Dr. Holly Lucille discusses Her Cancer Journey with Dr. Ben Weitz.

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Podcast Highlights

3:25  Dr. Lucille explained that she was in her infrared sauna and she had done a bentonite clay mask, when she did a breast self-exam and she found a lump in her left breast.  She saw her gynecologist, who recommended getting a full breast ultrasound.  She went for an ultrasound of her breast and the doctor told her that he did not think there was anything to worry about.  But he wrote in his report that the lump was most likely from trauma from an ill-fitting bra, which didn’t make any sense for her.  She decided to go for a second opinion to a breast surgeon and he called her the next day and told her that she had both inner and outer breast cancer.  Then Dr. Lucille went for an MRI and there was also something in her other breast, so this doctor offered Holly different options.  She asked this doctor what she would do if it her were her sister, which is a good question to ask your cancer doctor?  Dr. Lucille she elected to have a double mastectomy surgery rather than lumpectomy with radiation and constant monitoring of her right breast.

8:57  Dr. Lucille looks at her current practice focus as caring for people with patterns of cancering.  When she went to see the standard of care oncologist at Cedars Sinai, all he said was here take this and if that doesn’t work or has too many side effects, we have three others we can choose. He did not ask her anything about her diet or lifestyle, he didn’t take any further blood work, and he didn’t want to know anything else about what we call the terrain. 

17:05  Most oncologists and radiologists will tell patients not to take any natural therapies, esp. antioxidant supplements because it might uncouple the treatment.  On the one hand, there is a lot of misinformation out there from people watching things on the internet.  On the other hand, there is a lot of scientific information out there when a patient is on a certain conventional regimen what is contraindicated and also what is beneficial when co-administered.  There are natural diet and lifestyle factors that can reduce side effects to allow patients to better tolerate the treatments as well as making the treatments more effective.  And this is needed, since we haven’t moved the needle in improving standard of care therapy for cancer in 70 years as far as improving outcomes. 

18:58  Test, assess, and address.  Dr. Lucille elected to have double mastectomy and it was recommended that she also take an aromatase inhibitor, which is a hormone blocking agent, but after taking it for two weeks, her pain was so bad that she decided to stop taking it.  She does work with an integrative oncologist and they do detailed lab work regularly, because she believes that rather than guessing, we should test, assess, and address. This lab work includes LDL isoenzymes to assess the mitochondria, SED rate and HsCRP to assess inflammation, a CBC with differential, a comprehensive metabolic panel, copper and ceruloplasmin, zinc, and a full iron panel.  While too much copper or iron can increase cancer risk, we have actually been seeing too little copper in some patients, since so many people were loading up on zinc for immune support due to COVID.  Labs also include glucose, Hemoglobin A1C, since insulin sensitivity is a driver of cancer, and also IGF-1 since this is also a driver of cancer risk.

 

 



Dr. Holly Lucille has over 20 years experience in clinical naturopathic practice.  After her own breast cancer diagnosis, Dr. Lucille devoted herself to learning everything about integrative approaches to oncology. Dr. Lucille is the author of several books, including Creating and Maintaining Balance: A Women’s Guide to Safe, Natural, Hormone Health and the Healing Power of Trauma Comfrey.  She has lectured around the world on a variety of natural health topics, is on the advisory board of several natural health journals and is the host of the Mindful Medicine Podcast.  Her website is DrHollyLucille.com.

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. Today we’ll be speaking with Dr. Holly Lucille about her personal health journey and experience with cancer. Dr. Holly Lucille has over 20 years of experience in clinical naturopathic practice. She’s a peerless expert ready to help you achieve your best health, even in the context of a cancer diagnosis. Dr. Lucille is the daughter of two pharmacists, and she was well-versed in the Western medical approach, but she found herself coming over to the light, to the functional medicine world.  After her own breast cancer diagnosis, Dr. Lucille devoted the next year of her life to learning everything she didn’t know about integrative approaches to oncology. Dr. Lucille is the author of several books, including Creating and Maintaining Balance: A Woman’s Guide to Safe, Natural Hormone Health, and The Healing Power of Trauma Comfrey. She has lectured around the world on a variety of natural health topics, has made numerous appearances on TV, and advisory board of several natural health journals, and she is also the host of the Mindful Medicine Podcast. Holly, thank you so much for joining us.

Dr. Lucille:                           Ben, thank you. I was looking at you and your shirt, and I think that I should just have a Holly Lucille shirt that I wear every day, and that’s my uniform.

Dr. Weitz:                            That’s what I do, and this is now a write-off because I’m wearing my uniform when I-

Dr. Lucille:                           Yeah, I think it’s such a great idea. Oh, gosh.

Dr. Weitz:                            Well, it’s all about promoting the brand, right?

Dr. Lucille:                           Right, and simplicity. You don’t have to think about what you’re going to wear.

Dr. Weitz:                            Exactly. Exactly. Albert Einstein had seven blue suits. Every day, he got up, he put on his blue suit. He didn’t have to waste a minute of mental energy figuring out what he was going to wear.

Dr. Lucille:                           Isn’t he also the person that said, “Don’t bother memorizing something that you can look up?”

Dr. Weitz:                            I think that’s true. Now we-

Dr. Lucille:                           All the school later, where we had to circle all the right answers and such.

Dr. Weitz:                            Oh yeah, absolutely. Some of those worthless courses where you were memorizing the lifecycle of every parasite, or organic chemistry.

Dr. Lucille:                           Oh, gosh. I just got hives I think when you said that.

Dr. Weitz:                            Perhaps you can start by telling us how you’re doing, your health, your practice.

Dr. Lucille:                           Yeah, thank you. I think pretty darn good. I’ll give you the… Yeah, I’ll unpack that a little bit. It was during the pandemic, I was in my infrared sauna, and I had done a bentonite clay mask, and I was like, “You’re doing what you’re doing to get by.” I was just hanging out, trying to do some self-care, and I came across… I found my own lump, and I was like, “Hmm, what’s this?” Interestingly enough, like a lot of other people, my regular scheduled screening and gynecologist appointment had been pushed several months because of the pandemic, but I was seeing her five days later, so I forgot about it, but I really didn’t.

So when I saw her, she ran right over the same lump and said, “You know, I don’t know. It needs to be assessed.” Well, I did go get it assessed, and I’m just going to leave all names out of it right now. But my first assessment was thrilling because I got just a full breast ultrasound. He was like, “You know, I don’t think it’s anything.” I was like, “Well, it’s something.” He’s like, “Well, I don’t think it’s anything.” So we were thrilled, drove away, don’t have breast cancer, so excited. Now, I get his written report sent to me a couple of days later. In his written report-

Dr. Weitz:                            This is where he covers his ass.

Dr. Lucille:                           Well, I don’t know about this. He says, “Most likely it is trauma from an ill-fitting bra.” I was like, “Wait a minute. If I had a ill-fitting bra on for three seconds, it would not stay on,” not enough to cause-

Dr. Weitz:                            If he thought that, don’t you think he would’ve asked you about it?

Dr. Lucille:                           That alarmed me so much. Then, it had all of those typical signs. So I’d lift up my arm and it would dimple. I called my gynecologist and I’m like, “I need a second opinion.” So I went to a breast surgeon and, at the Bedford Breast Center, Dr. Heather Richardson, she did a great job, and called me the next day and said, “You have inner and outer breast cancer.” So a couple of things there. Obviously, it’s super important to be an advocate for yourself. It’s super important not to just listen to maybe the first pass. It’s super important to get second opinions, and to listen to your body. So, I was really happy that I did that.

Dr. Weitz:                            Great. So what was the next thing that happened? Did you get more testing?

Dr. Lucille:                           Yep. She wanted me to do an MRI right away, and then we would have a more tailored conversation. So, we did that. Again, we got the MRI results back and there was maybe something a little suspicious in the right breast. Then she offered options, different options. Another question that I actually encourage my patients to ask me, “If I were you, or if I was your sister.” So I said to her, “If I was your sister,” and she had a great question back, “How do you feel about your breasts?” I looked at my wife and she’s like, “I don’t care.” I’m like, “I don’t care.” So, I chose to have a double mastectomy. That was my choice in it, because I felt like I didn’t want to be looking over my shoulder having screening, radiate tissue, have a lumpectomy. For me and where I was, my choice was a double mastectomy. So, I did have that surgery successfully.

Dr. Weitz:                            So the other option would’ve been to have a biopsy, I’m assuming?

Dr. Lucille:                           The biopsy was done, we would’ve had a lumpectomy with radiation.

Dr. Weitz:                            Oh, okay.

Dr. Lucille:                           Then, constant screening on my right breast as well.

Dr. Weitz:                            Right.

Dr. Lucille:                           Again, there was enough risk factors. My prognosis, the way that they grade it, and stage it, and the Ki- 67 score and everything, to get a breast cancer diagnosis-

Dr. Weitz:                            Maybe you can tell those who don’t know what the Ki-67 scoring is.

Dr. Lucille:                           The Ki-67, I would say, in general, how proliferative, so how aggressive perhaps that particular tumor is. The higher the worse, the lower the better, and it helps to navigate treatment options.

Dr. Weitz:                            So this is one of, my understanding is, the newer tests that look at, analyze the characteristics of the cancer cells to see how that cancer is going to react over time, how aggressive, how it might react to different treatments, right?

Dr. Lucille:                           That’s correct. It’s one of those things where you get that pathology, and all of those things, so you really can understand your options, from this way to this way, of what you want to do as far as treatment is concerned.

Dr. Weitz:                            Isn’t it interesting that this is now fully embraced by mainstream medicine? It was decades that integrative oncologists would do typing of the cancer cell, send them out, you had to send it to some lab in South Korea, or someplace like that, and there was no consideration for that. Now, it’s being embraced. One of the reasons why it’s now being embraced, in my opinion, is ’cause now you can say, “Well, you have this type, you need this drug.”

Dr. Lucille:                           Well, that’s true too. We look at it a little differently because, one of the reasons that I got into what I call, Ben, caring for people with patterns of cancering, so just a different way to frame it.

Dr. Weitz:                            I like that, “Caring for people with patterns of cancering.”

Dr. Lucille:                           But my standard of care, the one appointment I was too afraid not to go to was my standard of care oncologist at Cedars. Because I think this whole C-word is just connotative, and it comes with a lot of fear. But my experience there was so underwhelming, I was blown away. It was back to my growing up and my parents. It was, “Here, take this. If that doesn’t work, and if you have too many side effects, we’ve got three others we can choose from.” Did not ask anything about my lifestyle, my diet, didn’t take any further blood work, didn’t want to know anything else about what we call the terrain.  It was the idea that you can’t heal in the same soil you got sick in. So, didn’t want to know anything about that. I was just like, “Wait a minute, this is it? I have to get in there and help.” It was almost like this recreation of how I first got started into medicine. It was a volunteer class. It was a summer, I wanted to do a little volunteer work, and I was at an orientation for a hospital. This was back in the Midwest. Literally, I learned there that when people were admitted to the hospital, they lost their rights, maybe lost their privacy, right to choose.

Again, I got incensed and I’m like, “I have to get into this profession and help.” So it was repeat 40 years later, same thing with this. Then, what I did is, I was really, really interested in nutrition as a foundation, as you well know in integrative functional naturopathic medicine, nourishment. When you look up diet in the dictionary, how, as a habit, do you nourish yourself? That is what it means, habitual nourishment. I know that it’s so foundational and so important. So I enrolled in the Oncology Nutrition Institute, and they’ve got an incredible course, 250-hour, really, really in-depth course to be an oncology nutrition consultant. So, that’s where my whole-

Dr. Weitz:                            Is this Nasha Winters’ course?

Dr. Lucille:                           No. This is Jess Kelley. So, Jess Kelley-

Dr. Weitz:                            Oh, okay.

Dr. Lucille:                           Is the Co-Author of Nasha’s book-

Dr. Weitz:                            Oh, okay.

Dr. Lucille:                           The Metabolic Approach to Cancer. So, it’s her school. Then she also owned Remission Nutrition. Now Jen Nolan, who’s the Lead Nutritionist there, has that. Then I, at the same time, concomitantly went to Dr. Nasha Winters’ course. In The Metabolic Approach to Cancer, I was cohort five. So I took a gap year in reverse, and just immersed myself in wanting to understand more of that terrain surveillance. We’ve got incredible people in standard of care looking at the tumor. What they don’t do though, and they don’t do it really good, is look at the whole picture or the terrain. So, it’s just been really fun to continue to learn in this area.

Dr. Weitz:                            Could you imagine a farmer, and he’s having trouble with his plants not doing well, and not really consider what’s going on in the soil, or the water, or anything else that’s affecting the plants?

Dr. Lucille:                           Right. Well, then you’ve probably seen this meme where there’s this fish that’s in the fish tank, and the water is really dirty. So the question is, “Do you clean the tank or do you vaccinate the fish?” So, medicate or vaccinate the fish. When you see examples like that, it’s like, “Of course. Why don’t we see what happens if we clean that tank? I bet that fish will thrive.”

Dr. Weitz:                            Perfect. Boy, when it comes to conventional care, I started looking into some of the current treatments, and there are a lot of different pharmaceutical approaches now to breast cancer. It’s incredible. Everything from traditional chemo, to hormone blocking therapies, to targeted therapies, to checkpoint inhibitors, and on, and on, and on.

Dr. Lucille:                           I think what’s really important… I would never call myself an integrative oncologist, that is not what I am. Definitely, like I said, I am starting to care for people that are showing patterns of cancering. But one of the most important things that I do is that whole dossier thing, doctor is teacher, because these people, they’ve got a lot going on, and they are provided with so much information that they know nothing about.

I think one of the roles that I can play really well is to help them understand these conventional therapies, and these standard of care therapies, and then help them be informed, and then help them make their own decision that is an informed decision because they know, “It’s not just because my doctor said it. It’s because this is what I am choosing to do because I know exactly the risks, I know the benefits, I know the potential outcome, I know the potential mid-course corrections that might need to be taken.” I think that’s one of the biggest roles that I have just the pleasure of playing with these people, is to really help them understand so they can make informed decisions. Because, as you said, there are so many so opinions out there, and there’s so many options.

Dr. Weitz:                            I think in general, for those of us in the natural health space, that’s a very important role that we can play in helping many patients, and this is partially ’cause it’s a different financial model. Patients are actually compensating us, to some extent, for our time so we can have the time to have a detailed discussion with the patients, and have time listening to them. Unfortunately, the traditional medical system, which is run by insurance companies, doesn’t recognize the importance of doctors having time to listen to patients, and address their concerns, and help them with things that take time, like diet, and lifestyle, and exercise, and other recommendations that are crucial for their overall health.

Dr. Lucille:                           It’s a huge problem. I think that goes hand-in-hand with that issue that you see all of the time, I know, is that there’s also a certain ignorance, and I say that with all due respect. I say that in, not somebody being ignorant, but ignorance about complimentary care, even if it’s to support conventional or standard of care treatments. Then a lot of times, the medical oncologists, because they don’t know that this is probably better off with the patient with standard of care than without, they’ll just say, “Please stop everything and wait until we’re done with treatment.”  We’re over here going, “Listen, this treatment in and of itself is carcinogenic we want to protect your body from, and we’re trying to help that.” That’s another thing that I get really upset about, because I think that there’s still this hierarchy with a medical oncologist who says this, and I see my patients do it, “I’m just going to do what he says,” or, “Just going to do what they say,” and they will abandon concomitant treatments because somebody said, “I don’t really know how that interacts, you probably should just wait.” So that’s another piece where you just have to really be advocates for these people, talk to them, teach, and support.

Dr. Weitz:                            Well, when it comes to using natural therapies, especially supplements at the same time as getting traditional care, it’s taken for granted among radiologists and most oncologists, that using anything that’s an antioxidant is automatically going to uncouple everything that they’re doing.

Dr. Lucille:                           Yeah, that is basically the blanket thought process and statement that they make, and it’s not true. Then you’ve got people like the FABNOs, the Fellow of American Board of Naturopathic Oncologists, these people that have worked at cancer treatment centers. These people that have studied this in and out, they understand contraindications with standard of care therapy and with conventional therapies. They understand all of that and wouldn’t recommend.

Now I have to say, Ben, this is really important, what I do come across, because this is another thing that happens, what I’ve been noticing as a pattern with people that have been diagnosed with patterns of cancering is, they’re not just the patient. Their entire circle of friends, family, and loved ones are, because why? They come out of the woodwork with so many suggestions. “I saw this on the summit, I saw this on the internet.” The questions that I am met with… I know exactly the summit that they’re watching too.  That’s what you have to be really careful about, because there’s a lot of information out there, there’s a lot of misinformation out there. But we do know, if they are on a certain conventional regimen what is contraindicated, and actually what is needed, co-administrative, to be beneficial. So we know all of that, and those are the things that we have to start advocating for because I think we haven’t moved the needle in 70 years in standard of care oncology therapy. We haven’t. We Just haven’t, for outcomes, and I know we can do better.

Dr. Weitz:                            Right. So as far as your own cancer journey, you had double mastectomy?

Dr. Lucille:                           I did.

Dr. Weitz:                            Did you have to have additional treatment?

Dr. Lucille:                           It was definitely prescribed to me. After two weeks on aromatase inhibitor… I also suffer, and as you get older, this gets worse, from Ehlers-Danlos, that connective tissue disorder. My pain was so bad, in trying to take these hormone-blocking agents, that I decided-

Dr. Weitz:                            What drugs did you take?

Dr. Lucille:                           It was an aromatase inhibitor. I forget exactly which one, because she said too many… “We’ve got three others we can go through.” Then the other thing that I did, there’s an algorithm out of Cambridge, and so I put all of those things that we were talking about, I put all of my stats in there, my age, postmenopausal, blah, blah, blah, blah, blah, blah, blah. Then, I was able to see, 5, 10, 15 years out, literally how much long of a survival rate I would get with being on these agents or not.  For me, and this is not doing anything else, it was so just insignificant that I was like, “You know what? I think I’ll pass.” So that’s it, double mastectomy. Then I did hire, and I still work with an integrative oncologist, who is amazing and follows me. I just got sent a LabCorp requisition, which I just scheduled, and when I get back from my vacation we’ll do our next round of blood work. The whole idea is, “We don’t guess. We test, assess, and address.” So, she stays on top of that.

Dr. Weitz:                            What are some of the important markers that you’re monitoring for your own journey? What are some of the most important ones, and ones that you would recommend to other patients who are cancering?

Dr. Lucille:                           So LDH and isoenzymes, really important to assess the mitochondria and in different tissues. That’s a great marker, one of the trifectas that Dr. Winters talks about.  A sed rate. So really wanting to understand inflammation, a highly sensitive C reactive protein as well, obviously a CBC with differential, looking at that neutrophil-to-lymphocyte ratio and, as well, a comprehensive metabolic panel. We’re just going to see basic things there.  The other thing that we look at, drivers like copper, ceruloplasmin and then, as well, iron, a full iron panel. Some of those things that I know that… The labs that I get from patients that are going through standard of care treatment, they’re pretty minimal. They’re just looking at, “Are they going to be able to tolerate this round again?” We’re looking at it, again, assessing the terrain. So a little bit more detailed.

Dr. Weitz:                            Higher levels of copper increase angiogenesis, inflammation, worsens cancer risk, drives cancer growth. What are some of the other important markers?

Dr. Lucille:                           Oh gosh, I could go on and on.

Dr. Weitz:                            Well, metabolic stuff, glucose, hemoglobin, A1C, insulin, right?

Dr. Lucille:                           Oh, little Hemoglobin A1C, of course, yes. I think that I probably missed it ’cause it was like, “Duh.” But, yes.

Dr. Weitz:                            Because we know that insulin sensitivity is huge factor in cancer, right?

Dr. Lucille:                           Yes. Insulin sensitivity, glucose, hemoglobin, A1C, IGF-1 as well.

Dr. Weitz:                            What’s your take on IGF-1?

Dr. Lucille:                           What do you mean?

Dr. Weitz:                            Well, in the longevity world, apart from the cancer world, for quite a period of time, a lot of the focus was on trying to make sure that your body could repair and regenerate. As you get older, you fall apart. So there was use of human growth hormone and hormone replacement, and that still has a role in some patients, but the ability to maintain growth hormone levels so that your body can repair, so you don’t fall apart, so you don’t lose your mobility, et cetera, et cetera, and IGF-1 is a marker of longevity.  I know, in recent years, there’s been some discussion that… Especially Valter Longo says that you got to get the growth hormone levels lower because of the Laron Dwarfs, and IGF-1 is a marker of growth hormone, so you’ll live longer if you have lower growth hormone levels. Then, of course, the first study that was done to show that you could actually improve epigenetic biological aging, used growth hormone.

Dr. Lucille:                           Oh my gosh, I know.

Dr. Weitz:                            The Fahey study. So there’s a lot of controversy, and IGF-1 is a marker for growth hormone.

Dr. Lucille:                           Well, obviously in this, we like to see it lower, and that’s why we’re assessing it.

