite unfounded and also that there are very specific things to know about HRT that really are involved in that risk that we saw, but something to consider is that in that study, the average age was 63 years old. 70% of the patients were aged 60 to 79, 10% were aged 50 to 54.  It was using conjugated equine estrogen, which is synthetic oral estrogen, and synthetic progestin, which is oral hydroxyprogesterone. These are very different than what we use now. 50% were current and past smokers, 35% with hypertension, 70% were obese, and there was no control for atherosclerosis. So, so many flaws, just to say across the board. This causes heart disease. No, this is a very confounded study with lots of things that weren’t controlled for. So, even just looking at that alone tells us that needs more analysis. But if you want to go through this chart later, this is the breakdown of those studies and actually what the conclusion was.

                                                What you’ll see if you look through that is that really, even with these CEE estrogens, the most dangerous kind, there really isn’t an increase in the risk unless the progestin was added to it. So, that’s very important to know in that even the worst kind of estrogen did not have that risk in particular. Now, we just know so much more even that we would never use that estrogen now. So, I’ll show you the breakdown of what we know as a summary. So, this is just a summary of everything. All the research that we have now, topical estrogen, so transdermal patches, gels, creams, these are much safer than oral estrogen. The oral estrogen turns into metabolites in the liver that cause clot and thrombosis. We see that with birth control pills.  We’ve known that for many years that they cause clot and thrombosis. So, it’s really not a surprise that the oral estrogens cause that. Transdermal does not seem to cause this. So, this is really good news. Transdermal estrogen and progesterone together, and this is using a synthetic progestin because they haven’t got enough research yet, even on micronized progesterone, natural progesterone. But even that combination does not increase breast cancer risk up to five years past the last menstrual period. Synthetic progestins clearly increased clot risk. We’ve always known that. They’re in birth control pills, Provera, Depo-Provera. All these things we’ve already known, they increased clot risk. So, it’s absolutely no surprise that they do that in menopause and they’re very strong.

                                                Compared to natural progesterone, they’re like orders stronger. So, it’s not necessary to take something like that. Plus, it doesn’t act like progesterone anyway. But we don’t see that risk with micronized progesterone. They have not found any thrombotic risk with that. We do need more research to understand long-term safety, but so far, it really looks quite safe, which makes sense considering this exact form our body makes. Initiating HRT after age 60, so this would be not being on any HRT at all, going completely with no hormones for maybe 20 years. Sorry, not 20 years, maybe something like 10 years. The average age is about 50, 51.  If they were to initiate it 10 years later, there was an increase in cardiovascular disease, breast cancer in obese, smokers, and hypertensive people. Why is that? We don’t know 100%, but what we think is that those people have a lot of plaques on their arteries in particular. They just develop lots of plaques in that time and then the estrogen softens those plaques and that can cause a risk. So, for that group of people, it does seem to be a bad idea to start it after 10 years. That being said, we still need more evidence on that, but for those people, it’d be best for them not to wait. They might just be accumulating so much risk. Oh, I am sorry about that. I do not know why.

Dr. Weitz:                            So interesting. So, you’re saying in particular women who have calcified plaque might potentially be at more risk because the estrogen might make the plaque less stable.

Dr. McCulloch:                   Yes, it softens it. So, if they initiate it within 10 years, though we don’t see that risk. It’s only if it sets in for that time and it’s only in these risky groups. So, they already have a lot of plaque and then they’re probably rapidly getting a lot of plaque in that 10 years and then the estrogen softens it and may cause an event.

Dr. Weitz:                            So I wonder what you would think about a woman who’s suffering with the beginning stages of Alzheimer’s, let’s say she’s 65 or something and has not been on hormones and now we think that perhaps going on hormones might be beneficial. I guess you have to weigh both factors.

