Dr. John Neustadt discusses How to Prevent and Reverse Osteoporosis with Dr. Ben Weitz.

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Podcast Highlights

3:08  Epidemic of osteoporosis.  Today we have an epidemic of bone loss termed osteopenia and osteoporosis in the US and one reason is because our society is getting older.  In fact around the globe, there are now more people over age 65 than younger than five.  About 80% of osteoporosis cases are women and the fastest rate of bone loss is as women go through menopause and the ten years after menopause.

4:03  Women more at risk.  The main reason why women are more at risk for osteoporosis has to do with their loss of estrogen as they get older.  Another risk factor for women is the use of antidepressant medications that artificially raise serotonin levels and there are serotonin receptors in the bones that stimulate increased osteoclastic activity, leading to more bone breakdown.  As people get older they also tend to have more inflammation such as autoimmune diseases and they tend to have more insomnia, etc., which are both associated with poor bone health. The average American woman also only gets about 800 mg of calcium per day from their diet, which is below the recommendation. They are also not getting enough of the micronutrients found in fruits and vegetables, which puts them not only at increased risk of osteoporosis but also for cardiovascular disease, dementia, etc.  Have less muscle mass also puts post-menopausal women at risk as well and partially due to not getting enough protein in their diet and also due to not doing enough exercise, esp. resistance exercise. Osteoporosis is a chronic disease, so it doesn’t just have one cause.

7:54  Medications.  There are a number of other common medications that result in a loss of bone mass.  Proton pump inhibitors, acid blocking medication often prescribed for reflux and other gastrointestinal complaints, such as Prilosec, damage bone and increase fracture risk.  PPIs block calcium, magnesium, and other minerals from being digested and absorbed from our food.  Taking a PPI for four years results in a 60% increased risk of a hip fracture. As mentioned, SSRIs, antidepressants, increased bone loss and for every 19 people taking an SSRI, we would expect one to break a bone.  There is also a long list of other medications that increase bone loss, including anticonvulsants like Phenytoin, prednisolone and other glucocorticoids, and aromatase inhibitors.

12:28  Detecting and assessing bone health.  The standard of care is a bone density test through a type of x-ray called dual x-ray absorptiometry test, a DEXA test, and that detects the quantity of bone and that’s used to diagnose bone.  A T-score of -2.5 or lower is diagnostic of osteoporosis.  While bone density is an important marker to look at, the most important factor is fracture risk, which depends upon a number of factors, only one of which is bone density.  Bone density only predicts 44% of women who will break a bone and only 21% of men. There are various factors that can affect the accuracy of the bone density test, including which mean is used, how they are positioned including that the hips are internally rotated 15 degrees or if they are very thin or obese or have arterial calcifications or bad arthritis in their spine of if they are taking strontium. 

17:10   Bone Turnover tests.  There are tests that measure whether you are losing or gaining bone, including the C-Telopeptide test, which is a breakdown product of collagen in bone.  If CTX is high it means you’re breaking down collagen and that has been associated with an increase in fracture risk.  The most consistent predictor of fractures in gait or mobility.  Can you get up from a seated position on a chair or the floor to standing?  What is your balance like?  Can you stand on one leg for 30 seconds? 

20:45  Medications for improving bone strength.  The bisphosphonates like Fosamax, Boniva, and Actonel are the most commonly prescribed drugs for osteoporosis.  If you have post-menopausal osteoporosis but you haven’t broken a bone since you’ve had the diagnosis, none of the oral bisphosphonates are effective at reducing both vertebral and hip fracture risks.  The only bisphosphonate that has been shown to be effective for primary prevention of fracture is intravenous Zometa.  To get benefits from any of these medications you have to take it 70-80% of the time for years to reverse bone loss.  Dr. Neustadt prefers Prolia, which also reduces osteoclast activity but which works by a different mechanism than the bisphosphonates and which is better at reducing fractures in secondary prevention of fractures and Forteo, which stimulates the osteoblasts and is also better at reducing fractures.  Both these drugs must be injected.

26:12  Exercise for Bone.  Dr. Neustadt says that we do not have enough good studies looking at fracture risk for which form of exercise is best for bones.  He is not convinced that we need to do heavy weight training or that you need to go to a gym but he feels that it is important that whatever exercise you do be done safely and certain types of movements, such as too much flexion type exercises might be dangerous and cause injury.  There are a number of studies that show increased bone density but few that show fracture risk.  Dr. Neustadt also recommends the stork exercise, where you stand on one foot while brushing your teeth.  You stand on one leg while brushing your bottom teeth and then switch feet and brush your top teeth.  He likes the vibration plates. He does not feel that Osteostrong has enough research to support it, though theoretically it makes sense.

34:20  Diet for Bone Health.  Dr. Neustadt does not feel that consuming milk and dairy are necessary to having healthy bones.  A lot of people have immune reactions to dairy and they can become phlegmy and congested.  A lot of people have a difficult time digesting dairy and they could be lactose intolerant.  Yes, consuming calcium in the diet is important, but milk is not necessary. Sardines are one of the best sources of calcium and almonds and swiss chard are good non-dairy sources of calcium.  It’s the overall dietary eating pattern that is the most important factor and not just one food that is eaten.  The Mediterranean-style of diet is best and has been studied for over 70 years and shows a 20% reduction in hip fracture, the most dangerous type of fracture.  While eating a more plant forward diet is healthy, eating an alkaline forming diet will not make much difference because this concept that eating an acidic diet will pull calcium from the bones has been pretty much debunked as a valid concept. 

              



Dr. John Neustadt is a Naturopathic doctor and he has published over 100 research review articles and four books, the most recent of which is Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis in 2022. He is also the founder and President of Nutritional Biochemistry Inc. (NBI) and NBI Pharmaceuticals. The website is NBIHealth.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 listeners. Our topic for today is osteoporosis and what we can do to prevent and reverse it, with Dr. John Neustadt.  Osteoporosis literally means porous bones, and it refers to a condition in which the bones become fragile and the risk of fracture is increased.  In fact, according to the National Osteoporosis Foundation, 1 out of 2 women and 1 out of 4 men over the age of 50 will break a bone due to osteoporosis. And that’s actually, I think an older statistic, so it’s probably worse now.  The most common sites of fracture are at the hip, the spine, and the wrist. If you have osteoporosis and you break your hip, there is up to a 40% chance that you’ll actually die within the next year.  When you look at a bone density scan, if there is a T-score of -2.5 or worse, this is generally defined as osteoporosis and a T-score of -1 to -2.5 is termed osteopenia, which is a loss of bone though not as severe as osteoporosis.  As I understand it, the way we should understand osteoporosis is that throughout our lives we have a balance of both cells that build new bone, osteoblasts, and cells that clear out old junky bone, osteoclasts.  When we’re younger, there’s a tendency for the osteoblast to dominate over the osteoclast, and when we get older, there’s a tendency for the osteoclast to dominate over the osteoblast.

                                                Dr. John Neustadt is a naturopathic doctor, researcher and frequent speaker. He’s published over 100 research review articles and four books, the most recent of which is Fracture-Proof Your Bones: A Comprehensive Guide to Osteoporosis, and he just published this last year. He’s also the founder and president of Nutritional Biochemistry Inc., and NBI Pharmaceuticals.  Dr. Neustadt, thank you so much for joining us.

Dr. Neustadt:                     Thank you for inviting me to share what I’ve learned with your audience. This is a topic that is near and dear to my heart that I’m very passionate about.

Dr. Weitz:                            Good, and near to your bones too. Why do you think we have such an epidemic of osteoporosis and osteopenia in the US?

Dr. Neustadt:                     Well, part of it is simply because we’re getting older. The average age in the United States is getting older, and in fact there are more people over the age of 65 now globally than there are younger than five. The baby boom generation is aging out, and this is a disease that commonly affects people as they get older.  About 80% of osteoporosis cases are in women and about 20% in men, and it’s through menopause and the 10 years after menopause when women have the fastest rate of bone loss. And so not surprisingly, as they get older, as we all get older, we’re at increased risk for osteoporosis.

Dr. Weitz:                            What do you think is the main reason why women are so much more at risk? Is it mainly because of the hormones or does it have to do with less muscle mass or?

Dr. Neustadt:                     So the current thinking is that it has to do directly with estrogen, and even maintaining bone health in men is due to the conversion of testosterone to estrogen. Men do have some estrogen, and we don’t get the declines in testosterone in men or the declines in estrogen in men that we see in women.  In estrogen is what’s called anabolic, it helps build bone but it’s more than that. As we get older, we’re all at higher risk for chronic diseases. One of the common causes of osteoporosis now in women is antidepressant medications. So the selective serotonin reuptake inhibitors like Prozac, SSRIs or SNRIs, anything that artificially increases serotonin. People probably know serotonin as the happy hormone and it helps elevate our mood.  But there are serotonin receptors in the cells in bones, and when we artificially raise that serotonin and increase it, what happens is it creates an imbalance, as you put it very well, where you get higher osteoclast activity, that is the bone breakdown is happening faster than we can build up new bone, and that’s because we’re artificially increasing the amount of serotonin in the bone.

                                                So there are secondary causes beyond just estrogen that are more common in people as they get older. Medications is one of them. Comorbidities, meaning other diseases, as we get older, people are more likely to have other diagnoses. Diseases that create chronic inflammation cause osteoporosis like autoimmune diseases or inflammatory bowel disease.  People, as we get older, are less likely to get a full night’s sleep, so have problems with insomnia, and that’s also been associated with poor bone health and poor outcomes in osteoporosis.  Chronic poor diet, 80% of women only get about… Or I should say the average American woman only gets about 800 milligrams of calcium per day from their diet, which is below the recommendation. And then all the other micronutrients found in fruits and vegetables, most people are not getting enough of that, not only just to maintain bone health over time, but also it puts people at risk for cardiovascular disease, dementia, and the list goes on and on.

                                                Muscle mass is an issue, not getting enough protein despite how popular the high-protein diets are. The US recommended amount of protein that the government thinks we should get as we get older is not adequate for maintaining muscle and bone.  In fact, research has shown if you’re just getting the amount of protein recommended by the government, you’re going to be losing muscle mass and losing about two to 4% of bone.   So it’s important that people have that foundation of diet. People have a sedentary lifestyle, they’re not exercising a lot. This is a chronic disease, it’s a chronic condition. So very rarely, like all chronic conditions, does it just boil down to one variable or one thing. There are risk factors for that, and it’s important to understand what those are and control what we can control to improve and grow stronger bones and reduce our fracture risk.

Dr. Weitz:                           What are some of the other common medications that also negatively affect bone?

Dr. Neustadt:                     One of the more popular ones are the acid-blocking medications. So proton pump inhibitors or PPIs, half of those in the US are prescribed for only one condition, which is reflux, acid reflux.  First of all, the FDA, all the way back in 2010, put out a warning that the PPI category of acid-blocking medications, the proton pump inhibitors like Prilosec, they damage bone and increase fracture risk. So we’ve known this for a long time. Subsequently, research has come out-

Dr. Weitz:                           And is that mainly because they block the absorption of calcium?

Dr. Neustadt:                     So it’s multifactorial. There are different issues. The mechanism of action, when you look at it, it is blocking calcium but it’s other minerals as well. People who are stopping their production of acid also then put themselves at risk for other deficiencies of other minerals like iron and magnesium and difficulty digesting and absorbing nutrients from their food, and put themselves at risk for dysbiosis and intestinal infections.  And so there are multiple ways that this can affect bone, and we do now know that there is a very strong gut-bone connection. The health of the intestine and chronic inflammation and gut dysbiosis, directly and indirectly affect bone. So if that’s not balanced, if that’s not healthy because you’re stopping the digestive process right where it begins in the stomach, then you’re stopping the acid from helping to sterilize the food, you’re stopping the acid from activating your natural digestive enzymes, then you’re creating a whole cascade of potential problems down the road, and osteoporosis is one of them.  We know now after four years of continually taking PPIs, there’s about a 60% increased risk in hip fracture. And with the SSRIs, the antidepressants, just briefly, we now know there’ve been multiple studies that have come out and looked at this, that it’s estimated now that for every 19 people taking an SSRI, we would expect one of them to break a bone.  And that’s just two of a very long list of medications. Anticonvulsant medication like Phenytoin, anti-inflammatories like glucocorticoids, prednisone, [inaudible].

Dr. Weitz:                            What about Neurontin? That’s an anticonvulsant medication that now is being used more and more commonly for pain, because doctors are trying to avoid using opioids.

Dr. Neustadt:                     Great question. I don’t know of any relationship of Neurontin and fractures, which is great to understand that it’s not all medications have been associated with bone damage and fractures. If you need to take a medication, even in the same class of medications, there often can be a safer one.   So for example, if you have to take an acid-blocking medication, it appears that the histamine-2 receptor antagonist or what’s called H2RA are safer than the PPIs. So it’s just a matter of education. There’s a whole chapter in my book called Medication Induced Osteoporosis looking at that topic, where people should take a look in your medicine cabinet because again, that could be one thing that you may… in your doctor, it’s often a blind spot. Conventionally doctors don’t know which medications they’re prescribing are actually damaging bone and increasing fractures.

Dr. Weitz:                            And if you listen to the podcast I just recently did with Dr. Steven Sandberg-Lewis on reflux, only about 20% of patients who have reflux actually have hyperchlorhydria.

Dr. Neustadt:                     I believe it, yeah. In fact, the problem might be people aren’t producing enough stomach acid. You may have talked about that. They may have hypochlorhydria and in fact, simple dietary changes may be effective. There are about five common foods that commonly cause acid reflux in people, citrus and raw onion and raw garlic, chocolate, coffee. And so just making some simple dietary changes, working with an integratively-minded or a nutritionally-minded doctor, like yourself or others, can actually go a long ways to helping people get off those medications.

Dr. Weitz:                           So how do we best detect and assess bone health?

Dr. Neustadt:                     That’s a great question. So the standard of care is doing a bone density test through a type of x-ray called a dual x-ray absorptiometry test, a DEXA test, and that detects the quantity of bone and that’s used to diagnose bone. You mentioned a T-score of -2.5 or lower being diagnostic of osteoporosis, that value is derived from that x-ray test, that DEXA test.  Now with any test, it’s only as helpful as it can predict fractures. And similar with any recommendation somebody’s going to give you, the question, the most important question… I go through in my book over and over like, here’s the questions to ask your doctor, these are the most important questions. When it comes to osteoporosis, the most important question is, okay, you’re recommending I do a test? Well, has it been validated? How well will it actually predict my fractures?

                                                Okay, now you’re recommending an intervention. You’re recommending I do something, whether it’s a medication or diet or extradite. How well has that been shown? Has it been shown even to reduce fractures, not just change a number on a test?  So that T-score, it’s a number on a test. It’s what we call a surrogate marker. Clinically, the most dangerous thing about osteoporosis is breaking a bone, as you put so well at the beginning of this podcast. And so a T-score, a bone density test, only predicts 44% of women who will break a bone and only 21% of men.  National associations that have looked at the body of the research at osteoporosis and fractures have correctly concluded that fracture risk depends on factors largely other than bone density. And people get so scared because too often they go to their doctor, they get their test result, and the only thing the doctor focuses on is that number on the test.

                                                And it is a scary diagnosis. And what I counsel people is take a breath, let’s put the test in its proper context. Fracture risk is largely dependent on things other than the bone density. It’s only one piece of the puzzle and only one small piece of the puzzle. Most of the things that you can do to reduce your fracture risk actually have nothing to do with a test.  And I know people love tests, they want to see the number spit out, they want the quantitative evaluation but that’s just not how fracture risk works. It’s largely due to other things. Now, bone density test is important because it’s one piece of the puzzle, but it should not be overemphasized.

Dr. Weitz:                            And as I understand it, there’s some issues with the testing that if the test is done properly, and my understanding is a lot of labs don’t necessarily put the patients in the exact same position. The hips need to be slightly rotated in 15 degrees. The knees are supposed to be bent, it’s supposed to flatten the spine. If all those things are not done properly, then you could get a different result.  If patient has scoliosis and they have a curvature, you’re not necessarily going to see the proper density of the spine. If they go to a different lab that uses a GE machine versus some other machine, you can get different results as well. Isn’t that right?

Dr. Neustadt:                     That’s all true. If they’re too thin or if they have arterial calcifications or if they’re obese, all of that. If they have bad arthritis in their spine, all of that can change results. If they’re taking strontium as a dietary supplement, that will create false bone density test results. And that is all true.  And so it’s important to go to the same testing center and ask for the same machine and getting that done repeatedly at the same place can be helpful for mitigating any of that variation that may occur.   And I think it goes back to the point I was mentioning earlier that it is a test, it’s a surrogate marker. I do believe people should get tested. That’s one piece of the puzzle. But exactly what you’re saying, there can be errors on the test. It shouldn’t be over relied upon. It’s just one piece of the puzzle.

Dr. Weitz:                           When we get to the part of the discussion where we talk about supplements, I’m going to challenge you a little bit about the strontium thing.

Dr. Neustadt:                     Sure, I love it.

Dr. Weitz:                           So are there any other tests that you feel are important for assessing bone health? Blood tests? Any other tests?

Dr. Neustadt:                     So there are. There are some tests that can be helpful for giving a general idea. You can get what’s called a CTX test. It’s a C-telopeptide test. It’s a breakdown product of collagen in bone. So bone is not just its minerals. A bone density test only measures the mineral component of bone. And so when you look at the tissue, bone is a tissue, it’s a complex mixture of different things. It’s not just the minerals. Minerals give the quantity to bone, but it’s the collagen or the proteins that give bone its quality in its ultimate strength.  So when CTX is high, it means you’re breaking down collagen and that’s been associated with increase in fracture risk and it is a marker that’s recommended for compliance with treatment to be tested for by the… The National Osteoporosis Foundation actually rebranded last year, it’s now the Bone Health and Osteoporosis Foundation. I’m on their corporate advisory round table and also the International Federation for Laboratory and Clinical Chemistry. So that’s one of the bone turnover markers.  But the challenge with the bone turnover markers is similar to the challenge… and I think even worse when it comes to what you mentioned with the bone density test. There is a lack of understanding among clinicians about when to test, how to test… The CTX and other bone turnover markers are very sensitive to changes.   If someone were to eat a few hours before, so they need to be done fasting. If they exercise within the 24 hours, if a woman is still getting her period, depending on the phase within her cycle, that can change the bone turnover markers. If you did break a bone, bone turnover markers can be elevated for up to year afterwards. There’s seasonal variation, summer versus winter.

                                                Again, there’s just limited utility to testing those. The biggest predictor, the most consistent predictor of fractures is gait or mobility. So how well does somebody walk? It’s called about a six-second walking test. Can they walk unaided? How fast can they walk for six meters?   Can you get up from a standing position from a chair without using your arms? Can you get up from the floor unassisted? What is your balance like? Can you stand on one leg for 20 seconds or 30 seconds?   Things like that are going to be more helpful in determining fracture risk because 95% of fractures occur because somebody falls. In terms of looking at bone quality, making sure that you’re taking things out of your life that are damaging bone. And feeding bone and giving bone as much of a leg up, so to speak, as much nutrients and lifestyle and the environment to flourish and to do its job, then you definitely can grow stronger bones. You can increase bone density, you can improve bone strength and quality.

Dr. Weitz:                            In terms of the medications that are available, the bisphosphonates are among the most popular but there’s some real issues with those. What’s your take on the current bone medications and are there any of them that you would prefer over others?

Dr. Neustadt:                     So the bottom line and the most important question, I alluded to previously, is have they been shown to reduce fractures? So there’s a chapter in my book on osteoporosis medications and questions for people to take to their doctors. So has a medication that’s being recommended been shown to reduce fractures in someone with my diagnosis and my medical history? So those are two important questions.  So when it comes to post-menopausal osteoporosis, which is the most common cause of osteoporosis, the question is have you broken a bone before with osteoporosis or have you not? And that’s important because not all medications are equally effective in both situations.  So what we know is that if you have not broken a bone before with osteoporosis, you have post-menopausal osteoporosis, you haven’t broken a bone since you’ve had the diagnosis, or around the time you got the diagnosis, none of the oral bisphosphonates are effective at reducing both vertebral and hip fracture risks.  They can be effective at reducing vertebral fracture risk, but that’s not the most dangerous type of fracture. It’s hip fractures which are the most dangerous.  So I’m not sure why any doctor would only want to reduce the risk of fracture in one area of the body and not the most dangerous types of fractures, not both areas.  The only bisphosphonate medication that’s been shown to do both for what’s called the primary fracture prevention, that is you haven’t had a fracture before, is intravenous Zometa. So that’s both hip fracture and vertebral fracture prevention. It is effective. None of the other medications are.  If you have already had an osteoporosis fracture, then the other medications are more effective. I’m not so thrilled with all of them as a category of medications though. I think that if you do want to take a medication, if there is a strong argument to take a medication, there are better medications.