Dr. Weitz:                            Right. But you probably don’t want it as low as possible, right?

Dr. Lucille:                           No, no, no, no.  I think you bring up a great point.  Each person is individual.  So, a lot of times, I’m trying to have my patients not use cast iron skillets, or what have you, just trying to keep that down, same with copper.  But if there’s a copper deficiency which, by the way, because of the pandemic, I have seen so much more.  Why?  Because people got on the internet and are like, “How do you prevent COVID?”  Well, quercetin, zinc, vitamin C, zinc, zinc, zinc. So, I’ve seen-

Dr. Weitz:                            Zinc/copper ratio, that’s what’s crucial, yeah.

Dr. Lucille:                           The zinc supplementation, just for days, I’m just going to stay on this. Then, all of a sudden, there’s these strange anemias I’m trying to figure out, or these pain syndromes that people have that I’m trying to figure out, and it comes down to this copper deficiency that I think has been contributed because of all of this. Everybody’s different, and I think that’s that big, really strong… 

Dr. Weitz:                            Well, even though it’s three years later, if you’re going to take booster shot number 17, then you might as well keep your zinc levels up too.

Dr. Lucille:                           I’ll leave that there.

Dr. Weitz:                            I will too.

Dr. Lucille:                           I think that’s a whole nother podcast.

Dr. Weitz:                            Yeah. Tell us about, what are some of the important factors when it comes to diet and cancer risk?

Dr. Lucille:                           Well, as you said, insulin, sugar. One of the things that I ask people when I’m trying to get in there… Ben, here’s the thing… Again, I go back to, “Here, take this approach.” Here, take this is easy medicine. Now I’m not saying chemotherapy, radiation, surgery, cut, burn, poison is easy on the body, but it’s easy to do, boom, boom, boom. People are like, “Okay, yes.” I try to get in there and really make a difference with lifestyle and diet.  It is not easy.  What I’ve come across in this recent iteration of my practice is that, I’ve known this for a long time but, as we all know, food is so much in our society.  There’s a subset of my population that grew up in India, so they are very connected to those flavors, to the substances, the rice and the bread.  It is a lot to educate because what I start to do, and I’m going to start this way, I ask them, most people have had a PET scan, “Do you know what solution that they give you?”  A lot of people do, and they’ll say, “Yeah, I think it was glucose, sugar.”  I’m like, “Yeah, why?”  They’re like, “Because it lights up cancer.”  I’m like, “Okay, we’re onto something. Yes, that is exactly why.”  So I think that a lot of evidence is out there on a therapeutic nutritionally dense ketogenic diet. Now, I say that because I wish sometimes that the ketogenic diet had a different name, that we could call it something else because there’s internet keto, there’s dirty keto, there’s just crappy keto where I see… No, it’s like back in the paleo days when I was in CrossFit, and I would watch my athletes, my girls, eat bacon wrapped bacon, or bacon wrapped sweet potatoes.

Dr. Weitz:                            Oh, that was Atkins diet, right?

Dr. Lucille:                           But we’re talking about nutrient dense, and keeping that environment, carbohydrate low, sugar low, so it’s adverse to cancer cells instead of welcoming. So that is definitely something that I think is extremely important. I think that, especially during chemotherapy, there’s a lot of evidence with fasting to decrease side effects and increase better outcomes.

Also, one of the tests that is a game changer across the board, because we can have all this conventional wisdom and have it be evidence-informed or evidence-based, but when you do a Nutrition Genome, that’s their genes. That’s taking these genetic weaknesses and using food to actually make them strengths, and support their whole terrain, and whole genetic makeup in that way, using food. It’s not just a test for more supplementation or anything like that. That’s just been a game changer in my practice.

Dr. Weitz:                            So when you advise patients on changing their diet, how strongly do you recommend a ketogenic approach? Do you tell them they absolutely must do this, it’s super important? Do you just ask them to try to clean up their diet, reduce the carbs? Is it general approaches? Does it depend on the person? Maybe their personality, maybe their cancer type?

Dr. Lucille:                           Yep. All of the above. I think what’s really important is where people are at in this pattern. If we have to close ranks and we’ve got a job to do, because the proliferation of those cancer cells is winning, then we’re going to close ranks and get as most aggressive as possible, pull out all stops. That comes from, I love… It comes from the organ player. The stops are the things in the organ. When you pull out all the stops, you just play as loud as you can.

But when you’re tracking and trending labs, and people are 2, 3, 4 years out, and they’re stable, and they’re doing well, and they’re cancer free, then there’s wiggle room to just nourish themselves and maybe not be in ketosis, but still be mindful of that. Or go on vacation and vary your palate again. So, it all really depends. But when you look at the evidence, when it comes to active cancering, a low carbohydrate ketogenic diet is very, very popular.

Dr. Weitz:                            Do you think that certain cancers require different dietary approaches?

Dr. Lucille:                           I think that certain people require different dietary approaches. In fact, about three out of the 40 Nutrition Genomes that I get back, it actually says in the printout of the algorithm, “A ketogenic diet might very well backfire,” or something like that. So we do adjust at that point in time.

Dr. Weitz:                            So what test is this that you’re referring to, specifically?

Dr. Lucille:                           It’s called Nutrition Genome, if you go to nutritiongenome.com. I think it’s fascinating.

Dr. Weitz:                            Okay, cool.

Dr. Lucille:                           Not only will it show you your macros, your APOE score, but also your strengths, which is great. You can focus on those, always fun too. But their weaknesses, and then the sweet spot is, they’ll give this personalized grocery list. That’s where people can just start nourishing themselves. If there’s a need for copper, if there’s a need for… If instead of people over methylating because they know of their MTHFR status, or what have you, they can actually understand foods that can feed this cycle, and we don’t need to go all the way over to overmethylating. Which, as you well know, people will feel just as bad if they’re undermethylated.

Dr. Weitz:                            What about some of the genetic markers like BRCA for breast cancers?

Dr. Lucille:                           Of course. My experience is, the medical oncology world does a pretty good job at, when somebody is diagnosed, making sure that those genetic markers that are more nuanced in our field of epigenetics are done. So a lot of times, people will come to me already knowing their status. But, that’s extremely important.

Dr. Weitz:                            Let’s say you see a patient who does not have breast cancer, but they’re concerned about breast cancer, and they’re positive for one of the BRCA genes.

Dr. Lucille:                           I have them in my practice. Same thing, there’s a lot of decision making going on. Of course, there’s prophylactic oophorectomy, there’s prophylactic mastectomies. I have a lady that just doesn’t want to do that. So, guess what? She is living her life, knowing and being aware of that particular piece of data. Also, we are keeping an eye on her.

Dr. Weitz:                            What do you think about women who are positive for BRCA, having prophylactic mastectomy/oophorectomy?

Dr. Lucille:                           Yeah. I think it’s a personal choice. Again, a lot of discussion as risk/benefit ratios. Sometimes people don’t want to be looking over their shoulders. Sometimes people just want to get it taken care of, and that’s exactly why they choose that. That’s been my experience, where they’re like, “You know what? I know the risk factor here. I don’t want to worry about it. I want to live my life,” and they choose something that radical to do to preserve that loss of innocence, in a sense.

Dr. Weitz:                            Oh, I wanted to ask you one more question on a diet. We have a percentage of people who advocate a vegan diet, and are very, very strong about that being the best diet to reduce cancer risk. I know a diet becomes almost like political ideology, but what do you think about patients who want to follow a vegan diet? Or maybe patients who just say, “Hey, I read this thing,” what would you say?

Dr. Lucille:                           So I have this policy, and I’ve had to push back on a couple patients. When they talk to me, or email me, or communicate with me with an, “I heard,” or, “I read,” or, “Somebody said,” it’s a deal breaker for me to go on. What I need from them is, I need to understand the context. Where? Who? what?

Dr. Weitz:                            “Dr, so-and-so website says-“

Dr. Lucille:                           So, it can be a teaching point for both of us. I empty my cup all the time. You only know what you know, and that just means you also know what you don’t know. That is super important, so I always ask people to do that. As far as that is concerned, we talk about it, and this happens a lot. But again, with bacon wrapped bacon, and bacon wrapped sweet potatoes, or dirty keto, the inflammatory things that can go into a ketogenic diet with poor quality food can happen in a vegan diet too. One of my best friends is a staunch vegan. She was served honey mustard dressing on a salad, and I thought the world was going to end, because there was bees involved in the honey in the honey mustard. It was pretty intense.

Dr. Weitz:                            Really?

Dr. Lucille:                           But, her diet is for crap. It’s very hard for me to even eat with her because we go to a vegan restaurant and she orders something called fish, but it’s just fried gluten, and something like that. So, I go back to food quality and the nutrient density.

Dr. Weitz:                            Unfortunately, like different political ideologies, there’s a whole worldview once you jump into that world, and there’s a certain amount of data that backs it up. In fact, carbs are not the cause of insulin problems. It’s due to saturated fat. If you-

Dr. Lucille:                           In a few people, absolutely, and you’ll see that in their Nutrition Genome, that too much saturated fat is driving up insulin and glucose. So, it’s a great teaching point, and it’s a great piece of data. But for the most part, again, you’re right… You know this too, as far as studies are concerned, if you want to see a calcium absorption study for any calcium, you’re going to find it. You will find it out there, it will be in the literature.  So that’s another piece of education where we just get to unpack things and look at the literature, look at how the study was done, look at how big it was, look at if it’s biased. For the most part, just be more commonsensical and do our best. Then also people, as you well know, they’ve got white-knuckle grips on certain ideologies. I think veganism, I’ve seen that, and then you work with them. You just work with them, and just really emphasize food quality, and then also-

Dr. Weitz:                            Try to get their diet as close to a keto version of the vegan diet as you can.

Dr. Lucille:                           Yeah. Again, then you’re also accepting-

Dr. Weitz:                            What do you think about meat and cancer risk?

Dr. Lucille:                           Well, I think Dr. Nasha Winters said this, “It’s not the food, it’s what we’ve done to it.”

Dr. Weitz:                            Right.

Dr. Lucille:                           So when you’re looking at grass fed, grass finished, these really conscious agricultural processes that are out there, and also the amount… I think it was Michael Pollan’s family that came up with the word flexitarian, which I really appreciated, which is really plant strong with an occasional and small bit of animal protein. Now, for me, my need for omega 3s is extremely high, based on my Nutrition Genome. So that wild caught salmon and sardines are things that I nourish myself with all of the time. And, I have the gene for the saturated fat, so too much even clean dairy, 22 grams a day, I’m going to start gaining weight and inflammation.

Dr. Weitz:                            What do you think about some of the data that targets specific amino acids as being important for cancer risk? I know some people… There seems to be, people focus on one. I know a doctor who says, “It’s all about methionine, and if you eat any animal products, you’re going to be high in methionine,” and other people talking other amino acids. I know Dr… I’m drawing his a blank on his name. The guy from Boston College who talks about the metabolic theory of cancer. He says, “Apart from getting on a ketogenic diet, you want to take drugs that block glutamine, because glutamine is the amino acid that cancer cells can also feed off of.” What about that data that seems to indicate that certain amino acids that are only found in animal products are cancer causative?

Dr. Lucille:                           I think it’s really fascinating to read that literature. I really, really do.

Dr. Weitz:                            Thomas Seyfried.

Dr. Lucille:                           Yes, as soon as you said it, his name went right away from [inaudible 00:39:18].

Dr. Weitz:                            Yeah, he was just on Mark Hyman’s podcast recently.

Dr. Lucille:                           Yeah. Yeah. I think you just have to take it all into consideration and then, once again, focus on that person in front of you. I do think that there are some cancers where that is true, and I see that in some people. In others, not so much. So I think that it’s so important that we don’t get caught in the cookie cutter protocol orientation of the trap that we’ve gotten away from. You call it traditional, I call it conventional medicine, because I think traditional medicine is what you and I do.

It’s what we used to do a long time ago where we took time, and we understood what the air was like that people are breathing, what the water is like that they’re drinking, what the food is, how their thoughts are. All of those good, fundamental things. That’s more traditional, and that’s what we do. So it’s the conventional side that’s gotten in the way, and I don’t ever want to be that cookie cutter, “This is what we do when we see this.”

It’s that curious mind, it’s the emptying the cup, that I think contributes to people’s best outcomes, and also that therapeutic relationship where they’re involved. I always tell people, “Listen, you are the driver of this process. I’m going to give you, from my best knowledge, my experience, my education, my best recommendations, but you get to decide.” I always want to empower people to do that.

Dr. Weitz:                            What about the use of intravenous vitamins for cancer?

Dr. Lucille:                           So I’ll give you an example, and this is a newly diagnosed, and really a painful case that I saw. She not only has two lumps in her left breast, one is ER/PR-positive and one is triple negative. Two different types of cancers right next to each other. Of course, she’s 32 years old and everybody is on board. Her boyfriend is-

Dr. Weitz:                            By the way, for those who don’t know, triple negative is probably the hardest cancer to treat, probably the most aggressive. Then, the ER-positive is probably the second-hardest one.

Dr. Lucille:                           ER-positive, PR-positive.

Dr. Weitz:                            And, that means estrogen receptor positive.

Dr. Lucille:                           Yes, sorry. And, progesterone receptor positive. Then there’s androgen receptor, we can go on, and on, and on. However, she started on chemotherapy and then went to a more targeted therapy. They were asking me about high-dose IV vitamin C. So I use a certain database called, Efficasafe. What I’ll do is, I’ll put in the targeted medication that they’re on, and I can see contraindications. I can also see, “Caution should be taken with,” and why. Also, things that are optimizers, like vitamin D is often an optimizer for standard of care treatment.

So in this particular case, there was going to be some contraindications with high-dose IV therapies. So there’s a place and a time for everything, and that’s just what you have to look at. Sometimes when they are going through standard of care, let’s just let the drug… It’s almost like an antibiotic. Do you take a probiotic with it, or do you let the antibiotic do its job and then we recover, and replace, and reinoculate afterwards? A lot of times you just have to look, once again, at that individual case and what they’re on. But I think that there’s really some great value in IV vitamin C, high-dose mistletoe therapy is huge. We all know that from… They’ve been using it forever in Germany, almost of standard of care in oncology.

Dr. Weitz:                            Right.

Dr. Lucille:                           Then ozone therapy, people are always asking about. Again, place and time for everything.

Dr. Weitz:                            Do you use ozone therapy? If so, which type?

Dr. Lucille:                           At this point in time, no. My practice is completely remote. So we can be talking about it, but I don’t offer that.

Dr. Weitz:                            Right. Do you recommend any of the other alternative cancer treatments, like heat, cold, a few things like that?

Dr. Lucille:                           Yeah. Well, mistletoe is a warming therapy in and of itself. HBOT therapy. One of the things that I got into, the HBOT, when I was preparing for my mastectomy because of the oxygen. There’s a-

Dr. Weitz:                            HBOT is hyperbaric oxygen.

Dr. Lucille:                           I have a translator here with me. Thank you. I usually am better at that? I usually just talk, and I’ll break down my acronyms. But, thanks for having my back today. Because there’s a risk for the double mastectomy of tissue necrosis, and so the idea of oxygenating that tissue pre and post-surgery is something that I chose to do for myself, and then oftentimes will advocate with other people as well.

Dr. Weitz:                            Cool. I know everybody’s individual, but what about some of the supplements that may have some anti-cancer effects in some patients?

Dr. Lucille:                           Yeah, absolutely. Curcumin, we could just have an entire podcast on that. But again, even with things that have really conventional wisdom, like green tea extract, curcumin, andrographis, I could go on, and on, and on. It is super important to understand what else is going on, and if there’s any contraindications and, as well, what is our COMT? We look at genetics so we can get a little bit more specific and tailored when it comes to supporting them with supplementation. So, there’s just a whole array of-

Dr. Weitz:                            What about a estrogen metabolism?

Dr. Lucille:                           Yeah. So that’s another that you bring… That’s a great point, and I was thinking about this earlier when we were talking about Nutrition Genome. Another test that I run quite often, especially with ER/PR- positive cancers, estrogen receptor positive, is the DUTCH test. So, that is really important because we want to see that metabolism of estrogen. Weird, but our bodies look at estrogen as a toxin that has to be metabolized through enzymatic pathways in our liver. It’s like the good, the bad, and the ugly road. If there are four hydroxy estrogens, then we know that they are linked to invasive breast cancer, they’re linked to DNA damage, and there are things in diet lifestyle supplementation that we can do to alter that metabolism. So, another good piece of information to understand.

Dr. Weitz:                            What are some of the other supplements that may have some powerful anti-cancer effects?

Dr. Lucille:                           Well, think about vitamin C in general, zinc we think about as well. Gosh, just depending on what people are going through and where they’re-

Dr. Weitz:                            Do you, for example, look at the zinc/copper ratio? You were talking about measuring copper.

Dr. Lucille:                           All the time.

Dr. Weitz:                            If so, do you have a target for that?

Dr. Lucille:                           Well, like I said, the thing that I’ve been seeing a lot is this copper deficiency. Another line you have to cross, or walk, is not wanting people deficient in anything, but not wanting an excess where there’s a driver going on. Same thing with fibrinogen, we know that’s maybe a poor prognostic for… So we want that fibrinogen level to be lower. So the use of nattokinase in situations like that. If iron metabolism is off, we’re really wanting to understand why. Artemis is something that I’ve used to try to get iron down, and then figure out also, if things like copper and iron are high, where is this happening in their lifestyle, their diet, in their body’s metabolism. So, it’s like a puzzle.

Dr. Weitz:                            Right. That’s one of the keys to natural approaches, is treating each person as an individual, get a sense from their history and detail testing to figure out how their body is working, and then try to optimize that terrain in their body that’s going to make it harder for cancer to grow.

Dr. Lucille:                           Yeah, and that’s why it’s just been interesting to me, and it’s been also another great reminder of a lesson, which is to empty that cup. So I think that we can get into a habit of, you see somebody’s… Because we have a lot of paperwork that is uploaded, and you can get an idea or a snapshot, maybe do even from the pathology of what somebody’s going through, but you have no idea.

This has happened to me, where I’ll read and I’ll prep all of my patients, and then the computer comes up, the Zoom link comes on, and everything that I thought that was going to go in my head went right out the door because that person, their energy, their motivation, their drive, their fear, their family, I did not take that into consideration. I was just looking off the paper. That is so important. So now I’m like, “All right, I got this off the paper. I know in my heart and my head, if this was just this off the paper, but I have to empty my cup and then go and meet that person because it’s all going to make a big difference.”

Dr. Weitz:                            Treat the patient, not the labs, but informed by the labs.

Dr. Lucille:                           A hundred percent, yes. So that was another… Especially now that a lot of things have gone more remote, is so important because you lose a little bit of that personal touch, or that sense. You can have good Zoom side manner. You can. You can work it in, but it’s just not the same. So emptying your cup, even more empty, is super important I think.

Dr. Weitz:                            How should women screen themselves for breast cancer risk, or any cancer risk?

Dr. Lucille:                           Well, I think just to take a look at, once again, diet is really important. When I say that, I feel like food quality is more the issue that we need to talk about in our modern day, not so much this diet or that diet. It’s the quality of food. Whether glyphosate is involved, if you’re not eating organic or you’re not mindful of that. What is your water source? Are you having a buildup of heavy metals? Where do you get your animal products?

Dr. Weitz:                            Right. Do you like to test for environmental toxins, heavy metals?

Dr. Lucille:                           Absolutely. Especially, let’s say somebody’s white blood cells are tanking, and I don’t know why.

Dr. Weitz:                            Somebody’s white blood cells are what?

Dr. Lucille:                           Tanking.

Dr. Weitz:                            Tanking, going down. Okay.

Dr. Lucille:                           Yeah, and I don’t know why. I’m going to screen for heavy metals. This is somebody that hasn’t been through therapy. In fact, this is actually the woman who is BRCA positive, and her white blood cells, even after some pretty aggressive intervention, continue to be low. So again, you have to put that sleuth hat on and figure out and understand why. So there’s a couple of things that contribute to that, and we want to rule those in or out.

Dr. Weitz:                            Do you recommend mammograms?

Dr. Lucille:                           Okay. It’s three minutes to the end of the hour, and we’re not going to [inaudible 00:50:54]. Self-breast exams, I found my own lump.

Dr. Weitz:                            Right.

Dr. Lucille:                           Every month, at the same time, in the shower, just get to know your body, so if anything changes you’re aware of it first.

Dr. Weitz:                            I know we’ve only got a few minutes, but what do you think about full body MRIs as a way to screen for cancer risk?

Dr. Lucille:                           Yeah, there’s things. I’m going to have a Prenuvo actually, after I come back from my vacation, which is a full body MRI without radiation, Prenuvo. It’s an interesting conversation because there’s going to be little artifacts that come up when you have something like that. There’s going to be little spot on your lung, there’s going to be spot on your liver, and that needs to be read and taken into consideration by somebody who’s seen a lot of these. Again, treat people not lab tests or these images.  But I do think that they can be lifesaving. The one thing that I think we all think about is, if it’s early detection and there’s early intervention, where the body actually is like, “Hey, you know what? I got this. There’s no need to intervene,” I think it’s you’re going to cause more harm than good. So those are some things that I think about. But I think knowledge is power, self-knowledge is superpower, and it’s all what we do with it.