Dr. McCulloch:                   You’d have to weigh it. What I expect to see is that we will learn how to do that. There’s probably a way to initiate it or a dose to initiate with in people with cognitive, but it’s hard to know. If they don’t have those other risks, maybe it will be fine for them. It’s just like for the safety data, it’s going to take time to get that. Yeah, I personally think for cognition, it’s going to be continued quite a long time once we get the data on that.

Dr. Weitz:                            Yeah.

Dr. McCulloch:                   Yeah, initiation within 10 years of the last menstrual period is protective against cardiovascular disease. So, it actually reduces the risk of cardiovascular disease across the board. So, it’s a great idea to go on anytime within that 10 years. That’s quite a long time. Obviously, if you can go on it immediately, that’s great, but you don’t have to. So, lots of protective effects there. In patients with a uterus, it’s very important that whenever there is estrogen, there absolutely must be progesterone added as well. It has to be oral or vaginal, because transdermal progesterone is not strong enough to consistently deal with the lining and reduce the risk of endometrial cancer.   So, it has to be something like oral micronized progesterone or vaginal progesterone. I tend to use vaginal progesterone in patients with extreme heavy bleeding in perimenopause because it works really well. Outside of that, I would use oral micronized progesterone just because it’s great for sleep.

Dr. Weitz:                            Do you cycle the progesterone two weeks and in two weeks now, or do you have women take it every day of the month?

Dr. McCulloch:                   So I always cycle it in reproductive age women. In perimenopause, if their cycles are highly irregular, I find cycling it actually causes more bleeding problems off and on. So, I just tend to do it continuously, especially if they have heavy bleeding. In menopause, once they’re past full that full year, unless the progesterone’s helping them, you can do it 12 days a month. If they feel good on it though, you can do it every day. If they’re like, “I sleep better on the progesterone,” they can do it every day, but a minimum of 12 days, we’ll deal with the lining risk.

Dr. Weitz:                            Steve is asking, “Do you use ultrasound to check uterine lining thickness if on progesterone?”

Dr. McCulloch:                   Yes. So, I do. Because I deal with a lot of patients with PCOS, I have a lot of patients who’ve had endometrial hyperplasia and cancer in my practice. In perimenopause, most of the time that there’s bleeding, it’s not endometrial hyperplasia, but if a woman is past menopause and you see a bleeding, that is not normal. So, definitely do an ultrasound. I always do a baseline ultrasound anyway, just to have a good look and make sure nothing else is going on, especially if they have just dysfunctional bleeding. But I find in perimenopause, once they’re on really consistent past three months, you don’t really see a lot of dysfunctional bleeding.  As long as they have estrogen in their body naturally and their eggs can have any capacity to make them, you will still see spotting, bleeding. So, yeah, peri and menopause are a little different that way, but yeah. Contraindications and this is from North American Menopause Society, undiagnosed vaginal bleeding. So, obviously, if somebody’s just hemorrhaging and you don’t have an ultrasound, it’s important to do an ultrasound just to make sure nothing is wrong. So, obviously, before starting estrogen, if somebody’s having three-week long periods, do an ultrasound. First, diagnose. It doesn’t mean that you can’t give because progesterone will solve that problem for a lot of people. Yeah, but do the ultrasound first.

                                                Suspected or known BRCA genes really should not be taking any estrogen. Estrogen dependent cancers of any sort should not be taking estrogen. Acute liver disease, this is more for oral estrogen, but it’s implied in the packaging. It doesn’t mean that somebody can’t take this if they have fatty liver disease, for example. This would be something where the person is actually very sick at the time with something and then venous thromboembolic disease. It’s just a contraindication. So, that’s somebody with like a DVT or a PE at the time really.

Dr. Weitz:                            What about particular types of topical estrogen? So for example, estradiol versus estriol. Some people feel that estriol is safer, has less risk for maybe somebody who’s at higher risk for breast cancer.