                                                I mean, first of all, in order to get the benefits of a medication, you have to take it 70 to 80% of the time. For the oral bisphosphonates and any of the medications, you have to be taking it consistently for years. Up to 50 to 70% of people stop taking their osteoporosis medications within a year of being prescribed because of side effects, because of compliance issues.  And so it is a big commitment that people need to educate themselves about and say, okay, if I’m going to do this, I’m committing to it. And of course if there are side effects and there can be quite uncomfortable side effects with some of the medications, some people are going to want to discontinue them.  But in terms of fracture risk, there are more effective medications than the bisphosphonates. Prolia is better at reducing fractures in secondary osteoporosis for secondary fracture prevention for both the hip and the spine. Forteo also better at reducing fractures. The challenge is those are both by injection.

Dr. Weitz:                            And those are both drugs, my understanding is, that stimulate the osteoblasts versus suppressing the osteoclast as the bisphosphonates do.

Dr. Neustadt:                     Correct, correct. And so part of the challenge becomes, and some of the side effects with the bisphosphonates in terms of they can actually create… in a minority of patients, but it’s statistically significant, it does happen… They can actually create new bone that’s weaker, that increases somebody’s fracture risk because it’s… You’re correct… poisoning the osteoclast. And so the osteoclast isn’t breaking down old bone, which we need it to do.  There’s a phenomenon bone called bone remodeling, where you’ve got osteoclast breaking down old bone that’s been used up and osteoblasts that are building and creating new bone, and it’s that healthy balance that creates strong healthy bone. And so when you’re not getting the old worn out bone removed and you just get new bone put on there, it can actually create areas of the bone that are weaker.  And in fact, in a dynamic system, a living system, which is our bones, about every 10 years with the healthy bone remodeling, your bones are all brand new again. There’s bone turnover constantly happening.

Dr. Weitz:                            So that’s why we see some fractures of the femur and certain other fractures associated with some of these bisphosphonates.

Dr. Neustadt:                     Correct. And when it does happen, it actually is more difficult for the fracture to heal unfortunately. And that’s also why you end up seeing osteonecrosis of the jaw, which there is a risk also with Prolia of osteonecrosis the jaw as well. It’s a very small risk, but it is there. All the drugs have some risk.  So it’s a matter of educating ourselves about the potential risks and the potential benefits, and making the best decision possible. And that comes down to making sure you’re asking the right questions so you can get the right information in the full picture, so you can make an informed choice.

Dr. Weitz:                            Now when it comes to exercise, what do you recommend for preventing and reversing osteoporosis? And there’s an argument that’s been made that we really need some sort of high-impact exercise to really load the bone sufficiently to create improvements in bone strength.

Dr. Neustadt:                     So the challenge is that it would take about 7,000 patients to do a controlled clinical trial on exercise with the fracture risk as the outcome, and that just hasn’t been done.  So when you’re looking at loading the bone and DEXA scans and all of that, there are studies that have been showing that doing resistance training can improve bone density, but they haven’t looked at fracture risk as an outcome.  There was one study many years ago that looked at some exercises as an outcome. It was a small study and it gave four different exercises to women. One was doing some sit-ups, one was doing kind of superman move where they’re on their back and stretched out. The other was a combination. Two were sitting in chairs, two were lying down. The bottom line was the flexion exercises where they were doing sit-ups and putting that pressure on the front of their spine, they were at an increased risk for fractures.  So when it comes to fractures and osteoporosis, to me, it’s not just a question of should we do weightbearing exercise? Should we not do weight-bearing exercise? Weight-bearing exercise is important, but we can just use our body weight.  But it’s also a matter of doing it safely because even with weightbearing exercise, even with your own body weight, if you have osteoporosis, you can actually be increasing your risk for fractures.  And so there are different types of exercises that can be done safely and there are ways to move to improve balance and improve strength to reduce fractures by reducing your risk of falling. But you don’t have to necessarily go to a gym. Yoga is great, but if you’ve got osteoporosis and you do certain moves in yoga, it can put a lot of pressure on your pelvis and potentially increase your risk for fractures down there. So it’s not a one-size-fits-all type of answer.

Dr. Weitz:                            Yeah, there was a study… I forgot the name of it, I was trying to come up with it. I think it was an Australian study that showed an improvement in bone density and one of the exercises, I think it involved maybe deadlifts and a couple of exercises like that and it involved them jumping up and onto a pull-up bar and then dropping down. So it added what might be seen as maybe a safer way of having some ballistic impact.  

Dr. Neustadt:                     That’s fascinating and I love that. I’d love to see that study. So this is where my mind goes when I hear that. So I would say, I would ask the questions, well, who is included in that study? Did they have osteoporosis already? Did they have a history of a fracture? It depends on their fracture risk if that could be safe for them or not.  The other thing I would say is, that’s great if it’s safe to do for somebody and somebody’s interested in doing it. What I’ve learned is that if it doesn’t interest people, these are like taking the medications to get the benefits from exercise, it’s something that needs to be part of somebody’s life. It’s longterm, it’s not a one-and-done kind of thing.  So I like to meet people where they’re at and say, look, you don’t have to go into a gym. It’s okay if you don’t like that. There’s tons of other things that you can do. Just going for a walk, walking 7,000 to 7,500 steps a day. Multiple studies have shown that’s been associated with the reduction in all-cause mortality of 50 to 70%, which is amazing. That includes death from all causes, including osteoporosis.

                                                I also love teaching the stork exercise, which is, you stand on one foot while you brush your bottom teeth for about a minute. If you need to steady yourself by holding the sink with one hand you can, and then when you switch to the top teeth, you switch legs and you do that twice a day. And even that will start working a little bit of your core, a little bit of your legs, your balance muscles, help improve your balance.  Park further away from the entrance to the store, take the stairs instead of the escalator or elevator. It’s all cumulative. Gardening can be phenomenal. So if you love going to the gym, I’m all for it. I just think it’s really important if you have osteoporosis or you want to do Pilates or you want to do yoga, whatever it is, that you make sure that you’re working with somebody who understands how to do it safely with somebody who has osteoporosis.

Dr. Weitz:                            What do you think about OsteoStrong?

Dr. Neustadt:                     I get that question a lot, it’s become very popular. So I met with one of the franchise owners a while ago and I asked for the studies and I looked at it.

Dr. Weitz:                           Is it John Jaquish?

Dr. Neustadt:                     I don’t remember. It was just a local, one of the local ones here that was [inaudible]-

Dr. Weitz:                           Oh, okay.

Dr. Neustadt:                     … I can’t remember his name. And what I learned at the time, so similar to many studies out there, there’s no fracture outcome data. So there are some studies showing improvement in bone density. But I do believe that the vibrational plate… And again, anything that can improve balance and working on a vibrational plate and they’ve got exercises where you’re strengthening muscles, I’ve got to believe it’s helpful, it’s good for you. So I don’t have a problem with it.

Dr. Weitz:                           Yeah, OsteoStrong is based on this concept that supposedly they can load your bones to something like 200 times your body weight or something.

Dr. Neustadt:                     And theoretically it sounds amazing. I think the concept is sound and it makes sense. Again, I ask the question, has it been shown in studies to reduce fractures. Now if there’s a lack of data… There’s a saying that a lack of evidence does not mean that that is evidence that it’s ineffective. It just means maybe it hasn’t been studied. It’s very expensive to do a study with fractures as an outcome. It’s much easier to do a study and less expensive where you’re just looking at a test result from a bone density test or a blood test. It’s cheaper and faster to do.  But that said, then I look at, we want to ask the question, well, does it actually make sense? So yes, if you’re reducing somebody’s risk of falling, you’re reducing their risk of fractures. And if you’re loading the bone and you’re improving bone density, that all sounds like great stuff.

Dr. Weitz:                            Yeah, from my perspective, I think it’s important that the exercise must A, load the bones in some significant manner. So there’s got to be some weight involved and it can’t be super light. B, there’s got to be some balance training involved, and you’ve got to make sure you’re strengthening the legs, which is what helps right you and reduces your risk of falling.

Dr. Neustadt:                     So I am in love with a new exercise that my wife Romy actually discovered, and she said I got to come with her to do these classes. It’s called Pvolve, and it started in LA. Kind of up in your neck of the woods, so I don’t know if you’ve heard of it. It’s a studio-based class, I do have some online classes, but the studio, I get a better workout. It’s amazing.  It’s functional training, and it’s working the muscles in your hips and your legs, your internal rotators and external rotators. And it’s resistance and it is flexibility and it’s strength and it is one of the best workouts that I’ve ever gotten in a class. And it can be done in a way that’s safe for, I believe almost anyone. Phenomenal.

Dr. Weitz:                           So what’s the most effective type of diet for improving bone density? Should we be consuming milk or dairy?

Dr. Neustadt:                     So milk and dairy are not necessary. So it’s really about-

Dr. Weitz:                           Are they bad, are they good, are they neutral? What’s the story on milk?

Dr. Neustadt:                     So I have a blog about dairy and milk and I think it’s called What’s in your Milk, or It’s Time to Ditch Dairy. I’m not a fan, I avoid it, I rarely eat it. Yes, I’ll have a little cheese now and then, every once in a while I’ll have a little ice cream, but you don’t have to consume dairy in order to have strong bones.  And it comes down to what I mentioned before, it’s the overall pattern. Just saying, okay, eat this one food and you’re going to have strong bones, that’s not reality. That’s not how the body works, it’s somebody’s overall dietary pattern.  I’m not a fan of dairy because a lot of people have immune reactions to dairy. They can become phlegmy and congested. Some people have a hard time digesting dairy, they could be lactose intolerant. But also in dairy, it’s a cocktail of hormones that’s from pregnant cows, and you’re putting those hormones in your body.  And research has shown there are a lot of other contaminants also that could be in dairy, including viruses and including other chemicals that accumulate in the dairy. And from a nutritional standpoint, it’s just not necessary.

                                                Yes, consuming calcium and having calcium as part of your diet is fantastic, but there are other amazing ways to get it that also give you other healthy nutrients. Sardines is one of the best ways to get it.  In fact, there’s a blog I have which are the top 10 non-dairy sources of calcium. Almonds and Swiss chard, there are lots of non-dairy sources of calcium, but it’s the overall dietary pattern that is most important.  And the research is clear that it’s the Mediterranean-style diet. It’s been studied for over 70 years. I’ve never seen any negative studies on it. It’s been shown to reduce the risk for osteoporosis, cancer, death from cancer, all-cause mortality, diabetes, obesity, dementia. I mean, the list just goes on and on and on.  And that’s primarily a plant-forward diet. In my chapter on diet, I walk people through how to transition into eating this way, making sure they’re getting enough plants and making sure they’re getting enough protein, which I mentioned before, how important protein is.  But that way of eating, that pattern of eating, has been associated with about a 20% reduction in hip fracture, the most dangerous type of fracture and better bone density. So that is the diet that has been shown to be the dietary pattern most effective. And it’s not a diet like, oh, I’m going on this fad weight-loss diet. This is really understanding and learning how you can eat to promote your health for the rest of your life.

Dr. Weitz:                            What about the concept of an alkaline-forming diet or acidic diet, does that make much difference? It’s a common thought out there that if you have a diet that’s more acidic, then the body’s going to pull calcium from the bones to alkalinize the system.

Dr. Neustadt:                     Nope. I mean, again, it’s the overall dietary pattern. If all you’re eating is… acid foods tend to be more animal proteins. And so if you’re eating just primarily an animal-type diet, you’re not getting the other nutrients required to feed your bones, you’re setting yourself for a problem. But is it because of the acid? There’s lots of studies that have been done, and it’s been debunked.  Now where it’s important to understand is if you’re eating a more alkaline diet or more balanced diet, you’re eating a more plant-forward diet, you’ll be eating more of that Mediterranean-style diet.  But again, it’s a complex condition and it’s a complex issue… It’s a chronic issue. So boiling it down to just one element of the diet, say, oh, it’s the pH of the diet, that’s the golden nugget of information that we all have to focus on. That’s just not how the body works, nor is it what’s supported by the research. It’s the overall dietary pattern.

Dr. Weitz:                            So let’s get into nutritional supplements for bone health, and I guess maybe we should start with vitamin D.

Dr. Neustadt:                     Okay, you got a specific question or do you want me to just go for it?

Dr. Weitz:                            We know vitamin D is super important, vitamin D is responsible for taking the calcium and bringing it to the bones. There’s some question as to what’s the ideal level of vitamin D we want in the body? What are your thoughts about this?   There’s the normal level which is over 30. There’s the moderate optimal range, 50 to 70. Some doctors like pushing it higher than that. What do you think is optimal for patients who want to have the best bone health?

Dr. Neustadt:                     Love it. Great setup. So first of all, I want to frame it with the most fundamental question when it comes to bone health and osteoporosis. Has vitamin D been shown to reduce fractures? If it hasn’t, that’ll change how I want to discuss it.  And the answer is yes. Calcium and vitamin D have been shown to reduce fractures. Now you asked the perfect question, what’s the optimal level of vitamin D for fracture reduction? What the researchers show is a vitamin D level between 30 and 44 nanograms per milliliter… That’s the units that are used in the United States. Canada and Europe, it’s different units… but 30 to 44 nanograms per milliliter is associated with the biggest reduction in hip fracture risk and the biggest reduction in fall risk, about 20% reduction in hip fracture risk.

                                                Now interestingly, back to that bone density study or bone density story, when you get to a level of vitamin D from nine to 30, nine to just below 30, right around that range, you see improvements in bone density, but they don’t find the reduction in fractures until you get higher than that. That 30 or 33 to 40 nanograms per milliliter range, that’s for bones.  You mentioned a higher level, 50 to 70. Now we’re getting more into immune system health and what the research shows is healthy for immune system. Vitamin D activates over 200 genes in the body. It has an incredible amount of activities in the body, beyond just helping with bone health or regulating calcium absorption.    And so for immune system function, the research does support at 50 or higher in terms of a blood level. I do recommend people get their vitamin D tested and track it that way.

                                                So vitamin D with calcium is the combination shown to work. Calcium by itself has not been. And when you look at the combination of calcium and vitamin D together, it’s associated and in clinical trials been shown to reduce fractures by about 18 to 23%. That’s supplemental calcium, supplementing. The US RDA for calcium is 1,200 to 1,500 milligrams per day.  And when people look at the recommendation from the government, the recommended daily allowance, that’s from all sorts of diet and dietary supplement. The average American woman consumes about 800 milligrams of calcium in her diet. So maybe supplementing if you need it with 400 milligrams, maybe a little bit more of calcium is appropriate to get you in that range.

Dr. Weitz:                            Some patients are afraid to take calcium, or a few studies that showed that calcium would increase heart disease. Some patients go to the doctor and he measures the serum calcium level and he says, “Well, you don’t need more calcium.”  What form of calcium do you recommend? Does it matter? Should it be calcium citrate, hydroxyapatite, carbonate? What form of calcium is best? Is calcium safe? Does it increase the risk of heart disease?

Dr. Neustadt:                     Great question. So the majority of the studies have done use calcium carbonate, which is a very poorly absorbed form of calcium, and you actually need stomach acid to break that apart.  So a mineral when you take it as a supplement, is not just a mineral, it’s connected to a carrier molecule carbonate in this instant, or citrate or malate. I believe you mentioned both of those as well. Those are the different forms that calcium can come in in supplements.  And what happens is as people get older, they’re at greater risk for having low stomach acid. And then if there are autoimmune conditions or if they’re taking acid-blocking medications, their stomach acid is going to be lower as well, they’re not going to be producing enough.  So your ability to actually digest and absorb the calcium from calcium carbonate is compromised. There is no indication that one form of calcium is better than another when it comes to reducing fractures. Zero. Zero evidence that one form is better than another.  I personally prefer the calcium citrate form because you don’t need stomach acid to be present in order to break that apart and absorb it. You actually absorb it in the small intestines and it disassociates. When there’s less stomach acid present, you can still absorb it. So that’s why I prefer calcium citrate. It also is relatively inexpensive to buy on the market and as a commodity in dietary supplements. And the reality is hydroxyapatite, coral calcium, whatever it is, there is zero indication that one is better than the other for reducing fractures.

Dr. Weitz:                            So how many times a day? With meals? At night? How do you like patients to supplement their calcium?

Dr. Neustadt:                     So the research points to the ability to absorb about 500 milligrams of calcium per serving at a time. So I personally, if you’re just taking calcium and vitamin D and all you need is 200 milligrams or 400 milligrams, you could take it once a day. You can spread it out twice a day. I think it’s personal preference.   This kind of segues into a conversation about the safety, is one way of taking it safer than the other? There’s no indication of that. Currently, the Bone Health and Osteoporosis Foundation and the American College for Preventative Cardiology have the position statement, having looked at all the research, that as long as somebody is not getting more than the safe upper limit of calcium as set by the National Academies of Medicine from all sources, diet and dietary supplements… And that amount is 2,000 to 2,500 milligrams per day of calcium.

                                                As long as people aren’t getting more than that, that it is considered safe from a cardiovascular standpoint. And there are studies, cohort studies and clinical trials, that have shown taking up to 1,000 milligrams per day has no effect on cardiovascular disease outcomes, and that means heart attacks.  So I think that the current state of knowledge right now is taking up to 1,000 milligrams is safe, but the reality is most people don’t need that amount. Most people only need maybe 400 milligrams of calcium.

Dr. Weitz:                            How do you decide how much calcium someone should take?

Dr. Neustadt:                     I look at their diet. In my book in the section on calcium or in my book, the chapter on diet, it talks about calcium, and then there’s in the appendix, a list of calcium-containing foods in helping people transition into eating this healthy way, this Mediterranean style. This osteoporosis-type diet that I teach and have walked thousands and thousands of patients through transitioning into.  I ask people don’t make any changes for a couple of days because first of all, you don’t want to make any huge changes overnight because those tend not to be sustainable, and just write down what you’re eating for a couple of days. People tend to eat the same foods day in and day out.  So just make a list without making any changes and then try an estimate. It doesn’t have to be perfect. It’s not an exact science. How many milligrams of calcium are you’re getting? How many grams of total fiber, how many grams of protein? And that’ll give you kind of a general idea. It’s not an exact science. People don’t have to be super particular about it. Get a general idea.

Dr. Weitz:                           With meals? In between meals? At night? Is there a best time to take your calcium?

Dr. Neustadt:                     I want to step back for a second because it’s really a question for me of what else is there in the formula? So if there’s vitamin D in the formula, then you want to be taking it with food because vitamin D is fat-soluble. So the fat-soluble vitamins like vitamin E, vitamin A, vitamin D, vitamin K, those are fat-soluble and those are absorbed better when there’s some fat there. And so you want to take that with meals because they’re probably going to be some fat with your meal. Plus it’s a good way to remember, it’s like I’m sitting down to my meal, create a habit around taking your supplements. It’ll just be easier to remember that way.

Dr. Weitz:                           Okay, let’s get into vitamin K.

Dr. Neustadt:                     Okay. I’ve loved the research on it.

Dr. Weitz:                           We’ve learned in recent years the importance of vitamin K, because vitamin K seems to reduce the potential for arterial calcification. It’s one criticism of some of the studies that seem to show that calcium might be a problem in terms of increasing heart disease risks that they didn’t include vitamin K.

Dr. Neustadt:                     So vitamin K is a phenomenal topic. So let me just start a little bit of the big picture because when people talk about vitamin K, they tend to think of it as just one thing, and that’s not the case. Vitamin K is a category, so there’s different-

Dr. Weitz:                           Right. So there’s K1, K2, MK4, MK7… I did a whole podcast on vitamin K actually.

Dr. Neustadt:                     Oh, phenomenal. It’s going to be fun talking to you about this then because you’re obviously up on the research. So the vitamin K1 and vitamin K2 are the two sort of big categories. Vitamin K1 is in plants, green leafy vegetables, and there is an association with a diet of eating more green leafy vegetables and a reduction in osteoporosis and fracture risk.  And then with vitamin K2, there are subtypes of vitamin K2. The most popular ones that you see in dietary supplements are MK7 and MK4. They’re designated by those numbers, but they are different molecules, they have different names, they have different chemical structures. They have similar effects in the body, it’s been shown, but they also have different effects in the body.  And when you look at outcomes trials, when you look at fractures, the only form of vitamin K2… the MK4, MK7… that’s ever been shown in any clinical trials to maintain or improve bone density, but most important, maintain strong bones as indicated by fewer fractures in clinical trials. The only form of vitamin K2 shown to do that is MK4, 45 milligrams a day.  In fact, if you do a search for MK7 on the National Library of Medicine database and you look for MK7 and osteoporosis, MK7 and fractures, and you look at all the clinical trials… there were only a few… there are no outcome study of MK7 fractures showing that it reduces fractures.  But even when it comes to bone density, the research shows those clinical trials in the National Library of Medicine database show that it only slows how fast somebody loses bone. It hasn’t been shown to actually increase bone density, but most importantly, it’s never been shown to reduce fractures. Only MK4, only in the amount of 45 milligrams per day.