Dr. Weitz:                            Okay. Thank you so much, Holly.

Dr. Lucille:                           It’s always a pleasure.

Dr. Weitz:                            How can listeners, viewers, find out more about you or work with you?

Dr. Lucille:                           I think the best place to always go is just going to be my website. It always needs to be updated, but it’s just drhollylucille.com. Drlucille.com.

Dr. Weitz:                            Okay. Great. Thank you, Holly.

Dr. Lucille:                           All right, Ben. Great to see you. Thanks so much for having me, and thanks for all you do.


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. 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. Heather Sandison discusses How to Reverse Alzheimer’s Disease 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

3:05   The most recent drugs for Alzheimer’s disease that have recently been approved, including Aducanumab, that remove beta amyloid from the brain, do not actually make patients better and may make them worse.  I did a podcast with Dr. Bredesen in episode 271 where we discussed that the landmark study that supposedly showed that the amyloid plaque that was seen in the brains of  Alzheimer’s patients in the landmark paper in Nature in 2006 that was so influential in influencing this whole amyloid hypothesis of Alzheimer’s disease, that these images were falsified. Dr. Sandison said that she wishes for all the patients and the families of those out there who are suffering with a loved one who has dementia that there was a pill or an IV that would just make the nightmare go away.  Unfortunately, despite the billions of dollars that have been spent on this problem and despite the uncountable hours of really smart researchers who have been working on the concept, they have been barking up the wrong tree.  The two most recent drugs approved are Aducanumab and Lecanemab they both cause brain swelling and brain bleeding and at most they make you get worse at a slower rate. They might keep your mom in memory care longer. But your goal should be to have your mom improve and get out of memory care.

7:02  The great news is that we have an alternative, which is the precision medicine/Functional Medicine approach pioneered by Dr. Dale Bredesen.  Dr. Sandison is working on a book called Reversing Alzheimer’s that will be published in June 2024 by Harper and she has just published a paper using this Functional Medicine model in the Journal of Alzheimer’s Disease:  Sandison H, Callan NGL, Rao RV, Phipps J, Bradley R. Observed Improvement in Cognition During a Personalized Lifestyle Intervention in People with Cognitive Decline. J Alzheimers Dis. 2023 Jun 19.   This paper is similar to the one that Dr. Bredesen and Dr. Kat Toups published in the Journal of Alzheimer’s in July 2022, but Sandison’s trial used patients who had more severe cognitive decline and she got similar results. Toups K, Hathaway A, Gordon D, Chung H, Raji C, Boyd A, Hill BD, Hausman-Cohen S, Attarha M, Chwa WJ, Jarrett M, Bredesen DE. Precision Medicine Approach to Alzheimer’s Disease: Successful Pilot Project. J Alzheimers Dis. 2022;88(4):1411-1421.  Bredesen used patients who had a MoCA (Montreal Cognitive Assessment) score of 19 or better, while Sandison took participants with a MoCA scores between 12 and 23. This showed that this Functional Medicine approach can work with patients with more severe cognitive decline.  While the Bredesen study lasted nine months, the Sandison study only lasted six months. They were both pilot studies with 23-25 patients.  The Sandison study saw 73.9% of our participants improve their cognitive function, while the Bredesen study saw 84% improvement of cognitive function.  The key thing to focus on is that this Functional Medicine approach did not just slow the decline of cognitive function as these super expensive drugs did, but patients actually got better and had improved cognitive function! 

11:33  While we might not yet be seeing a significant change in attitudes among conventional doctors or among insurance companies, who essentially control the healthcare system in the US, the Journal of Alzheimer’s Disease is highlighting Dr. Sandison’s paper in their annual periodical. And things will have to change because there are a massive number of people in the baby boomer generation who are approaching the age at which the risk is higher and there might be so many with Alzheimer’s that the cost of caring for them will overwhelm the healthcare system. The cost in paid care from Medicare was $300 billion in 2020 alone and the estimated cost of unpaid care for children and spouses who are not being paid for caring for someone with dementia in 2020 is another $200 billion.  The cost of Dr. Sandison’s Functional Medicine care program averages $19,000 for six months, while the average cost of a memory care center is $12,000 per month, so if you can delay going into a memory care center, it makes sense to invest in seeing a Bredesen trained doctor. 

26:50  Insulin Resistance and the Ketogenic Diet.  Dr. Sandison recommends a ketogenic diet, which reduces insulin resistance and allows the brain to use ketones for energy instead of glucose.  She wants them to have a ketone level in their blood over one millimole per deciliter.  She finds that the patients who do the best are the ones who dive in fully who follows a ketogenic diet and commit to change their lifestyle. They’re taking supplements, getting rid of toxins, getting on hormones and changing their diet, changing their exercise routine, prioritizing sleep, meditating and balancing their stressors and getting into activities that are fun and cognitively engaging. Dr. Sandison recommends for patients with cognitive challenges following a  ketogenic diet and being in ketosis for 3-6 months and then add some season fruits and some squashes and more starchy veggies like beets and carrots and some sweet potatoes, quinoa, and legumes, but not ever going back to eating pasts and breads.  For prevention, she recommends doing keto for 4-6 weeks every 3-6 months.  Dr. Sandison recited a story about a patient who’s daughters brought him in and followed the ketogenic diet and he started remembering all his grandkid’s names and the names of the animals on his farm.  His son came into town and he started eating pizza and ice cream and hanging out with his family and by the time they left, he couldn’t remember their names, couldn’t remember the farm animal’s names.

41:07  Nutrients.  Among the most important brain-supportive nutrients are vitamin D, citicholine, and B vitamins.  Dr. Sandison also likes a nootropic called Qualia Mind from Neurohacker.  She also recommends bacopa, rhodiola, and amino acids like taurine and threonine that support neurotransmitters. She recommends 3-5 gms per day of EPA and DHA from omega 3 supplements. Coffee berry, gingko, lion’s mane, gingko, and huperzine are all important brain nutrients.  She also recommends probiotics, which can help with generalized inflammation and mood and sleep, all things that can affect cognition. Dr. Sandison has a colleague who did a PhD project to determine how to get probiotics to colonize the gut and the things that can help are to take a lot of probiotics, so she recommends taking 100 billion CFUs with a variety of different strains and to take them with food.  Recommended products include Xymogen ProbioMax, Designs For Health, Klaire labs, spore based probiotics, and a Garden of Life product.   

45:15  Hormones. The first question that some might ask is taking hormone replacement therapy for a women in her 60s or 70s safe, since the Women’s Health Initiative in 2001 seemed to indicate that it was not?  But the impact of this WHI study was overblown and there were many problems with this study, including that they used oral conjugate equine estrogen and synthetic progesterone and not bioidentical hormones.  There was a Finish epidemiological study that found that there was a reduction in your risk of dying of cancer if you initiated hormone replacement therapy, whether it was estrogen alone or estrogen plus progesterone in your 50s, 60s, or 70s.  (Mikkola TS, Savolainen-Peltonen H, Tuomikoski P, Hoti F, Vattulainen P, Gissler M, Ylikorkala O. Reduced risk of breast cancer mortality in women using postmenopausal hormone therapy: a Finnish nationwide comparative study. Menopause. 2016 Nov;23(11):1199-1203.)  There’s another study in the UK that shows that hormones reduce all-cause mortality. There are also French trials.  Dr. Sandison mentioned often recommending Estrogen, progesterone, testosterone, pregnenolone, and DHEA.  Obviously, each patient’s risks should be taken into consideration, including her cancer risk, whether she is BRCA positive, etc. When it comes to cognitive decline, hormones can be very helpful. She feels that hormones are very protective of your bones and your brain, no matter when you initiate them.

                                             

            



Dr. Heather Sandison, is the founder of Solcere Health Clinic and Marama, the first residential care facility for the elderly of its kind. At Solcere, Dr. Sandison and her team of doctors and health coaches focus primarily on supporting patients looking to optimize cognitive function, prevent mental decline, and reverse dementia by addressing root causes of imbalance in the brain and body.  She was awarded a grant to study an individualized, integrative approach to reversing dementia and is a primary investigator on the ITHNCLR clinical trial.  At Marama, Dr. Sandison has created an immersive residential experience in the lifestyle proven to best support brain health. She understands that changing your diet, adding nutrients, creating community and optimizing a healing environment are all challenging even for those will full cognitive capacity. The website to her clinic is Solcere.com.  The website to Marama is Maramaexperience.com.  

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. To learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.

                                                Hello, Rational Wellness podcasters. Today, I’m excited to be talking about how do we prevent and reverse Alzheimer’s disease with Dr. Heather Sandison. Alzheimer’s disease is the most common form of dementia and the most common neurodegenerative disease, and the numbers are increasing. It’s crucial that we make some progress on preventing and treating this horrific condition. But conventional research has not been all that fruitful and is centered on the role of beta amyloid protein plaques that are found in the brains of most patients with Alzheimer’s disease.

                                                Now we know that the leading drugs for Alzheimer’s not only don’t make patients better, but actually shrink their brains, making them worse. What can we do? Well, functional medicine may have an answer. Dr. Heather Sandison is the founder of Solcere Health Clinic, where she and her team of doctors and health coaches focus primarily on supporting patients looking to optimize cognitive function, prevent mental decline, and reverse dementia by addressing root causes of imbalance in the brain and body. She was awarded a grant to study an individualized integrative approach to reversing dementia. As a primary investigator on the ITHNCLR clinical trial, it’s great. We need more research on functional medicine approaches. Dr. Sandison also founded Marama, which is the first residential care facility for the elderly that utilizes a functional medicine approach to improving cognitive function by helping residents to change their diet and lifestyle and make the other changes necessary to promote better brain health. I know, for sure, from watching my mom having been in a memory care facility, that the conventional memory care facilities do nothing to help clients other than take care of them and charge you more.

                                                Dr. Sandison is also the host of the Reverse Alzheimer’s Summit, and this is in its third year. She also hosts the Collective Insights Podcast where she works to share what’s possible for those suffering with dementia. Dr. Sandison, thank you so much for joining us.

Dr. Sandison:                     Thanks so much for having me.

Dr. Weitz:                           That’s great. I’d like to focus most of our discussion today on natural things that we can do to help patients, but perhaps you might want to make a comment on some of the latest data on these beta amyloid removal drugs have been coming onto the market for Alzheimer’s patients, the most recent of which is Aducanumab, and maybe comment on this whole amyloid hypothesis and focus on the development of these drugs. For those who are not aware, part of the controversy about these drugs came to light last year, and I did a podcast with Dr. Bredesen in episode 271, where we discussed that the landmark study that showed that amyloid plaque that was accumulating in a brains of Alzheimer’s patients that was in nature in 2006, that was so influential in this whole drug research on the amyloid hypothesis that the images in the paper were actually falsified to make the point.

Dr. Sandison:                     Yeah, it’s really frustrating. There’s a really phenomenal book by a gentleman named Karl Herrup called How Not to Study a Disease: The Story of Alzheimer’s. Essentially, my comment on the medications is, I wish I that for my patients and for all of the families out there suffering with a loved one who has dementia, that there were a pill or an IV or something simple that would just make the nightmare go away. That’s just not unfortunately the reality. Despite the billions and billions of dollars that have been spent on this problem, and despite the uncountable hours of smart, really intelligent people’s time that had been thrown at this disaster, we’ve been essentially barking up the wrong tree. You’re absolutely right. There was this paper that was published in 2006 in Nature that I wouldn’t say it was like this seminal paper, but it was one of those ones where in 2005, everybody was scratching their heads questioning this hypothesis that beta amyloid plaques were the problem, that they were the evildoers that were causing dementia.

                                                In 2006, this connection became essentially what we thought was more real, that there was more of a connection between cognition and amyloid plaques. Well, the issue that really came out of that is that it amplified the funding. When everybody was questioning themselves going, “Maybe we should look in other directions and look at modifiable risk factors or at something else causing dementia,” they doubled down on this hypothesis that was going nowhere. What we see with you mentioned aducanumab, there’s actually one that has come out even since then called Lecanemab that’s slightly less risky in terms of brain swelling and brain bleeding, but these are the types of… Unfortunately, it doesn’t work that well, let’s start there. Then secondly, there are a bunch of issues with the side effects, including brain swelling and brain bleeding. These super expensive drugs that essentially prolong a torturous process, I think there’s an ethical consideration right there.  It’s like, do you really want your mom in memory care longer? Because all these drugs do is essentially, they draw out the decline process. A lot of people might say, “Yes, absolutely. I just want my mom around longer.” But for a lot of people, they might go, “She’s barely here and she’s not enjoying life. I don’t want to do that, especially for $56,000 a year, plus all the doctor’s visits to make sure that she’s not having brain swelling and brain bleeding, plus whatever else comes with it.”

We have an alternative, which is the great news. There is hope. I’m actually working on a book called Reversing Alzheimer’s with Harper, and that’ll be published in June of 2024. But before that, in August, the clinical trial that you referred to is going to be published in the Journal of Alzheimer’s Disease. We’re really, really excited about that coming out this summer in 2023. Thank you. It has been-

Dr. Weitz:                            No, we need more research in journals for functional medicine on all these topics.

Dr. Sandison:                     Essentially, this paper is very similar to the one that Dr. Bredesen, who you interviewed as well who… He supported my friend Kat Toups, she was the primary author on that. It was published also in the Journal of Alzheimer’s Disease in July of 2022. Our trials are very similar. They took 25 participants and did a nine-month intervention of this Bredesen approach, and they took participants with a cognitive decline that was down to a MoCA score of 19. A MoCA score is a way that we can put a number on how severe someone’s dementia or cognitive decline is

Dr. Weitz:                           MoCA score stands for Montreal Cognitive Assessment, right?

Dr. Sandison:                     Exactly. That’s right. The Montreal Cognitive Assessment, it’s a single worksheet that you can do with… Typically, there’s a tech in someone’s office. There’s also the Mini-Mental Status and the SLUMS test.

Dr. Weitz:                           By the way, the MoCA test is the one that Donald Trump bragged about the fact that he got a good score on…

Dr. Sandison:                     Right. This is where you draw a clock, you copy a box, you name some zoo animals and you tell everyone what day and time it is, and maybe you are-

Dr. Weitz:                           Then that all qualifies you to become president.

Dr. Sandison:                     Well, and it gives us, as clinicians, it gives us a 30-point scale, so that we can put a number on how severe someone’s decline is. A perfect score is 30, anything over 26 is normal. Then once you go down into the low 20s, this is measurable cognitive impairment. Then when you go into the teens, this is also measurable impairment of course, but other people are starting to notice it. This is when things start to, and everybody’s a little bit different, but either spatial awareness, a short-term memory, ability to do math, recall names, that is starting to be affected.   Once we’re down into the low teens below 10, this is severe cognitive function. A MoCA score of around two is almost non-verbal, so really severe. We can basically put this on a scale, and that’s the utility of having a worksheet like the MoCA score. Dr Toups and Dr. Bredesen, in their paper that they published last year, they took people with a MoCA score above 19 and then watched what happened and measured what happened. In our trial that’s about to be published, we took 23 participants, about the same number of participants, and we took them through a six-month intervention, so it was a little shorter than their nine-month intervention, and we took participants with MoCA scores of 12 to 23, so more severe cognitive decline, and we got very similar results. With Dr. Toups, her paper, they had 84% of participants improve their cognitive function, and we had 73.9% of our participants improve their cognitive function.

Dr. Weitz:                           Awesome.

Dr. Sandison:                     Yeah. As you might imagine, we had more severe patients and we didn’t have quite as much time, so we got slightly about 10% fewer improve their cognitive decline. But when you look at that, compared to these super expensive brand new drugs on the market, and especially when you can compare them to the old drugs, with those guys, they’re not getting improvement, they’re getting a slowing of decline.

Dr. Weitz:                           In March, a new review of all these drugs was published showing that actually you get increased shrinkage of the brain, so actually patients are getting worse.

Dr. Sandison:                     Then we didn’t do any imaging in my trial, unfortunately, we will in a follow up, but Dr. Toups, they show that you actually get an increase in gray matter volume, and then you also get a reduction in the slowing of the hippocampal volume that’s normal with aging. Your brain is shrinking less fast, your cognition is getting better, which I think should be the standard. What we want is an improvement in quality of life and in cognition, and that’s what we see when we basically take all of functional medicine and throw it at the brain.

Dr. Weitz:                           Are you starting to see a change in attitudes yet among either conventional doctors or the public in general? Is the word starting to get out or not yet, that functional medicine can have a significant impact on helping patients with dementia?

Dr. Sandison:                     Yeah, I think we’re about to see, I feel really, really fortunate and honored, just so privileged because the Journal of Alzheimer’s Disease is highlighting my paper in their annual periodical. They are attempting to set the course of research around Alzheimer’s disease and really reset the course of research. My hope is that things will change. Now, here’s the issue. It has to, because this is a desperate situation, not only for families, but for Medicare. There are a massive number of people who are approaching the age at which the risk is higher. The baby boomer generation is about to be in that unmodifiable risk category of advanced age, and there are so many of them that there essentially won’t be enough people to take care of those who need it with Alzheimer’s. The cost of this is absolutely unbelievable. The cost in paid care or Medicare is over $300 billion in 2020 alone.

                                                Now, the cost of unpaid care, so all of the adult children and spouses who are not being paid to care for someone with dementia is over $200 billion in 2020. These numbers are just absolutely astounding. I mean, the number of people in the US right now, it’s about $6 million people who have been diagnosed with Alzheimer’s. But I’ll tell you this, there’s a whole lot that haven’t been diagnosed, because they don’t want to go to a neurologist, because they think, “They’re not going to help me, and the only thing they’re going to do is take away my driver’s license,” so a bunch of people go undiagnosed, and that number is just getting bigger. Around the world, it’s between 50 and 60 million people who are suffering with Alzheimer’s. Even if conventional medicine or the conventional press doesn’t want to start changing the narrative, we have to, we absolutely have to.

Dr. Weitz:                           It’s going to be so difficult because of the way insurance companies control the healthcare system that to start paying for functional medicine in a way that allows functional medicine doctors to survive, it was so far away from that. I mean, the insurance companies have been increasingly paying doctors less and less and not being willing to reimburse doctors for time at all. It’s going to take a major paradigm shift as long as insurance companies are deciding what happens to healthcare dollars.

Dr. Sandison:                     Well, also, you mentioned senior living, right? We need a change in that industry. We certainly need a change in the medical industry and insurance and that racket. We need a change in the food system.

Dr. Weitz:                           Oh, 100%.

Dr. Sandison:                     In society in terms of isolation and the time spent on screens, there are huge systemic and societal changes that we really need. Yet, here’s the math. Dr. Ben, it costs about $12,000 to have somebody in memory care. For our trial, we budgeted $25,000 for each of our participants, and we never use that much. If you can set aside, let’s even say, I think the person who spent the most, all the IVs, all of the doctor’s visits, all the labs, all the supplements, all the medications, the most spent of all of our… And he was really sick. Of all of our participants was $19,000. You can go through that in two months of memory care. Even if you can delay going into memory care, it makes sense to invest in seeing a Bredesen-trained doctor.

Dr. Weitz:                          100%. It will just do our part to make sure things change in the right direction. Let’s get into how do we help patients? When you have a patient you suspect of having some cognitive problems, where do you start? Which cognitive tests or tests do you like to run?

Dr. Sandison:                     Yeah, yeah. Pretty much now the only patients I see are patients with cognitive decline. Where we start is a thorough intake, because many of these people are at the last quarter of their lives, let’s say, and hopefully the last third, they’ve still got lots to look forward to. There’s a lot to discuss. They have a lifetime of health history to collect. In my first visit with them, my goal is to get to know them, to understand them, and also to understand the dynamics in their family. What can they afford, quite frankly? What are they able to do? Can they do all the testing? Even if they can’t, are they going to have the support at home to potentially get on a ketogenic diet? Which we see as being really, really helpful. It’s not the only diet that’s great for the brain, but it certainly is very, very helpful when we see a ketogenic diet really helping cognition.

                                                Are they going to have support with that at home? If you have a spouse who’s got cookies lying around, this is just a non-starter. Are they going to be supported in getting exercise and getting social interaction and getting outside and maybe help with stress management? What does that look like? Are adult children are spouses involved or are they on their own? I’ll tell you this, we’ve worked with several health coaches. Health coaching, I’ll just say right now, my stance on health coaching is it is the best investment you can make. It is the best bang for your buck because the foundations of health, diet, exercise, sleep, stress management, these things are your 80-20. They are the 20% that you’re going to change, the 20% of the money you’re going to spend, and they’re going to get you 80% of the benefit.