Dr. McCulloch:                   Yeah, so compounded HRT is often called Biest, which is a combination of estriol and estradiol. The trend before used to give a large amount of estriol, so 80/20 where you were giving a lot of this estriol and the thinking was that estriol is protective against cancer. Estradiol is the bad estrogen and it’s going to cause cancer. But now, we actually have learned differently in that if you give too much estriol, it can block the receptors for estradiol and then you have to give more estradiol and you’re ending up giving much more than you need to. You’re just basically giving way too much.  So, now, mostly, they are 50/50 if you’re doing Biest. So, usually 50/50. I always target though to the estradiol when I’m looking at the dose, because that’s the one that makes the person feel better is generally estradiol. The estriol is there to mitigate risk and it can possibly help with some symptoms, but it’s very subtle compared to estradiol, which has a massive clinical effect for people. They used to have Triest, which was estrone, which is now not a good thing at all. Yeah. So, things have changed quite a bit with that.

Dr. Weitz:                          Well, in the category of women who are nervous because they feel like they have an increased risk of breast cancer, what about women who are afraid of taking estrogen, but they want to do something about the vaginal dryness and atrophy and stuff and they want to do something topically?  Some people have recommended topical intravaginal DHEA, intravaginal testosterone versus intravaginal estrogen and estradiol versus estriol. What do you think about what is the best and safest?

Dr. McCulloch:                   Yeah, those are all great. Actually, I have a slide on this. One second.

Dr. Weitz:                          Okay. Sorry.

Dr. McCulloch:                   No, I’m going to bring it up now because it’s like a perfect time too. But yeah, the DHEA actually is really a great option for vaginal tissue. So, it really can be used vaginally. It definitely can make a difference. The other thing is you can do just estriol with hyaluronic acid. That is a really good combination I use a lot. It’s very moisturizing, the hyaluronic acid. So, it retains the water and fluid. Then the estriol does have an effect in the local area. There’s also low dose vaginal estrogens like Vagifem, the very tiny amount. That works amazingly well. So, if it’s really just vaginal atrophy, dryness, that can be great. So, any of these can be awesome.  I think there’s the brand, they’re called something cube, I’m sorry. It’s in the US. We don’t have it here, but I wish we did. There’s these cubes. I think they’re called something cubes, and they have DHEA progesterone. I’ll get the name for you, but you can order them. They’re all vaginal, Bezwecken. They’re called Bezwecken Cubes. So, they have all these different types of vaginal treatments that are basically a variety of these different types of options that don’t have estradiol in them.

Dr. Weitz:                          Are those over the counter or those prescription?

Dr. McCulloch:                   They’re over the counter.

Dr. Weitz:                          Wow.

Dr. McCulloch:                   In the US. Yeah, they are. So, they’re really cool and they’re quite popular. Patients will say they’re very good. We just don’t have them in Canada, but I’ve heard a lot of the US patients tell me about that.

Dr. Weitz:                          Cool.

Dr. McCulloch:                   Yeah, so if I go to this slide, I just want to talk about the difference between estrogen and progesterone clinically and what you would expect to see because they have actually different effects. So, the estrogen, what you can expect to see that have an effect on hot flash, it’s like the best thing for hot flash by far. Some people will say progesterone helps with hot flash and it can, but not that much. It’s estrogen that really helps with hot flash. When someone is on estrogen, their hot flashes go away. It’s very intense on in its effect that way, even not at a very high amount. So, it really does help with that.

Dr. Weitz:                          Maybe you’re going to get to this, but what about supplements that might be beneficial for hot flashes?

Dr. McCulloch:                   I do have. Yeah.

Dr. Weitz:                          Okay. Well, hold the question there.

Dr. McCulloch:                   There are certain ones that are really good for hot flash.

Dr. Weitz:                          Okay, we’ll hold it.