                                                And it’s been so well studied that since 1995, it’s been approved by the Ministry of Health in Japan for bone health. And as a full disclosure, that’s why, because of that research and the decades of clinical trials, over 7,000 volunteers in clinical trials lasting for years, that I created my products. I needed it for my patients. Osteo-K and Osteo-K minis that have the clinical dose of MK4 in it, shown then to promote healthy bone density and maintain strong bones with calcium and vitamin D in those products.  So I don’t use the MK7 because it hasn’t been shown to work for the most important thing that we want to try and help when it comes to bone, which is maintaining strong bones.

Dr. Weitz:                            I think one of the issues with vitamin MK7 is it’s 100 times more expensive, and there’s more marketing behind it, and it seems to stick around in the bloodstream longer. It has a longer half-life. So they market it as being more effective because it lasts longer in the bloodstream, but the mere fact that it lasts longer in the bloodstream doesn’t necessarily mean that it’s being absorbed into the tissues. In fact, it may mean that it’s not getting absorbed into the tissues and it’s still sticking around in the bloodstream.

Dr. Neustadt:                     You’re exactly right. I mean, looking at just because it’s in the bloodstream, again, that’s not clinically the most important thing. That’s another surrogate marker. It’s just a number on a test. And our body has the machinery to actually create MK4 in small amounts. So MK7 is not produced produced by humans, it’s produced by bacteria, and when it’s absorbed in the body, the physiologically active form that accumulates in tissues around the body, the brain, the testes, the pancreas, the intestines, the breast, throughout the body, the form of vitamin K that accumulates is MK, which also points-

Dr. Weitz:                           The one exception is the liver. Apparently the liver stores vitamin K as MK7.

Dr. Neustadt:                     I’m not familiar with that. I will have to take a look at that, that’s not my understanding.

Dr. Weitz:                           But I think all the other tissues store the vitamin K, and if you consume K1 from green leafy vegetables, it ends up getting converted and stored in most of the tissues as MK4.

Dr. Neustadt:                     Well, and the reality also is, okay, what about clinical trials? That’s great, and that can give you some clues about where is it helpful. When you’re talking about liver health, there are no outcome trials with MK7 in liver health. There are outcome studies with MK4 in liver health.  There’s a published clinical trial, I believe it was published in the Journal of American Medical Association, looking at people who had hepatitis C. Hepatitis C increases somebody’s risk for liver cancer. When they took the MK4, 45 milligrams per day in this clinical trial, it significantly reduced the risk that it would go on and progress to liver cancer. And so we have outcomes data for liver health.  Look, it’s a dietary supplement. So I need to say that it’s not approved by the FDA, it’s not a drug. It’s not approved to diagnose, treat, cure, or prevent any disease.

                                                I’m talking about the research on this nutrient. It’s been shown to powerfully promote health in different areas of the body. Similarly, when it comes to bone health, bone is more than just minerals and collagen. Our bone also produces platelets for healthy blood clotting, our red blood cells and our white blood cells.  MK4 has been used in up to phase II clinical trials in people with acute myeloid leukemia and myelodysplastic syndrome and shown to promote healthy platelet production, kill blast cells… Those are the cancerous or pre-cancerous cells in blood… without harming healthy cells and improve red blood cells, numbers on tests.  So those are up to phase II clinical trials. Again, it’s not a drug. It’s not approved to treat any of those things, but MK7 has not been shown to have any of those health benefits either.

Dr. Weitz:                            Now, most experts on osteoporosis recommend consuming magnesium along with the calcium, is often recommended that you take them in a 2:1 ratio, but I understand from talking to you previously that you don’t feel that there’s enough data to justify magnesium.

Dr. Neustadt:                     So I keep asking, I’ve been asking… I’ve been doing this for nearly 20 years now… please send me studies that I can review that shows why this is actually important, not just a theoretical consideration.  Now, I love magnesium, don’t get me wrong. Magnesium is important. It has many different activities in the body, it’s a phenomenal nutrient. Magnesium has never been shown to reduce fractures.  And in the clinical trials using MK4, 45 milligrams per day for bone health, the only other nutrients that were given were calcium and vitamin D to get that over 70% reduction in fractures in those volunteers, they didn’t use magnesium.  Now, don’t get me wrong, I love magnesium and some people should probably supplement it, but there are no clinical data. There are no outcomes studies showing that it’s actually required when it comes to this goal of maintaining strong bones. To take it required, I’m talking about taking it as a dietary supplement, nor is there any indication that it has to be taken in a specific ratio.

Dr. Weitz:                            Okay. Strontium. So I know you’re not a believer of strontium and-

Dr. Neustadt:                      No, I am a believer in strontium. No, no, no. I am a believer in it. There is research on it. I just don’t recommend it for different reasons. When I say I’m a believer in it, what’s the most important question? The question is, has strontium been shown to reduce fractures? The answer is yes, I believe in that. That is good research, but that’s on strontium ranelate.  Strontium ranelate is a medication that was approved in Europe for osteoporosis. It’s not available in the US. It was actually taken off the market in Europe because of risks and health concerns. In the US is strontium citrate. There are no clinical trials on strontium citrate, either outcome studies or safety studies. And so I just want to be honest about what the research shows.  Strontium citrate may be helpful. It may reduce fractures the same as strontium ranelate. We just don’t have the data supporting it, the data doesn’t exist. Now, that’s just an honest assessment of the research. With strontium citrate… Or if you looked at the research on strontium ranelate, there are six large clinical trials on strontium ranelate in Europe. Five of the six studies showed that it only reduced vertebral fractures. It didn’t reduce hip fractures. Only one study showed hip fracture reduction and the studies that showed vertebral fracture reduction, it was about 45%. So similar to Fosamax.  And so it gives false bone density test results. It competes with calcium for absorption, so you can’t take it at the same time. There’s some safety concerns potentially around strontium that it may increase the risk for blood clots that can cause heart attacks and strokes. And for those reasons, that’s why I don’t typically recommend it.

Dr. Weitz:                           Another nutrient that you don’t recommend is boron?

Dr. Neustadt:                     Correct.

Dr. Weitz:                           So boron has been shown to prevent bone loss. It’s been shown to slow down the activation of the enzyme that breaks down estrogen and testosterone. Boron seems to have a lot of benefits. It’s even been shown to be beneficial for osteoarthritis. It seems to make sense to add boron to the mix for osteoporosis prevention or reversal.

Dr. Neustadt:                     So here’s my philosophy on which I base formulate. Has it been shown… I’m going to sound like a broken record. Has it been shown to reduce fractures? No, it hasn’t. Does it mean it’s unimportant? No, it has important physiological functions. But when somebody comes to me and says, “Doc, I have a diagnosis of osteoporosis,” or, “I have this, what can I do nutritionally to help?” Hopefully people aren’t just taking one dietary supplement. This is a holistic approach with diet and exercise.  So I’m looking at what are the clinical trials shown to promote bone density, but more importantly than that, reduce fractures. Now, most people also are likely going to be looking at a multivitamin and mineral formula. Well, a good formula is going to have some boron in it. It’s just a trace mineral, you don’t need a lot. Right?   But even when we’re talking about whether you should take it or shouldn’t take it, the study showing more than 70% reduction in fractures with the MK4, didn’t use boron. It wasn’t there, it’s not necessary.  If we get a little boron, can we get that up to 75 or 80%? I don’t know. It’s theoretical, but you’re going to be getting boron trace. If you’re eating a plant-forward diet, that’s where it’s found. You’re going to be getting those trace minerals. You’re going to be getting enough vitamin C. You’re going to be getting enough boron and then supplement with a good multivitamin mineral formula if you want a little bit of an insurance policy. But when it comes to bone health, I’m very focused on what can we do to reduce people’s risks of breaking a bone, and based on clinical trials.

Dr. Weitz:                           And since bone is built on a matrix of collagen, does it make sense to add collagen to the supplements?

Dr. Neustadt:                     It’s not my first line. There are no outcome studies looking at collagen and fractures. There’s one study looking at collagen and CTX where somebody took supplemental collagen or volunteers did, and their CTX… that’s that laboratory marker I talked about earlier… did significantly decrease. And maybe there’s also rationale for taking melatonin. There was a study in osteopenia that looked at melatonin, a dose-response study where one or three milligrams and taking three milligrams of melatonin also improved bone density if somebody’s having a difficult time sleeping.  But those are not my first line. I think, yes, if you want to be more aggressive, collagen may be good to take. But also, I think more importantly than that is getting the nutrients from food, eating enough protein, making sure you’re getting an adequate amount of dietary protein, to me, is more important than taking the supplement.

Dr. Weitz:                           Okay. Have you looked into any of the peptides?

Dr. Neustadt:                     I have not.

Dr. Weitz:                           Okay. All right. I think those are the questions. Any final thoughts you want to leave our listeners and viewers about bone health, osteoporosis?

Dr. Neustadt:                     Yeah. The first thing is it’s a scary diagnosis for sure, and it is a serious situation. But when somebody gets the diagnosis of osteoporosis, just to take a deep breath and realize this isn’t an emergency, that I have time to educate myself so I can make the best decisions for me. I have time to put together a holistic plan for myself, which is what my book Fracture-Proof Your Bones does. It walks people through how to create a holistic plan for themselves.   And so that’s the take-home message, that it’s not just about a number on a test, it’s what can you do to reduce your risk for fractures? What can you do to actually maintain strong bones and improve your bone strength?          And take a deep breath. There’s time to educate yourself, get the resources together so you feel comfortable that you’re not being pressured into making a decision to taking a drug, or doing something that you’re not really sure that you want to be doing.

Dr. Weitz:                           How can listeners find out about your products?

Dr. Neustadt:                     They can find everything on the website, NBIHealth.com… NBIHealth.com. There are links also to all the research studies. There’s a blog on there on MK4 or MK7. What’s better for bones? There’s blogs on diet and exercise. My products that I formulated for my patients, this all started back in my medical clinic because I needed the dose in combination of nutrients shown in clinical trials to work for my patients, and they didn’t exist.  So I created the company to provide those products to my patients. And now we’ve shipped into over 35 countries around the world. So NBIHealth.com is where they can find that information and they can reach me through there as well. And also all our links to social media are on the website.

Dr. Weitz:                           Okay. Sounds good. Excellent. Thank you, doctor.

Dr. Neustadt:                     Thank you.


Dr. Weitz:                            Okay. 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. Nasha Winters discusses The Metabolic Theory of Cancer with Dr. Ben Weitz.

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Podcast Highlights

1:30  Cancer is more likely caused by mitochondrial damage, often related to the metabolic environment in our bodies and related to the modern diet and toxins, et cetera, rather than primarily caused by somatic DNA mutations.  Dr. Theodor Boveri, a German zoologist, comparative anatomist and co-founder of modern cytology, first proposed the somatic mutation or genetic theory of cancer in 1914.  We have taken this theory and run with it for the last 109 years without really proving it. At about the same time, Otto Warburg had proposed the metabolic/mitochondrial theory of cancer and it was outpacing the somatic theory until the 1950s when Watson and Crick found the DNA helix and everyone went back to the genetic theory of cancer. Nixon launched the war on cancer 52 years ago but given the increase in the number of people being diagnosed with and dying of cancer continues to grow, we are sadly not winning this war.  We mapped the human genome and we hoped that this would provide more answers, but it really just raised more questions than answers. And clearly the one gene, one target, one cause is not what we had hoped it would be.  Also, multiple studies using a nuclear cell transfer have been unable to create cancer in a cell by transferring the nuclei out of a cancer cell into a healthy cell.  This demonstrates that cancer is not caused primarily by somatic mutations.

6:08  We have been able to show that the mitochondria not only make energy but are the protectors of our DNA and our genetic expression. Unfortunately, most of the therapies we use to treat our genes, like chemotherapy, only further damage the mitochondria, which then make us even more vulnerable to recurrence, progression, and even having a cancer diagnosis to begin with.  What affects the mitochondria are everything we put in, on, and around us, from food, to thoughts, to water, to the people around you, to the environments you live in, to the light you’re exposed to, to the chemicals you put on your skin and spray in your gardens.  Your mitochondria are signaling agents and they take in information and translate it into the body.  We can have a big impact on the environment in our bodies by how we lead our lives, which can either drive cancer growth or make it more difficult for cancer to thrive.  With the genetic theory, it’s just bad luck and there’s nothing that you can do about it.

12:11  Blood Sugar.  High glucose levels can increase free radicals and lead to DNA mutations. Sugar in the body creates glycosylated end products, which essentially means that you are oxidizing or rusting your innards.  Hemoglobin A1C is a blood test that measures this glycosylation.  We can also measure certain cytokines that direct the inflammation.  When glucose is high, it stimulates cortisol and estrogens and these things impact glucose as well.  High insulin levels also blunt your immune response.  We can literally treat disease by what is on the end of our fork.

15:15  New targeted therapies.  For decades conventional cancer care has consisted of chemo, radiation, and surgery. But now we have newer more targeted therapies, including immunotherapy, CAR T-cell therapy, etc.  Before commenting about the new therapies, Dr. Winters pointed out that there is a better way to utilize the standard of care like chemotherapy.  When you pair metronomics with chemotherapy at a dose less than 20% and pair this also with natural stressors, like fasting, hyperbaric oxygen, and other natural therapies, you get more effectiveness with fewer side effects. This is using chemo smarter.  When it comes to the newer therapies like immunotherapy, it’s interesting that Integrative doctors like Dr. Winters have been recommending therapies to stimulate the immune system for decades, such as Mistletoe, though it is only now being embraced by the conventional cancer care community.  While we have heard of some miraculous successes with some of these new drugs, including the checkpoint inhibitors, the PD-1/PD-L1 inhibitors like Keytruda and Opdivo, these drugs only work about 20% of the time.  Unfortunately, there are unfortunately terrible side effects to these drugs most of the time.  In 2018 MD Anderson came out with a prognostic score for who would be a good candidate for these drugs based on seven questions: 1. Are you over age 52?, 2. Do you have elevated neutrophils?, 3. Do you have low lymphocytes?, 4. Do you have elevated LDH lactase dehydrogenase? 5. Do you have elevated platelets?, 6. Do you have a poor ECOG score?, 7. Do you have elevated liver enzymes?  If you have 3 or more yeses, you should probably avoid these drugs.  We also know that these immunotherapy drugs are worthless if you’ve had a bout of antibiotics in the last six months prior to taking them, so we know they are working through the microbiome.  As Integrative practitioners, we need to make sure to address the microbiome to allow these drugs to work better. Also, these drugs are better suited as first line therapies instead of as last line, but this is because they are expensive and insurance companies don’t want to pay for them until cheaper chemotherapy drugs fail first.  But even with these new immunotherapies, we have not extended life much more than 2-3 mths for stage 4 cancers, so we have to do better.

24:35  Cancer Stem Cells.  

 

 

 



Dr. Nasha Winters is a Naturopathic Doctor and a Fellow of the American Board of Naturopathic Oncology.    And she is also a cancer survivor herself.  Dr. Winters is a sought-after speaker and an authority on integrative cancer care and she is currently involved in research on using Mistletoe Extract, hyperthermia, cannabis, the ketogenic diet, and IV Vitamin C to treat cancer.  Dr. Nasha is a co-author of the best-selling book, “The Metabolic Approach to Cancer” and in 2021 she published Mistletoe and the Emerging Future of Integrative oncology.  Her website is Dr. Nasha.com  and she is focused on educating practitioners about the metabolic approach to cancer.

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 our topic is an integrative approach to cancer with Dr. Nasha Winters. Dr. Nasha Winters is a licensed naturopathic doctor and a fellow of the American Board of Naturopathic Oncology. She’s also a cancer survivor herself. She’s a sought after speaker, an authority on integrative cancer care. She’s the co-author of the bestselling book, The Metabolic Approach to Cancer, and in 2021, she published Mistletoe and the Emerging Future of Integrative Oncology. Dr. Nasha is on a mission to educate and empower the nearly 50% of the population, unfortunately, expected to have cancer in their lifetime. Prevention is the only cure. Dr. Winters, thank you so much for joining us today.

Dr. Winters:                        Oh my gosh, Ben, it’s great to be back with you and your tribe, so thank you for having me.

Dr. Weitz:                            Thank you. Thank you. So let’s explain what causes cancer and why you feel it is more likely caused by mitochondrial damage, often related to the metabolic environment in our bodies related to the modern diet and toxins, et cetera, rather than primarily caused by somatic DNA mutations.

Dr. Winters:                        I love it. So that’s a perfect way to start. Back in 1914, Dr. Theodor Boveri is considered the father of modern day somatic mutation or genetic theory of cancer. And that just got thrown into the universe, a theory. And shortly thereafter, in the early 1920s, Dr. Otto Warburg also started to explore other theories of cancer. And for him, it was not about the DNA damage that started the course of cancer, it was what happened upstream from that, which is at that mitochondrial level. And so, many of your listeners might’ve heard about the concept of the Warburg theory, and we’ll talk a little bit more about that in a moment. But what I think is really interesting about this is these are theories that were thrown out there that we have since, like some of them we’ve just adopted like the somatic mutation theory. We have just taken that and run with it for the past 105, 106 years without really, really proving it.

                                                And then, what’s very interesting is that at the same token when the metabolic theory or the mitochondrial starting points of cancer of Otto Warburg, who later won a Nobel Prize for his work, it was cranking along. It was actually outrunning, outpacing the somatic theory during its time until the 1950s when Watson and Crick found the good old DNA helix, and basically, everyone was kind of looking over here and went back to the old genetic ballroom. And so, that energy is where we put all of our focus.  And so, just so your listeners have a big construct of this is that we claimed the war on cancer in 1971. So that was the year I was born. So 50, almost 52 years ago, Nixon said it’s claim the war on cancer. And sadly, at the start of this, you introduced me as talking about that nearly 50% of people affected by this diagnosis. In fact, just this week, it is one in two people are expected to have cancer in their lifetime. So the studies are now outpacing cardiovascular disease as the number one cause of death, and that we really are looking at a one to two chance of having cancer in your lifetime. So clearly, we’re not winning any wars here. So that’s a big one.

                                                And then the other interesting thing that was coming out of this as we mapped the genome and we thought this is where all the answers are going to be for us, and all as it did was basically say there’s a lot of genes, there’s a lot of what they call junk DNA, we don’t really know. We have more questions now than ever before, but clearly the one gene, one target, one cause is not the holy grail that we were hoping it would be. The other thing is that for decades, not once, not twice, but many times over, we’ve done multiple studies where with what’s known as the nuclear cell transfer studies. And this is where you take two cells, one of them is a cancer cell, one of them is a healthy cell, non-cancering cell, and inside each of those cells is this nuclei, which think of that as like the hard drive, the brain, the important, this is where all the magic and all the communication, all the signaling theoretically happens from.  If this was a cancer caused by a genetic somatic DNA mutation as the primary cause, if you took the cancering nuclei out of the cancer cell and you replaced the healthy nuclei of healthy cell, if this was somatic genetic, you would turn on cancer, and vice versa. If you took the healthy out and replaced the unhealthy nuclei of the cancer cell, you should make a healthy cell. That does not happen over and over and over and over and over again. We’ve shown that.  So in essence, we’ve come up with multiple studies that show that this is not a somatic mutation.

                                               However, what we have been able to show and the research is luckily catching up with us, is that when the mitochondria, those little powerhouses that we were all taught in, what, sixth grade biology, that we only thought their only function was to make ATP, the energy source of our cells and our bodies, it does so much more than that. We now understand that the mitochondria are the sort of protector of the DNA, of our genetic expressions. And so, it’s whatever we’re doing to encourage the health or the disease of our mitochondria, that is the precursor of protection or destruction of our DNA.  So we needed to back it up a notch. And yet, in standard of care today, we are still fighting hard for the concept that this is a genetic disease. We’re still spending billions of dollars of resources every year trying to find ways to silence those genes, splice those genes, replace those genes, gene, gene, gene all the way along. And yet, ironically, most of the therapies we even offer to treat those genes, to destroy those genes, to go after that will only further damage the mitochondria, which then make us even more vulnerable to recurrence, progression, having a cancer diagnosis to begin with.

                                                And then, all of the things we’ve since learned that affect the mitochondria, just everything we put in on and around us, from food to thoughts, to water, to the people around you, to the environments you live in, to the light you’re exposed to, to the chemicals you put on your skin to spray in your gardens, all the things directly impact our mitochondria. And just simply put, think of your mitochondria as just signaling agents and antennas. They’re taking in all the information, they are translating that information, and they’re sending signaling pathways back out into the body. So when you mess up there, you mess up everything.

Dr. Weitz:                            Another interesting thing is that when DNA is the cause of our cancer, of our health problems, we no longer have any agency in that. It takes the blame away, but it also means that we really have no say in the matter. It has nothing to do with what we’ve done or say or anything else. And therefore, the only possible treatment is something that somebody else can put on us or do to us.