                                                If you’re just trying to out supplement this, I can’t help you. Working with a health coach is really like, that’s the foundation. The icing on the cake is going to the doctor and getting all the labs done. That can be really, really helpful, especially if we identify something like toxic burden or something like that. But when I’m first working with a patient, I’m trying to identify, what’s going to work for them best? I want all that data. I love to do $3,000 in labs. We basically aim to do that. Again, we go back to this investment makes sense. Cognitive decline is in your family. If you are concerned about Alzheimer’s because your brain doesn’t work the way it did 5 or 10 years ago, what Dr. Bredesen calls it is a cognoscopy. You might’ve heard him say this.

Dr. Weitz:                           Of course. Yeah.

Dr. Sandison:                     I love it. It’s so catchy, right? Because there’s all that emotion associated with a colonoscopy, but for your brain. It does just what a colonoscopy does for colon cancer, we’re doing for cognitive function. We’re saying, How likely are there things there, like the polyps in your colon? Are there polyps in your brain? So to speak, right? Are there toxins? Are there nutrient imbalances? Are there inflammatory markers or infections? What is going on that might affect every neuron in your brain, and how well it communicates with the others so that you can remember that person’s name or where you parked your car or where you left your keys? All of these little things so that you can continue having conversations with your loved ones into your 90s and beyond. That set of labs is really important. That is where I start.  Well, I start with understanding what’s going to work for this family. Do they need health coaching? Are they able to do the foundational pieces? If not, how do we get them the support that they need? Then I typically do some nootropics, omegas, some probiotics, some vitamin D, and then we order all the labs. I also recommend Kirtan Kriya, I mean, there’s a long laundry list. Is it okay if I just go into these things?

Dr. Weitz:                           Sure, yeah.

Dr. Sandison:                     Okay, great. We recommend Kirtan Kriya. It’s a meditation practice. It’s the Sa Ta Na Ma, and there’s a lot of great research associated specifically with Kirtan Kriya meditation and Alzheimer’s and other related dementias. Great for caregivers because caregivers for someone with dementia are anywhere from two and a half to six times the risk of being diagnosed with Alzheimer’s later on in their life. Caregiving increases of stress, you don’t eat as well, you don’t sleep as well, you don’t exercise as much because you’re caring for someone else.

                                                My recommendation whenever I’m working with caregivers is you got to get on this too. You need to be on this plan with the person you’re caring for. Do the Kirtan Kriya with them, do red light therapy if you can with them. Change up your exercise so that you’re getting strength training, aerobic and potentially contrast oxygen therapy and maybe dual task where you’re engaging both your cognitive function. You’re on the edge of what you can do cognitively and physically at the same time because you get way more cognitive benefits when you do both of those things together.

Dr. Weitz:                           What was that last thing you were talking about, cognitive and exercising while you’re playing chess, or what is it?

Dr. Sandison:                     Yeah, great question. Dual task exercises, if you look this up on YouTube per se, it’s a little newer, but we’ve seen it in Parkinson’s clinics, TBI clinics, stroke patients. This is a really helpful way for neurogenesis, to promote neurogenesis. What you’re doing is you’re finding that edge where you’re engaged cognitively and you’re engaged physically. For some people, if they’re struggling with cognitive decline, this means a class, a Zumba class, maybe a Pilates class, a yoga class where you’re being cued by an instructor to bring your right arm down to your left hip, something like that, it takes some effort for you to keep up cognitively. Now, if I go to my Pilates class that I’ve been to three days a week for the last five years, I’m spacing out. This is not engaging me cognitively.

Dr. Weitz:                           It’s going to be something new and novel.

Dr. Sandison:                     Exactly. Ballroom dancing comes up. This is something that’s been associated for a long time with cognitive function and improving that and protecting it. There’s a bunch of pieces here to the activities that you might think about doing if you are concerned about your brain health. I think of them like checkboxes. All right. Does it involve exercise? Yes. Ballroom dancing, yep, checks that box. I’m going to be physical. I’m going to get my heart rate up. Does it involve cognition? Yes. I’ve got to remember the music and the steps. I’ve got to remember these pieces and put them together. Check, yes, cognitive function. Is it social? Social isolation is one of the known risk factors when it comes to dementia, and certainly through COVID, we saw the ramifications of that on people’s cognition. Check, yep, ballroom dancing, check the social box. When you start putting these things together, I like to add being outside, communing with nature.

                                                There are a few other boxes that we can add here, but ballroom dancing certainly checks a lot of them. If you’re thinking about taking on a new sport or a new hobby, how can you do all of that? That’s a way to make this feel a little more approachable. It can feel like a full-time job to do all of these things. But if you can start the Venn diagram where you’re doing multiple at once is really helpful.

                                                I have some patients, I had this really sweet patient. She would go for walks with her granddaughter and her granddaughter would quiz her. She was a nursing student focusing on holistic nursing, and she was really interested in nutrition. She would quiz her on the ketogenic diet, and then she would also quiz her on her grandchildren’s birthdays, something really emotionally important to her grandma. They would basically just go on these walks together and talk about nutrition and talk about the grandkids, and she would get these little quizzes. What I do is I will have a podcast in when I’m running or rowing, and I will stop Peter Attia and I will go back and I will think through like, “What did he just say? What did I just learn?” I will stop Andrew Huberman and be like, “Okay, what is the mechanism of…” Blah, blah, blah, whatever he was talking about. That’s how I do it.

                                                I find that those things stick a little bit better. Having fun when you’re doing these things too also is there’s a great article in Cognition Today that explains the importance and the mechanisms of why it’s so important if we want to learn and create these new connections, these new neurons and synapses in our brain, then we have to make it fun. We’re going to do so much more if we’re in a rest digest and heal state and that parasympathetic state, we’re going to learn so much more than if we’re in a stressed out state. This is just as true for toddlers and grade school students and college students as it is for seniors who are battling cognitive decline.

Dr. Weitz:                           You mentioned Peter Attia. I’m going to bring up cardiovascular. I heard Peter Attia say recently that you should get your ApoB level below 40, that you need to drive that down as low as you can, and that is the only way to reverse, eliminate cardiovascular disease. It has no effect on brain function, because the cholesterol, by using statins and PCSK9 inhibitors and other drugs, were only affecting the cholesterol that’s produced by the liver that goes into the bloodstream and the cholesterol in the organs like the brain is produced in the brain.

Dr. Sandison:                     I’m not an expert on all of that, and I’m certainly not a cardiovascular [inaudible 00:25:44].

Dr. Weitz:                           Just trying to create a bit of controversy here.

Dr. Sandison:                     I have respect and trust that Peter Attia has a good resource for that, a good reference. What I have seen clinically is that patients who have cholesterol levels-

Dr. Weitz:                           Yeah. All the studies that have been funded by big pharma say that statins are perfectly safe and have no negative effect on brain health.

Dr. Sandison:                     What I’ve seen clinically is that patients who have cholesterol levels below 150, it’s [inaudible 00:26:15]… Total cholesterol, yeah. It’s really hard for them to heal. Wound healing is more challenging. Depression and anxiety are more prominent. I remind patients that cholesterol is the backbone of your stress hormones and sex hormones and required for healing. Driving that number down is not without risk. I trust and respect Peter Attia. I haven’t read everything that he has, so I will leave that there.

Dr. Weitz:                           How important is insulin resistance for Alzheimer’s prevention?

Dr. Sandison:                     We recommend a ketogenic diet. I recommend a ketogenic diet, not forever, but for somebody struggling with cognitive decline, I recommend-

Dr. Weitz:                            Now, how do you characterize the ketogenic diet?

Dr. Sandison:                     We have a handout. It’s a keto diet guide, and our goal is to have patients measure a blood level over one millimole per deciliter of ketones. That’s our target range. Mild ketosis is 0.5 to 0.9. Really what I would love to see my patients do and the patients who do best, first of all, the patients who do best, they dive in fully. They’re not dipping their toe in the water here. They are really committing to changing their lifestyle. Yes, they’re taking the supplements. Yes, they’re getting rid of the toxins. Yes, they’re getting on the hormones, and they’re getting on the diet. They’re changing their exercise routine. They’re prioritizing their sleep, they’re meditating and balancing their stressors, and they’re getting into activities that are fun and enjoyable and cognitively engaging. They’re doing all of it. Now, I take that back. They’re not necessarily doing all of it, but they’re doing the majority of it.

                                                They’re really, really making meaningful change, because you’re not going to get out of this doing… We’re asking for a miracle. We’re asking to reverse Alzheimer’s and reverse the cognitive decline on the way to Alzheimer’s. That is a miracle. It’s not expected. It’s not what we typically see. To get that reward, you have to put an effort. Again, I wish there were a single pill or an IV that we could take. Ketogenic diet, what I recommend is three to six months in ketosis, one millimole per deciliter. What I do in prevention mode, I don’t have a family history, but I love this stuff, I live this stuff. I’m in ketosis right now. I’ve been in ketosis for about three weeks. I had come back from vacation and it was time. Every three to six months, probably quarterly, I get into ketosis for four to six weeks. For my patients with cognitive decline, I recommend three to six solid months in ketosis.

                                                Now, it’s not going to happen, right? Nobody’s going to stay there for three to six months. You’re going to have some accident where you taste something. I mean, I had this happen the other day. I was at a friend’s house and I made tea, and I thought their almond milk was unsweetened and it was sweetened. I tasted it immediately, but I then felt later that I was kicked out of ketosis. I could feel the difference. It’s going to happen. You just get right back on the horse and get back into ketosis. Then when you’re not ketosis, what I recommend is not going back to processed foods, because we know that is a modifiable risk factor for Alzheimer’s and dementia, is the consumption of highly processed foods, and so not going back to the pastas and the breads. But when you come out of ketosis to add your whole foods, your seasonal fruits, your squashes and your more starchy veggies like your beets and carrots, and the other things that are going to raise your blood sugar but that aren’t highly processed, maybe some rice, maybe some quinoa, certainly lentils, beans, legumes.

                                                Those are also great things to add when you come out of ketosis. Then again, if you are cognitively declined, you’re going in and out of ketosis. You’re increasing your metabolic flexibility. To get to the succinct answer to your question about insulin resistance, this is critically important, because as we age, even if you don’t have diabetes, we all have some degree of insulin resistance as we get older. That means that more sugar hangs out in our bloodstream. We can’t use that insulin as effectively to get sugar into the cells of the brain or wherever. That sugar can become very toxic. Glycotoxicity is one of Dr. Bredesen’s types of Alzheimer’s.

                                                Also, insulin itself can become toxic. What we want to do, I mean, the human body just amazes me, that we can just switch fuel sources. We can go from using carbohydrates, sugar, glucose, you can use those interchangeably to using fat or ketones for fuel. What we see is the brain actually prefers that. There are very rare times that both ketones and glucose are available to the brain to use as fuel. When we’ve seen that, they’ve measured, the brain will pick up the ketones before the sugar, and also it burns cleaner. I interviewed Dr. Steven Gundry for my summit recently. He has some really interesting mechanisms that he’s proposing for why this burns so much cleaner and what’s going on with the change in our metabolism when we move into ketosis. But where the rubber meets the road, what I see clinically is that people perk up.

                                                We had a patient, he had a bunch of kids, and one of his daughters brought him in and got him into ketosis. It was fantastic. He did great. He started remembering all of his grandkids names, and he started remembering the names of horses and cows and cats and dogs and the farm animals around where they lived in this rural area. Before, he couldn’t remember the word horse, the word cow. He gets into ketosis, starts remembering the names of his grandkids and the names of the animals. His son comes into town and those grandkids, they want to have pizza, and they want to eat ice cream, and they want to hang out and watch TV with grandpa. By the time they left, he couldn’t remember their names, couldn’t remember the farm animal’s names. We can see what happens and people can feel it. I certainly feel, I wake up at 5:00 AM ready to get out of bed when I’m in ketosis, I drag myself out of bed between 6:00 and 6:30 when I’m not. We can see and feel the differences.

Dr. Weitz:                           And so, do you recommend the clients measure their blood ketone levels? What about doing the breath ketones?

Dr. Sandison:                     Oh gosh, this is another one of those. I wish they worked. We haven’t been able to get the breath ketone meters to work consistently. Same, urine. Urine can be helpful, but it doesn’t seem to be as consistent after about a month in ketosis. The blood ketone levels really are the most consistent and the most accurate in my experience. I would love if somebody could prove me wrong and show me one that really did work that didn’t require a finger prick. What I’ve used and many of my patients coaching clients have used is a-

Dr. Weitz:                           Continuous glucose monitoring.

Dr. Sandison:                     Glucose monitoring. Thank you. You can see me pointing at my tricep. That’s like the Libre.

Dr. Weitz:                           You’re talking about CGM.

Dr. Sandison:                     Yes. That they’re inversely related. If your blood sugar is up, your ketones are down. When your blood sugar is down, your ketones are up, typically. What was most helpful for me was the way I felt. I could tell, okay, I’m in ketosis, and then I could double-check myself and say, “Okay, what’s my blood sugar at? Oh, well, if it’s 97, I’m probably actually not in ketosis. If it’s down at 72, yep. I’m probably in ketosis. Also, I love to drink matcha. Andrew Weil has these great matcha products. I drink his matcha, and there’s one that’s an adaptogenic blend. On the back of the label, it says zero carbs, zero sugars. But when I drink that one, my blood sugar spikes. I’m not saying they put anything in it. Everybody just has a different metabolism. I can’t tell you how many times I’ve had patients, a husband and wife getting into ketosis, and she can stay in ketosis, eating zucchini all day long, and he gets kicked out. I had a patient come in and tell me they could eat white rice and stay in ketosis, which makes no sense at all.

Dr. Weitz:                            If there’s adaptogenic mushrooms, like [inaudible 00:34:40] mushrooms, that actually have a fair amount of carbohydrates in them.

Dr. Sandison:                     Yep. My recommendation, don’t just rely on the labels. Mostly eat things that don’t have labels. Everybody’s an individual. Your metabolism is different. If you’re going at this, measure.

Dr. Weitz:                            I wanted to mention, I like to try to hit on a few of the controversial things, when it comes back to cardiovascular health, there’s a marker for cardiovascular health that’s been talked about a lot recently, and it’s called TMAO. This marker is something that can be measured that shows that you have an increased risk of clotting and heart disease. TMAO comes from eating red meat, eggs and supplements that contain choline or L-carnitine. Many of us in the functional medicine community have been using choline as a very important brain supporting nutrient. How do we square these two?

Dr. Sandison:                     As I mentioned, I don’t recommend that anybody’s on a ketogenic diet forever. My recommendation from this ancestral health diet or this concept that maybe we should approximate more of our hunter-gatherer ancestors diet, the consistent thing about what our ancestors ate 100,000 years ago was inconsistency. I’m not recommending that somebody be in ketosis for the rest of their lives. I’m recommending that they switch it up and eat seasonally and that you watch these levels, watch these lipid levels. We have most of our patients who get into ketosis, and this is a very plant forward ketogenic diet. This is not eating bacon and eggs and cheese all day every day. This is cruciferous veggies and leafy greens and avocados.  I have an egg allergy, so I can’t even have them. Lots of people have, they have a dairy allergy, so they have to work around that, but it still works, and you’re not doing it forever. Watch the fricking labs. If it’s not working for you, we got to figure something else out. Maybe more fiber, maybe some amla or berberine, something to make this work for you so that you’re not increasing your risk. There’s a lot of options there, and everybody’s different. Most people that we have get into ketosis by the time they hit month six, their lipids are coming down, because they’re using them for fuel. You’re using fat for fuel, so those lipid levels are normalizing. In the first six weeks, they’re definitely raised.

Dr. Weitz:                           Yeah. TMAO is a little bit different than measuring lipids, but what about supplements that contain choline, [inaudible 00:37:44] choline, other forms of choline? I am not a believer in this TMAO marker. There’s too many problems with it as far as I’m concerned, but I’m just wondering.

Dr. Sandison:                     I associate TMAO with gut bacteria, so I don’t know. It sounds like you’re associating… It was something different than I’m. [inaudible 00:38:05].

Dr. Weitz:                           Stanley Hazen from the Cleveland Clinic has pioneered it as an important marker for cardiovascular health and recommends measuring it. Then typically, this is a sledgehammer that can be picked up by vegans to tell everybody who’s eating meat why they shouldn’t eat meat. But that’s my take on it. I think it is the case that only certain people are going to turn choline or L-carnitine into TMAO depending upon your gut bacteria. It may be that this is actually a marker for an unhealthy gut, but it is being used in parts of the cardiovascular world as a way to measure cardiovascular risk, a little bit different than LDL and some of the other markers.

Dr. Sandison:                     Got you. Yeah. For cardiovascular risk, we’re looking at Lp-PLA2, which typically indicates some inflammation in the gums and can come from oral health. If I see that elevated, I’ll refer people to a biological dentist. We look at ApoB and Lp-PLA2 and sdLDL, homocysteine of course. TMAO, we run. I don’t typically see it really abnormal, so I haven’t focused on it a ton. My response to the vegans is, you’re absolutely right on the environmental front all day long, I’m not recommending the best health for the environment or for the planet. What I am recommending is what I have seen clinically be the best healthy diet for your brain. Now, I am a strong believer that if you’re eating, if you’re consuming animal products, they should be organic, they should be grass-fed. If it’s salmon, it should be wild, even though the salmon fisheries are shut down completely right now, it’s really frustrating, and that you shouldn’t be on this diet forever, that you should [inaudible 00:40:08].

Dr. Weitz:                           What’s that? The salmon fisheries are shut down right now?

Dr. Sandison:                     I’m so bummed. The wild Alaska salmon that I usually eat from May to October is unavailable this year because the salmon fisheries are closed.

Dr. Weitz:                           Really? Why are they closed?

Dr. Sandison:                     I don’t even know that much detail. I just got sad and walked away from the butcher.

Dr. Weitz:                           Well, you can still get it frozen.

Dr. Sandison:                     You can get it frozen. Yeah. The point here though is, you’re not going to be on this forever. Measure your labs. If you’re vegan, it’s really hard to do a healthy vegan ketogenic diet. It’s really, really hard. You’re going to be nutrient-deplete. I don’t recommend doing that for long, if you’re going to do it. Then if ketosis is something you’re willing to experiment with, then go back and forth between the plant-based diet and a ketogenic diet. While you’re on the ketogenic diet, have a little more of the animal protein and have it be well-sourced.

Dr. Weitz:                           Okay. What are some of the most important brain-supportive nutrients?

Dr. Sandison:                     Well, we talked about a few. Vitamin D certainly is a signaling hormone that supports neurogenesis and synaptogenesis. I mean, you talked about citicholine. I use a nootropic called Qualia Mind from Neurohacker, and that has a lot of the ingredients for a nootropic that essentially it’s a stack of good quality nootropic supplements. You’re going to need your B vitamins, you’re going to need the basics, your B’s. Then what we can do, in my mind, I’m like, “Do we want to talk about the signaling stuff?” Which is hormones, because not really a supplement, it’s not really a nutrient? Because hormones-

Dr. Weitz:                           Why don’t we hit the nutrients first and then we’ll go to hormones next?

Dr. Sandison:                     Okay, great. There are a bunch of different nootropic blends out there. I chose Qualia Mind, because it was formulated by friends of mine to be frank and their geniuses. I also have watched it really, really, really help people. I felt the benefits of it. That’s why I’ve used it.

Dr. Weitz:                           I’ve been using Brain Vitale that Kat Toups recommended, actually.

Dr. Sandison:                     Oh, yeah. I mean, there’s a bunch of them, and I think Kat’s probably recommending some of the ones formulated by Dr. Bredesen, but they look pretty similar. You mentioned choline. Choline is a often in here, bacopa, rhodiola, taurine, threonine, amino acids that are going to support neurotransmitters. I’m looking because I have-

Dr. Weitz:                           Omega 3s. Yeah.

Dr. Sandison:                     Usually, I do omegas separately, because you’re not going to get enough omegas from some combination of nootropics. Your omegas, it’s really important that they don’t become rancid, so keeping them maybe in the fridge or something. I do omegas on their own, and I recommend people get three to five grams of EPA/DHA a day. But then coffee berry, you mentioned lion’s mane, ginkgo, huperzine, these are all things that can be seen in these classic nootropic formulas that we use. Then, I mean, we’ve already talked about the gut-brain connection potential with the marker that you’re running. I can’t connect it to that, but I put everybody on probiotics because I have watched that significantly change generalized inflammation and mood. Mood is really the biggest thing, but also sleep, all things that are indirectly related to cognition.

Dr. Weitz:                            Is there a certain type of probiotic for this particular issue that you find beneficial? Or do you rotate probiotics or?

Dr. Sandison:                     Yeah. My recommendation to my patients is 100 billion per dose, take them with food. I know the wisdom from the elders was to take them before bed or on an empty stomach. I have a friend who she got her PhD in functional gastroenterology, I guess.

Dr. Weitz:                            Yes.