Dr. McCulloch:                   Yeah. The vaginal dryness, really estrogen is the one for vaginal dryness, but you can do local estrogen like these Vagifem or these cubes or suppositories. You can do estriol. If estriol and something like hyaluronic acid or one of these other ones doesn’t work, you can try the low dose estradiol vaginally. So, vaginal dryness, it works amazingly. Bone density, same thing. So, mood is a big one. Estrogen really lifts the mood. It’s helpful for depression especially. So, a lot of people will feel their mood is so much better and they have more energy.

                                          I should have mentioned in this section two, libido in women is primarily driven by estrogen. A lot of people think it’s testosterone, but it’s actually estrogen that drives a lot of the libido in women. So, sometimes with the patients, you’ll give them testosterone or DHEA or something, because in women, DHEA turns primarily into testosterone. They don’t have any change, but you give them estrogen, all of a sudden, their libido’s amazing.

Dr. Weitz:                          Where does that myth come from that women’s drive comes from testosterones?

Dr. McCulloch:                   I mean, I think part of it does, but I think more of it is from estrogen.

Dr. Weitz:                          Steve says that’s because information comes from men.

Dr. McCulloch:                   Right, yes. That’s probably part of it. But if you think about estrogen rises at ovulation, that’s when you have a massive spike of estrogen. Right at ovulation, there’s a little rise in testosterone, but a massive rise in estrogen. It’s like that combination is probably what does it. So, yeah, but I always bring that up because sometimes people don’t think of estrogen that way. Then cognition, for us to say with 100% certainty, it does help that. We don’t have enough evidence, but there was another study that came out. It really looks like it is going to be a big thing for preventing Alzheimer’s and improving cognition. Too much estrogen replacement will cause breast tenderness, mood swings, sadness, crying, irritability, acne spotting, bleeding, weight gain around the waist and hips.

                                                So, those are over replacement. That being said, when you’re using topical estrogen in these amounts, which are not very high, it’s not that common to have that. Often, it’s just that you haven’t balanced it properly with the progesterone. Sometimes the high estrogen is actually coming from the person’s ovaries. The estrogen replacements we do in our Canadian units. I’m sorry, I don’t know the US conversion, but I’ll use the Canadian ones. Say at the beginning of the cycle, the estrogen’s about 100. At ovulation, it’s about 800. In the luteal phase, it’s about 400. So, when we’re using these topical estrogens, we’re putting people’s estrogens somewhere about 150 to 250. So, they’re nowhere near any of these reproductive levels.

                                                They’re at a low level, but sometimes their ovaries bust out an egg and makes a 1,500 of estrogen. That’s what causes those problems more so rather than these replacements. So, that’s where you’ll see it. It’s endogenous estrogen in perimenopause. Progesterone is essential with estrogen in anybody who has a uterus. If the person has their uterus removed, you don’t need to use progesterone. It’s not necessary to prevent the cancer risk. However, also, it has a lot of benefits. So, the first thing is it does oppose the estradiol. So, it thins the lining and prevents endometrial cancer. It is amazing for heavy bleeding. This is my top treatment for heavy bleeding. I use it all the time. It works so well.

                                                Vaginal or oral micronized progesterone and this is in perimenopause, I’ll often start with that and using a high enough dose that it’ll eventually stop the bleeding or turn it into light spotting. Once that happens, then you can start looking at estrogen if it’s needed, but it’s so amazing for menorrhagia and can prevent so many patients from having surgical procedures or going on other types of treatments. So, it’s something I use all the time. It’s great for sleep. It improves the depth of sleep. There’s a metabolite it turns into called allopregnanolone that can cross the blood brain barrier, and it does improve calmness, GABA, sleep. It’s very relaxing. So, a lot of patients will say, “Oh, I just slept so much better.” It doesn’t deal the hot flash as well as estrogen that wakes people up, but it definitely is very calming.