Dr. Winters:                        Yes. Yeah. I really love that you brought up this idea of agency, of personal responsibility, but also of personal empowerment. I mean, to me, the message that there’s something happening at the mitochondrial level versus at the DNA level is frankly much more hopeful at its core. It gives us a lot more opportunity to realize we are far more powerful than we’re led to believe. And really, in the moments when there is a true genetic deficit defect problem, that’s happening in the cancer realm less than 5% of the time. Even standard of care acknowledges that and says that 90 to 95% of all of our cancers are actually caused by dietary and lifestyle influences. What they don’t say is what those diet and lifestyle influences are doing. They’re imparting their wisdom, if you will, their input into our mitochondria. And so, that is where it gets funky.

                                                So it’s like they’ll tell you that, but they don’t really put the dots together of what’s going on. And so, I like you really appreciate the part about the agency and about how this changes it into our court. One thing I’d like to also offer to people, because sometimes there are people, especially if they’re in a state of duress or stress or anxiety, they may take that message wrong or take it into a system that’s quite wounded and fearful and that, “Oh, you’re saying this is my fault.” So let me reframe that while we have this opportunity.

                                                You don’t know what you don’t know until you know. So you could not have known. 99.9% of the people that have ever seen me or one of my colleagues that have trained will tell us that they were healthy until they got cancer. That is impossible. You may not be aware of all the contributing factors that allowed for this process to take off in your body, but once you do have that awareness, then it does become, for lack of your fault, it’s that you knowingly have this information now, and yet you still choose to abuse those mitochondria for whatever reason.

                                                So if you’re still spraying the glyphosate on your gardens, you don’t want to bend your ass over and pull weeds out of the ground, that’s a problem. That’s cognitive dissonance at its best. And so, these are the pieces where my work and the work we’re doing in the research world, in the metabolic oncology world is understanding some of the unknown offenders and drivers and doing something about them. So it really is about an education and an empowerment process to help you make different choices to better your ability to prevent this from every landing in your body and expressing in your body, and to prevent it from ever progressing or mutating or prevent it from ever recurring.  And so, those are the types of things that we can impart this knowledge into the population to empower them instead of having them believe that a lot of the researchers, and I guess the main belief systems out there still today, unfortunately, the dominant paradigm is that this is just bad luck, that you’re just a sitting duck, there’s nothing you can do about it, it’s just your genes, and just go on blindly doing all the things that are causing harm to your body.

Dr. Weitz:                            Right. And really interestingly in your book, I was reading it for the second time, you argue that high glucose levels can actually increase free radicals and lead to DNA mutations.

Dr. Winters:                        Yeah. So it does a few things. So it does that, it creates, and in fact, what we know is sugar in the body creates these things called glycosylated end products, very fancy name for basically rusting your innards. Would that be a fair description?

Dr. Weitz:                            Oh, yeah. Most people know what hemoglobin A1c is, and that’s a perfect example of it.

Dr. Winters:                        Yeah, you can literally measure how quickly you are oxidizing or frying or rusting your innards with this blood test that shows you the average of your glucose over three months. So it’s not like a one and done, like you had a bender over the weekend with your friends and now your glucose is really high.  It’s the average of that glucose in your body over those three months, which is the idea that we need to temper what we’re being exposed to, so it does that. It also just directly increases inflammation, both secondarily from that glycosylated end product, but also directly by increasing certain cytokines, certain inflammatory molecules that just keep you in a state of inflammatory process. It definitely changes your metabolic expression, so it affects your hormones. So when glucose is high, it stimulates cortisol, it stimulates estrogens and vice versa. All those things impact the glucose as well.  Just being even under stress will affect your glucose. A poor night’s sleep will increase your insulin, which will affect your glucose. Then, the other thing that having a high sugar intake or a high glucose, high insulin in your diet does is it blunts your immune response. So it has such so many levers and so many triggers that we have to be mindful of this, and ultimately it should be foundational. Since we can literally treat disease or create disease by every single thing is at the end of our fork, we need to be taking advantage of using our food strategically.

Dr. Weitz:                            A good way to think of glycosylation is imagine if you could open up your cell phone and pour a bunch of honey in there and see how well it works.

Dr. Winters:                        That is a really good analogy, or even putting a bag of white sugar into your gas tank.

Dr. Weitz:                            Right.

Dr. Winters:                        Right? That’s the thing. I remember I heard my mom talking about growing up that that’s what they would do, like toilet papering houses and pouring sugar in a gas tank. That will destroy the engine. That’s what we’re ultimately doing to ourselves. We are destroying our own engine. We are destroying our own hard drives in our cell phones and our computers or whatever, our bodily ones when we ingest too much carbohydrate.

Dr. Weitz:                            Now, when it comes to conventional cancer care, for many, many decades we’ve had chemotherapy and radiation and surgery, but now we have all these newer targeted therapies, immunotherapies, CAR T-cell. What do you think about some of these newer therapies and how should we think about them? How do they interact with diet and lifestyle differently than say chemotherapy does?

Dr. Winters:                        Gorgeous. So a couple of things here is first of all, one thing I want to also put out into your community is that there’s a way to use standard of care better.  So we can be doing, not to say chemo’s bad, but we certainly can know exactly what somebody’s cancer cells are going to respond to.  So we can do testing that is FDA approved and insurance covered to know what targets that person’s cancer type has, and that tells us then what are the best suited therapies for it.  We have this now, and yet it’s rarely actionable, like really do we do anything with that data, which is really sad, but we could take that information and say, okay, we now know that this person has these targets, so let’s approach it with this tool.  But the best part is when we lower the dose of that tool.  So chemotherapy, oftentimes patients will have to lower the dose a little bit. If their treatment’s just been too harsh, we might lower it 25%, maybe upwards of 50%. But what’s really cool is when you pair metronomics, so chemotherapy at a dose less than 20% with some stressors into the system such as being in a fasted state or with hyperbaric oxygen or with other integrative natural therapies, you can actually potentiate the fact that that 20% of chemo to drive it directly into the cancer cell while protecting the healthy cells. This is using chemo smarter. That’s one example.

                                                The next example that you mentioned are the new hot to the market immune therapies. I’ve been at this for over 30 years. It was not, but a couple years ago where literally the entire, I was the charlatan, I was the quack for even mentioning, for even whispering that the immune system might have anything to do with the cancer process. And so, now that it’s a trillion-dollar industry, now everyone, they’ve all invented sliced bread themselves. And so, the irony of these therapies is we actually have many of these therapies that have co-evolved with us.   One of the most simple is just fever. Our internal favoring process is a strong immune reaction, which ironically is what a lot of these pharmaceuticals will induce is a favoring process. We have in the latter part of the 1800s into the 1900s, we have the Dr. William Coley from Sloan Kettering of all places, where to this day they give a Dr. Coley award for medical innovations, and yet nobody seems to understand who this person was. They don’t even know their own medical history to know that this man was the first man who was giving patients injections of an infection, so of a bacteria, that then stoked this massive fever experience that reduced the tumors.  This was used in standard of care oncology until the 1960s. Then, we just pretend that didn’t exist. And then you have mistletoe, which is one of my favorites. You mentioned my book in the beginning with co-authors, six authors including a hematology-oncologist and conventional medical doctors, other naturopaths, like a whole mix of us. We’ve all brought our well over 100 years of experience with this plant to a book that’s a best practices for physicians and a great resource for patients to educate their doctors on this therapy. That’s the most studied integrative therapy out there. It’s been used continuously as an injection of an extract of the Viscum album or the mistletoe plant for a treatment of and support of other cancer therapies since 1917. So we have, this is between Coley’s toxins, between fever therapies, between mistletoe, we’ve had immune therapies available to us and working beautifully for some time.

                                                When we brought out this whole new checkpoint inhibitors, the PD-1/PD-L1 inhibitors like Keytruda, Opdivo, we brought on the drugs like the CTLA-4 and 6 inhibitors, when we brought on the CAR T that you mentioned, these drugs even by all of standard of care work at best about 20% of the time. And when I say work, that means response. That does not mean cure, that means response, meaning it’s going to give some tangible shrinkage of the tumor itself or the tumor load, the burden itself. The bad news is that over 80% of the time, there are terrible side effects, no effects or death, really harsh. These guys are really harsh. And the thing that was so crazy is as an integrative oncologist, I knew upfront what was going to make somebody respond well to those drugs and what wasn’t going to respond well to those drugs.

                                                And even in 2018, MD Anderson came out with their own prognostic score to show who’d be a good candidate or not for these drugs. Seven simple questions. Are you over the age of 52? Do you have an elevated neutrophil level? Do you have a low lymphocyte level? Do you have an elevated LDH lactase dehydrogenase? Do you have elevated platelets? Do you have a poor ECOG? So daily function score, and do you have anything going on in your liver? If you answer three yeses or more to that, you probably should reconsider bringing on one of those drugs because they can have a holy hell nightmare in your body that is far worse than the cancer process.

                                                And so, what’s cool is somebody like me is we can actually get those yeses to nos with our integrative therapies to make a drug like this work better. And just like I talked about the metronomic dosing of chemo, we can also do that with immune therapies. And even better, the latest studies, which we’ve also known is that the immune therapies are basically worthless if you’ve had a bout of antibiotics in the last six months. So that right there gives us indication. And the studies are showing us that the microbiome is integral to receiving and using these medicines. And the craziest part is these medicines, immune therapies, they’re best-suited as a first line versus how they’re often given today as a last line because you have to have at least some amount of immune system left for these drugs to play with. And so, a really good example-

Dr. Weitz:                            But the reason why that’s not happening?

Dr. Winters:                        Because we’re blasting the crap out of them. Well, money.

Dr. Weitz:                            Because of money, because the insurance companies run the healthcare system and they want to use the cheaper therapies first.

Dr. Winters:                        And that’s a very good point, because a CAR T therapy can be upwards of $1 million. A typical KEYTRUDA is like 10 grand a month for those injections. So these are expensive, and so the patient may not see it directly because their insurance covers it, but it’s crushing our medical system, the expenses of this. And so, here’s the other thing to tie in the standard of care approach is in the last 17 years, there was a study that came out a couple of years ago that showed that the 96 new drugs that have come to the market in the last 17 years specific to oncology, so specific to treating cancer, when you put them on a bucket at best, and you probably know this study, you probably run across it, but guess what the overall survival rate is of what we’ve brought to market in the last 17 years.

Dr. Weitz:                            3%.

Dr. Winters:                        Well, 3%, but overall, 2.4 months. That’s what it’s giving us.

Dr. Weitz:                            Oh, yeah. Okay.

Dr. Winters:                        Right? I mean, and to your point, statistic of the 2 to 3% is actually these studies have been repeated over and over about the actual efficacy of chemotherapy, which is about 2 to 3% depending on the study. At the time, and there’s only a handful of cancers, testicular, some lymphomas that are actually responsive to chemotherapy. The rest really aren’t. It’s like it’s moving the paper around the desk until the immune system figures out what to do with it on its own. And that’s why when people finally end up in an immune trial or an immune therapy is offered, they’ve obliterated what little bit of functioning immune system they had with those standard of care therapies. And at best, modern day oncology is bringing us 2.4 months extended overall survival. These are all studies that I’m not, this isn’t a naturopath’s opinion. This is just the reality, and this is why it is time for us to be having conversations like this with 50% of us going to face this in our lifetime. We have to do better. We have to do better.

Dr. Weitz:                            Yeah, no, absolutely. I’ve seen plenty of those studies where the result was an increase in lifespan of two months, four months, something like that, and then the stock shoots up. The drug is lauded as the next billion dollar drug.

Dr. Winters:                        Exactly, exactly, exactly. Yeah. Yep.

Dr. Weitz:                            So what are cancer stem cells?

Dr. Winters:                        So I’m going to simplify this. Dr. Mark Rosenberg, who’s an integrative oncologist down in Florida, I heard him present at a conference a few years ago, and he described it really elegantly, the stem cells. Think of the stem cells as the sleeping mother cells. They’re just taking a nap. The active cancer cells are the daughter cells. These are the ones that are proliferating, mutating. They’re the ones that are active. Those are what the conventional therapies like chemo, radiation, surgery target, they target the active proliferating cancer cells, the daughter cells. The stem cells wait and rest. They’re waiting out in a state of quiescence, not doing anything until we over harvest, over-treat, over stress, things like the good old mitochondria and over-treat all those daughter cells to the point of harvesting them down below 20% of what’s left in the body.

                                                At that point, mama bear wakes up and she’s pissed. That’s the stem cell. That puppy wakes up. It’s a different personality, a different behavior, and a different aggressivity, and it’s less responsive to therapy. In fact, that’s the time you must consider a different approach because if you’d been on, let’s say, carboplatin and Taxol for your ovarian cancer all along, which was going nicely after your daughter cells and you over-treat, and so somebody like me, I can tell on the labs, I can tell with the patient, I can tell immediately when they’ve been over-treated, right? Maybe there’s no evidence of disease on scans or CA 125 is now normalized.

                                                But they say, “We’re going to give you a couple more for good measure.” That’s called the maximum tolerated dose approach. When that happens, you now push those far enough down that the mother wakes up, she sprouts up, she’s no longer responsive to that CarboTaxol. In fact, if you give her more of that, she will eat it like candy and she will make it her bitch and she will turn it into new cancering processes and be much more aggressive and much more difficult to deal with. It creates a drug resistance and it creates a stem cell and cancer persistence that’s really difficult to treat. And so, that’s why a lot of people were like, “I had a really good response my first round of chemo, but then the second round, not so good. And then the third round even less, and then the fourth round even less,” because our response gets shorter and shorter as we wake up more and more of those stem cells.

Dr. Weitz:                            I’m sure cancer researchers are aware of stem cells. What have they been trying to do about this?

Dr. Winters:                        It’s hilarious. So in 2013, I was speaking to the concerns of stem cells and seeing this in my practice and talking about it, and everyone, literally, every oncologist I ever encountered was like, “Bah, humbug, hooey. This is BS. This doesn’t exist. There’s no such thing as stem cells.” I’m like, I’m quoting them from Dr. Wicha’s research and Dr. Dean’s research, all of these big institutions that are sounding the alarms of, “Hey guys, when we over-treat, when we see patients having recurrences or we see them becoming drug resistant, this is what we’re seeing. This is the actual reality.” They literally couldn’t see the writing for the wall. Again, once we had some therapies that are worth millions, if not billions of dollars come out of the market theoretically targeting stem cells, now they’re talking about it. Well, now we can test for it. Okay, great.

                                                They make fun of us when we tried to run our CTC testing, our circulating tumor cell testing saying, “Those don’t exist. That doesn’t exist in nature.” It’s so weird what a decade difference will make when you’re saying the exact same thing that whole time and until you have a profitable treatment for it that’s patented and owned, then and only then will they take interest. And so, what’s crazy now is what I have patients do is I want them to ask their physician, “What are you going to do for my stem cells while we’re treating my cancer? While we’re treating those active cancer cells, what will you be doing to support my stem cells?” And I explained to them that this is a really good filter for you. If that doctor looks at you like you have 10 eyes, tells you that’s bullshit, that doesn’t exist, it’s time to get a different doctor. That’s how much we’ve learned. That’s how much the data backs it, and that’s how much we can even test even-

Dr. Weitz:                            What could a conventional oncologist offer?

Dr. Winters:                        Exactly. So what a conventional oncologist could offer is what is an emerging approach in the oncology world, which is known as the adaptive theory or the adaptive approach of cancer, which people like Dr. Gatenby at Moffitt University and oh gosh, I can’t believe his name just left my brain, but he is a really well-known researcher in University of Arizona, these guys talk about we want to just push back just enough, so get the patient out of harm’s way. So let’s say we’ve got a massive tumor burden, like a very high elevated tumor marker. We’ve got a big, big mass somewhere in the body. Maybe it’s starting to push up against some valuable real estate of our blood vessels or organs. Maybe it’s pushing against our colon and causing us problems.

                                                So we definitely need to debulk that. We need to take some of that tumor volume out of the body, so it has a time and a place to use some of these targeted therapies, immune therapies, chemotherapies, radiation therapy, surgery to do that. But you just want to take it back enough so that you don’t further harm the terrain or further harm the mitochondria. And then, you want to bolster the immune system and the mitophagy of our healthy cells, the new creation of healthy mitochondria that can scooch out the cancering process and hold it at bay. Either treat it like a manageable disease process, just like something like diabetes, or actually getting into remission.

                                                In my world, I don’t shoot for remission with patients. That’s a great side effect if that happens. In my world, I treat this like a manageable disease process because what happens when people think that there is a start and an end point to cancer, that is where your most dangerous thought process happens. When you ring that bell at the end of your chemotherapy or the end of your radiation, what I tell people is you’re not ringing in the end of a treatment, you’re ringing in the beginning of what actually needs to happen to help you prevent this from coming back or progressing further. And so, these are the ways we are thinking about this differently. You can push back just enough and then take much needed pauses and breaks and don’t bring on more aggressive therapies unless the cancer’s getting more aggressive. And so, it’s this just gentle pushback so that you can actually bring in all of the other resources both within and outside of you that helps stave this cancer off even further.

Dr. Weitz:                            And what are some of the integrative approaches to cancer stem cells?

Dr. Winters:                        Wow, high dose IV vitamin C. That’s one of our best. The other one that’s one of our best is good old intermittent fasting, therapeutic ketosis, which can be achieved through fasting, can be achieved with a high fat, low-carb diet, can be achieved with just carbohydrate restriction, can even be achieved with some pharmaceutical interventions such as metformin, things along those lines. So ways to get that, and in fact, there’s some really compelling study of both metformin as well as its herbal counterpart berberine that have some direct influence over the stem cells as well.

Dr. Weitz:                            Cool.

Dr. Winters:                        Yeah. Very cool.

Dr. Weitz:                            Let’s talk about cancer and diet.

Dr. Winters:                        Ding, ding, ding. Here we go into the danger zone.

Dr. Weitz:                            Okay. Vegans over there. Carnivores over there.

Dr. Winters:                        Yeah, exactly. Duking it out.

Dr. Weitz:                            I did solicit some questions from our functional medicine group and one of the questions was about methionine restriction from Mark Simon. I know that you generally tend to recommend a lower carb approach for most patients.

Dr. Winters:                        Yeah. I would say all patients need to be on a lower carb approach. And let me just bring, so I love this because I almost brought on Dr. Ahmed Elsakka last night just to have this piece, because I saw that on your forum about the methionine question, which comes up. If I had a dollar for every time it comes up, I could probably retire. But I like the questions coming up because it’s a very compelling piece here. But what happens is people don’t understand what it means. So people when they think, so I know Dr. Hoffman’s research, gorgeous. This man is brilliant. I have his textbook. I understand this is a real thing. But even that, what happens is even though he’s sharing this knowledge, the average lay person and the average physician is misinterpreting the state.

Dr. Weitz:                            You know what? Let me just back up a second.

Dr. Winters:                        Sure.

Dr. Weitz:                            So I’m thinking if somebody’s not familiar with what we’re talking about, I jumped just right into methionine. In the context of what kind of diet is best, there’s concerns about carbohydrates and glucose and the metabolic concept of cancer. There’s a number of researchers who claim that protein, especially animal protein, leads to cancer possibly through increasing IGF-1 levels, other ways in which it promotes growth. And then, some researchers have focused on specific amino acids, which are the building blocks of proteins and have targeted those and said, “Okay, methionine. If you can reduce methionine, that’s going to help with cancer. If you can reduce glutamine, that can help with cancer,” and so, in this context.

Dr. Winters:                        Gorgeous. So big picture, cancer is opportunistic. It will go after whatever is overly abundant in the system. Pretty straightforward. We can simplify that right there. So if you have an overabundance of glucose, it will go after that. If you have an overabundance of trans-fatty acid, like really toxic high omega-6 fatty acids, the linoleic acid, it will go after that. If you have high levels of glutamine when there’s been a metabolic shift into a cancering process, that can be problematic. If you have high elevations of methionine in certain situations, that can be problematic. Arginine is another one. Cysteine, which is actually more related to the methionine piece as well.

                                                So to your point, there’s this way that people are like, if you look in a Petri dish and a cell line, there’s a lot of theoretical things that are happening. If you look in an animal study that is a rat or a mouse that has very different metabolic needs and dietary like normal genetic dietary requirements, they’re not as effective. When you look in the models like dogs, they also get naturally the types of cancers we do as humans, those are a closer fit. So you can see a little bit more translational information. So I want folks to have that context first. Number two, methionine is… So you’ve got your healthy metabolism like a normal, you’re not cancering, everything is good, and you have your cancering metabolism. These two are very different animals themselves.

Dr. Weitz:                            And by the way, I love the way, the fact that your cancering as opposed to having cancer, and I know that you say that very deliberately.

Dr. Winters:                        Thank you. I appreciate you pointing that out because we all have cancer cells all the time, all of us. It’s when they hijack the metabolic processes that it can get out of hand.

Dr. Weitz:                            In fact, we all have hundreds or even thousands of cancer cells, right?

Dr. Winters:                        Some say even upwards of a trillion.

Dr. Weitz:                            Why?