Dr. Sandison:                     She said that her PhD project was how to get probiotics to colonize the gut. It was a whole lot of them, as much variety as possible and with food. This makes sense, because they’re going to hitch a ride on the food when the stomach acid is at its lowest through the gut and then potentially colonize the intestines. I just recommend people rotate them. Some brands I like, I mean, I love the Xymogen ProbioMax. Designs for Health has a good one. Then Klaire Labs has great ones. The spore-based ones are really popular. Those help some people. Oh, Garden of Life is one that’s really easily accessible, and I see patients get great benefit from that.

Dr. Weitz:                           Cool. Let’s get into hormones. Hormones like estrogen, progesterone, testosterone. Then of course, is it safe to place, say, a woman in her 70s on hormone replacement?

Dr. Sandison:                     Yeah, great question. I would add pregnenolone and DHEA to that list. I think of five primary ones.

Dr. Weitz:                           Estrogen, progesterone, testosterone, pregnenolone, and DHEA.

Dr. Sandison:                     Yeah. Let’s chat about the women first. Is it safe? There’s a Finish trial, epidemiological study, of nearly half a million Caucasian women in Finland, and it showed that there was a reduction in your risk of dying of cancer if you initiated hormone replacement therapy, whether it was estrogen alone or estrogen plus progesterone in your 50s, 60s, or 70s.

Dr. Weitz:                           Interesting.

Dr. Sandison:                     Huge, huge dataset that showed that adding hormones actually reduced your risk. Now, there’s another study out of the UK that shows that hormones reduce all causes of mortality, hormone replacement. There are French trials as well. The Women’s Health Initiative study, I think, was very overblown by the media. I mean, there was a New York Times article recently about this that explained what happened, and we’re seeing more and more of this.

Dr. Weitz:                           Well, one of the theories about that was the timing hypothesis, which was the idea that the reason why these women had an increased risk is because they didn’t start the hormones immediately after going into menopause. They waited 10 years. And so that’s a risky thing to do.

Dr. Sandison:                     Well, and also perhaps those women had other comorbidities, and so there’s a lot of variables in there.

Dr. Weitz:                           They weren’t doing bioidentical hormones and… Yeah, yeah, yeah, yeah. Lot of problems with that study.

Dr. Sandison:                     Yeah, I see hormones being… It’s like I can see a wilted flower come into my office and they get on hormones and they perk up. It’s a dehydrated plant that’s been watered. It’s just wild to watch. Let’s consider the cancer risk. If you’re BRCA-positive and you haven’t had a mastectomy and a full hysterectomy, which most of the patients I’ve seen that are BRCA-positive, I’ve seen an older population, they’ve already had that done. Then if you have a history of cancer, then there’s a different risk-benefit analysis. If you have a significant family history of cancer, there’s a different risk-benefit analysis. But if you have a strong family history of cognitive decline and you have cognitive decline right now, you have osteoporosis, you have heart disease, I don’t see two sides to that really anymore. It’s just way too protective of your bones and your brain, no matter when you initiate.

Dr. Weitz:                           You’ve talked a little bit about exercise. What would be the full exercise protocol? You mentioned things like activities like dancing, but what about weight training, cardiovascular exercise, balance training, things like that?

Dr. Sandison:                     Like diet, my recommendation is mix it up. You want to get enough, and I refer back to the Framingham trial that showed so much cardiovascular benefit exercise is going to increase blood flow to the brain just at the simplest level in terms of mechanism. Your aerobic exercise is going to do that. Best strength training is going to increase muscle mass, which is going to increase those [inaudible 00:49:04] or the endocrine signaling that’s going to come from the muscles to the brain to promote, again, synaptogenesis and neurogenesis. We want to optimize for both of those things. I mentioned the dual task. In an ideal world, you’re getting about 200 minutes a week of moderate to vigorous exercise, and this is 220, the number 220, minus your age, and then you can multiply that by 0.5, and then 0.75 or 0.7. I’ve seen a little bit different things, but basically you want to get about 50 to 80% of your max heart rate is where you’re in that moderate to vigorous.

                                           Another thing I’ve heard people say that’s just much simpler than doing the math is you want to be breathless several times a week. You want to be out of breath from exertion. 10,000 steps a day, when I’m talking to patients, it totally depends on where they’re at. I’ve had patients who won’t get off the couch to go to the mailbox. Just walk around the neighborhood for five minutes, and that is an improvement. I’ve had other patients who are exercising too much that it’s a stressor. They’re doing triathlons every six months. It’s too much, and it’s probably basically creating an adrenal burden. We have to back off. But in an ideal world, what you’re doing is you’re getting a mix of things, dual task exercise that includes strength training and cardiovascular exercise about 200 minutes a week. That engages both physically and cognitively.

                                                Then if you can add contrast oxygen therapy, and this is where you’re going from concentrated oxygen to 8% oxygen. What we breathe in normal air is about 20% oxygen. You go up to 80% and then down to 8 or lower percent of oxygen. That creates a hormetic effect where the body is essentially stressed. In that you have vasodilation, you have detox pathways kick in, you have cytolytic events where you get rid of those old senescent cells. You have an increase in mitochondrial density per cell over several months of doing this. Those are things that if you have access to a contrast oxygen therapy device-

Dr. Weitz:                           What is a contrast oxygen therapy device?

Dr. Sandison:                     Yeah, pretty simple. We use a Schwinn Airdyne, it’s like a bike with the arms. Some people will use a treadmill, other people will use even just like a rebounder. You want to be able to get that cardiovascular effort and be stationary. I use a rower, and so I’m always dreaming that this will happen, but there’s tubing and stuff. What’s happening is there’s an oxygen concentrator, just like any other oxygen concentrator. These are pretty easy to come by, but that’s hooked up to a reservoir, a big bag of concentrate, where the concentrated oxygen will collect so that you can use it while you’re exercising.  Then you have a mask on, and that mask is connected to a tube, then connected to your reservoir, and you can flip that tube open and closed. When it’s open, you’re on positive oxygen. When it’s closed, you’re on negative. When you’re on negative, you are getting vasodilatory effects. You’re basically being starved of oxygen while you’re sprinting typically. Then you recover on the positive oxygen. You take those dilated vessels and you’ve flushed them with highly oxygenated blood, and you recover there and you go back and forth for as many times as you can for 20 minutes.

Dr. Weitz:                           Is this something that you control manually?

Dr. Sandison:                     Yeah, exactly.

Dr. Weitz:                           Okay, interesting. That’s a way to get oxygen. Is that an alternative to hyperbaric oxygen or ozone?

Dr. Sandison:                     Yeah. Yeah, definitely different from ozone, but I would say an alternative to hyperbaric is different, but yes. If you talk to the guys that created these contrast oxygen therapy devices, they would say one 15, 20-minute session on a contrast bike, riding a bike with contrast is going to be worth 31-hour dives. That’s probably an overstatement from the guys that created this and really believe in it. But it’s also, from what I’ve seen, probably not far off. Your dives, you’re very passive. You’re in a chamber, and most people, what they have access to is a soft chamber. There’s Israeli studies about hyperbarics for Alzheimer’s. They’re using hard chambers that cost millions of dollars to build that nobody here has access to.  We’re not talking apples to apples when we talk about a soft chamber that goes to 1.4. We’re talking about something really, really different. The soft chambers, you’re totally passive, you’re lying there. Great if you can read a book or do something, but your ears have to be able to tolerate it, you need to be able to communicate. For somebody with severe Alzheimer’s, this is not an option. Some people are claustrophobic, not an option. I mean, the mask is a whole situation on the contrast side that not everybody can tolerate, but contrast, you’re getting the pressure and you’re getting concentrated oxygen, but you’re not working, so you’re not getting as much delivery of that oxygen.

Dr. Weitz:                           There’s a number of devices that have been designed to stimulate the brain. I think you mentioned red light. There’s a purple light. People are using various other types of devices, electrical devices, to try to stimulate the brain to promote brain health. Which of these do you find or any of them do you find beneficial?

Dr. Sandison:                     Yeah. The red light therapies we definitely see people have benefit from now, have they been-

Dr. Weitz:                           Is this the one where they put the helmet on? Is it that one?

Dr. Sandison:                     We use V-Lite at Marama, and that’s what I recommend to patients. This is in that mid-600, mid-800 wavelength. This, it works on the cyclooxygenase enzyme around the mitochondria. It improves the mitochondria’s ability to create ATP. It basically makes that process more efficient, and so you have an increase in energy production in the cells, which Dr. Bredesen has proposed that it’s an energy deficiency that essentially causes Alzheimer’s. Our beta amyloid plaques and our tau proteins, although they might be associated, certainly there’s some relationship, they are the results of that. Then you have all these other causes for why there’s a depletion of energy.

                                                If we can do something like use a red light to increase our ability to create energy or switch to ketogenic diet, increase our ability to create energy, then we have a better fighting chance. That’s what we understand is going on with this pretty specific spectrum of red light. There’s two. Then 1070 nanometers, there’s some research around it as well. 20 minutes once a day, we have patients who when they do the alpha, they’re much less anxious, so we can use it for that. Then gamma is more specifically for memory.

Dr. Weitz:                           Okay. Have you found peptides to be beneficial?

Dr. Sandison:                     Yeah. Yeah. Clink, Cmax, Cerebrolysin, those are the typical ones used for cognitive decline, specifically. What I find with Clink and Cmax is that often it’ll be a little bit of a win. People will feel a little boost, and then it plateaus and goes away. I typically don’t have patients on it super long-term, but they’re great because you can do them intranasally, so they’re easy, you don’t have to inject anything. Whereas cerebrolysin, you really need to inject, and it’s much harder to come by. We do that by IV, probably in higher doses than most people do. But that’s what I’ve seen work best. Then I’m a huge fan of BPC and TA1 and Matsi. There’s lots of them, [inaudible 00:57:24]. Love peptides. Sometimes they’re hard to get, sometimes they’re really complicated to get. We do what we can there and help people in ways that are appropriate with those.

Dr. Weitz:                           Cool. You have this Marama Center for assisted living. Maybe you can tell us a little bit about that.

Dr. Sandison:                     Yeah, sure. Absolutely. What happened was I had patients coming into my office getting better with cognitive decline, the Alzheimer’s. Then people started asking me, “Where do I send my loved one? I have an uncle and I can’t take him in. I’m in the sandwich generation caring for my kids and managing my household and trying to keep my full-time job and my marriage together. I can’t do all of this for my loved one. Where can I send them?” I realized that there wasn’t a place that existed. I asked around and thought, “How hard could this be?” And ended up creating this new concept, senior living facility, that’s very much based on what we’ve been talking about. It’s an organic ketogenic diet in a non-toxic environment. We use organic sheets and mattresses and all that. It’s a social environment, so everyone’s engaged.

                                           Then the activities from sunrise to sunset and beyond are all about enhancing cognitive function. We have the LiVO2, the contrast oxygen therapy, we’ve got the V-Lite. We’ve got Biomax. We’ve everybody in engaged in Pilates, or excuse me, probably not Pilates these days. There has been some in the past, but now it’s yoga and meditation and dancing. We’ve had hula dancing classes and pets that come and go. Then sleep is really prioritized in terms of light and noise in the house, it’s really important to us that our residents can get really high quality sleep.

                                           Then the residents, they are expected to get better by the caregivers. Part of it is about how the caregivers interact with them. They’re expecting them to improve. They also are helping them with all of their crazy supplements and hormones and everything they’re on, and they understand why and how important those are. Then they are engaging them in ways that are really inspired by a woman named Teepa Snow positive approaches to caregiving. Then also through how to speak, which is very much about diffusing and creating a very loving, fun, playful, relaxed environment so that they can really optimize cognitive function that way.

Dr. Weitz:                           That’s so great. I’m glad that you set that place up. We really need more places like that.

Dr. Sandison:                     Thank you.

Dr. Weitz:                           Maybe you can tell listeners about some of the programs, if by the time this runs your summit will be over, but they could order the summit. I think you have some training programs available as well, maybe for practitioners or?

Dr. Sandison:                     Yeah, yeah. Actually for caregivers. People who are caregivers, caring for someone who has Alzheimer’s, the Bredesen approach, I can’t tell you how many people have walked into my office withholding a Bredesen’s book, [inaudible 01:00:37] and Post-It notes and notes in the margin telling me how much benefit they got just from that. Even more patients walk in and they say, “I read the book,” or, “I listened to the podcast and I get it, but just tell me what to do. How do I implement this?”

                                                And so, that’s what we’re trying to do across my entire spectrum of offerings, basically, is get you and caregivers, people who are looking to prevent, people who are caregiving, and even people who have severe Alzheimer’s, we’ve seen them get better now. They don’t necessarily go back to work, but they get better. They improve their quality of life. Our goal is just to make Dr. Bredesen’s protocol more accessible. We have coaching, we have evergreen courses, we have one-on-one coaching, we group coaching. There’s everything from the Evergreen course to Marama, which is a full immersive residential experience. We hope there’s something for everyone who’s on that spectrum and suffering with this, and it can all be found at drheathersandison.com. Just drheathersandison.com.

Dr. Weitz:                           Awesome. Thank you so much, Dr. Sandison.

Dr. Sandison:                     Ben, it’s been an absolute pleasure. Thanks for having me.

 

 


 

Dr. Weitz:                           Thank 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, 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.  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. Ben Weitz discusses SIBO and Irritable Bowel Syndrome 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

0:32  I’m going to make some comments, pose some questions, and discuss some recent podcasts that we’ve done on SIBO and IBS. We had a discussion with Drs. Rahbar and Gurevich on SIBO and IBS: Discussion on SIBO and IBS with Dr. Sam Rahbar and Dr. Ilana Gurevich: Rational Wellness Podcast 298.  We also had a presentation by Dr. Mark Pimentel on the latest research that his group has recently published on SIBO and IBS:  SIBO: New Research Findings with Dr. Mark Pimentel: Rational Wellness Podcast 311.   I also recommend that you listen to the interview that Shivan Sarna and Dr. Allison Siebecker conducted with Dr. Ali Rezaie of Dr. Pimentel’s group:  Digestive Disease Week 2023 Research Update by Dr. Ali Rezaie (June 2023)   

3:42  Irritable bowel syndrome or IBS is the most common gastrointestinal disorder occurring in up to 20% of the US population.  It is a functional digestive disorder marked by the following symptoms: gas and bloating, stomach pain, diarrhea, constipation, or alternating diarrhea and constipation.  IBS is considered a functional disorder because if you do a scope or do a CAT scan, you won’t see any structural problems in the intestines.  By contrast, if you have Crohn’s or ulcerative colitis and you do a scope or a scan, you’ll likely see damage to the lining of the intestines, possibly bleeding, and erosions.  Because it’s a functional disorder, IBS was often considered to be a stress-induced disorder.  Dr. Pimentel has now proven that approximately 60% of cases of IBS are caused by Small Intestinal Bacteria Overgrowth or SIBO

5:35  The large intestine, aka, the colon, is a large and very elastic tube and it contains the trillions of bacteria, archea, and fungi that compose our microbiome. When these bacteria in the colon ferment and produce gas, this is not a problem. But the small intestine is a smaller tube and doesn’t stretch as much and doesn’t contain anywhere as much bacteria as the large intestine.  The small intestine is where most nutrients are absorbed from our food, so there need to be a smaller amount of bacteria lining its mucosa or this would interfere with this.  If you consume fermentable fiber and there is an overgrowth of bacteria in the small intestine, this can lead to gas and bloating, which can cause pain and a change in bowel habits.  Hydrogen sulfide and hydrogen gas are usually associated with diarrhea, while methane gas is usually associated with constipation. 

 



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. Today I’m going to do a solo cast and I wanted to make some comments about some recent podcasts we’ve had about SIBO and IBS. We had an interview with Drs. Rahbar and Gurevich about SIBO and IBS, and we also had a presentation by Dr. Mark Pimentel on the latest research that he’s been conducting with his group on SIBO and IBS. And I wanted to mention to regular listeners of the Rational Wellness Podcast is that while most of the podcasts are typically me interviewing a guest or sometimes me just speaking, about once a month I organize this functional medicine discussion group meeting and we have a prominent speaker in the functional medicine space come in and sometimes we do a Q and A or they might do a presentation.  And so for those times when they do presentations like Dr. Pimentel did, you would probably benefit from going to my YouTube page so you could also see the slides. So all my podcasts are on Apple Podcasts, Spotify, wherever else you get podcasts, and then there’s also a video version on my Weitz Chiro YouTube page. So a lot of information has come through about small intestinal bacterial overgrowth and irritable bowel syndrome, and so I thought it might be important to give you some of my thoughts and comments and even some questions about some of this new data.

                                Also included in my thoughts are, having listened to an interview that Allison Siebecker and Shivan Sarna recently had with Dr. Ali Rezaie of Dr. Pimentel’s research group, Allison Siebecker also did a review of some recent papers from Dr. Pimentel. You can find out more about Shivan Sarna and Allison Siebecker’s information by information going to sibonfo.com, which is Allison Siebecker’s page, or going to the SIBO SOS website. So for anybody who’s listening who’s not really familiar with SIBO or IBS, let me define a few terms before we get started.  Admittedly, we’re going to get into some of the higher level science here, but if possible, in order to understand what we’re talking about today, if you go back, if you haven’t already, and listen to Rational Wellness Podcast episodes 298 and 311.

Irritable bowel syndrome or IBS is the most common gastrointestinal disorder occurring in up to 20% of the US population. Irritable bowel syndrome is a functional digestive disorder marked by the following symptoms, gas and bloating, stomach pain, diarrhea, constipation, or alternating diarrhea and constipation. Sometimes there’s urgency, sometimes there’s diarrhea, and there’s a whole bunch of other symptoms that sometimes are associated, and it’s considered a functional disorder because if you do a scope or do a CAT scan, you won’t see any structural problems in the intestines.  By contrast, if you have Crohn’s or ulcerative colitis and you do a scope or a scan, you’ll see damage to the lining of the intestines. You might see bleeding. You might see erosions. There’s structural things that are visible, but functional disorders, there’s nothing visible that you can see. And for many years, IBS was essentially considered a stress-related disorder. That is until Dr. Mark Pimentel discovered that many cases of IBS, approximately 60%, are actually caused by Small Intestinal Bacterial Overgrowth or SIBO, S-I-B-O. SIBO refers to an increase in the amount of bacteria growing in the small intestine.

                                The large intestine is a large and very elastic tube, and most of our microbiome is in the large intestine, also known as the colon. There, these trillions of bacteria ferment and produce gas, and this is not a problem. It doesn’t cause pain. It doesn’t cause gas and bloating because the colon can easily expand, but the small intestine is a smaller tube, it doesn’t stretch as much, and if there’s a bunch of gas produced there, then it’s liable to cause discomfort and/or gas and bloating as well as changes in bowel habits.  There’s supposed to be a relatively smaller amount of bacteria in the small intestine, and one of the reasons for that is because the small intestine is where most of the nutrients are absorbed from our food. And so if there was a large amount of bacteria lining the small intestine, it would be a lot more difficult for us to digest and break down and absorb the nutrients from our food.

And so if you consume fermentable fiber and there’s too many bacteria in the small intestine, those bacteria will digest that fiber and they’ll produce one of three gases. And those gases are hydrogen, hydrogen sulfide and/or methane gas.  Hydrogen sulfide gases are generally associated with diarrhea and when they are the cause of IBS this is generally referred to as IBS-D, for diarrhea, while methane gas is generally associated with constipation, and when this is the cause of IBS, it’s generally referred to as IBS-C, for constipation. So we refer to these three different forms of SIBO as hydrogen SIBO, hydrogen sulfide SIBO, and methane SIBO. So now we refer to methane SIBO as IMO or intestinal methanogen overgrowth to reflect the fact that it could be caused by methane producing organisms living in the large intestine as well as in the small intestine.

                                So now we’re going to get into some of the new data. So we now know that most cases of hydrogen SIBO are caused by the overgrowth of two particular bacteria, and that’s E. coli and Klebsiella. It’s very clear that when you have hydrogen SIBO the microbiome diversity goes down and you get these two bacteria predominant in the small intestine. And so one of the significant implications of this is we now know clearly that this is not the bacteria that grew up from the colon. When the concept of SIBO first came along, the thought was that the bacteria from the colon would grow up into the small intestine.

                                And one of the reasons we thought this is because the part of the small intestine closer to the colon, the duodenum, tends to have higher amounts of bacteria, but it’s clear now that we’re learning some of the particular bacteria that are causing SIBO, that in the case of hydrogen SIBO that’s not the case. And that probably also means that one of the thoughts of the things that increase your risk for SIBO were if you had a ileocecal valve that didn’t close properly or somehow the integrity of it was damaged or compromised in some way, that’s the valve that separates the small intestine from the large intestine.

                                Okay, so when it comes to hydrogen sulfide SIBO, we now know that the main components, the main bacteria that are responsible for that are Desulfovibrio and Fusobacterium. In methane, the main microbe is now known to be Methanobrevibacter smithii, and this is a methanogen, and it’s actually not a bacteria, it’s a microorganism. It’s similar to a bacteria but it’s not a bacteria. It’s actually known as a archaea, and is a very primitive microorganism. And the fact that it’s not a bacteria is probably at least one of the reasons why curing IMO or methane SIBO seems to be more difficult than a hydrogen form.