                                                So, the combination can be amazing for sleep. It does increase bone formation. Estrogen does a little bit more that way, but it definitely does that too, cardiovascular disease. So, it is really good for the endothelium. It’s anti-inflammatory. It also prevents coronary artery disease. Because of its anti-inflammatory effects, that’s most likely. So, it’s actually the opposite of synthetic progestin, which increases the risk of all of these problems. Over replacing bioidentical progesterone, it’s very interesting. The first month that you give somebody this, there’s something called crosstalk. If they have a high estrogen and they’re going to have more symptoms in the first month, that’s because their hormones…

                                                I always just explained to some that your hormones are ironing themselves out. They’re resetting. Hormones are complex because they’re all made by the ovary. These eggs have been going through different things ongoing. You have to wait for them to burn out and for the next stages to start. So, the over replacement symptoms are not often actually over replacement. They’re just initiation of progesterone in a high estrogen state. Secondly, too much progesterone could cause that in certain people, but we always give progesterone at bedtime, because consistently, oral progesterone makes people feel groggy and tired. It’s just the metabolites it turns into. So, vaginal does that far less and so does cream, but oral is quite likely.

                                                But when it’s given that bedtime, people are sleeping, so that’s great, they just sleep better. Then water retention sometimes, but that tends to resolve in time as patients get used to it as well. Then I just want to mention one more time that progestins are not the same as progesterone. There’s something called hydroxyprogesterone that sounds like progesterone. It really does, and even pharmacists can be confused about this. So, it’s really absolutely not the same thing as micronized progesterone. Very different altogether. So, always just make sure that it is actually micronized progesterone. Synthetic progestins, they all behave differently depending on the kind they are.

                                                Some of them actually proliferate breast tissue, and whereas natural micronized progesterone does the opposite. So, many of them increase the risk of clot. So, they’re all different, but they’re just substances that basically will thin the lining in the same way, but will not really improve the other elements that progesterone does. Androgens are a little complicated. So, because a lot of my practices in polycystic ovary syndrome where people have high androgens throughout their life, I actually see a lot of these patients who go through menopause. But what you’ll see is a lot of menopausal patients, even if they don’t have PCOS, they start to get androgenic symptoms. The reason for that is testosterone does decrease with age, but it’s gradual. Whereas these other ones, it is just like blam, none at all really compared to before.

                                                I mean, there’s a little bit left, but not much at all. But the testosterone’s still there. So, it becomes a more dominant hormone in the skin, for example, where it can exert things like hair loss or hair growth here. So, sometimes patients have this relative excess of testosterone, and sometimes you need to treat the DHT in the skin or treat it another way. Interesting thing is that progesterone is anti-DHT, so it is an anti-androgen. It can lower LH, which tends to encourage more testosterone. So, if a person has a lot of those types of symptoms, you can use progesterone as one of the treatments or things like saw palmetto, other types of herbs like that. But then there are some people who really do benefit from androgen replacement, DHEA, especially if they have very low DHEA, very low testosterone.

                                                If they don’t have these side effects, they can do really well with it. So, it just really depends on the person I find. I don’t want to be it too high in testosterone compared to the other hormones generally. The next one here was the DHEA. So, we already chatted about that, but this is a study, if you’d like to read it, just about DHEA and vaginal tissue. I’m just going to go into some of the herbs. There’s a category of herbs that I like to call endocrine adaptogens. So, that means that they basically help the endocrine system adapt to change. So, just adaptogens with the adrenals that help us adapt to stress and changes in cortisol, we also have herbs that either mimic hormones, fit into hormone receptors, or have hormone effects.

Dr. Weitz:                            If you don’t mind taking a question, Rosita is asking, “If a patient complains about weight gain when starting HRT, what can be done?”