Dr. Winters:                        [inaudible 00:37:14] know what to do with it. That’s the beauty is when you have functioning mitochondria that can take in all the information from its environment and send off signaling, your mitochondria are what are in charge of apoptosis, the programmed cell death. So if they sense something awry, they’re going to take it out. They know what to do. But if you’ve damaged it over and over by excesses of anything or deficiencies of anything, you make them vulnerable and you make them less likely to respond and react to those cells that need to be removed.

Dr. Weitz:                            We just have to equip on mitochondria with these new baby AR-15s.

Dr. Winters:                        Yeah, exactly. Nice. I like your brain. You’re thinking in this. So here’s what happens with the methionine piece. So in healthy metabolism, this is one of our nine essential amino acids, essential meaning you have to have it to live, period. So that’s one thing to remember. The other thing to remember is that it is so integral in the repair and cleanup of all of our healthy DNA. It is literally what’s helping our immune system function, our adrenals function, our neuroendocrine systems function. It is absolutely required for you to live.

                                                So one thing I want your listeners to listen to or hear is that when we start to get so myopic and say, “We’re going to put in this pharmaceutical or this drug or this herb or this dietary intervention to starve something,” when you understand that it is just as integral, if not more so to survive to help our healthy cells survive, it should probably give you a moment of start to realize the way you use these therapies need to be very judicious, because we can fall into the same trap we do in standard of care oncology that you over-harvest, over-treat, over-push the system in one direction or another. That is a bad idea. Think always of the teeter-totter of balance. If you’re like, “I’m going to methionine restrict, I’m going to want carbohydrates…” You got to keep focusing in the center of this teeter-totter, because it’s a dynamic flow.

                                                So that being said, there is some interesting biochemistry that happens at that cellular level, especially in our methylation pathways where we should have a normal process, we should have homocysteine turning into methionine and off we’re running into health creation. When there’s a metabolic shift in the cancering process, that clock goes backwards. So methionine goes into homocysteine and then becomes this bastardized process that can definitely influence cancer cell progression and proliferation. So I want folks to know that yes, it’s real. Yes, it can happen. But here’s what they don’t get told by the researchers is that we have a very simple means of knowing when and where that is appropriate.

                                                And the one thing about methionine restriction is it should never be done as a long-term lifestyle. It will kill you. It will absolutely kill you. You change your methionine process within a matter of days when you methionine restrict, days. So literally, the concept here is what I tell people is instead of fighting over, like you said, which diet, which camp is right, the most effective therapy we have that gets everybody out of the way of their own bullshit, excuse me, I get really passionate about this, is fasting. So when you put things head to head and you’re like, “I’m going to carbohydrate restrict, I’m going to methionine restrict, I’m going to glutamine restrict,” and you look at any of those by themselves, yes, all of them will have some pushback in the cell line studies.

                                                When you take methionine restriction and you partner it with carbohydrate restriction, you get a massive synergistic approach that pushes back even harder. But what wins hands down out in front of all of these strategies is intermittent fasting. So that’s the simple answer for people. But here’s the place here. If I have a patient with an elevated homocysteine, so for me, my normal range is seven. If it’s a tiny bit higher than that or a tiny bit lower than that, I’m watching it. If I have it a little bit higher than seven, I put a patient on a methylation support supplement, pretty high doses for anywhere from six days to two weeks, so a week to two weeks. Then, I retest that homocysteine.

                                                If the homocysteine stays exactly the same or gets worse, I know we have a methionine problem. If the homocysteine gets better, we just have a simple methylation problem. Maybe you’ve got MTHFR, MTR, MTRR, which are all methyl transferase receptor issues, and that it just means that you just probably should take a little bump of folinic acid or leucovorin on the pharmaceutical world or a B12 on occasion. Those are things that are very helpful.

                                                But if a patient is stalling and their homocysteine is high no matter what we do, then and only then is it appropriate to consider a short-term methionine restricted diet. But what I want to caution for folks is the BS that’s online and that influencers have taken on is they tell people a methionine diet is a vegan diet. So I want to throw that, I want to kick that one out of here, because you can actually put a link in there of the top 10 methionine-rich foods. And yes, animal proteins have a lot, but so do vegan proteins, tofu, quinoa, many of the nuts and seeds, but especially Brazil nuts and beans.

                                                So what does that tell you right then and there? You’re going to have to fricking starve yourself to avoid methionine. And then the people, like a colleague of mine who is really promoting of the NORI diet, a lot of people will just get on fruit. What I just explained to you will kill you, because fructose is definitely a problem in the cancering process. And carbohydrates are definitely a problem in the cancering process. So even if someone’s going to do a methionine restriction because they have all the parameters that say, “Hey, this is a therapy that’s suited for you,” it must also be done in carbohydrate restricted. They have to go hand in hand.

                                                And then what happens is once you get that process and you’re using the homocysteine testing to know, you then literally wean them off methionine, restricted diet, back into a carbohydrate restricted diet only, and then you only pulse the methionine restriction if and when it’s warranted. I have been at this for a very long time, and because I test homocysteine levels on every patient every month, I’ve had three patients that needed methionine restriction. All of them were able to get that process down, and all of them were able to go back into just a restricted carbohydrate lifestyle with intermittent fasting. That is the simple strategy that gets everybody out of their own way of fighting each other of what’s right and what’s wrong. And what’s-

Dr. Weitz:                            Another thing you pointed out in your book, which I thought was really interesting is making sure you consume some organ meats, because those contain the B vitamins that help balance out the high methionine levels in the muscle meat.

Dr. Winters:                        Yeah. And so, that’s also, think about that as your master methylaters, and it’s helping you in that process is it’s helping keep the chain, the circle moving in the right direction. But again, we don’t have to guess here. We don’t have to assume. It’s a simple blood test and it can be run regularly. In fact, it can be run every week if you wanted to watch the process. And a lot of us are doing that, and we’re doing some research in this field. And so, there is an absolute time and place for this, but it’s far less common than people are led to believe, and it’s not meant to be on long-term. In fact, the longest anyone’s ever… has been on and should be on a methionine restricted diet is two to three months maximum. But I will tell you, I’ve never had a patient get that far because they start to get very cachectic and very sick pretty quickly.

Dr. Weitz:                            And this is all in the context of the fact that losing weight for cancer patients is not a good thing, that once they start losing a bunch of weight, that’s really bad for survival.

Dr. Winters:                        Well, there’s a difference between losing weight and becoming metabolically cachectic. So cachexia is a type of sarcopenia, type of muscle wasting that is not caloric-specific. It will never respond. You could give that patient 20,000 calories and it will not stop this process. It’s a metabolic process. And cachexia is driven by two things very simply, inflammation and sugar. So the worst thing you can tell a patient who’s losing weight with cachexia, by the way, we can start to see cachexia not by how a patient looks. I have a lot of morbidly obese patients in cachexia, because you would never look at them and think, “Oh,” and I have patients who look like walking skeletons that are not in cachexia.

Dr. Weitz:                            And the first recommendation, of course, is Ensure.

Dr. Winters:                        Which is only going to ensure your untimely death, and not which is like, it’s just-

Dr. Weitz:                            Because it’s loaded with sugar.

Dr. Winters:                        Yes, and really high linoleic acid, corn syrups and corn bits and… Talk about, so Ensure is super high in methionine. That’s what they’re bringing into the patient. So if a patient has a homocysteine that’s elevated along with cachexia and they’re put on Ensure, it’s going to ensure that a lot of processes are going to feed and fuel that cancer and that patient’s going to be dead. So the cachexia is you have to take… I mean, I literally had patients in cachexia do better in a deep fasted state to reverse their cachexia than patients who’ve even tried to do a high fat diet, like a high protein or high fat diet.

Dr. Weitz:                            Wow. Interesting. Say that one more time. So we’ve got patients who are in what we often refer to as the wasting stage, where they just start losing their muscle, their cheeks get hollow, they start looking really bad, and say again, what you found.

Dr. Winters:                        And this is again, under deep, we’ve got medical, we’re taking labs, we’re staying in close contact with this patient, so this is medically supervised, but we will fast those patients for 5 to 10 days, and they will actually reverse the cachexia. The inflammation drops and the glucose and insulin drop. And then, because what happens after about five days into fasting is you start to build your muscle mass again. And so, we’re having-

Dr. Weitz:                            Now, that’s pretty scary though, right?

Dr. Winters:                        Well, of course, it is because we’ve been told by, I mean, we fasted patients in the oncology world into the early 1970s when someone said, “Oh, that just seems really cool to do this to them as well.” And yet, now you’re seeing this is probably one of our most powerful tools. In fact, in 1909, Dr. Moreschi was able to debulk all of the tumors in his patients with deep fasting anywhere from 10 to 30 days, medically supervised fasting. And basically patients would go in, I’m pretty certain as an accident because I had a bowel blockage at the time of my diagnosis in 1991, that the very thing that turned around my cachexia of severely cachectic that dried up my ascites, I had a belly the size of a nine-month baby, despite every time they kept pulling the fluid out, it would fill right back up. And because of the bowel blockage, I could not eat for two months.

                                                And so in that, that’s probably accidentally why I’m here today, because that means I starved arginine and glutamine and methionine and brought down my insulin, and I had all kinds of the polycystic ovarian syndrome metabolic patterns that were prior to my diagnosis. I took away all the inflammation, which was the drivers of both the cachexia as well as the ascites. I accidentally cured myself, not cured, but stopped this process from going off a cliff. So we have known this for millennia. Hippocrates fasted his patients. Many have over time. You want to be doing it in a supervised state. I accidentally, unbeknownst to myself, did it by myself back then. I do not recommend that. I luckily was also studying herbology and things. I knew about electrolytes, I knew about herbal teas. I knew the things that I could take into my body that was helpful, but you have to do this with somebody who’s got some training in this.

                                                But yeah, we are really approaching this incorrectly, the world of cachexia, and we’re also really getting too dogmatic about our dietary. Even though my book came out and because of SEOs and whatnot, the publisher really wanted us to really highlight the ketogenic diet. What I really want people to hear that I do and that I really think is about metabolic flexibility diet is about approach the patient where they are in that moment and what is asking to be either nourished or depleted within them. And that’s what can lead to the fact that I will use a methionine restricted diet in certain situations. I will use a glutamine. Now, you can’t glutamine restrict in any diet. There’s no way to do this. People talk about that all the time. It’s literally impossible. Your body will start to auto digest your muscles to get glutamine because glutamine is absolutely critical for you to survive.

Dr. Weitz:                            Yeah. Thomas Seyfried talks about pulsing some glutamine restricting drug.

Dr. Winters:                        Yeah, exactly. And they’re harsh. That’s why they’re still in clinical trials, because they kill the patients. They’re tough. We’re coming up with new, there’s some really cool studies about new delivery systems and lower dosing and how to pulse press these up and coming pharmaceuticals. The same thing in the methionine restriction world, there are really cool ways to use methionine enzymes and things like that that we can use and target, get in, get out like a scalpel very gently. That adaptive approach we talked about earlier, instead of this like let’s lambaste you and [inaudible 00:51:35] on the field, which is what would happen if you got thrown on dawn, which is the glutamine suppressing therapy or put on some of the methionases that are the drugs that wipe out your methionine levels, you will die.

                                                But we do have kids who were born with issues in methionine metabolism that have to live on a restricted methionine diet, and they have to take a lot of other nutrients to offset that. And it’s a tough life for those littles. It’s really hard to grow and overcome that. Now, they’re not cancering, so it’s totally appropriate for those kiddos to be eating more fruit and the things like that, that are higher in sugar and higher carbohydrate because they’re growing their little bodies. But you reach a point where that will flip a switch and start to become problematic in all of us. And so, strategically, people are like, “Well, what diet should I do?” Well, the best would be start to play with intermittent fasting, and then when you do eat, eat real food, clean food. Stay away from the bars and the powders. Get to the real food. What did your grandparents or your great-grandparents eat? Get as close to the source as humanely possible of like, did it come from a tree, the earth, the ocean, the sky? What did it come from?

Dr. Weitz:                            It’s really hard. You almost have to grow it yourself.

Dr. Winters:                        100%. And this is what’s so crazy. Do you know they give people like me a diagnosis now of orthorexia because I so worry about where my food comes from and what is in it? And they’re like, “Well, that’s crazy.” Well, when you’ve kicked the can down the road for 32 years past your expiration date, you feel pretty passionate about knowing what you know from all the years of study, and all the studies continue to come out that we do need to take more attention to what we put in on and around our bodies and what’s going in on and around our soil, to our plants, to the animals, to the planet, to us. It is a constant chain of events. And if we don’t address all of them, the chain gets broken and we get problems.

Dr. Weitz:                            One last question. You’ve mentioned certain lab tests, and I know there’s a lot of lab tests that you like to do on a regular basis, but I don’t really want to go into the whole panel right now given the time, but you talk a lot about lactic dehydrogenase, and I’ve never really appreciated that marker. So can you make me appreciate lactic dehydrogenase and how important it is?

Dr. Winters:                        Ben, I love this question. This is a great way to end on this topic because LDH, talk about 15… Yeah, I know, right?

Dr. Weitz:                            You got to be a geek to think that-

Dr. Winters:                        You do. I like it.

Dr. Weitz:                            … lactic dehydrogenase is an exciting topic to end on.

Dr. Winters:                        It’s really exciting, sadly. It’s like, in fact, in the new book, the Mistletoe book, we have an entire section about this. So if people have that book, they can go to my lab chapter and read about this. But specifically, up until about 15 years ago, LDH was part of all of our complete metabolic panel testing. And then someone behind a desk decided, “Frivolous, we don’t need this test test.” But what I can tell you is it is literally the most important marker of our mitochondrial health. When you think about when you look at the Krebs cycle and you look at the pyruvate and the dehydrate, this is exactly where it interfaces. So when there is a respiratory chain problem in the Krebs cycle, that’s going to impact the expression of your LDH and at various tissues. You can even break down your LDH into the tissues. That’s-

Dr. Weitz:                            The isoenzymes?

Dr. Winters:                        Exactly. So you’d be like, “Oh, is this happening at the kidney level, at the liver level, at the bone level, at the marrow level?”

Dr. Weitz:                            Do you order the isoenzymes all the time, or do you just get to-

Dr. Winters:                        I do now because after, I’ll throw a little controversy into the mix, but after COVID, either the injection or the infection has changed a lot of LDHs, which tells me something right there, changed a lot of our mitochondria, which is probably not a good thing. But I can then go into the isoenzymes to know exactly what tissue took on the destruction, took the hit, if you will, and then support that and change that expression again. So it is such a powerful tool. It shows us your metabolic health. It shows us your liver health. It shows us your bone health. It shows us your kidney health. It shows us your bone marrow health. It’s so critical, and it’s so funny. It’s so not appreciated as you mentioned. When I have patients order this in far away places, most of the time they come back with an LDL because their doctor literally hasn’t a fricking clue what this test is.   And so, when they start to read, if you have, your listeners just go and run LDH as a prognostic marker in all cancer, a prognostic marker in chronic illness, you will be blown away at the utility of this. And by the way, it is the marker for multiple myeloma, leukemias, lymphomas, and melanomas. So it should be a standard test in every patient dealing with those diagnoses. And it rarely, if ever is. So it’s a doozy. My husband says if the LDH is on, so if it’s elevated, and elevated in my ranges, right?

Dr. Weitz:                            Okay. That’s what I wanted to ask you about is what’s the range that we should be concerned about?

Dr. Winters:                        So if you see the LDH on, you know the mitochondria are off, simply put. That can be your take home for this. But in the ranges, in the United States, LabCorp, they have a range from like, I don’t know, 50 up to 250. We want that one under 175. If it’s a quest test in the United States, they have a range that goes up to 450. We want that under 300. We want to be well in the middle of that zone or less.  Too low is also a problem. It can be a genetic issue, but it can also be sarcopenia and it could also be massive suppression of the marrow. And so, those are things too, that’s more rare, but it shows up on occasion. That’s why the isoenzymes are helpful. Even if you get a low or normal LDH, you can still see what tissues, because the LDH isoenzymes are the average that lead to that LDH. So you might have a really low LDH, but a really high bone isoenzyme. So that’s the average of that is the total LDH. So it’s a very important marker to be running on yourself and your patient population.

Dr. Weitz:                            Cool. That’s a great clinical pearl. I’ll have to add that to all the panels.

Dr. Winters:                        Right on. Perfect.

Dr. Weitz:                            All right, so I guess I also want to ask you about this center that you’re working on opening in Arizona. That sounds very exciting. This is going to be a cancer center hospital research facility that incorporates integrative care.

Dr. Winters:                        Yeah. A lot of our patients have to leave this country to go find seek treatments elsewhere. So if they want metronomic chemo, they have to go abroad, because the cost is pretty prohibitive in the United States of those who do offer it here. If they want to get hyperbaric oxygen paired with high doses of curcumin IVs, which is no longer available in the US unless you get it under the table, they have to go elsewhere. If you want to get photodynamic therapy injected right into your tumors, you have to pretty much go elsewhere. People are doing some of these things in the United States. They’re doing it quietly, they’re doing it underground, and it’s very, very costly for patients.

                                                So we’re building the first ever truly integrative oncology hospital and research institute on a 1,200 acre regenerative farm in southeast Arizona. This will bring in the best, as I mentioned, the metronomic chemos, the tissue assays, the thorough testing, the evaluations, the fractionated radiation partnered with hyperthermia. It’s going to bring the best of a modernized up-to-speed standard of care with all the proper testing to know how to use these other therapies along with the best vetted integrated medicine under one roof. It will be a training ground for physicians from all over the world. It will be a place where patients. We’ll have an 80-bed hospital to start. So it’ll be a campus that is people who are very, very sick and come and stay.

                                                It’s also going to be a wellness destination. There’s options on this that if you are just well and you want to just come and have a full assessment of your terrain, we can do that and help you fortify yourself a bit more and enjoy the beautiful nature that we’re offering and the bounty that we’re offering on feeding everyone who comes from the land of which we’re building this hospital. So we hope this becomes the model for a new global healthcare system and that this is our beta campus, and the plan is to see them perk up, pop up all over the world.

Dr. Weitz:                            And since it’s in Arizona, you can incorporate hyperthermia just by being there.

Dr. Winters:                        Exactly. Especially this summer there. Poor people. My God. Oh, yeah. We will harness all of what nature has to offer, including the sun right now. Holy cow.

Dr. Weitz:                            So I understand you’re not seeing patients anymore, but you’re doing practitioner training?

Dr. Winters:                        Yep. I’m treating physicians, but I will do consulting with the doctor of a patient. So if someone says, “I really want my doctor to consult with you on my behalf,” I still do that type of work. I also train now 155 physicians in 16 countries. Our eighth cohort starts in September. So if you are interested in joining this tribe, we need you. We cannot keep up with the demand. We get about 1,000 inquiries a month for people trained under this methodology. We can’t meet that need. We also have trained almost 300 patient advocates. That next cohort starts in November. So if you have a nursing degree, a nutrition degree, or just something in the clinical health coaching world, and you want to be part of this mission and vision, that next cohort starts as well. We have you being the beautiful liaison between the patient and the physician. So this is this beautiful system that we’re creating. We’re literally, we’re building a new model of healthcare and it’s really, really, really exciting.

Dr. Weitz:                            And where do we go to find out about that?

Dr. Winters:                        All of this we’ve talked about here between my books and podcasts and lectures and all the things we’re doing with that, to the hospital, to the data platform we’re building, to the lab, mitochondrial metabolic lab that we’re building, to the trainings are all on mtih.org, our nonprofit organization, the Metabolic Terrain Institute of Health. If you Googled that, you’d get there, but mtih.org should get you there.

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

Dr. Winters:                        Oh my gosh, Ben, thank you. Really grateful.

 


 

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.

 

Dr. Eric Osansky discusses Hyperthyroidism with Dr. Ben Weitz.

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Podcast Highlights

3:51  Hyperthyroidism.  Hypothyroidism or Hashimoto’s is a lot more common than hyperthyroidism.  Hypothyroidism is when you have low thyroid levels and TSH or thyroid-stimulating hormone is elevated.  With hyperthyroidism there’s too much thyroid hormone and TSH will be low.  With such patients you might see an elevated resting heart rate, heart palpitations, weight loss, hair loss, and thyroid eye disease that may include eye bulging and double vision.  While the optimal TSH should be between one and 1.5 or 2, TSH below 1 and esp. at .5 or below is reason for concern for hyperthyroidism.  For most patients with Grave’s disease (Autoimmune hyperthyroidism) the TSH is undetectable.

7:54  Grave’s Disease.  Most patients with hyperthyroidism (at least 80%) have elevated thyroid-stimulating immunoglobulins (TSI), which means that it is an autoimmune condition that is referred to as Grave’s disease. 

9:13  Medical treatment.  The most common medical treatments for hyperthyroidism are the use of anti-thyroid medications including Methimazole or Carbimazole, which converts into Methimazole, and several other anti-thyroid medications, including Propylthiouracil.  The other medical treatments are radioactive iodine, which obliterates the thyroid gland, and surgery to remove the thyroid gland.  Some endocrinologists feel that the surgery is the way to fix the condition and that is their primary treatment for this condition.