                                Now, the difficulty of curing IBS-C or methane SIBO or IMO has led to a number of alternative theories about what might be playing a role in such cases. And these alternative theories include that there may be co-infections of Lyme disease, there may be toxins like mycotoxins from mold, or there may be fungal overgrowth. At our functional medicine meeting with doctors Rahbar and Gurevich, they’re both practitioners who are treating patients regularly. Dr. Rahbar is a gastroenterologist, and Elana Gurevich is a naturopathic doctor who specializes in gastrointestinal disorders, and they both find that fungal overgrowth often seems to be playing a role, especially in cases of IMO. And they both also find that treating search patients with nystatin which is a prescription antifungal may be helpful.

                                One of the tricky parts about this whole concept is how can we test for fungal overgrowth? Fungal overgrowth, by the way, is sometimes known as SIFO or a small intestinal fungal overgrowth. Breath testing cannot pick up fungus, and stool testing is not all that accurate either. You can sometimes see candida on a stool test, but it’s not considered that sensitive for it. Urine testing has not been scientifically validated yet to the highest scientific standards as far as I know. Now, Dr. Gurevich noted that she will often task for candida antibodies by running a candida immune complex, an ELISA Antigen test for Candida IgG, IgA and IgM, and she’ll get this from a conventional lab like Quest or LabCorp.

                                Dr. Rahbar, I think for the most part, accepts that there’s a high likelihood that there may be fungal overgrowth and doesn’t necessarily test for it, though I think he sometimes does stool testing or urine testing or both. One of the interesting things that Dr. Gurevich said when she treats patients with fungal overgrowth is she may use nystatin or she may use nystatin for some of the treatment and the rest of the treatment she’ll use a series of herbs, which as a functional medicine practitioner is typically what I do when I treat patients with SIBO or SIFO. And one of the herbs she uses I thought was really interesting, she mentioned that she uses Gymnema sylvestre, which is an herb that I’ve often used for patients with blood sugar imbalances and/or diabetes. But Gymnema sylvestre has also been shown to prevent the yeast from budding and going into its hypha form when it’s harder to get rid of.

                                There’s a number of other herbal antifungals that she’ll use, including undecylenic acid, oregano oil, et cetera, et cetera. So we now know from Dr. Pimentel’s research with high likelihood, that most cases of hydrogen and hydrogen sulfide SIBO are caused by food poisoning. Now for a while this has been a theory with some evidence, but it appears to me that it is now pretty well proven. And the bacteria, campylobacter, shigella, salmonella or E. Coli that typically cause food poisoning, one thing they all have in common is they release a particular endotoxin, which is known as cytolethal distending toxin B.

                                And then when that endotoxin is picked up by the immune system, the immune system forms antibodies to CdtB, and then these antibodies cross-react with the structural protein in the intestinal wall known as vinculin, and this damages the cleansing waves. Now, what are the cleansing waves? We all know about the normal peristaltic waves when you eat. So as the food is going down you’re getting this rhythmic contraction of the intestinal muscles that helps to push the food down. But when you haven’t eaten for three or four hours, you get this peristaltic waves that are called the cleansing waves. And this is really done to keep a bunch of bacteria from growing in the small intestine.

                                So if those cleansing waves are damaged, that’s going to greatly increase the potential for overgrowth of bacteria in the small intestine. And so we now have pretty convincing evidence that perhaps 60% of cases of IBS are, particularly cases of hydrogen and hydrogen sulfide SIBO, are caused by autoimmunity. And we now have pretty convincing evidence that at least 60% of cases of IBS are definitively caused by SIBO, and that we can now rely on the lactulose breath test to diagnose most of these.

                                Now of course this doesn’t tell us much about the other 30 to 40% of cases of IBS that are not caused by SIBO and what is the cause of these? Might these be caused by SIFO or parasites or LIBO or dysbiosis or fruit sensitivities or something else? And that’s really a question. Dr. Pimentel noted that his data showed that a relatively small percentage of cases of SIBO also have SIBO, and he has that I think in the three to 5% range, while Dr. Rahbar and Gurevich find that SIFO appears to be more common. Now this may be partially because they are specialists who tend to see the worst of the worst patients.

                                Dr. Rahbar speculates that fungus facilitates the growth of the archaea, and this has been shown in studies where they’ve used yeast to help facilitate the growth of the archaea and the archaea responsible for the methane SIBO or IMO. Dr. Rahbar’s thought is that the fungus reduces oxygen from the small bowel resulting in an anaerobic environment and methanogens have to have an anaerobic environment. We know the colon is fairly anaerobic, meaning lack of oxygen, but the small intestine tends to have a certain amount of oxygen, but you really need to have an anaerobic environment for methanogens to flourish.

                                Once again, I mentioned we don’t really have a definitive test to diagnose SIFO, and this is really a problem. Now, I regularly on my patients with digestive disorders, will do a stool test and we’ll look for candida overgrowth. I have found that organic acids testing through urine is sometimes helpful to indicate fungal overgrowth as well. Now personally, since I treat SIBO patients mainly with herbs, many of the herbs that are antimicrobial are also antifungal. So I feel pretty good about that, and what that probably means is that there’s a number of cases where I am actually treating fungal overgrowth by treating the bacterial overgrowth because there’s overlap in the herbal effectiveness.

                                Okay. Now that methane SIBO is referred to as IMO to reflect that the methanogen overgrowth may occur in the colon as well as the small intestine, it would appear that breath testing may not be sufficient for a diagnosis since breath testing only measures the small intestine. However, what if we were to look beyond the 90-minute cutoff for the breath test, and since IMO occurs in the large intestine as well as the small intestine, and once again this is a question, should we look at doing the breath test for two hours and maybe even three hours and looking at what the methane level is beyond 90 minutes?

                                And then the question is, so we know what the cutoff is for methane in the small intestine, what should the cutoff be for methane in the large intestine? I’m assuming it would be higher, but that might be something for us to consider. And when you do the Genova SIBO breath test with lactulose, you can choose two hours or three hours. The trio test, you can only choose two hours, but you can choose to have the patients, instead of doing it every 10 minutes, they could do it every 15 minutes and you can stretch it out to three hours even though that’s not part of the instructions.

                                So the question is, would that be a good idea? And I don’t think we know, but I think that’s something that we should look into. And once again, it also certainly appears that stool testing now becomes a viable way to diagnose some cases of SIBO, specifically methane SIBO or IMO, because we can see Methanobrevibacter on a stool test, and both the GI map and the GIFX, two of the leading stool tests, both have those included. What about looking at the desulfovibrio as an indication of hydrogen sulfide SIBO, seeing desulfovibrio on a stool test? Do we know? Maybe it could be a factor.

                                What does what I’ve just said tell us about the treatment for IMO? So if IMO means that the methanogens are overgrown in colon as well as in a small bowel, then an antibiotic like rifaximin, which is believed to be not absorbed, that tends to act in the small intestine, might not be that effective for reducing the methane in the colon. So if you’re using antibiotics you might have to use systemic antibiotics. Unfortunately these are potentially going to damage your microbiome. What does this say about the use of herbs from methane? I don’t know if we really know which herbs are more effective in the small intestine versus the large intestine.

                                I mean, we do know that, for example, allicin is one of those herbs that seems to be particularly effective for methane SIBO. Methane leads to constipation. Now, why do you get constipation from methane? Is that because you’re not getting the motility of the GI tract? Is that because you’re not getting the rhythmic contractions in the intestines? No, because if the intestinal tract stops contracting, then the food will just go right through and you’ll have diarrhea. What happens in IMO, is that you get a spasm of the gut muscles, they hypercontract.

                                One thought I have is since we often use magnesium citrate to treat IMO, and that’s partially because magnesium citrate is a natural stool softener, but it’s also a natural muscle relaxer. And if what happens in IMO is that gut muscles are going into this hypercontraction, maybe magnesium is relaxing some of those muscles. All right, so those are the main thoughts I have about IBS and SIBO, and those are based on the talks we’ve already had as well as some of the data that Dr. Pimentel has been publishing or presenting at the recent GI conference.

                                So thank you very much, listeners, and I will see you next week. 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. Kabran Chapek discusses Concussion Recovery at the Functional Medicine Discussion Group meeting on June 22, 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

3:13  There are two main points to this talk: 1. Traumatic brain injuries are a significant cause of mental illness, incl. depression, anxiety, anger problems, and headaches.  2. There is a standard concussion protocol, but we need to take a more holistic approach and we need to look at treating the cause of the damage. 

4:47  There are a lot of patients that have had a traumatic brain injury and don’t know it.  You might have to ask your patient a series of patients till they recall an incident in which they fell out of a tree, had a car accident, played contact sports, etc..  It is important to figure this out because it is a different treatment approach if there’s a brain injury.  Even a whiplash car accident without hitting your head can result in a traumatic brain injury.  We need to understand that the brain is composed of very fragile tissues and has the consistency of jello. In fact, if you take a fresh brain out and set it on the countertop, it’ll be dew in a few hours because it will melt.

10:00  There’s a standard concussion protocol with baseline testing preseason and referral to a medical provider when needed an MRI or CT scan and Tylenol and Advil and ice.  But we need to go further.  The primary injury of concussion is actually ripping of neurons and shredding of tissue.  What we tend to see in our offices are the secondary injuries from the cascade of inflammatory and oxidative stress on the brain that continues after the initial trauma.  There is a massive glutamate dump in the brain that stresses the mitochondria and there is a flooding of calcium. There’s free radical production and oxidative stress. There are also glucose deficiencies in the brain.  Fortunately, studies with mice shows that glutathione, a simple nutritional intervention, applied to the mouse skull reduced brain cell death by 67% if applied immediately and by 51% if applied within three hours.  Between 29 and 60% of those who have a concussion, will go on to have a post-concussion syndrome, a chronic brain injury.  If you sprain your ankle on the filed of play we have a protocol that involves applying ice, compression and elevation that we apply immediately. But with head injury, we simply watch and wait to see if a post-concussion syndrome develops.  We should have a concussion rescue program to save brain cells that we apply immediately after a head injury.

16:04  A better approach to traumatic brain injury would be to address structural integrity, to look at sleep, nutrition, supplements, exercise, and brain retraining exercises.  We should also include some imaging–a SPECT brain scan and some questionaires to fill out to assess cognitive function.  T-B-I from Brainline.org is one good questionaire that assess for trauma, behavioral change, and impact on daily functioning. Other cognitive assessments include NSIBA, MoCA, and CNS Vital Signs. There is also an app, CRR (Cognition Recognition and Response), that athletes and coaches can use to track concussion recognition and response.

28:23  SPECT brain scan.  A meta-analysis shows that 99% of the reviewed articles show that SPECT brain scans pick up subtle differences in the brain, indicative of mild brain injury, whereas CT and MRI did not pick these up.  Raji CA, Tarzwell R, Pavel D, Schneider H, Uszler M, Thornton J, et al. (2014) Clinical Utility of SPECT Neuroimaging in the Diagnosis and Treatment of Traumatic Brain Injury: A Systematic Review. PLoS ONE 9(3): e91088.   

28:58  Labs recommended: 1. CBC, 2. CMP, 3. HsCRP, 4. Lipid panel, 5. Hormones, including morning Cortisol, IGF-1, IGFP3, Testosterone, Full thyroid panel, 6. Nutrients, incl. zinc, copper, ferritin, vitamin D, B12.  Growth hormone can be affected because the pituitary in the brain can be damaged by brain trauma. The adrenals and thyroid are also often affected.

33:09  Pregnenolone and DHEA are two precursor hormones that can be affected with TBI and it can be helpful to supplement with these, esp. if you are working on correcting adrenal dysfunction.  Pregnenolone can help with anxiety, memory problems, insomnia, irritability, and hypervigilance because its a calming hormone that stimulates GABA activity in the brain  Progesterone.  There are hundreds of studies on progesterone and TBI and it holds a lot of promise as a treatment for TBI, including in the hospital.  But they also need diet, sleep, the structural component, hormones, and supplements for a comprehensive approach to get results. The dose used in most of the successful studies on progesterone for TBI is 200 mg per day. There was a trial–the SYNAPSE trial in which progesterone failed, but Dr. Chapek has talked to the researchers on this and he still thinks that progesterone is helpful.  Dr. Chapek mentioned a case with a Marine who had TBI and he had headaches, fatigue, depression, suicidal thoughts, very low libido, extreme agitation, and irritability, couldn’t be around his girlfriend.  His LH, FSH, and his testosterone were low for his age, so he was prescribed clomiphene to stimulate his gonads and all his symptoms went away.  So this was due to low pituitary function. 

42:05  Sleep is very important for brain recovery and 30 to 70% of TBI patients have sleep problems. One study showed that TBI patients tend to have low melatonin, so giving melatonin can be helpful. 

42:54  Nutrition.  The brain is a really hungry organ and it uses 20-30% of the calories we ingest. After a brain injury there will tend to be low glucose and it can stay down for a while because the glucose transporters are damaged. During this period, it may be better to follow a ketogenic diet, so that you brain can use ketones for fuel.  Unfortunately, if you are hospitalized, you will be given IV glucose, which will likely make things worse.  Adding some medium chain triglyceride oil and exogenous ketones can also be helpful.

42:12  Nutrients.  Some important nutritional supplements to consider are Omega 3s, B vitamins, vitamin C, Vitamin D, Gingko and vinpocetine for blood flow, AlphaGPC/Citicholine and Huperzine A for increasing acetylcholine levels, NAC and Lipoic acid for antioxidant support, Acetyl-L-Carnitine and CoQ10 for brain mitochondrial support, and phosphatidylserine for cell membrane support. N-acetylcysteine (NAC) really has some good data to support its use.  It’s an antioxidant, anti-inflammatory, and it helps with glutamate excess. (Eakin K, Baratz-Goldstein R, Pick CG, Zindel O, Balaban CD, Hoffer ME, Lockwood M, Miller J, Hoffer BJ. Efficacy of N-acetyl cysteine in traumatic brain injury. PLoS One. 2014 Apr 16;9(4):e90617.)  Here is a study looking at the administration of NAC on the battlefield to soldiers after traumatic brain injury that show amazing benefit with NAC administered at high dosages right away for a week–first 4 grams, then 2 grams per day for 4 days, and then 1.5 gms for 3 days.  There was 81% reduction in symptoms after a week as opposed to a 40% reduction in those who did not get NAC.  (Hoffer ME, Balaban C, Slade MD, Tsao JW, Hoffer B. Amelioration of acute sequelae of blast induced mild traumatic brain injury by N-acetyl cysteine: a double-blind, placebo controlled study. PLoS One. 2013;8(1):e54163.)  You might want to have an emergency kit and if there’s a TBI you administer right away high dosages of NAC, vitamin C, omega-3 fish oils, and curcumin.  Dr. Chapek recommends curcumin at a dosage of 500-1000 mg twice per day for the first month after injury. Curcumin is anti-inflammatory and it reduces IL 1 and opens Aquaporin 4, which reduces swelling in the brain.  An optimal level of vitamin D for concussion should be 60-80 ng/mL.  IV vitamin C can be helpful at 10,000 mg per day but oral vitamin C is also very helpful. Alpha lipoic acid reduces glial scar formation. Zinc is important for brain healing and also for ADHD symptoms.  

 



Dr. Kabran Chapek is a Naturopathic Doctor and he has been a staff physician at Amen Clinics in Seattle, Washington since 2013.  Dr. Chapek is an expert in the use of functional and integrative treatments for traumatic brain injuries, dementia, Alzheimer’s disease, PTSD, and anxiety disorders. He wrote a book, Concussion Rescue: A Comprehensive Program to Heal Traumatic Brain Injury and he also offers the Concussion Rescue course.  Dr. Chapek’s website is https://www.amenclinics.com/team/kabran-chapek-nd/.

 

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 everybody. I’m Dr. Ben Weitz, and this is the Functional Medicine Discussion Group meeting. Our topic for tonight is healing from traumatic brain injuries, including ones that have happened in the past using a functional medicine approach.  A traumatic brain injury, which may or may not include a concussion, is caused by sudden damage to the brain caused by a blow or jolt to the head, common causes include car or motorcycle crashes, falls, sports injuries, and assaults. And according to the CDC, there are over two million new head injuries in the US. Dr. Kabran Chapek is a naturopathic doctor and a staff physician at Amen Clinics, and the author of Concussion Rescue: A Comprehensive Program to Heal Traumatic Brain Injury. Dr. Chapek uses a functional and integrative approach to the treatment of patients with traumatic brain injuries, Alzheimer’s and dementia, PTSD, and anxiety disorders. Dr. Chapek, thank you so much for joining us.

Dr. Chapek:        It’s a pleasure to be here. Thanks, Dr. Weitz.

Dr. Weitz:           Excellent.

Dr. Chapek:        All right, let’s get into it. So I’ve been working at am Amen Clinics the past 10 years, and a lot of the patients that we see have had a traumatic brain injury, as you mentioned, and some of them didn’t know they had it until we scanned their brain. So we’re known for doing brain SPECT imaging. We’re going to talk about ways to assess the brain, including SPECT imaging, but also things you can do in the office, including lab tests or cognitive tests that are very useful and can be done tomorrow.  And why I’m so passionate about this is that it’s really a common problem. Three million Americans go to the emergency room every single year with a concussion. So those are the ones we know about. But how many kids on the soccer field or friends, loved ones, they bonk their head and they see stars? That’s enough to have a… that could be considered a concussion or brain injury. If there’s any symptom, which is, such as seeing stars, feeling a little dizzy, woozy, that’s enough to be considered a concussion. And then there’s also the sub-concussive hits to the brain that we know from football players who have many repeated hits to the head, that’s cumulative damage and can cause brain injury and inflammation in the brain.

                                Really, there’s two main points to this talk that I want to convey. It’s very simple. First is that traumatic brain injuries are a significant cause of mental illness in this country, including depression, anxiety, anger problems, headaches. And it’s not being recognized, because we can’t see the brain or we think, “I’m fine. I hit my head, I saw stars, I’m fine.” But then if symptoms don’t occur immediately, I think, “Okay, it must be due to something else.” And we’ll talk about that.  The second point is that while there’s a standard concussion protocol and there are standard treatments, which are great, the approach is not comprehensive enough. We need to take a more holistic approach. We need to look at treating the causes of healing or the causes of damage, and just really more thoroughly help these patients out.  And so it’s these two main points, and we can ask questions, we can discuss, there’s a lot of different aspects to this. And my plan was to go through some of the mechanisms fairly quickly, some of the myths, some of the science of how it works, and then get into some of the treatment strategies, because I really want you to have that in your tool bag as you start working with patients.

                                The first thing is, I would say at Amen Clinics, just to pick it up, first of all. I mean, we see so many people and we can fall into the pattern of treating our patients with depression with a certain approach or look for certain things psychologically. But one in six of the patients that we see at Amen Clinics have had a brain injury on their scans and some didn’t know about it.  And so it’s important to ask, and if you’ve ever heard Dr. Amen speak, he talks about this, where he’s asked patients, “Okay, so have you ever fallen out of a tree? Off of a log? Had a car accident? Played contact sports?” And they’ll say, “No, no, no.” But then they’re, “Oh, yeah, I did fall off my bike when I was 10, does that count?” And maybe that’s when depression symptoms started. And it’s a different approach, it’s a different treatment approach if there’s brain injury.  So first off, just ask your patient multiple times. It’s kind of like in functional medicine, if someone has environmental illness, they may not think they have a moldy house, so you have to ask them specifically, “Do you have any mold in your home? If you had a roof leak? Flooding? Mildewy smelling basement? Ever had water damage?” It helps to ask specifically about brain injury. People tend to blow it off, not think about it, just sort of forget about it.

Dr. Weitz:            And by the way, Dr. Chapek, you can have a traumatic brain injury without actually hitting the head, correct?

Dr. Chapek:        Correct. Correct. Yes, just by having whiplash. If it’s enough to cause damage to the neck, that rapid acceleration/deceleration force can certainly damage the very fragile tissues in the brain. In fact, if you take a brain out, a fresh brain and set it on the countertop, it’ll be dew in several hours, just because it kind of melts. It’s so fragile.  The other thing to keep in mind is it can be delayed. Symptoms can be very often delayed. I had this pastor who came in who had a car accident, and he was fine for the first week or so, but then the next Sunday, he couldn’t write a sermon, because he had had this car accident and inflammation had gotten to the point finally where he started having symptoms. This is a really common problem.

                                I had this other guy who was a baseball player, and he was an outfielder, and he was running for the ball and he collided with another outfielder and lost consciousness just for a couple seconds. And he was apparently fine, until the next day, and he started having anterograde amnesia. But it was like 50 First Dates, if you’ve ever seen that movie, where she can’t form a new memory. So he has about four days of memory, and they thought he was faking it or he was depressed or something like that, but it was actually due to brain injury. They thought because it was a day apart, it couldn’t have been due the brain injury. But it clearly was, when he scanned his brain.