Dr. McCulloch:                   Oh, yeah. So, normally, people lose weight when they start HRT. So, I would say I would look at what they’re taking firstly and be like, “Are they on a synthetic progestin?” Because that causes weight gain for sure. For most people, Provera causes weight gain guaranteed for almost everybody, like 10 pounds. Birth control pulls are the same. So, I would be like, “What’s their progestin? What kind of estrogen are they taking? Is it transdermal? Secondly, do they have something else going on their thyroid, for example?” Because estrogen affects the thyroid quite a lot. When you give estrogen, it binds thyroid. Thyroid binding globulin goes up when estrogen goes up. So, sometimes just the menopause and then going out of it will bring up that element.  So, I would just assess every single thing and see why that might be happening. Because normally, they should actually lose weight on estrogen, especially. Yeah.

So, these are our endocrine adaptogens. These affect our hormones. So, the sex hormones primarily, estrogen, progesterone, testosterone, these ones here. So, the left-hand side, these are androgenic herbs. They have androgen promoting effects primarily in women, which are different than in men. So, some of the herbs that we’ll see for men and women are just a little bit different because androgens can have dimorphic effects. So, they’re like maca, tribulus, Panax ginseng, damiana, epimedium, bacopa and Gotu kola. These tend to be more like stimulating testosterone types of promoting herb. So, people who have low libido, fatigue, energy.   On the right side are the kinds of estrogen, progesterone types of herbs that really help with these symptoms related to those problems. So, hot flashes, vaginal dryness, menstrual symptoms, insomnia and mood, any symptoms of estrogen deficiency. So, shatavari is tonic generally from Ayurvedic medicine. It’s a really great herb I find for perimenopause, for mood, skin, hair, hot flash energy. Black cohosh is very famous for perimenopause and menopause. It used to be thought of as being a phytoestrogen, but now, actually, they believe it works in the brain and not as a phytoestrogen. Wild yam, dioscorea is often thought of as mimicking progesterone, but it actually has to be converted into progesterone in a lab.  It can be, but it is not progesterone. In fact, it seems to have effects on estrogen primarily. Siberian rhubarb is one of the phytoestrogens that is most effective for hot flash. So, that is my top one that I usually recommend for a hot flash right now. So, I really like Estrovera by Metagenics for this, and they actually have a guarantee. If it doesn’t get rid of the hot flashes within two months, I think it’s two months, they’ll give you your money back or reduce them. It does work, I find, not as well as estrogen, but for people that can’t take it, I find this extract is pretty good for hot flash. Red clover is another phytoestrogen. Vitex is probably one of the most misunderstood herbs. It’s thought of as being progesterone, but actually, Vitex is not directly progesteronic. It’s those that research is because it can encourage ovulation in certain situations, which increases progesterone. But for the most part, Vitex acts on dopamine and prolactin in the brain. So, if somebody has amenorrhea and stress, often they have high prolactin. If they have hypothalamic amenorrhea, this is a helpful herb. So, if there’s like a mood component and a change in cycles, it can be helpful, especially with prolactin being high. Kudzu is another phytoestrogen. It’s quite strong, I find. So, for hot flash, it can be useful. Dong quai is from traditional Chinese medicine, Angelica. I find it similar to shatavari. It’s like a tonic generally. Hops is another phytoestrogen.

                                                Okay, and the next section is the adrenal adaptogens. I like to include these because they’re super important. They’re just a little bit different than the endocrine adaptogens. The first one is Ashwaganda, Withania somnifera. This is my favorite adaptogen for stress and sleep and for anxiety. It’s a very calming adaptogen. It takes it down a few notches. It’s great to give it bedtime, to keep people from waking up in the night from a cortisol spike. So, that is my favorite way to use Ashwaganda, or I also give it in the daytime for people with anxiety, irritability. Holy basil is a really nice herb because it really is a good mood booster in perimenopause. Plus, it has some really nice effects on skin and hair. So, a lot of patients like it.   Eleutherococcus is a really great adaptogen. I always think of it as a stress shield. So, if life is stressful and you’re on eleuthero, you will not feel the stress as much. It gives energy. It’s a really good tonic. It’s great for people who want to start working out. So, I do really like an eleuthero. Rhodiola is a very uplifting herb, so I find it’s very good for people with low cortisol or depression or fatigue, dopamine problems. It can help with attention, brain fog. Panax ginseng actually is quite similar to it’s uplifting, stimulating. For people who have more anxiety, it might not be the right fit, but for people with a lot of fatigue and low testosterone, it’s a really good one. Then sage is really good just for mood, energy, overall cortisol balance.  So, often it’s added into formulas, herbal formulas.