11:25  From a Functional Medicine perspective, what happens is that the immune system is attacking the TSH receptors.  There are four main categories of triggers for such autoimmune diseases that we can look at: 1. Food sensitivities, such as gluten, dairy, and corn, 2. Stress, 3. Toxins, including environmental toxins, heavy metals and mycotoxins from mold, and 4. Infections that includes viruses like Epstein-Barr, bacteria in the gut such as H. pylori, Yersinia Enterocolitica, and potentially even parasites. 

14:02  Dr. Osansky was diagnosed with Grave’s disease in 2008 and got it under control without the use of surgery, radiation, or medications.  When Dr. Osansky sees a patient for hyperthyroidism, he takes a very thorough health history. Then he will run some lab tests, including a CBC, a comprehensive metabolic panel, vitamin D, iron panel, etc. Dr. Osansky also likes to look at adrenals, either through saliva or urine with the DUTCH test. He also likes to test hormones and run a comprehensive stool test and perhaps organic acid testing.  He also likes to test hair minerals, including heavy metals. When Dr. Osansky was diagnosed with Grave’s in 2008, he did salivary cortisol testing and found out that both his cortisol and DHEA levels were quite low most of the day.  Grave’s causes you to feel hyperactive, so he did not feel fatigued like patients normally do with adrenal fatigue.  He worked on improving his ability to manage stress, changed his diet, and he took certain herbs, including liquorice root and certain nutrients, which helped his recovery. 

20:49  Anti-thyroid nutritional strategies. While we are using the Functional Medicine approach to search for the underlying causes for their hyperthyroid condition, there are certain herbs and nutrients that can help to manage the excess thyroid hormone, including the herbs Bugleweed and Motherwort.  Bugleweed is an herb with anti-thyroid properties, that helps to lower the thyroid hormone levels.  Patients often get heart palpitations with hyperthyroidism and Motherwort is an herb that can help with that. It has been found to calm the heart, sort of like a natural beta blocker. Lemon balm can also have a calming effect. He prefers the liquid tinctures in an alcohol base and with a two to one ratio.  Dr. Osansky likes the MediHerb product with Bugleweed and Motherwort, but there are also products on the market from HerbPharm, Hawaii Farm, and Wise Women Herbals.  Dr. Osansky usually recommends taking the herbs 15-20 min prior to meals typically 1/2 to one teaspoon twice per day but they may need two teaspoons if taking a less potent product like HerbPharm, which is a five to one ratio.  Bugleweed dosage depends upon the thyroid testing, while Motherwort dosage should be titrated till the heart symptoms are calmed.  If Bugleweed doesn’t work, L-carnitine at a higher dosage–2 to 4 grams per day–has anti-thyroid properties and it inhibits T3 and T4 from getting into the cell nuclei, according to some research. If the symptoms are not under control with Bugleweed and L-carnitine, sometimes lithium orotate (low dose lithium) is helpful at a dosage of 5-10 mg.  Selenium may help to lower the TSI and TPO levels if elevated and it could help with thyroid eye disease.  He typically recommends a dosage of 200 mcg but may go up to 400 mcg. Dr. Osansky does not like using high dose iodine with patients with hyperthyroid, even though it may suppress thyroid function at higher dosages, but it creates a lot of oxidative stress, so he usually discourages his patients from taking iodine supplements or even eating a lot of seaweed.  Cholestyramine is a prescription binder often used in mold detox programs that can bind to thyroid hormone and help lower levels.  It is up for debate whether nutritional binders like activated charcoal and zeolite, etc., may be able to do the same thing to lower thyroid levels.  Low dose naltroxene (LDN) may also be effective though modulating the immune system.

 

 



Dr. Eric Osansky is a chiropractor and one of the leading experts on a natural approach to hyperthyroidism.  He was personally diagnosed with autoimmune hyperthyroidism, also known as Graves’ disease, and he was able to overcome it using a natural, Functional Medicine approach.  He avoided both the prescription antithyroid medications and the radioactive iodine treatment as well as thyroid surgery.  He has a Masters of Science degree in Human Nutrition and Functional Medicine, is a Certified Clinical Nutritionist, is a certified nutrition specialist and a certified functional medicine practitioner for IFM.  In 2011 he published his first book, Natural Treatment Solutions for Hyperthyroidism and Grave’s Disease, in 2018 he published Hashimoto’s Triggers on hyperthyroidism, and he is currently editing the third edition of his first book, to be released soon.  Dr. Eric Osansky can be found at SaveMyThyroid.com  and at  NaturalEndocrineSolutions.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 listeners, I’m very excited today to be speaking about hyperthyroidism with Dr. Eric Osansky. We’ve had a number of discussions on this podcast about hypothyroidism, or Hashimoto’s Thyroiditis, which is a condition marked by underactive, sluggish thyroid, and this is the most common thyroid disorder. But some patients have an overactive thyroid, which we refer to as hyperthyroidism.   Like with hypothyroidism, most patients with hyperthyroidism have it as part of an autoimmune condition. Unlike hypo, when the body does not make enough thyroid hormone, in hyperthyroidism the thyroid produces too much thyroid hormone. Hyperthyroidism speeds up the body’s metabolism, and this can result in many symptoms, including weight loss, hand tremors, rapid heart rate, irregular heartbeat, anxiety, sweating, et cetera. Not too many functional medicine practitioners talk about hyperthyroidism, so I’m thrilled that we’ll be talking to Dr. Osansky today. Dr. Eric Osansky is a chiropractor, and one of the leading experts on the natural approach to hyperthyroidism. He was personally diagnosed with autoimmune hyperthyroidism, also known as Graves’ Disease, and he was able to overcome it using a natural functional medicine approach.   He avoided both the prescription anti-thyroid medications and the radioactive iodine treatment, as well as thyroid surgery. After seeing how well natural treatment methods helped with his autoimmune thyroid condition, Dr. Osansky began using these natural thyroid treatment protocols to help others with different types of thyroid and autoimmune thyroid conditions, such as hyperthyroidism and Graves’ Disease, and hypothyroidism, and Hashimoto’s Thyroiditis. While Dr. Osansky realizes that conventional medical treatment is necessary in some cases, there are millions of people with these conditions who’ve been told they need to be on prescription drugs on a long-term basis, or receive thyroid surgery or radioactive iodine, when this may not be the case.  Dr. Osansky has a Masters of Science Degree in Human Nutrition and Functional Medicine, he’s a certified clinical nutritionist, is a certified nutrition specialist, a certified functional medicine practitioner for IFM. In 2011 he published his first book, Natural Treatment Solutions for Hyperthyroidism and Graves’ Disease, and he’s currently editing the third edition, to be released soon. Dr. Osansky, thank you so much for joining us.

Dr. Osansky:                       Dr. Ben, it’s a pleasure being here, thank you for having me.

Dr. Weitz:                           Sounds good. So perhaps you might want to put a little more on the bones of explaining what is hyperthyroidism, what is Graves’ Disease?

Dr. Osansky:                       Sure, definitely can do that. As you mentioned, hypothyroidism is… First of all, hypothyroidism, Hashimoto’s a lot more common than hyperthyroidism. And so with hypothyroidism, that’s when you have low thyroid hormone levels, even though some cases of Hashimoto’s it’s more subclinical where they’re within the range but less than optimal. But typically, you’ll have thyroid hormone levels on the lower side or overtly low, and then there’s a thyroid-stimulating hormone, or TSH, that’s a pituitary hormone, that signals a thyroid gland to produce thyroid hormone. But with hyperthyroidism, as you mentioned, there’s too much thyroid hormone. There’s the excess secretion of thyroid hormone, and you could get multiple symptoms, you mentioned some of them.  So when I dealt with Graves’ Disease I had elevated resting heart rate, also known as tachycardia, had heart palpitations, I lost almost… Actually I lost 42 pounds, I have that specific-

Dr. Weitz:                            Ouch.

Dr. Osansky:                       I have that down, 42 pounds I lost, which was a lot more than I was hoping to lose. Because actually, prior to being diagnosed I was trying to lose weight, so that’s why I didn’t catch on right away. I was dieting and detoxifying, but yeah, I lost 42 pounds, had increased appetite, my stools were a little bit on the looser side. So yeah, the metabolism was sped up, accelerated, and hair loss is common, even though I don’t have a lot of hair. But again, I work with a lot of women who it’s really noticeable. And sometimes there’s thyroid eye disease, which is associated with Graves’ Disease, where someone could get eye bulging, double vision in some cases. And so on a blood test, that will present as elevated thyroid hormones, so T3, T4, the main thyroid hormones.  And I mentioned TSH, so with hypothyroidism TSH is elevated, with hyperthyroidism TSH is low. And the reason it’s low is because it’s trying to slow down the production of thyroid hormone, so TSH in this case doesn’t want the thyroid glands to produce thyroid hormone. But-

Dr. Weitz:                            So, what particular level of TSH do you really get concerned?

Dr. Osansky:                       Well I mean, I would say optimal TSH would be between one and 1.5, and even between one and two depending on the person. If someone’s like 1.8 and everything else is great, I might not panic. For hyperthyroidism, I mean, if it’s a little bit below the reference range, like if someone’s like .8, I wouldn’t be too concerned. But really, when it gets like .5, .6, I start paying attention. But I’ll say this, with most cases of especially Graves’ Disease, the TSH is undetectable. So by the time they’ve seen me, usually the patient has already been diagnosed. It’s a little bit different with Hashimoto’s, as you know with Hashimoto’s it’s a long process. People could go like five, 10, 15 years before getting diagnosed, they might attribute the symptoms like fatigue and brain fog and waking to something else.

                                                But when someone is having an elevated resting heart rate, and palpitations, and losing weight, it’s scary. So a lot of times they’ll go to the medical doctor not knowing what’s going on, get diagnosed. So usually, they’re already diagnosed when they see me. And then I’d say probably like 90% of the time, the TSH is non-detectable. There are some cases actually, I saw a patient today who had more sub-clinical hyperthyroidism, and the TSH… Actually, the recent TSH was undetectable. But more recently it was like .4 and .6 were some of the other readings. And I mean, that also is a little bit of a concern, but I mean, the thyroid hormones are to me more of a concern when they’re elevated. But yeah, like I said, a lot of people, arguably most people with Graves’ have undetectable TSH levels.

Dr. Weitz:                            And do most of the patients that you see with hyperthyroidism have the antibodies, the TSI?

Dr. Osansky:                       Yeah. I think you mentioned before, most of the time it’s autoimmune. So yeah, with hyperthyroidism most of the people who see me have elevated thyroid-stimulating immunoglobulins, or TSI levels. I do see some people with toxic multinodular goiter, where they don’t have the antibodies. And then there’s some other hyperthyroid conditions, like sub… Well, subclinical hyperthyroidism, even though you could have subclinical Graves’, where it’s not too common, where someone could have normal thyroid hormone levels, low TSH, elevated TSI. But yeah, to answer your question most people do test positive for TSI.

Dr. Weitz:                            Right. And so, would you say 80, 90% of patients with hyperthyroidism have Graves’?

Dr. Osansky:                       Oh yeah, definitely, I would say that, yeah. At least like 80, if not more, like [inaudible 00:09:04].

Dr. Weitz:                            Okay. And that’s basically when the TSI, when the antibodies are present, that’s when you diagnose Graves’, correct?

Dr. Osansky:                       That is correct.

Dr. Weitz:                            Right, okay. So what are some of the most common medical treatments for hyperthyroidism?

Dr. Osansky:                       Yeah, so typically most people with Graves’, hyperthyroidism will go to an endocrinologist, and there are three main treatments that they recommend. One treatment, anti-thyroid medication, and the most common medication at least in the United States is Methimazole. Some other countries will give Carbimazole, which converts into Methimazole. And then there’s another PTU, which is a different type of anti-thyroid medication. So a lot of endocrinologists will recommend the anti-thyroid medication, but then there’s two others. Another one is reactive iodine, which obliterates the thyroid gland. It involves a small amount of radiation, radioactive iodine. Well actually, the radioactive iodine does…

                                                It depends on how much they give, so they give enough to obliterate the thyroid gland. Unfortunately, some people need multiple doses of the radioactive iodine. But I was thinking, there’s also what’s called a radioactive iodine uptake test, which we could talk about. But that involves a small amount of radioactive iodine, the radioactive iodine treatment actually involves a good amount of radioactive iodine, which you need to destroy the thyroid gland. So, that would be the second treatment. And then a third treatment would be surgery, some doctors recommend thyroid surgery, and there’s some reasons why they might recommend surgery instead of radioactive iodine. Like if someone has thyroid eye disease, and they receive radioactive iodine, it’s more likely to exacerbate the thyroid eye disease.  So a lot of endocrinologists will not recommend radioactive iodine for those with thyroid eye disease, they’ll either give the person anti-thyroid medication, or if they think that… If the anti-thyroid medication isn’t tolerated, or if they just… It depends on the doctors, but some just are more aggressive than others, and some will just shunt to the surgery. So, depends on the-

Dr. Weitz:                            And when you say surgery, essentially you mean remove the thyroid gland?

Dr. Osansky:                       Exactly, remove the entire thyroid gland, mm-hmm.

Dr. Weitz:                            Right. So, what are some of the, from a functional medicine perspective, what are some of the most common underlying triggers, or root causes for hyperthyroidism? Because there’s a reason why the body’s gone wrong, why the immune system’s attacking the thyroid. In this case, attacking the thyroid TSH receptors, correct? Or thyroid hormone receptors?

Dr. Osansky:                       Correct, yes, exactly. So what happens is the immune system attacks those TSH receptors, and that’s… Yeah, so as far as… I’d talk about four categories of triggers or four main categories. So one, food, so certain foods can cause problems. Obviously we’re familiar with gluten these days, I’m sure your listeners… And same thing with Hashimoto’s, gluten can cause problems, and in some cases dairy, in some cases corn. I mean even salt, if you look at the literature, just with autoimmunity too much salt could raise Th17 cells, increase Th17 cells, which are associated with autoimmunity. So, food could be a trigger. A second one, stress. And when it comes to Graves’, there’s literature that shows the correlation between stress and Graves’.   And we can’t say the… Or stress, I think, is a factor with all chronic health conditions, but just the research, like if you do some research on the PubMed, some autoimmune conditions, there’s really no correlation, according to the research. Now again, we know even if it’s not in the research it could be a factor. And that was, stress was a big factor with my Graves’ Disease condition, and we could talk more about that if you like. A third potential trigger, environmental toxins, we live in a toxic world and it’s not getting any better, and there’s heavy metals such as mercury, there’s xenoestrogens, Bisphenol A, there’s… I mean, glyphosate, which disrupts the gut microbiome. And then a fourth category of triggers, we have infections.   So viruses such as Epstein-Barr, bacteria such as potentially H. pylori, Yersinia Enterocolitica, potentially even parasites. And it doesn’t mean that in everybody it’s a trigger, like we could have someone who has Graves’ Disease have H. pylori, and it might not be the trigger. But again, it potentially could be, and like I said there’s also literature to support that as well.

Dr. Weitz:                            So, patient comes in, you take their history, you go through. And then how do you decide which direction you’re going to go?

Dr. Osansky:                       Yeah, that’s a good question. I mean, I definitely do what I’d consider some basic tests, I do blood testing, complete blood count, comprehensive metabolic panel, vitamin D, need healthy levels of vitamin D to have a healthy immune system. I mean, even things like iron, like for example even though most people with hyperthyroidism, including Graves’, are women, men like myself could have Graves’. And when we think about iron deficiency, we might think of more cycling women. But we also don’t think of iron overload, which could cause oxidative stress, and also could be a factor when it comes to autoimmunity. And then I do look at adrenals, either saliva testing, or I’m sure you’re familiar with Dutch testing, dried urine testing.

Dr. Weitz:                            Sure, yes.

Dr. Osansky:                       So I look at adrenals, hormones, sometimes comprehensive stool testing, sometimes organic acids testing. So it does depend on… I can’t say I recommend all of these tests to everybody, but the basics like blood testing, saliva testing, I actually do some hair testing too, which goes back a number of years. Don’t rely on it completely when it comes to minerals and heavy metals, but I do still like looking at that. But yeah, sometimes I’ll do organic acids, sometimes I’ll do like I mentioned, comprehensive stool panel, I do a lot of those. And yeah, and sometimes other tests as well.

Dr. Weitz:                            Right, yeah. I saw where you’re doing that hair and mineral analysis, I remember doing that. We kind of went away from it, partially because I was concerned about the accuracy given all the exposure of hair products and everything else. But it’s also a little tricky, especially if you have somebody who doesn’t have that much hair, and now you’ve got to cut a big chunk out from the base of their neck or something. And then we tended towards some of these bigger nutrition panels, where they look at functional status of nutrients as well. So let’s start out with stress as a factor for hyperthyroidism. You said you like to do either the salivary adrenal stress testing, or the Dutch testing for that?

Dr. Osansky:                       Correct. When I was diagnosed with Graves’ back in 2008 I don’t think there was Dutch testing, if there was I wasn’t aware of Dutch testing. So I did saliva testing, and in my situation cortisol was low, like very low, DHEA, which is another adrenal hormone was low. I mean, everything was low. And the thing that-

Dr. Weitz:                            So, low the whole day, whereas it’s supposed to be elevated in the morning and then slowly come down?

Dr. Osansky:                       Correct, yeah. I mean, the first two levels were below the reference range, the third and fourth were on the lower side. But because, as you mentioned, yeah, it’s supposed to be lower later in the day it was still within range. But yeah, the first two are very low, and yeah, DHEA was also low. And I didn’t feel like that’s what some would refer to as like an adrenal fatigue pattern, when you have everything low. And I mean, probably because of the Graves’, again, I felt more hyper, I felt… Again, I didn’t feel low-energy at all. And so that’s why I’m a big believer in testing, and one could make the argument, “Well, maybe Graves’ is a little bit different because you have that hyper component, and you can’t always go by how you feel.”    But yeah, I did saliva testing. And then these days I still do saliva testing, but it depends. I mean, if someone wants to do a deeper dive into the hormones, and what I like about the Dutch is that it also looks at the metabolism of the hormones, so a real-

Dr. Weitz:                            You do that Dutch complete?

Dr. Osansky:                       Correct. When I do the Dutch, yeah, I will do that Dutch.

Dr. Weitz:                            So what did you do in your case when you realized that you had low cortisol levels?

Dr. Osansky:                       Initially I was in denial, so I was surprised that my adrenals looked as bad as they did. Because I knew stress was a factor, I just thought I was doing a good job of handling the stress, which is another reason to do the test. That sometimes you have to convince people that their adrenals aren’t looking good either, and that definitely was the case with me. So I definitely started blocking out time for stress management, I mean I changed my diet even prior to doing the adrenal testing. And I took certain herbs, I took liquorice root, which extends the life of cortisol, [inaudible 00:19:00] complex, I took nutrients that helped support the adrenals. So a combination of herbs, nutrients, diet and lifestyle.

Dr. Weitz:                            So it’s interesting, because it’s a little bit counter-intuitive, because as a functional medicine practitioner I’m thinking, “Cortisol in the morning is what gives you energy to wake up, you’ve got hyperthyroid, you’ve got too much stimulation, too much energy already.” This seems like it might make it worse, but actually when you go by the testing, and you see what the body needs, and you give it what it needs, things balance out.

Dr. Osansky:                       Yeah, exactly. Yeah, right. I mean, cortisol is supposed to give you energy, and I definitely had energy when I was dealing with hyper. It’s funny how it works though, I will say going back to the symptoms, I should say that not everybody… I do work with people with hyperthyroidism that do experience fatigue, and there’s reasons behind that. Like it does affect the mitochondria and depletes CoQ10 in a lot of people, which, that could lead to low energy. And I also should add, before I mentioned I lost 42 pounds, and we don’t have to get into great detail with this. But some people actually gain weight with hyperthyroidism. I mean, sometimes it’s due to the anti-thyroid medication, but sometimes there are other factors.   But yeah, getting back to the cortisol it’s just, you’re right. I mean, even though my energy levels were fine, increased cortisol could potentially increase even further. I think it played a big role in my recovery, and I can’t say I felt more hyper when addressing those cortisol levels.

Dr. Weitz:                            Yes, that’s really interesting. And so, while you’re searching for these underlying causes for their hyperthyroid condition, looking at stress, looking at toxins, looking at infections, looking at gut health, there are certain nutritional supplements and herbs that can help to manage the excess thyroid hormone, if you want to try to take a natural approach instead of either removing your thyroid or taking those drugs that block the thyroid.