                                Let’s see, this is to illustrate how soft the brain is. It’s about the consistency of jello. And look how hard this skull is. That’s why it can be so easy to damage the brain. These are common symptoms. Doesn’t have to be loss of consciousness, but certainly that would count, any of these symptoms, confusion, memory loss, feeling dazed, they’re common symptoms.

                                And Ben talked about some of the myths. There’s all of these myths. So if you wearing a helmet, you can’t have had a concussion. If you’ve had a negative MRI or CT scan, it wasn’t a concussion. These miss concussions all the time, or brain injuries all the time. Symptoms starting days later, don’t have to lose consciousness, all of those are symptoms of concussion, or those are myths.  I don’t know, I think popular storytelling really exaggerates the myth that people are fine after… It makes a really good movie plot if someone gets knocked out and then they wake up later, but then, oh, if they don’t have any light sensitivity, they’re not confused, they just keep running and going. These people would have post-concussion syndrome and be disoriented. I think it adds to the diminishing symptoms of concussion.

                                And so here’s a standard protocol, baseline testing preseason, referral to a medical provider. If there’s symptoms, see a doctor, see a coach, see a trainer. This is all good stuff. I mean, we don’t want to not do these things. We just need to go further, further than Tylenol and Advil and ice. We’re going to talk about more than that. That’s really important.  What actually happens? Well, mostly what we’ll be seeing in our practices are due to secondary changes from brain injury, not primary. Primary injury is actually ripping of neurons, shredding of tissue. The secondary injury is essentially due to this cascade of inflammatory and oxidative stress on the brain that continues. So it’s really low grade. It’s like a fire that smolders. And I think why symptoms are sometimes delayed until a point the swelling gets bad enough or the cells that are damaged finally degrade. One of the mechanisms is essentially there is a massive glutamate dump.  So brain injury, there’s this glutamate release, it kicks up the circuitry in the mitochondria, all of this excess of calcium floods, that excites the mitochondria. There’s free radical production and oxidative stress. There’s glucose deficiencies, and utilization is low by glucose transporters. It’s really kind of a complex cascade, and it’s more than just inflammation. There’s low blood flow and oxidative damage and stress.  It’s really interesting, this researcher, this is actually an undergrad researcher at Stanford, Theodore Roth, and he did some studying of mice. And he was able to implant an intracranial microscope into the skulls of these mice. And then poor little mice, they got a brain injury, and you were able to see happens. So uncompressed means uninjured, and the red line is a blood vessel. And then these green squiggles are microglia, sort of the immune cells in the brain, like the macrophages that are supposed to eat up damaged tissue.

                                And so on the right side after compression, you could see in real time sort of this injury, and then these macrophages, microglia swell and start building up and pulling in tissue. And there’s dead cells and there’s less blood flow. So that had never before been seen. But what I thought was very fascinating that he did next was he applied glutathione, this antioxidant, to the mouse skull, and saw that if glutathione was applied immediately, there was 67% less cell death. And if applied within three hours, there was 51% less cell death.  But he changed the outcome for these mice brain cells with this very simple but powerful intervention. So showing the microglia, macrophages on the left, they’re nice and swollen, but with glutathione they go back to their normal size. So that’s a huge insight.

                                When we think about brain injury, I love this quote from Seth Godin, “We need to go back to the drawing board. Isn’t the drawing board the place where all the best work happens? It’s not a bad thing, it’s the entire point,” in that we now understand the mechanisms more clearly. We don’t want to just watch and wait, and hope the brain gets better. And the brain is your most important asset. Why would we let our children just get concussions and then wait and see if they have an alleviation of symptoms?

                                It’s common around 29, depending on the research you look at, between 29 and 60% of people who have a concussion, it will go on to become post-concussion syndrome, chronic brain injury. And we have this window of time in which to act. Like if you twist an ankle on the field of play or you hit your head, we all know to grab ice. Rest, ice, compression, elevation, it’s so clear, everyone knows it. Almost even before you see the swelling start, someone’s grabbing ice. “Oh, you knocked your ankle, it’s twisted. Let’s get…” But when we hit our heads, we just kind of watch, wait, test.  Why don’t we apply and do things immediately that will save brain cells, and maybe prevent post-concussion syndrome? There’s actually a lot of data out there about this. And really the reason I wrote this book, because there’s a lot of research, I put it together, to share it with people. Because there’s millions of people having concussions all the time, and they may not know about this. Should I keep going? Questions so far?

Dr. Weitz:            No, I think we’re good.

Dr. Chapek:        So what would be a better approach? How should we approach this then? Well, in addition to the standard protocol, we want to correct structural integrity. I’m talking to one of the world renowned chiropractors, Dr. Weitz here. We’re going to talk a lot about structural integrity, so important. Something I missed actually for the first few years working at Amen thinking about brain injury, that’s a critical piece. Sleep has to be a key piece, nutrition, supplements, exercise, and brain retraining. So we’ll talk about all these things.  I think a better approach would be doing some labs in addition to all of these things and some imaging. So SPECT imaging, of course, but you can also do pencil/paper tests. So there’s the TBI from BrainLine, which assesses for trauma, behavioral change, impact on daily functioning. So it’s a list of questions that can be done. The NSIBA, Ohio State University has a TBI Identification Method. There’s the MoCA, which we use for assessing for dementia and mild cognitive impairment, but it’s also useful for assessing levels of functional impairment from brain injury, another cognitive conditions. So we can learn how to-

Dr. Weitz:           Is that kind of in general, would most of the cognitive assessment tools for dementia also be beneficial in this realm?

Dr. Chapek:        A lot of them would, yeah. Like the mini-mental status, the MoCA, I think-

Dr. Weitz:           What about the CNS Vital Signs?

Dr. Chapek:        Yeah, we do a version of that called Total Brain assessment, but CNS Vitals is a really robust method to assess. Yeah, absolutely. Because you want to measure cognitive domains in attention, processing speed, executive functioning, recall, and short-term memory. You just want to get all of that, if you can, and see where… Because some people have deficits in more with focus or some more with memory or some more with behavior like irritability or depression. Yeah, it’s individualized.  So actually, yeah, that was my next slide. So ImPACT testing, CNS Vital Signs, Total Brain. There’s apps, the CRR, concussion recognition and response. It’s kind of nice, because coaches or athletes can use this and you can track symptoms with it, and it gives suggestions and things, so it’s helpful.

Dr. Weitz:            What would you say for, say, a chiropractor or somebody treating musculoskeletal injuries, somebody comes in with a whiplash injury, and what would be the easiest way to just get some sense whether there might be a head injury?  Because a lot of times the patients aren’t quite clear. They did a CAT scan of their brain at the hospital and the hospital says, “Well, everything’s fine.”

Dr. Chapek:        Yeah, I think if they’re having any symptoms, my threshold would be very low. I think just based on the patient’s symptoms and they hit their head, I would say, “Yes, you have a concussion. You need to be treated.” And then you know, can do cerebellar tests and looking in their eyes, looking for nystagmus and things like that. But oftentimes those are negative. If they’re positive… I think that’s one thing is with the eyes, and some of the, I don’t know, functional neurology chiropractors are really into that-

Dr. Weitz:            Yes.

Dr. Chapek:        … and very useful. Very useful. Good question. And imaging, of course. So very interested in imaging. And there’s a difference between MRIs, which is looking at structure, and functional imaging like SPECT imaging, PET imaging that looks more at function. And we’ll talk about that a little bit.  This is not a patient, this is from a movie, the movie Whiplash. But it reminds me of a patient that I had who was a jazz drummer, we’ll call him Jeremy. And he had been suicidally depressed since around the age of 14 to 15, been on several different classes of medication, working with a great therapist, and still just drinking alcohol, using cannabis. It was the only thing that kind of alleviated some of his symptoms. And he is really struggling.

                                And he came in and this is what his brain looked like. This is him on the left. So there’s asymmetrical decrease. This is the bottom of a brain, color doesn’t matter. This is the left temporal lobe, and this is a prefrontal cortex. So his left side is very damaged and injured, and the right is a healthy scan, healthy brain, should look very full and round.  And I said, “Jeremy, when did you have a head injury?” He said, “I never have had a head… What are you talking about?” And I said, “Well, okay, hmm? Have you ever fallen out of a tree? Off a log? Had a bike accident? Car accident?” “No, no, no.” “Ever played contact sports?” “Oh, okay. I did start playing football around age 13, 14. It was tackle football. I was a scrawny little kid. I was matched up against the coach’s son and he would just tackle me so hard, and I would feel kind of dazed.”

                                And so he had had these head injuries and brain injuries that he didn’t realize were brain injuries, because he couldn’t see it. And so we started treating him for brain injury, instead of for depression, and focusing on these areas of the brain. And he started to improve. He stopped drinking alcohol, stopped smoking pot, no more suicidal thoughts, and started getting into his jazz drumming, getting better, and eventually went to college for music. He went to Berklee School of Music in the Northeast, in Boston, and doing great several years later.  So I think this is helpful. If patients have tried lots of things, they’re having mental health symptoms, think brain injury. Ask them at least four or five times, “Have you ever had a brain injury?” And look at treating, using some of the things we’re going to talk about. 

Dr. Weitz:           Is there any way to get that same type of imaging through an MRI? Maybe doing an MRI with volume?

Dr. Chapek:        I do like the volumetric MRIs. Yeah, those are useful. Especially in kids, there’s so much brain reserve, it’s just not going to show up.

Dr. Weitz:           Okay.

Dr. Chapek:        So SPECT imaging-

Dr. Weitz:           I just hate using a form of imaging that requires radiation and using contrast agent as well, correct?

Dr. Chapek:        Correct. There’s no contrast, but there is some radiation. It’s about equivalent to a head CT or CAT scan. So there is some, but it’s not a lot. And yeah, I think, sure, we don’t want-

Dr. Weitz:           So no contrast in a SPECT scan.

Dr. Chapek:        Mm-hmm. No contrast in a SPECT scan, pure radiation and saltwater, so there’s really no risk of allergic reaction. But, yeah, there is a small dose of radiation. And there’s clinics all around, you can refer, and just order scans at our clinics, and that’s one option. But, yeah, there’s other ways to assess too, like asking them the questions, and doing some of the cognitive testing is a good way.

Dr. Weitz:            Sure.

Dr. Chapek:        Clearly football damages a child’s brain. And this is healthy, this is [inaudible 00:25:03]. This is from a professional athlete on the right, just holes everywhere, likely headed towards CTE, chronic traumatic encephalopathy. Can’t be diagnosed, it’s just diagnosed on autopsy, but we have worked with a lot of these football players and they’re headed towards that, chronic traumatic encephalopathy.

Dr. Weitz:           In terms of kids playing football, is it more dangerous if they play football at… Is there a certain age like, oh, it’s better if they not get a trauma before a certain age because the brain is more vulnerable? Or…

Dr. Chapek:        Yeah, I mean, I would say before age 25, I mean, honestly. Well, so this study that they did… Yeah, I mean, I think the younger they are the worst it’s going to be, that’s a good point. That’s a good question. I don’t know if they look at… This study was done with fMRI, ages 15 to 19 year old males, and they found that… Essentially, the punchline is they scanned three groups. One group had known concussion. And the second group had no known concussion. And the third group, they didn’t think they had had any brain injury from playing football, but it turns out that they did from neurocognitive testing and fMRI. And so just showing, sub-concussive hits made an impact. And it was 11 of these players, age 15 to 19. So, gosh, I think, flag football, something else. I love sports and stuff, but it’s got to protect the brain, the most important…

Dr. Weitz:           And how bad is it to head a soccer ball?

Dr. Chapek:        Also, bad. Yeah, I’m a soccer player. I cringe, but it’s pretty heavy. I don’t know if it’s… I just saw a soccer player today, he’s 60 now, but you could see some denting in the frontal lobe, and it’s likely from lots of headers. So not helpful, worsens focus and that, I think. Yeah, I’ve headed lots of soccer balls too, and I played soccer and I love the game, but I wish that there was a way to play without headers somehow. Anyway.

Dr. Weitz:           Is it wearing a helmet in soccer, do you think that’s beneficial?

Dr. Chapek:        I think that would help. Yeah, I think that would help lessen the blow. I think people would still get those sub-concussive hits, but it would be a lot better, especially for crosses or big kicks that you’re… When I was playing at intermural, low level, I would just chest it. And they’re like, “Hey, why didn’t you head the ball, you could have headed it?” “Nope, not worth it for me.” Got some flack for that, but…  This is just a study comparing SPECT to MRI. So essentially 99% of the reviewed articles, this is a meta analysis of 212 studies showing that SPECT really does pick up subtle differences, whereas CT and MRI are useful for bleeding risk, but not so useful for picking up mild injury. This is just another brain injury showing low cerebellum, which happens as well.

                                I think this is useful to measure lab tests. So learned a lot about this from Dr. Mark Gordon. And he’s really done a lot for teaching about pituitary dysfunction from brain injury causing… Many of the concussive symptoms that we attribute to brain injury are actually due to low hormones, low cortisol, low testosterone, low thyroid, and repleting those can be significantly helpful. Yeah, this is Mark Gordon here. And that can be tested with a simple blood test. This is Dr. Kevin Yuen, he’s a neuroendocrinologist. He’s down at the Barrow Institute in Arizona. And since essentially published that 28% of retired NFL football players have pituitary deficiency and low testosterone or low growth hormone or both. And they need repleting.

Dr. Weitz:           Do you use IGF-1 as a measure of growth hormone?

Dr. Chapek:        Yes, I think, [inaudible 00:30:14]-

Dr. Weitz:           And what-

Dr. Chapek:        … Dr. Gordon-

Dr. Weitz:           … level of IGF-1 do you consider problematic?

Dr. Chapek:        So IGF-1 and IGFBP3, those are the two. And I think-

Dr. Weitz:           What’s the second one?

Dr. Chapek:        IGFB, as in boy, P as in papa, 3.

Dr. Weitz:           Okay.

Dr. Chapek:        And I believe that IGF-1 has a 10 minute half-life, and IGFBP3 has 24 hour. It’s much longer than actual growth hormone, which is just seconds. It’s always going to be low pretty much if you test it in the morning, but IGF-1 I [inaudible 00:30:55]… So the reference range, per Dr. Gordon, is around 200 or above. And so a lot of the hormone folks are really into higher level’s better. And then you go over here and talk to the longevity folks and low IGF-1 is better.

Dr. Weitz:           Valter Longo, and he says it should be below 175, that-

Dr. Chapek:        Mm-hmm. So there’s this tug-of-war, and so who’s right? I think it’s a matter of finding balance. What’s going on with that patient? Do they have symptoms? Do they have low muscle mass? Do they have significant fatigue? Maybe they need a boost and their growth hormone needs to be higher. So, yeah, it’s interesting, the push and pull on that.

Dr. Weitz:            Jama asked, and what do you do if the pituitary is spewing out ACTH after traumatic brain injury, while cortisol is low?

Dr. Chapek:        So if ACTH is high, then the pituitary is working, it’s not injured, but it seems the adrenal glands are not responding to that. So figure out what’s going on with the adrenals would be my answer to that. And it may be due to the stress and the trauma of the brain injury, maybe due to sleep or insomnia, problems like that.

Dr. Weitz:            And do you check adrenals with the salivary cortisol test?

Dr. Chapek:        I do prefer that, yeah. The four point salivary cortisol. I’ll often do a morning blood cortisol test, because we’re ordering other labs as well. But if we really want to assess adrenal function, it’s that four point cortisol is the way to go. The three big ones to look at gonadotropins and growth hormone, corticotropin and adrenals, and thyroid, so the sex hormones, the adrenals, and the thyroid and growth hormone, and pregnenolone, of course. So the precursors, DHA and pregnenolone, which if you’re having adrenal problems that may be part of the issue is needing the precursors. And they’ve studied pregnenolone in veterans and mild TBI and found it helps with insomnia, irritability, hypervigilance. Because it’s this calming sort of increasing GABA receptor activity in the brain that’s like a neurosteroid and [inaudible 00:33:41]-

Dr. Weitz:            Really? Really interesting.

Dr. Chapek:        Anxiety, and I think it’s keynotes would be anxiety and memory for pregnenolone. And sometimes you’ll need it… See it feeds over here into cortisol, and so I find it very helpful to add pregnenolone and DHEA if you’re working on adrenal dysfunction.

Dr. Weitz:            Interesting. So let’s say it’s a man, what level of pregnenolone do you like to supplement with?

Dr. Chapek:        Well, I’ll do lab tests to try and get them to around a 100. But usually don’t need more than 30 to 60 milligrams a day, male or female. That’s a good question. And there’s actually hundreds of studies on progesterone and TBI. It seemed to hold a lot of promise as a treatment for traumatic brain injury, like severe traumatic brain injury in the hospital, in the ER. But when they got to larger scale studies, it failed to show benefit.   And the reason is similar to what Dr. Bredesen will share with you is that when it comes to the brain, it’s not one thing that causes the problem. Remember it’s this whole cascade of oxidative damage, inflammation. Doing only one thing is not really going to help, ultimately. It’s like the diet, the sleep, the structural, the hormones, the supplements really a comprehensive approach, a functional medicine or naturopathic medicine approach is really the way to go.

Dr. Weitz:            Do you sometimes-

Dr. Chapek:        And so-

Dr. Weitz:            … supplement progesterone for men with head injury?

Dr. Chapek:        Yeah. If they have traumatic brain injury, I will not hesitate to give progesterone-

Dr. Weitz:            Interesting.

Dr. Chapek:        … to them. So you can do topical, you can do oral. I may use a little lower dose, but the dose is typically, they use in these studies, are around 200 milligrams a day. And the trial that failed was called the SYNAPSE-trial. And I’ve reached out to some of the researchers and talked with them, and I think it’s very helpful still. I think it’s part of the protocol in my book to use for severe traumatic brain injury.  So in my book, there’s like this chapter on the first aid for your brain, kind of what to do immediately after. I don’t really have progesterone there. Progesterone because you don’t want everyone just taking progesterone willy-nilly. But I think it is a useful aspect. [inaudible 00:36:44]-

Dr. Weitz:           Yeah, it’s a great clinical pearl. I don’t normally include pregnenolone and progesterone when I test hormones and that.

Dr. Chapek:        Yeah. And for this situation, yes, it would be indicated. This guy, so he was a gunner in the Marines, and he had headaches, fatigue, depression, suicidal thoughts, very low libido, extreme agitation, and irritability, couldn’t be around his girlfriend. So here’s his testosterone for a 30-year-old, really good shape, he was very fit. And you can see here his LH and FSH were just really low, 1.6, 1.5. Low testosterone for his age, really should be closer to 600.  And for him we used clomiphene, so stimulating the gonads, stimulating the testes to produce testosterone. He’s 30, we don’t want to use actual testosterone. And went back up to actually a 1,000. And all of his symptoms went away, headaches gone, energy back, libido up, not agitated. So it’s kind of this thing about low testosterone can actually be irritability as much as too high a testosterone can be irritability as well, Goldilocks. So some of these symptoms, I think, can be, again, due to low pituitary function.

                                So here’s an option for lab panel. Lots of tests to do. Structural, very important. These are the seven philosophical principles of naturopathic medicine, address and physical alignment. As I said, I was missing this for a while. And when I realized, oh my gosh, this is key, really was helpful, especially if someone is having dizziness, daily headaches, daily headaches, pressure, fullness in the head never goes away. We want to think about impingement on this cerebral spinal fluid flow and blood flow.

                                This can be addressed with physical therapy, chiropractic, cranial sacral, and upper cervical chiropractic in particular. So essentially, Scott Rosa has done a lot of research in this area, misalignment in C1 and C2 brought on by head or neck trauma can contribute to either distension of the cerebellar tonsils, down through the frame and magnum, so the cerebellum sort of plugging the spinal cord and causing impingement and flow. Or just misalignment and impinging upon CSF flow and blood flow. Here’s a picture of that on the side view. So the stenosis or the blockage of the spine here and then pooling and CSF, which looks white here, in the prefrontal cortex, and then reduction of that stenosis due to an adjustment, probably. Then the brain is gray again and normal, so it’s flowing.

                                So this is a very important one. And sometimes on MRI this gets missed. And so Scott Rosa is into doing an upright MRI, so standing or sitting in an upright posture can reveal the impingement. So for example, the cerebellar tonsils are descending down into the space where they shouldn’t be, and then line down it’s normal. So just gravity kind of pulls the brain back up. So I’m actually curious what your thoughts are, Dr. Weitz. I refer a lot to upper cervical or NUCCA chiropractors really focused on that area or cranial sacral therapists that are really highly skilled to help with structural integrity. What are your thoughts about that or other approaches? I’m eager to learn.

Dr. Weitz:           Yeah, sure. I think that makes sense. As well as chiropractic neurologists, they’re also trained to use specific exercises and some other approaches.