                                                  The next slide, sleep and mood. So, sleep and mood, I want to include some of the natural treatments here because it’s probably one of the most common complaints. So, on the left side, I have some of the treatments I tend to use for insomnia. Now, of course, HRT is going to have the biggest impact on this because it just resolves it so well for so many people. So, I always start with progesterone if they’re open to it because it helps so much. But magnesium, melatonin, these melatonin with sleep onset. Magnesium is just something that is one of those general supplements that everybody should be on if they’re having a sleeping problem because most people are deficient in magnesium and the herbs.  So, there are many herbs that you can use for sleep, valerian, skull cap, passionflower. Zizyphus is one of my favorite herbs for sleep. It’s often not even considered, but it’s a great herb from traditional Chinese medicine for sleep. Then Withania, so Ashwaganda. So, I use that a lot at bedtime. I really like the Douglas Labs’ Ayur-Ashwaganda, so I just find that extract really good. Two of those at bedtime is really helpful for preventing the 3:00 AM wake up. Anxiety and irritability, so of course there’s so many options here too, but we’re looking at all of these nutrients like GABA, threonine, phosphatidylserine, taurine.  Again, Ashwaganda, St. John’s wort, which you can’t combine with SSRIs and Vitex actually helps quite a bit with irritability and anxiety and other kinds of mood effects. That is all that I have presenting to present today. So, do you have any questions? I’m happy to answer.

Dr. Weitz:                          Yeah, no, that was great. Excellent. Good information.

Speaker 3:                         I got a question, Ben.

Dr. McCulloch:                   Yes.

Speaker 3:                         My wife is on 0.0125 Vivelle-Dot estradiol, and she’s on compound microdose pharmacy 100 milligrams of progesterone. She’s been on that since menopause. She’s doing fantastic. The question is about pulsing that. Some people say not to, some say to do it. We haven’t done it. She’s doing great as she is. Is there any problem with that Vivelle-Dot? She’s doing great.

Dr. McCulloch:                   I don’t think that there’s any reason that we’ve ever learned that it should be pulsed. Sometimes that makes people bleed and spot. So, they used to be like, “Oh, the receptors.” But what we know is that reproductive age women always have estrogens. The receptors don’t go away just because the estrogen is at a certain level. When the estrogen goes away, the receptors go away. So, keeping the estrogen there is probably better for the receptors, but they’re very-

Speaker 3:                         How long will she have to be on this, the rest of her life far as I’m concerned? I mean, when she’s 95, we’ll stop it.

Dr. McCulloch:                   Well, right now, what we know is that it’s safe up to 10 years. It’s safe up to five years after the last period with progesterone if it were a synthetic progestin. We don’t have enough data to say that natural progesterone is safe past that, but it probably is because it’s never been shown to cause clot. So, they’re going to have to have the research to show that it’s safe to 10 years like estrogen and then we don’t know beyond that point actually.

Speaker 3:                           Wow. So, she’s going over 10 years. Oh, wow.

Dr. McCulloch:                   There’s lots of people on it past 10 years and they’re generally doing very well. I think this is just the research has to be done.

Speaker 3:                         Thank you.

Dr. McCulloch:                   Yeah. When I graduated school, there was doctors doing HRT in our city and they have had patients on it for decades doing well. So, yeah.

Speaker 3:                         Thank you.

Dr. Weitz:                          What about, is there value in tracking the estrogen metabolites through the urine testing to see how they’re metabolizing it and then using particular supplements to try to influence that to make sure that they’re metabolizing it along the safest possible pathways?