Dr. Osansky:                       Exactly. So I mean, there definitely is a time and place for the anti-thyroid medication. And there are some people where the herbs aren’t effective, I’d say maybe like 20, 25% of the time. So if there’s a choice between taking the meds or receiving radioactive iodine surgery, I would say like go on the meds. But in my case, I took the herbs bugleweed and motherwort. And so bugleweed, it’s a herb with anti-thyroid properties, so it does help to lower the thyroid hormone levels. And so I started just with the bugleweed, but I was still experiencing some heart palpitation. So then I added the motherwort, and that did help with the palpitations. Motherwort focuses more just on the cardiovascular system. There’s lemon balm, which has a calming effect.

Dr. Weitz:                            I think in your book you describe motherwort as sort of a natural beta blocker?

Dr. Osansky:                       Yeah, it’s obviously a different mechanism than a beta blocker. But yeah, just to make a comparison, exactly.

Dr. Weitz:                            Right. And bugleweed is an anti-thyroid herb, right?

Dr. Osansky:                       You got it, yep.

Dr. Weitz:                            Now, what particular products do you like for this? I’ve used… Herb Pharm has a combo with bugleweed, motherwort, and lemon balm. But I know in your book you were saying that you’ve got to get the right dosage, and you like to see, I think you said sometimes a two to one ratio. And I noticed on the Herb Pharm, they don’t list the ratio.

Dr. Osansky:                       Actually, I think they… Well, they used to, it used to be one-to… It’s one-to-five, it should be, Herb Pharm. So yeah, I look for a one-to-two. It really depends on the person, I mean, there are people that, when they’re seeing me, the first consult they’re already taking something, because they just went online, and they got the Herb Pharm thyroid-calming formula, or someone’s… Actually someone I spoke with today, they were taking, it was something called Thyroid Soothe, which has the bugleweed, the motherwort, the lemon balm. And in this case, the person today, she seemed to be doing okay with that. So I won’t always switch into… The one-to-two is more potent, so it does depend on the person. And I’m a little bit biased, because that’s what I took when I was dealing with Graves’. I took the one-to-two extra [inaudible 00:23:49]-

Dr. Weitz:                            What product did you take?

Dr. Osansky:                       I took MediHerb, MediHerb has bugleweed and motherwort. But there are others, there’s Hawaii Farm has one that’s a one-to-three extract. And then yeah, there’s actually… There’s not a lot of, as you know, not a lot of companies that have bugleweed, because it’s not as popular as other supplements out there.

Dr. Weitz:                            Right. I saw Wise Woman Herbals has a combo product.

Dr. Osansky:                       Yeah. And one thing I should say too, which really, those were all formulas. But with bugleweed, or again, other herbal formulas, ideally you want to take the alcohol extract if you can tolerate it. Like, they use ethanol as a solvent, and if I have people… Like if someone goes to, let’s say some people, they might choose like Hawaii Farm because they have options for glycerine-based without the alcohol, but the alcohol extracts… It does a better job of extracting the phytonutrients, so it actually will do a better job. So if someone were to take an alcohol-free version of the bugleweed and it doesn’t work, it could be because it’s just not effective. Like maybe it doesn’t matter what bugleweed they would take, but it could also be because they took the glycerine-based version. So, that’s something for people to keep in mind as well.

Dr. Weitz:                            Oh, okay, okay, interesting. And what is the typical dosage, and how many times do you have them take it, and is it okay to take it in the evening, is it okay to… I guess it’s good to take it in the evening, because it’s going to be blocking the thyroid hormone. You want to take it apart from meals, before meals, after meals?

Dr. Osansky:                       Usually I recommend it 15 to 20 minutes before a meal, so away from meals. If someone can’t tolerate it on an empty stomach then they could take it with food, but it works a little bit better if the herb’s away from food. And then yeah, usually I recommend divided doses, like one in the morning, like one before breakfast, one before dinner. And then I mean, if someone’s having sleep issues also I might give lemon balm like right before going to bed, which has mild anti-thyroid properties, but just more of a calming effect. And as far as dosing, it does depend. Maybe an average dose would be a teaspoon twice per day, or five milliliters twice a day, sometimes I’ll give like half a teaspoon. And if they’re taking like Herb Farm, which is less potent, I might have them take two teaspoons, or 10 milliliters twice per day.

                                                At least with the bugleweed. The motherwort is more based on the symptoms, so the bugleweed, we’ll put someone on a dose, and then we’ll see what the next thyroid panel looks like and see if we need to adjust it, similar to like anti-thyroid medication. With the motherwort it’s more symptom-based, so if someone starts with let’s say half a teaspoon twice a day, and it helps with their symptoms, their palpitations, then they might be good with that dose. If they’re still experiencing palpitations, then they might need to go up a little bit.

Dr. Weitz:                            Okay. What other natural agents are there?

Dr. Osansky:                       For symptom management?

Dr. Weitz:                            Yeah, for symptom management. I know you talked about L-carnitine.

Dr. Osansky:                       Mm-hmm, yep. So L-carnitine, typically L-carnitine tartrate in higher doses. The literature shows between two grams and four grams per day has anti-thyroid properties. So, that’s what I’ll give now. Again, sometimes people… Like I just took the bugleweed when I dealt with Graves’, just honestly I didn’t know about the L-carnitine back then. But some people will take bugleweed and L-carnitine. I had someone just recently I consulted with that they’re just taking L-carnitine without the bugleweed, but yeah, L-carnitine is also another option.

Dr. Weitz:                            And so, in your book you explain how it inhibits T3 and T4 getting into the cell nuclei? That’s kind of interesting.

Dr. Osansky:                       Correct. Yeah, at least that’s from the research that I did, yes.

Dr. Weitz:                            Okay, yeah. And we know cardiovascular problems often go along with hyperthyroid, and L-carnitine seems to be particularly beneficial for cardiovascular health as well.

Dr. Osansky:                       Mm-hmm, yep, yeah. It has a number of different benefits. So you’re right, bugleweed, I mean, all herbs have multiple properties. But still, it’s really known for the anti-thyroid properties. But you’re right, L-carnitine does have other health benefits as well.

Dr. Weitz:                            Okay. What other things can help with symptom management, natural agents?

Dr. Osansky:                       Lithium, so I can’t say I give lithium. And it’s really just based on more a habit than anything, just because the other agents usually work. But lithium carbonate, now that’s prescriptions. I don’t give lithium carbonate, but they discovered years ago that giving lithium carbonate can lead to hypothyroidism. That’s how some functional medicine practitioners like myself recommend lithium orotate, and it’s like a small amount, like five, 10 milligrams. And that’s not my first go-to, it’s probably like my third go-to after the bugleweed, L-carnitine. But it is another option if for any reason someone is unable to get the bugleweed, or unable to tolerate the bugleweed, and for whatever reason maybe can’t tolerate the L-carnitine, even though that’s not too common.

Dr. Weitz:                            And it could be helpful for mood disorders as well.

Dr. Osansky:                       Yeah, yeah, exactly. Yep, yep.

Dr. Weitz:                            And you also mentioned selenium is having some benefit?

Dr. Osansky:                       Yeah. I wouldn’t say so much as like an anti-thyroid agent, but selenium is… And I’m sure you know this with Hashimoto’s too, just, there’s a good amount of research. First of all, there’s research that shows that it could help lower TPO, or thyroid peroxidase antibodies, and then there is evidence that it could also help with the thyroid-stimulating immunoglobulins, there’s evidence hoping that it could help with thyroid eye disease by helping to reduce those TSI levels. So, yeah.

Dr. Weitz:                            Yeah, there’s an oxidative storm that occurs when there’s a lot of thyroid being produced, and it helps clear out some of that excess oxidation too.

Dr. Osansky:                       Exactly, yeah. So selenium is something that I recommend to just about everybody, usually starting at like 200 micrograms. Sometimes I’ll go higher, I try not to go too high, just fear out of toxicity. Most people could tolerate between like two, 400 micrograms. Some people go higher, but again, I get a little bit nervous if someone’s taking six, 800 micrograms per day.

Dr. Weitz:                            Right. Now, what do you think about iodine? We know that iodine is an important nutrient for the thyroid, in fact the difference between the different thyroid hormones, T4 and T3, is based on the number of iodine molecules in that hormone. So, we know iodine’s really important. What do you think about using iodine in such patients?

Dr. Osansky:                       So there, it’s interesting with iodine. And again, I definitely have experience with iodine in the past. And so I’ll say this, iodine, as a mineral it’s important. Like you said, it plays a big role in the production of thyroid hormone. And when you think about that you might wonder, “Well, why would you want to take it for hyperthyroidism if it helps with thyroid hormone production?” And with hyperthyroidism, you want lower thyroid hormone levels. But actually in higher doses, it could suppress thyroid production. The problem with iodine, and again, personally I’ve had a good experience with… I have not had any negative experiences personally. But the problem with iodine, especially like higher doses of iodine, is it can cause a good amount of oxidative stress, which you mentioned before.

                                                And speaking of selenium, that’s why a lot of practitioners that recommend high-dose iodine will recommend selenium to try to offset that. But still, many times it’s not enough, and in some cases it could actually exacerbate hyperthyroidism, in some cases it could exacerbate the autoimmune response. So I mean, if someone is taking a multivitamin with iodine, I’m not going to tell them… I think that’s fine, I see most people doing okay with like a multi with iodine. If they’re eating regular food sources of iodine, I’m okay. If they’re eating higher dose, like sea vegetables, I’ll tell them to take a break from that. And again, everybody’s different. There are some people that eat seaweed, they do perfectly fine. But same thing with some people taking Iodoral, and they might do okay. But, just trying to be more conservative.

Dr. Weitz:                            So essentially, what you’re saying is, is taking what we would consider a modest amount of iodine, like 100 to 200 micrograms, MCG, is not a problem. But some who advocate higher dosages, say in a milligram level, that tends not to be helpful, is what you’re saying? In most patients.

Dr. Osansky:                       It could be a… Yeah, yeah, it definitely could be a problem. Again, I mean, when you say not helpful, like I said there are some practitioners who successfully use it as an anti-thyroid agent. And I guess you could make the argument that if someone is unable to tolerate the anti-thyroid meds, and the herbs aren’t effective, and they’re faced with taking high-dose iodine, versus radioactive iodine or surgery, I mean, I haven’t really faced that. There are other things like LDN, cholestyramine. But yeah, it is playing with fire. Again, I’m not anti-iodine, but it’s something where if someone takes especially like the milligram doses they could run into trouble.

Dr. Weitz:                            You mentioned cholestyramine, so that is binder that is sometimes utilized in programs to help bind to mycotoxins to get them out of the body when someone’s suffering from mold toxicity. If you could talk about that, and for those of us who can’t get a hold of cholestyramine because it’s a prescription, can other binders like nutritional binding agents have some benefit? And my understanding is the mechanism with the cholestyramine is, it’s binding to the thyroid hormone and reducing some of the levels?

Dr. Osansky:                       That is correct. So cholestyramine is, like you said, it binds to the thyroid hormone, and it could bind to mycotoxins. So you are correct, some practitioners who have prescribing rights might give cholestyramine in the case of toxic molds. And I will say this, if someone is listening to this, they have hyperthyroidism, and they can’t tolerate the anti-thyroid meds, and maybe the natural agents aren’t effective, if they go to the endocrinologist and they present the research, because that’s how I found out about cholestyramine. I don’t remember exactly, it probably was because I was looking into the cholestyramine and mold connection, and then just came across how it could help with people with hyperthyroidism.

                                                Up until then I didn’t know, it wasn’t in my first or second edition of the book because I didn’t know at the time. But if you showed the research [inaudible 00:35:47] endocrinologist, well they will recommend. Now, if you show him like my book or my website they probably won’t, because they don’t want anything to do with functional medicine. But again, I’ve had endocrinologists prescribe it to patients, and it does seem to be pretty effective. Now, as far as natural binders, I haven’t gotten too aggressive. I have used some things like activated charcoal and zeolite, and I haven’t seen the same effect. But to be honest, I haven’t had a person take really high doses of the binders.

                                                Maybe if I dramatically increased the binders, something that… Yeah, it’s one of those things where when someone’s dealing with hyperthyroidism too we want to try to lower the thyroid hormone levels as quick as possible. So I’ll give the bugleweed first, if that doesn’t work the L-carnitine. And again, I’ve tried regular doses of binders, like G.I. Detox, there’s different products out there. And I’ll go maybe like a capsule or two on an empty stomach, and I haven’t seen the same effect, maybe if I gave like five to 10 capsules [inaudible 00:36:54]-

Dr. Weitz:                            Yeah, yeah, you’ve got to use the powder, or yeah, give more capsules than that, yeah.

Dr. Osansky:                       Yeah. But it’s a good question, it’s something that I probably need to do more experimenting for for someone who is unable to… Where the bugleweed doesn’t work, and maybe the L-carnitine isn’t working either, maybe trying something like really high-dose binders, like natural binders for someone who either can’t take the cholestyramine or just doesn’t want to take the medication.

Dr. Weitz:                            Right. Somebody needs to do that study. And sometimes you recommend low-dose naltrexone? Or you’ve seen patients do well with that, because I know that’s a prescription?

Dr. Osansky:                       Yeah. I mean, it’s hit or miss. I mean, cholestyramine works with most people, anti-thyroid medication… I mean, methimazole, PTU work in most people, the problem is side effects are common. With LDN, low-dose naltrexone, side effects aren’t as common. I mean, some people will get insomnia, mild side effects. But it’s, again, a flip of the coin, maybe even less with Graves’. So LDN modulates the immune system and could be used for different autoimmune conditions, including Hashimoto’s. But again, there’s like an urgency to try to get the thyroid hormone levels down. And so usually if I recommend it, it’s when, again, someone can’t take the anti-thyroid medication and the natural agents aren’t working, then I’ll talk more about the cholestyramine, the LDN.

                                                LDN is easier to get usually, because you could even just hop on a phone. There are I guess like ldndoctor.com, there’s different websites where you can just schedule a consult with a practitioner and just get a prescription for LDN, where you can’t do that with cholestyramine. But the LDN’s typically not as effective, but if it works it works well, because it modulates the immune system, and obviously Graves’ is an immune system condition. So if someone takes the LDN and it works, then they might not need to take any of these other things that we mentioned while they’re trying to address the cause of the problem.

Dr. Weitz:                            So let’s go into some of the other root causes besides stress. We’ve got toxins, infections, gut health, take it where you want to go.

Dr. Osansky:                       Sure. I mean, let’s talk about infections. So just a few years ago we got hit with a big virus, and-

Dr. Weitz:                            Oh, what are you talking, about what virus? Oh.

Dr. Osansky:                       Well I mean, the thing is with the COVID situation, it actually… I mean, business definitely increased when it came to hyperthyroidism. And it’s in the literature too, where… And there’s Epstein-Barr, there’s other viruses too. But yeah, I mean, [inaudible 00:39:56]-

Dr. Weitz:                            Yeah, a little bit of stress too.

Dr. Osansky:                       Yeah. I mean, with that question, I mean, and that’s a good point. When someone has, whether it’s COVID in the past, whether it’s Epstein-Barr, these other viruses, I do think of them more as immune system problems. And usually it’s other factors dragging down the immune system, and they’re like the-

Dr. Weitz:                            I mean, think about the level of stress. “Oh my God, I’m going to die, I have to wear this mask, and gloves, and I have to wash my bags before I bring them in, I have to wash my Amazon box.” It was like, oh my God, it was crazy.

Dr. Osansky:                       Yeah, no, I get… Yeah, you’re right. I mean, the stress… Yeah, that was a big factor as well.

Dr. Weitz:                            I got stressed just watching everybody else being stressed out, and scared [inaudible 00:40:43] to walk down the block without a mask on. I mean, it was crazy.

Dr. Osansky:                       Yeah. No, I agree. I mean yeah, we definitely can’t discount the stress, as we just had that discussion earlier on. But then there’s other infections, there’s like I said, the literature, H. pylori, Yersinia Enterocolitica. I understand correlation doesn’t always mean causation, so as I mentioned earlier just because you have H. pylori doesn’t mean it’s a trigger. But if I encounter someone with Graves’ Disease, and if they test positive for H. pylori, at least up until this point I’ve been one to treat it, and I’ve seen people go into remission. Now, I’m not only getting rid of H. pylori, so I could make the argument, “Well, maybe it’s because I’m not just getting rid of the H. pylori, but improving their adrenals, and healing their gut, and doing everything else.” But again, that’s what’s worked with me, and-

Dr. Weitz:                            So you’ll do say like a GI map, and see an elevated H. pylori. Let’s say you see slightly elevated H. pylori, but no virulence factors. Well, is that something that you’ll consider targeting?

Dr. Osansky:                       Yeah. I mean, if it’s red flags, yeah. I mean, with GI map, as you know it’s quantitative PCR, so a lot of times I’ll pick it up, but it won’t be elevated. And [inaudible 00:42:02]-

Dr. Weitz:                            Right, so it’ll be above detectable levels, but it’s not in the red?

Dr. Osansky:                       Correct, yeah. So I mean, it’s great when I see it less than DL, less than detectable limits. But yeah, if it’s above the range I’ll treat it. But again, it’s like the treatment’s going to be… It’s going to be like probiotic therapy, some herbal therapy, I definitely wouldn’t… I’m not advising the person to get the triple therapy with two antibiotics and the PPI. I mean, some people opt for that, and usually I’m telling them, “Well…” I mean, the thing with the natural approach, it does take longer and it’s not always effective. But the problem with the medication, as you know, it disrupts the gut microbiome, and it’s also not always effective. That’s why they use two antibiotics with H. pylori.

Dr. Weitz:                            Right. So you’re going to typically use some product that has mastic gum in it?

Dr. Osansky:                       Correct, yeah, exactly. So mastic gum, use some probiotics in there as well, use some other… Black cumin is one that works good, I mean, even garlic. Not supplement-wise, but there’s some evidence and research that eating raw garlic, like a few… I think it’s like two cloves twice a day, which I did try on patients. And sometimes if they’re symptomatic I’ve seen it reduce the symptoms, but-

Dr. Weitz:                            You don’t see fewer patients coming in after eating all that garlic? No, I’m just kidding. Okay, so we got gut health. Talk more about toxins, I mean infections. And you were talking about the big infection that we had, and it turns out that reactivation of infections that are sitting there, like Epstein-Barr, turns out to be one of the things that’s involved with long COVID.

Dr. Osansky:                       Yeah. I mean again, Epstein-Barr, cytomegalovirus, I mean, as you’ve mentioned, yeah, those-

Dr. Weitz:                            HSP, yeah.

Dr. Osansky:                       Yeah, so all those could potentially be factors. Parvovirus in the literature, hepatitis C, there’s some evidence with hepatitis C, and I believe both Graves’ and Hashimoto’s in the literature. So yeah, I mean, again, a lot of people have… I mean, everybody has viruses, most people have Epstein-Barr. So again, we can’t always make that relationship. And like I said, it’s different with H. pylori because I can’t say I never use antiviral, like natural antiviral agents, but most of the time I’m just looking at the weaknesses in a body, like trying to focus on improving adrenal health and gut health, reducing the toxic load rather than trying to directly attack the virus.

Dr. Weitz:                            So will you, say, order a viral panel?

Dr. Osansky:                       Yeah. I mean, usually I’ll… I mean, I’ll test for Epstein-Barr. It depends on the person too, sometimes they won’t want to test, sometimes they’ll just test Epstein-Barr. But I don’t go crazy with all the viruses, because like I said it doesn’t necessarily change my approach. Like Epstein-Barr I’ll test for, just because it’s notorious when it comes to being a potential factor when it comes to Graves’. But I can’t say like I have everybody test for all the viruses I mentioned, everybody test for Hepatitis-C, and Parvovirus, and all these other viruses.

Dr. Weitz:                            Right, right. Yeah, some of the companies offer like a panel of a number of the most common viruses, like we use Vibrant a lot.

Dr. Osansky:                       Yeah, I’ve used medical… If you’re familiar with Medical Diagnostic Laboratories, they also look at viruses. I’ll use them more if I’m thinking maybe the person also has Lyme, or Bartonella, which also could be potential triggers too. So then I’ll-

Dr. Weitz:                            Right. What’ll tip you off that maybe that’s a factor?

Dr. Osansky:                       Well, I have a history of chronic Lyme. In 2018 I was diagnosed, and it was tricky because I didn’t have the classic Lyme symptoms. Mine was more neurological, there was no evidence of a tick bite. So in my case, I wasn’t sure at first if it was Lyme, but it just was atypical symptoms. Like I was having neurological symptoms that was jumping around in my body, and with Lyme you get the… Usually it’s the pain, like the migrating muscle and joint pain. With me it was more the migrating neurological symptoms, and I spoke with a few practitioners that I knew, and I thought maybe it was MS. They were like, “No, it doesn’t sound like MS.” And then yeah, so I ended up testing for Lyme. I was thinking, “Well, maybe it is Lyme.”