Dr. Chapek:        Especially, I find if there’s dizziness, functional neurology chiropractor is really helpful. Dysautonomia problems, POTS symptoms, and that very, very helpful.

Dr. Weitz:           Yeah, I’m not an upper cervical chiropractor, but we regularly adjust the upper cervical spine. And a lot of times-

Dr. Chapek:        Good.

Dr. Weitz:           … find that very helpful for headaches and some of these other symptoms.

Dr. Chapek:        Well, that’s good to hear. Okay, awesome. Yeah, I think that’s key. Sleep, very important, of course. And why is this? 30 to 70% of TBI patients have sleep problems, so just make sure to address that. And why is it the case? One study showed low melatonin production after TBI, sometimes just giving melatonin helps. I would say that’s a smaller percentage, but it does help. Hypocretin is this wake promoting chemical, which is suppressed, so you feel kind of tired during the day and just can’t sleep well at night. I think also just the neurons are damaged and the brain is firing improperly, and sort of brain’s awake when it’s supposed to be asleep, and sleepy when you’re supposed to be awake.

                                Switching to nutrition, very important topic. So we know that the brain is really a hungry organ. It uses 20 to 30% of calories in the diet, just straight to the brain. So imagine your plate, that’s a quarter of what you’re eating just for your brain. And so what this diagram is showing is that after a brain injury, there’s this orange line which is a spike in glucose, but then a drop. And so it goes up and then it goes down, and it will stay low for long periods of times. So there’s low glucose, because glucose transporters are damaged, brain can’t use glucose as well. That’s what we think.   And so what do we do about that? Doesn’t the brain need glucose? It’s the main fuel source, yes. And in fact, there’s another fuel source that the brain loves, which is ketones. So ketogenic diet, very popular, fad diet, but there’s a lot of neurological benefit to the ketogenic diet. Number of studies on Parkinson’s, Alzheimer’s, and migraine headaches, seizure disorders, ketogenic diet is useful for many different conditions. If it’s right for you, it can be very helpful.  There’s an ongoing study right now with humans and ketogenic diet. So there’s not a lot of data, but there’s no other diets for TBI and it has the most evidence to date. They gave glucose to some patients that had had a brain injury and found that actually it suppressed ketogenesis. So there was some degree of ketogenesis, like the brain was actually using 16% ketones, beta-hydroxybutyrate and acetoacetate for fuel for these comatose patients. Their brain was using some ketones for fuel and some glucose, but they gave them IV glucose and it completely suppressed the ketone production. And so it made things worse. So you don’t want to just give sugar, basically.

Dr. Weitz:            And if you’re hospitalized, you’re going to get that, right?

Dr. Chapek:        It’s likely you’re going to get some version of that, yeah. And the other crazy thing is that they used to give corticosteroids as the standard of care in the ER for TBI, because it was, we think, okay, inflammation, corticosteroids, suppress everything, good. But more people were dying who had that done, because it’s not just a simple thing. You don’t just suppress everything. And so they don’t do that. That’s not a standard of care anymore. It’s a multifaceted approach. You want to do things that are gentle, broad spectrum, multiple mechanisms of action, like food, like supplements, like herbs and plants. So I’m a big fan of ketogenic diet, if it’s right for you.

                                Oh, goodness. This is a story about a teacher that essentially had to stop working because of a brain injury. And doctor told her, “You’re going to recover in two weeks.” Three weeks later, she couldn’t do her job. Actually, I saw her six months, she hadn’t been working for at least six months. She’s on long-term disability, couldn’t look at screens, couldn’t read. And the ketogenic diet was one of the elements, that was one of the key things that helped her. And she found that she was able to start working again, eventually, energy came up. And another thing that helped her was upper cervical work.

Dr. Weitz:            Can you point out on these images what we’re looking at?

Dr. Chapek:        What we’re looking at, oh yeah. So these little bumps here in the middle are the temporal lobes, and they’re kind of bumpy. They’re kind of squared off. They should be rounded full like tires or balloons filled up. The temporal lobes are damaged, memory issues, mood issues, light sensitivity. And then on the top, on the right, there’s these bumps in the back. That’s where she kind of hit her head was in the back. So you see these dents in the back. Doesn’t mean she has the dent in her brain, necessarily, but those are injured cells that need help. And so ideally if you re-scan the brain after doing some healing work, it should sort of smooth out and buff out is what it would look like.

                                Here’s some data on keto. Looking at core nutrients. We want to look at lots of different things like omega-3s, B vitamins, thinking about ginkgo, vitamin C, phosphatidylserine, acetylcarnitine. We’re going to go through a couple examples. This is actually the trial that I was talking about, the CRASH trial, with worse outcomes with corticosteroids. Like NAC, N-acetylcysteine has a good amount of data on it. It’s a molecule that increases… It’s an antioxidant, anti-inflammatory, helps with that glutamate excess. And so it’s really kind of an ideal nutrient for acute brain injury.  And you may be aware of this study done in 2013, they had 81 active duty military professionals. In the field of war, they get a concussion, they run to the medics tent and they give them a big dose of NAC. They gave them four grams and then two grams twice a day for four days, and then one and a half grams twice a day for three days, so basically a week.  And so they had two groups. The group that had the NAC had 81% reduction in symptoms after a week. And the group that didn’t get the NAC had a 40% reduction in symptoms. So 40% got better anyway, but 81% got better who took the NAC. So in the book I talk about sort of a list of things, in addition to the NAC, but that can be in a kit. So it’s like you have it in your glove box, so if you, god forbid, get in a car accident, you can just take some of these things immediately. Or you’re on the sports field, you have your athletic tape, you have your ice packs, you have your little PBI first aid kit to take.  Because we know brain cells are being damaged immediately. You can’t see if there’s damage. Why wait a week to see if you’re going to have symptoms? Why not just take it? Take NAC, vitamin C, omega-3 fish oils, curcumin. Like integrated therapeutics curcumin, which sounds amazing, there’s lots of good curcumin out there. 

Dr. Weitz:            And aren’t a lot of these nutrients, that anti-inflammatories, is it a good idea to have a loading dose first?

Dr. Chapek:        Yes. Yes. So for example, it depends, if it’s a kid or adult, but essentially kids are half the adult dose, it’s a 1,000 milligrams twice a day or more of curcumin. And it’s like that first week, but really it’s the first month. I would consider the first month to be acute. So if you actually are having a concussion, I recommend the full month of higher dose supplements like this, and certainly the first week. And if it’s sort of just a preventive prophylactic, “Hey, I hit my head on something. I saw stars for a second. I’m not really having symptoms, but I want to be cautious,” which I recommend, take it for at least a few days.   And hopefully you’re already optimizing your vitamin D levels. Vitamin D, if your levels are good before an injury, you’re less likely to have post-concussion syndrome. If your levels are low before an injury of vitamin D, you’re more likely to have post-concussion symptoms. There’s a study out of Oxford University about this.

Dr. Weitz:            What do you like to see as a optimal vitamin D level-

Dr. Chapek:        60 to 80.

Dr. Weitz:            … for concussion? 60 to 80. Yeah. Okay.

Dr. Chapek:        Yeah, that’s my recommendation. And I’m up here in Seattle, in the northwest, it’s hard to get enough sunlight to get vitamin D levels up, so you pretty much have to supplement. And vitamin C, simple vitamin C, but it’s actually a really potent antioxidant for the brain. Especially after injury, you need more. They did this study with vitamin C and E in severe brain injury and found that it helped. And they used, actually, in this one, they did a study with 10,000 milligrams of IV vitamin C for TBI patients in, I think it was Iranian study, and it found that it reduced brain swelling. And they also gave vitamin E via injection, 400 IUs a day, so not that much. And that improved the outcomes of these patients. Which for them it’s like living, they didn’t die. So it’s pretty amazing. So oral vitamin C, good stuff.  Alpha lipoic acid reduces glial scar formation, great antioxidant. Another simple one, zinc is a significantly helpful treatment after brain injury, and also useful for ADHD symptoms at times. At Amen Clinics, we did this study with players, so we had 30 of them. And prior to the study they were having in general problems with attention, motivation, mood, and sleep. And they had 80% improvement after six months of essentially taking the supplements that we were talking about.

                                There’s this… Actually, oh, it’s right here is a list: Ginkgo, 120 milligrams a day; phosphatidylserine, 150 milligrams a day; phosphatidylserine, a 1,000 milligrams a day; NAC, 600 milligrams; alpha lipoic acid, 300; huperzine A, 150; vinpocetine, 15 milligrams; and then three grams of fish oil a day and a high potency multi. And then we did have them exercise and treat sleep apnea, if they had sleep apnea. So sort of this holistic program. Didn’t include hormone treatment, didn’t include structural support, this was all prior to that work.   But you can have a significant… And this was many years later, so it’s not too late. Even if you’ve had a brain injury 10, 20 years prior, it’s not too late to at least try and improve healing and brain function, and think about it in those terms. I think that’s fascinating to think about how many of your patients you’re treating who have had a brain injury, and that’s maybe partly why they’re getting better with a functional med approach is because you’re helping their brain function better. And maybe part of it was a past injury.

                                This is a picture of a lineman who played for 16 years professionally, he’s now like 60 years old, and essentially has dementia symptoms, can’t find his way to the grocery store. He’s angry. He’s depressed. He’s suicidal. And his brain looked a lot better after 18 months of care. And this is with hyperbaric oxygen, by the way. This is with supplements, exercise, diet, weight loss, and hyperbaric oxygen, which is a really powerful intervention. It’s an oxygen chamber, it’s pressure, time intensive, expensive. You have to go in every day for 40 sessions, maybe 80 sessions. However, it’s very powerful.

Dr. Weitz:            I was just listening to somebody who was on Dr. Hyman’s show talking about ketogenic diet, and this was for cancer, but he was saying that, “If you get in hyperbaric oxygen while you’re in ketosis, you’ll get a real big bang for your buck.” You’ll get a bigger benefit.

Dr. Chapek:        Wow, with mitochondria, I bet. Well, that makes a lot of sense for brain injury. I hadn’t considered that, but I think that makes a lot of sense. I’m going to start recommending that if people are able to do both. Gosh, that does make sense. Because with keto, it’s not like you’re at in ketosis, technically, the whole time. It’s like you’re going to try and stay in for periods of time, then you eat, you’re going to go down, you’re going to come back up again. All these things affect it, but if you can try and peak while you’re in hyperbaric, I think that, gosh, that makes a lot of sense.

Dr. Weitz:           Somebody asked about fasting for traumatic brain injury, which has similar benefits to ketogenic diet.

Dr. Chapek:        Yeah, there’s a couple animal studies on that, actually, where they showed the rats that, basically, they had them fast after a brain injury, survived more, function better after the brain injury. I don’t know about humans. I think that’s very individualized, but you definitely don’t want to eat a lot of sugar and carbs afterwards. You would want to either intermittent fast, fast, keto, something, at least, low-carb, higher protein, and fat. Fasting is so individual.   Because I think there’s potentially some risk there, the brain is already low in glucose. You start fasting, there’s that initial phase where it takes time to get into ketosis and your brain might be suffering more, initially, even if it’s helpful after a day or two. But maybe if you’re used to fasting, you’ll go into that faster. A lot of variables there. But, yeah, it’s interesting to think about.

Dr. Weitz:           Oh, what about [inaudible 00:58:33] the use of glutathione?

Dr. Chapek:        I think that’s tremendous. I think harder to have in your first aid kit, because it’s so fragile, but you can actually get those little packets, Tri-Fortify packets. You could use, I think either one NAC or glutathione. There’s that mouse study with the topical glutathione. The mouse skull is very thin, and they shave it down, and so it was almost like getting right into the brain. I think human beings [inaudible 00:59:05]-

Dr. Weitz:           So for human, to rub it on the back of the head, you don’t think you’d get any absorption?

Dr. Chapek:        I don’t know. I don’t think so. I would go more with oral liposomal glutathione or NAC.

Dr. Weitz:           And what about [inaudible 00:59:18] IV glutathione?

Dr. Chapek:        Oh, that would be best. Yeah, if you can get it.

Dr. Weitz:           Now, Steve asked, can you overdo IV glutathione? Steve, you want to unmute yourself and ask your questions?

Steve:                 Thank you, Doctor. I have a female patient who’s got anxiety, depression, and her MD’s given her glutathione daily with a million [inaudible 00:59:44] other things. They changed her meds. She’s gone from Lexapro to Zoloft to Abilify, and plus daily glutathione last five days. And I’m concerned that’s going to be over [inaudible 00:59:54]-

Dr. Weitz:           And daily IV glutathione.

Steve:                 Correct.

Dr. Chapek:        Well-

Steve:                 Thank you.

Dr. Chapek:        … I think there is that risk, detoxing too fast or sort of overwhelming the system. Yeah, I think there is that risk. I would kind of track with them and see, is it helping? Is she getting better? If she is soaking it up, if she’s not getting better, you may want to reduce it.

Steve:                 Thank you.

Dr. Weitz:           I mean, the other possibility is if she has any considerable amount of toxins and she’s taking that much glutathione, she might be liberating those toxins, and so she could be having a reaction because of that. So you might consider adding some binders.

Dr. Chapek:        Good idea. Yeah, good call. Kind of double-edged sword, speaking of glutathione, there’s also exercise. Should you exercise after a brain injury? Answer really is, yes, you should exercise. And now out of Stanford, there’s some recommendations, which I think make a lot of sense, is that you want to start exercising pretty soon, as long as it’s not worsening symptoms. You want to start increasing blood flow, you’re going to get BDNF, and just sort of improve someone’s mental state when they feel like they’ve been taken out of the games. And I recommend looking into Stanford’s standard protocols around this. It’s very useful. There’s some handouts that they have. Let’s see.

Dr. Weitz:           Somebody also asked about nitric oxide stimulators.

Dr. Chapek:        That’s an interesting idea. I haven’t looked at it, to be honest. I’d be curious to go to PubMed and see what the literature shows. I think theoretically it makes a lot of sense.

Dr. Weitz:           Possibly, increased blood flow.

Dr. Chapek:        Yeah, makes a lot of sense. That’s good. Brain exercise, also, don’t want to overdo it, but also very helpful to start. And you can do meditation. There’s a quality of life study on mindfulness meditation after brain injury. Brain training with neurofeedback is really helpful after brain injury as well. And-

Dr. Weitz:           Oh, you know what? I want to ask a question about exercise. What about using with exercise something that restricts and increases oxygen flow?

Dr. Chapek:        Right. I’ve heard of those devices.

Dr. Weitz:            I just interviewed Dr. Heather Sandison and she’s using it as part of her Alzheimer’s program in some of her patients.

Dr. Chapek:        Yeah, is this the exercise with oxygen or a different one?

Dr. Weitz:            I think so. She said, “Hey, you get oxygen deficit and then you have a control and then you have a lot of oxygen.”

Dr. Chapek:        And you flood in… Yeah, that sounds like exercise with oxygen. I do recommend that for Alzheimer’s and dementia. And if people can’t do hyperbaric, I’ll recommend it. But for brain injury, I don’t know. It seems like those tissues are fragile and damaged. I think it kind of depends. Like if it was acute, first month, maybe a few months, I probably wouldn’t, but I would do hyperbaric. And then if it’s more chronic, it’s been years or something, I think then it would be worth a try certainly, to kind of revitalize the brain and increase oxygenation. I would kind of look at where they’re at in their recovery process. That’s a great question. Yeah, I like it because it does have exercise in it and oxygen, so it makes sense. [inaudible 01:04:03]-

Dr. Weitz:            Now, when you use hyperbaric oxygen, should antioxidants be restricted around the time of using the hyperbaric oxygen? Or would that not… Or would it be synergistic?

Dr. Chapek:        I think it would be synergistic. I mean, the hyperbaric oxygen is going to increase… There is an antioxidant effect already, and we’re using it more not to kill stuff, we’re using it more to increase blood flow and oxygen and activate stem cell growth and all of this. And really it’s low pressure, long periods of time. So this is showing a hard shell chamber, but doesn’t have to, I’d say most patients do the soft shell chamber, 1.3 and 1.4 atmospheres. And it’s really the time in the chamber every day, five days a week for 40 sessions, ideally, if they can swing that. Reassess, they may even need more, or renting a chamber, buying in a chamber, big investment.  If I only had one treatment, like say, “Okay, you can pick one thing,” I might choose hyperbaric oxygen for brain injury, because it helps so many people. But I also would suggest, it’s going to work better and you may not need it down the road. So it’s like if you do the labs, you do the history, you do the testing, sort of, this is my idea here.

                                Let’s see, first visit, you do diet, sleep, supplementation, exercise if needed, order labs. They come back, review the labs, change, tweak, add hormones, add nutrients. They should then be getting better in the first one to three months. If they’re not, then layer in hyperbaric oxygen, then you know your investment is working. And this is similar to what we’ll do for dementia patients as well. And sort of add the hyperbaric after a little bit of time, unless you can afford it or you have access to it and you just want to do it acutely, then do it. There’s no risk or harm in layering it. But-

Dr. Weitz:           What about red light therapy to the brain?

Dr. Chapek:        Yeah, great question. There is some data on this and I’ve certainly recommended it. I’ve seen it work sort of 50/50. Some patients find it really useful, some not so helpful. Like the Vielight therapy helmet. There’s a couple other ones out there that you put on the neck, infrared and red light, and it makes sense. It turns on mitochondria and activates cells, but for some reason it just hasn’t been as powerful as some other treatments.

Dr. Weitz:           Susan asked about the use the vibration plates during the exercise for a traumatic brain injury.

Dr. Chapek:        Is it a risk to vibrate them?

Dr. Weitz:           Or could it be beneficial?

Dr. Chapek:        Yeah, I don’t know. You guys are asking questions I haven’t thought about. This is interesting. What do you think about it, the vibration plates? Are there any risk there with the shaking? I don’t really understand. Doesn’t think so.

Dr. Weitz:           Yeah, I’m not sure. I could see where there could be a possible risk.

Dr. Chapek:        Yeah.

Dr. Weitz:           Might be too much at the beginning, maybe.

Dr. Chapek:        Right. I think so. I wouldn’t do it in the beginning.

Dr. Weitz:           Steve asked about magnetic therapy. We’ll just send him for an MRI. No.

Dr. Chapek:        Steve, are you thinking like TMS or like-

Steve:                 Exactly. Exactly.

Dr. Chapek:        Yeah. There’s some data on that actually for brain injury, after sort of later stages, if they’re not getting better. And it’s really cool is we’ve had some [inaudible 01:08:21] target using SPECT imaging. So you saw that guy with the low left temporal lobe, left frontal lobe, and I’ll say, “Okay, focus the magnet here, left temporal lobe, left frontal lobe.” And that’s very helpful for a lot of folks.  But, yeah, I would say the strongest treatments are really some of the basics like ketogenic diet, the supplements, and things like exercise, and then fixing structural integrity. I can’t highlight that enough, how important it’s to do the structural pieces. Getting into see your good chiropractor and getting things aligned is just helpful for so many.

Dr. Weitz:           Have you used peptides?

Dr. Chapek:        A little bit. A little bit. I’ve been kind of cautious. I’ve kind of gone with what most of the literature shows and sort of the basics, but, yeah, they’re promising. They’re powerful, powerful… Mostly I’ve used them with low growth hormones like sermorelin and things like that. That’s where I’ll certainly use peptides. Because there’s not a lot of other natural things besides exercise that work for increasing growth hormone levels.

Dr. Weitz:           Yeah, I’m thinking like BPC 157, cerebrolysin.

Dr. Chapek:        I use cerebrolysin a little bit, couple cases, didn’t seem to help, but I’m not an expert. I think BP 157’s a really good call for acute TBI, maybe [inaudible 01:10:00]-

Dr. Weitz:           Have you tried that intranasal synapsin I mentioned?

Dr. Chapek:        No, I was just thinking about that. Oh, that’s an interesting… I’ve used it with Alzheimer’s and dementia some, but it’s a good idea to try for TBI certainly. I’ll probably experiment with that now.

Dr. Weitz:           Cool.

Dr. Chapek:        Great.

Dr. Weitz:           Okay.

Dr. Chapek:        What a great group you have.

Dr. Weitz:           Thank you. Any other questions? Everybody get their questions answered? Okay, excellent. How can listeners, viewers who are here now or who are listening to this on the recording, how can they get ahold of you, find out about your work?

Dr. Chapek:        To you all here and the future listeners, I’m Dr. Chapek. I’m at Amen Clinics Northwest in Seattle, and we have a clinic here. There’s 13 clinics across the country, California, New York, Florida. Patients can come here and see me in Washington. We have other great naturopathic doctors in other clinics and psychiatrists. I do see patients via Zoom, mostly. And I also have a book, Concussion Rescue, so if you want more information, want to read in depth, it’s designed to be used for clinicians as well as patients to help sort of about how to approach this really important issue of traumatic brain injury.

Dr. Weitz:           Excellent. Thank you so much and thank everybody who joined, and we’ll see you next month. 

 


                               

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, 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.