Dr. McCulloch:                   Yeah, exactly. So, I think you can do the DUTCH test, take a look at what’s happening there, if there’s anything risky. Breast cancer is complex. It’s not estrogen. It’s the entire situation and then estrogen just feeds it, but that can be done. Then just the dose is generally so small in these groups. We don’t use large doses. The older people get, the less these large doses are ever going to be needed. So, it’s like a tiny baseline just to prevent the receptors from going away and give that little bit of stimulation. So, there’s probably lots of ways to make it very much safer.

Dr. Weitz:                          I mean, I know there’s a concern that as women go through menopause, there’s an increased risk of bone density. Do you recommend particular strategy, supplements during that period to maximize bone density or limit bone loss?

Dr. McCulloch:                   Yes, 100%. So, the HRT definitely is a huge thing that is the top thing. Then a really good bone mineral formula, something that has the whole array of nutrients, something like we have here, Ortho Bone, but there’s so many other products like this out there. I know we have a lot of Canadian products, but one of those bone formulas that has a good quantity. Then exercise is critical. I recommend exercise for everybody. Even if someone isn’t that mobile, there’s also whole body vibration that’s been shown to have a lot of effect on osteoporosis.  Anyone can do that really. You can get the plates at home. Even somebody who’s disabled can do that. So, there’s lots of things like that that can be done and phytoestrogens might help, but it’s not a lot not compared to estrogen.

Dr. Weitz:                            Rosita asked about using DIM for estrogen dominance or PMS symptoms.

Dr. McCulloch:                   DIM is a really good supplement to lower high estrogen. So, somebody consistently has high estrogen and perimenopause, it can be really good. It can also direct it down a less harmful pathway to be eliminated. Making sure no constipation is very important too, so that it doesn’t get reabsorbed back in the gut. You can use calcium D-glucarate to make sure that that happens too, because it keeps it from breaking down basically in the gut and getting reabsorbed. So, someone has a gut issue, high estrogen, you probably want to deal with constipation and add D-glucarate with the DIM too.

Dr. Weitz:                          Now, I have talked to some doctors who say every time they put women on HRT, they automatically give them DIM and calcium D-glucarate and iodine or something like that.

Dr. McCulloch:                   Yeah. I don’t tend to do that because DIM lowers estrogen. So, sometimes that can be not a good thing and that you’re giving it and it’s going out. So, you have to know what’s the reason for that. Because DIM as a concentrated supplement is very different than eating those vegetables that have I3C. So, I usually do that in a response to something very specific I’m seeing.

Dr. Weitz:                          Right, yeah. Treat each case specifically. Allison is asking about AMH levels in perimenopause.

Dr. McCulloch:                   So AMH levels in perimenopause are always low. They’re never going to look good unless someone has PCOS. In some cases, they actually still have really good AMH, so they tend to go through menopausal later. But for most people past age 40, there’s really not a lot of point of testing AMH because it’s just going to look low. You can already tell from their age and their pattern of their cycles if they’re in perimenopause, but in a younger woman, sometimes you can’t tell that’s what’s going on. It might be they have stress, they lost weight or something else.  It’s causing the cycle irregularity. In perimenopause, it has a pattern like it’ll shorten and it’s consistent. It doesn’t go back. It just continues that way, marching along towards the end. So, you can do it and it just depends on the situation. If you’re really not sure, you can definitely do it, but it should be very low.

Dr. Weitz:                          Okay. So, I think we’ll conclude. Thank you so much, Fiona. It was awesome.

Dr. McCulloch:                   Thanks. I’m glad it was helpful.

 


 

Dr. Weitz:                            Yes, absolutely. Thanks, everybody, and we’ll see you next month. 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 Podcasts or Spotify and give us a five-star ratings and review. That way, more people will discover the Rational Wellness Podcast. I wanted to let everybody know that I do have some openings for new patients so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way.  That usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So, if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.