                                                And sure enough I tested, I tested positive for Lyme, Bartonella, a few other things. So with a patient it’s similar, like most people I’m not going to test for Lyme. But if they’re having some unusual symptoms… I mean, if they have like a history of a tick bite… Again, even then I can’t say I always test for Lyme, but that would be a red flag. But if they’re having some type of neurological symptoms, and things that just doesn’t tie into the hyperthyroidism, the Graves’ Disease condition, then I’ll at least bring it up as a possibility, if they’re having… Just because someone has neurological symptoms doesn’t mean they have Lyme or Bartonella, just because someone doesn’t…

                                                If they have even fatigue with migrating muscle and joint pain, I’ll highly suspect Lyme, but it doesn’t guarantee. Today, one of the patients I spoke with, they had… In the middle of the night they woke up with night sweats, but they were drenched in the middle of the night. And she has subclinical hyperthyroidism, so her thyroid hormone levels are normal, TSH is low, which again, most of the people I deal with that’s not the case. So I didn’t think in her, I don’t think it’s the hyperthyroidism causing that. It could be hormonal potentially, she’s in post-menopause. But again, Babesia, if you’re familiar with Babesia parasite, that could also cause that too. So that was like, I was thinking, “Ah.”

                                                You know, I wasn’t pushing it hard and saying, “Yeah, you definitely have Babesia.” But I’ve mentioned it to her that it could be a possibility, it could be hormonal, possibly thyroid, but just because her thyroid looks good… But yeah, so those are some of the things I look for.

Dr. Weitz:                            So in that case, you might do say like a Lyme and co-factors panel?

Dr. Osansky:                       Exactly, it’s something at least I’ll bring up, like when sending her followup recommendations. I mean, I spoke with her about it during the consult, I’ll bring it up with the followup again, and really leave it up to her. She might decide to look more into the hormones, but yeah. So it’s a possibility, is what I left it at with her. So [inaudible 00:48:52]-

Dr. Weitz:                            And how did you treat the Lyme in yourself?

Dr. Osansky:                       With the Lyme, when I dealt with Lyme I did panic a little bit, and I underwent IV ozone. I should backtrack, so first I thought it was acute Lyme, so I did take the doxycycline for a few weeks, which, I regret taking that. But a few weeks prior I was in upstate New York with my dog, and my dog was all over me that night, we were at a park, and I thought I got bit by a tick. Even though there was no evidence of tick bite I was putting the pieces together, because I developed like a low-grade fever right around that time. And I’m like, “Okay, this must be acute Lyme.” And of course I try to avoid the antibiotics, but one thing… Up until that point I was terrified of getting Lyme, and I’m like, “All right, I don’t want to take the doxy, but I don’t want it to turn into chronic Lyme.”

                                                It turned out it was already chronic Lyme, so maybe it was like a reactivation or something of a past Lyme infection that I wasn’t aware of. But when I was diagnosed I worked with a functional medicine practitioner who was a Lyme specialist, and she told me I could take like long-term antibiotics, which I don’t want any part of, and she was talking about the ozone. And prior to my Lyme diagnosis I was doing research on ozone, and I was already sold. I knew it wasn’t a cure for the Lyme, but I was just looking to get aggressive, to try to make sure it didn’t turn into a real bad case of chronic Lyme. So I got IV ozone and UV light for a few months, and I took some homeopathy, I took herbs as well.

                                                If I had to do it all over again… I mean, I can’t say I have regrets because everything turned out okay, but I probably would have been okay just the herbs, the homeopathy. I mean, I was already eating somewhat clean, the stress. I mean, stress is always going to be a factor, but based on my Graves’ experience I thought I was doing a better job of managing the stress and all that. So, that’s why I probably got aggressive with the ozone, because I felt like I was doing a lot of the things based on the Graves’ disease diagnosis, I was still doing things to maintain my health and I was like, just I want to… Yeah, so anyway I wouldn’t say it’s something that everybody should get, but that’s the approach I took.

Dr. Weitz:                            So let’s hit on the toxins a little bit.

Dr. Osansky:                       Sure. So heavy metals, mercury is probably the biggest culprit in the literature. I mean, aluminum is known to stimulate the immune system, but as far as like a relationship between Graves’ and aluminum there’s nothing in the research showing it. But I will say in hair testing though-

Dr. Weitz:                            I just want to make a comment, it was really annoying. I take a lot of supplements, and some of the companies put an aluminum little cap, when you unscrew the cap there’s an aluminum sealing thing. And you have to rip that off, and it’s so annoying handling aluminum. Anyway.

Dr. Osansky:                       Yeah. Yeah, no, I agree, yeah. But I was saying, hair testing, actually that’s one thing that it picks up pretty good. Almost everybody with the hair tests I do, it shows aluminum-

Dr. Weitz:                            Oh really?

Dr. Osansky:                       … which is interesting.

Dr. Weitz:                            Do you use Doctor’s Data, or who do you use for the hair testing?

Dr. Osansky:                       No, I use… I don’t know if you’re familiar with Analytical Research Labs?

Dr. Weitz:                            Okay, I’ve heard of them, I haven’t used them.

Dr. Osansky:                       Yeah, yeah, so they’re like almost everybody shows some levels of aluminum. I mean, not everybody like sky high, but it usually picks it up pretty well. So yeah, there’s mercury, there’s, again, aluminum that stimulates the immune system, cadmium, lead, arsenic. Again, not a lot of literature when it comes to thyroid and autoimmune with the other ones. With mercury there is, so if someone has mercury amalgams, again, I’m not going to push heavily to get them out. But I will bring it up, and talk about biological dentistry, and suggest even if they don’t get it out now something maybe to work on in the future. Like if they have like five silver fillings, even if they get out like one or two a year, before they know it they’ll all be out.

                                                Whereas if they don’t do anything, in a few years they’ll still obviously be present. And then xenoestrogens, so bisphenol A from plastic water bottles, and other endocrine-disruptors. Just even things like… I mean, we don’t tend to… I mean, I’m sure you think of it, just like I think of it. But like the mattress, trying to use more natural mattresses.

Dr. Weitz:                            Absolutely, yeah. They’ve got the flame-retarding chemicals that they [inaudible 00:53:45] mattress and the [inaudible 00:53:45].

Dr. Osansky:                       Yeah, exactly, those flame retardants, and bringing your clothes to the dry cleaner. I don’t do a lot of dry cleaning, but if I do it’s, we use an organic dry cleaner. And then of course in the house, just trying to use natural products like cleaners and fluoride-free… Even though fluoride is more associated with hypothyroidism, disrupting thyroid function, but still using a… So one could make the argument, maybe we should take fluoride if we have hyperthyroidism. So seriously, I do recommend avoiding the fluoride, since it’s also a neurotoxin. Yeah, I mean, glyphosate I mentioned earlier, glyphosate, which disrupts the gut microbiome, which is a factor with all different autoimmune conditions, not just Graves’ Disease. And just, unfortunately we can’t completely avoid glyphosate in this day and age.

Dr. Weitz:                            Well you know, the reason why some people advocate avoiding fluoride for the sake of hyperthyroid is, it blocks the iodine because it’s in that same family. So therefore, even more reason to avoid supplementing with a lot of iodine, if you have hyperthyroidism.

Dr. Osansky:                       Yeah, yeah. Good point, with the halides competing with each other. So yeah, that’s [inaudible 00:55:01].

Dr. Weitz:                            Right, yeah. Consume more bromide on purpose.

Dr. Osansky:                       There you go. But yeah, just again, as you know… So there’s no shortage of environmental chemicals, and there’s so many we’re just not aware of also. So we’ve just got to do our best, and most of the things we can do are in our own home. Once we step outside, there’s not a whole lot we can do.

Dr. Weitz:                            Yeah. Vibrant Labs offers this Total Tox-Burden test through urine, that includes heavy metals, environmental toxins, like 30 different ones, as well as mycotoxins.

Dr. Osansky:                       Oh, interesting, okay. So it includes the mycotoxins too? Yeah.

Dr. Weitz:                            Yeah.

Dr. Osansky:                       Because I know Great Plains out there, Mosaic Diagnostics I think, they changed their name. But they-

Dr. Weitz:                            I think they got bought out, yeah.

Dr. Osansky:                       Oh, did they get bought? Okay, I didn’t know they got bought out. But anyway, so you have to purchase… I think you could get them as a bundle, but they have the separate mycotoxins test. But also it’s interesting, which I’m sure you know, they also now… They have Cyrex Labs, that does like immune system testing for environmental chemicals, to see your immune system response [inaudible 00:56:15].

Dr. Weitz:                            Sure. Yes, yeah, yeah, yeah. You can do immune system reaction to foods, to chemicals, to toxins, to infections, yeah.

Dr. Osansky:                       Yep, yeah. So there’s a lot more options these days than there was 10, 15, 20 years ago.

Dr. Weitz:                            Yeah. In testing, tests don’t guess. So, yeah. I think we’ve covered the topic pretty well. There’s any final thoughts you have for our listeners and viewers?

Dr. Osansky:                       Well, I would just say for those listening who have hyperthyroidism, I mean, the big thing initially is to be safe. You want to make sure, whether it’s the natural agents, or if you absolutely have to take the medication, just do what’s necessary to make sure those thyroid hormone levels are lower. So, you don’t have a resting heart rate of like 120 or 140. And it also affects bone density, we’ve got to keep that in mind when the thyroid hormone levels are too high. And then while you’re addressing the cause, whether it’s doing it naturally or even if you have to rely on a medication, obviously you want to do things to find and remove those triggers, correct those underlying imbalances. Because again, [inaudible 00:57:32] and thyroid surgery, I’m not saying there’s not a time and place for surgery. But, it’s not doing anything for that immune component of Graves’.

Dr. Weitz:                            You know, we should cover one more thing real quickly. We didn’t really talk about diet for hyperthyroid, and I know that that’s something that you take seriously.

Dr. Osansky:                       Yeah, no, that’s right, we didn’t cover… I spoke about food when we talked about triggers, but I just spoke about gluten and common food allergens, but you’re right. So yeah, diet when it comes to really any autoimmune condition, yeah, there’s no single diet that fits everybody perfectly, and I think you probably would agree with that, Dr. Ben. But yeah, I mean, I will say I do like paleo, I do like autoimmune paleo, but they’re starting points, they’re not… And we don’t want anybody to get really stressed out, so if I talk about autoimmune protocol, because it is quite restrictive. And the goal is not to reduce calories, that’s the last thing we want to do with someone, especially someone who is in a similar situation that I was when I was losing a lot of weight.

                                                We don’t want someone to think that they can’t eat, they can hardly eat any food. So if they’re following AIP, assuming they’re not vegan/vegetarian, if they are that’s a whole different story. But yeah, definitely make sure you’re getting enough protein, eat a decent amount of meat if… And also I recommend vegetables, fruits. But some people do fine on paleo, where they’re eating eggs, they’re eating some nuts. Of course avoiding refined foods, sugars, the allergens that I mentioned like gluten, dairy, corn, avoiding nightshades, also something that not only I recommend but a lot of people when it comes to autoimmune. But yeah, I do recommend more of a paleo, AIP-type diet. If someone is vegan/vegetarian I’m not completely opposed to them modifying that, where they’re eating some pressure-cooked legumes to make sure they’re getting enough protein. Because a big problem with hyperthyroidism, you’re losing a lot of muscle mass too. So, you just want to make sure you’re getting enough protein.

Dr. Weitz:                            There’s certain foods, like cruciferous vegetables, that are considered [inaudible 00:59:53], that they block thyroid hormone. Is that a good idea in the case of hyperthyroid, to consume a lot of [inaudible 01:00:05] foods, like broccoli?

Dr. Osansky:                       Yeah, I’ve actually spoken about this, I think I mentioned in the book too. But on my website and in the podcast, I think I mentioned it in an episode. I tried intentionally to… Especially with pregnant women in the past, when working with pregnant women, and ones who didn’t want to take the medication, and they can’t take things like bugleweed.

Dr. Weitz:                            Herbs, yeah.

Dr. Osansky:                       And yeah, so and then even L-carnitine, there’s no research taking like two to four grams, like that high of a dose, I’m more conservative with a pregnancy about doing things like that. So I actually experimented, I figured there’s no harm in having them eat a lot of cruciferous vegetables to see if that will lower thyroid hormones. And honestly, it didn’t have much of an effect. So I would say, go for it if that’s what you want to do, but I wouldn’t expect that alone to have a significant impact on the thyroid hormone levels.

Dr. Weitz:                            Right. Actually, there is some interesting data on the benefits of L-carnitine for pregnancy, and I know Metagenics now includes a separate L-carnitine supplement as part of their prenatal.

Dr. Osansky:                       I guess the high dose is what I was referring to, like I don’t know, probably 500 to 1,000 milligrams, yeah.

Dr. Weitz:                            Yeah, yeah, yeah. I think they’re recommending like five [inaudible 01:01:22] yeah, yeah.

Dr. Osansky:                       Yeah. But like 2,000, I mean, honestly it probably would be okay if they took like 2,000. I just don’t know, that’s the-

Dr. Weitz:                            Yeah, I don’t want to take a chance with pregnancy. Okay, great, excellent. So you have two books out, right?

Dr. Osansky:                       Correct, so Natural Treatment Solutions for Hyperthyroidism and Graves’. As you said, I’m currently as of recording this getting ready to release the third edition. And then Hashimoto’s-

Dr. Weitz:                            When is that going to be released?

Dr. Osansky:                       I’m hoping by September, September 2023.

Dr. Weitz:                            Oh, okay. Are you self-publishing?

Dr. Osansky:                       Yes, yes, mm-hmm.

Dr. Weitz:                            Okay, great. And where will that be? Will that be available through Barnes & Noble and all the booksellers, or where?

Dr. Osansky:                       Yeah, that will be… You could go online to Amazon Online, Barnes & Noble. So yes, they could… Yep.

Dr. Weitz:                            Good. And then you have another book on hypothyroid, right?

Dr. Osansky:                       Correct. So in 2018 I released the book Hashimoto’s Triggers, which you could also… Actually, I don’t know if that’s on Barnes & Noble’s. I know that one’s, Hyperthyroid, but I think this one I just… Again, I self-published this as well, but this also is… I think this one is just on Amazon, both print book and Kindle.

Dr. Weitz:                            Okay, great. And how can listeners and viewers get a hold of you if they want to find out more, or possibly work with you?

Dr. Osansky:                       Well they could visit savemythyroid.com, and they could click on Work With Dr. Eric is probably the best way if they want to work with me. Or if they’re still not sure, they could click on Podcast, listen to some of my podcasts, and read my books. But yeah, I would say that would be the action they would want to take if they do want to work with me.

Dr. Weitz:                            Excellent. Thank you so much, Dr. Osansky.

Dr. Osansky:                       Thanks, Dr. Weitz. Appreciate your time, and thank you so much for having me.

 


 

Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoyed 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. Dale Bredesen discusses Reversing Alzheimer’s Disease at the Functional Medicine Discussion Group meeting on July 27, 2023 with moderator Dr. Ben Weitz.

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

 

Podcast Highlights

5:35  Alzheimer’s disease is now optional, because Dr. Bredesen’s precision medicine approach can help to prevent and reverse Alzheimer’s and it is hoped that this approach can be extended to all of the major neurodegenerative diseases.  Dr. Bredesen and his group have published over 220 peer-reviewed papers on the underlying mechanisms of neurodegeneration.  On the conventional treatment front, so many amyloid antibody drugs have failed including bapineuzumab, solanezumab, gantenerumab, and crenezumab.  The newest drugs include aducanumab, which has a minimal effect, and lecanemab (aka, Leqembi), which does have a measurable effect.  But these new drugs do not make anyone better, but instead they lead to a slowing of the progression and they often have some negative side effects like brain bleeding and brain swelling and several patients have died. 

7:40  Homotaurine. This is currently a nutritional supplement that is currently in clinical trials. It prevents the oligomerization of A-beta, so it looks like it may be a very interesting adjunct to other parts of the Bredesen protocol.  The dosage used was either 100 mg three times per day or 150 mg twice per day. [Manzano S, Agüera L, Aguilar M, Olazarán J. A Review on Tramiprosate (Homotaurine) in Alzheimer’s Disease and Other Neurocognitive Disorders. Front Neurol. 2020 Jul 7;11:614.]   Combined metabolic activators (CMA) shows benefit in improving cognition in patients with Alzheimer’s disease. CMA dosage includes:  12.35 g L-serine (61.75%), 1 g nicotinamide riboside (5%), 2.55 g N-acetyl-L-cysteine (12.75%), and 3.73 g L-carnitine tartrate (18.65%). AD patients received one dose of CMA or placebo daily during the first 28 days and twice daily between day 28 and day 84. [Yulug B, Altay O, Li X, et al. Combined metabolic activators improve cognitive functions in Alzheimer’s disease patients: a randomised, double-blinded, placebo-controlled phase-II trial. Transl Neurodegener. 2023 Jan 26;12(1):4. ]

8:39  Dr. Bredesen is starting a randomized controlled trial of his ReCode system with six absolutely fantastic clinicians: Craig Tanio down in Hollywood, Florida, Nate Bergman in Cleveland, David Haase in Nashville, Kristine Burke in Sacramento, Kat Toups in the East Bay, and Ann Hathaway in Marin County. 

9:25  KetoFlex.  Dr. Bredesen’s recommended dietary approach for Alzheimer’s disease, the KetoFlex and he worked with Nutrition for Longevity, a group founded by Dr. Valter Longo, to develop KetoFlex meals for home delivery, which is now available.

11:30  New lab tests for help with analyzing Alzheimer’s disease1. p-tau 181, 2. p-tau 217 is coming soon, 3. Abeta 42:40, 4. Neurofilament light, and 5. GFAP (glial fibrillary acidic protein), which will be available soon. P-tau 181 lets you know that you have the specific signaling characteristic of Alzheimer’s. The Abeta 42:40 test lets you know whether you are making Amyloid beta protein, which is typically associated with inflammation and with Alzheimer’s. Neurofilament light is not specific for Alzheimer’s, but it tells you that you do have neuronal damage.  This also goes up in frontotemporal dementia and ALS and certain other neurodegenerative conditions.  GFAP lets you know that you have reactive astrocytes in the brain, which can precede Alzheimer’s disease. 

16:00  When you compare the state of the treatments for Alzheimer’s disease, with no treatment the patient’s MOCA score will decline by about three and a half points and if you take the Lecanemab, which is the newest drug given FDA approval that costs about $40,000 per year, of which the person on average will end up paying $10,000 per year after Medicare, and it will slow the decline by 27% in men or 12% in women. Only Dr. Bredesen’s ReCode precision medicine approach will result in a gain of about 4/30 points in cognition.  

 

18:27  The standard of care for patients with cognitive impairment is inadequate.  If you go to a memory center of excellence, they will likely tell you that they are only going to treat you if it gets pretty significant.  There’s no attempt to identify the cause of the problem and they adhere to this outdated claim that nothing can prevent or reverse Alzheimer’s.  If you’ve got someone in a nursing home with Alzheimer’s, they don’t tell all the children that they should be on active prevention. The average patient spends an average of $350,000 before they die, with most of that on nursing homes.  The only treatment offered is mono pharmaceuticals.  Such a treatment approach is out of date.  Telling a patient that they only have mild cognitive impairment is analogous to telling them that they only have mildly metastatic cancer.  Unfortunately, once a patient has mild cognitive impairment, it is a relatively late stage of the underlying pathophysiology. 

There are four stages of Alzheimer’s:

1. Asymptomatic.  Stage one is when you are asymptomatic but you can see abnormalities on spinal fluid, PET scans, and on those blood tests that were mentioned, like p-tau 181. 

2.  Subjective Cognitive Impairment.  If you don’t do anything about it and continue to go downhill, you start to develop subjective cognitive impairment (SCI), which is stage two, when you have some changes in cognitive function, though you may still score in the normal range on a cognitive questionaire. 

3. Mild Cognitive Impairment. Stage three is mild cognitive impairment (MCI) and now your cognitive testing is abnormal, though you can still perform you activities of daily living.  Even though this is called mild, it is actually a relatively late stage of the disease.

4. Alzheimer’s disease. Each year 5-10% of those with MCI go on to stage four, or Alzheimer’s, which is the stage of dementia.  The diagnosis of Alzheimer’s is typically made 20 years after the initial biochemical changes occur. 

 

21:35  When you look at scans of the brains of patients with Alzheimer’s, you can see significant differences. The brain shrinks and the sulci widen and you can see differences in the ventricles.  The first area of the brain that shows damage in Alzheimer’s patients is the locus coeruleus in the brain stem, which literally means the blue spot.  Damage to this area results in people losing their way, losing their verve, losing their interaction. 

22:39  Amyloid protein and phosphorylated tau.  If you look at the brain under a microscope you can see collections of amyloid protein and you can see neurofibrillary tangles from phosphorylated tau.  There is inflammation in the brain, so you can see reactive microglia and reactive astroglia.  This is part of the model to explain Alzheimer’s, but none of this led to any approach that resulted in effective treatment.  When you simply remove the amyloid, you don’t get much of an effect in clinical trials.

23:25  There are actually a large number of risk factors for Alzheimer’s, including low vitamin D, type II diabetes, metabolic syndrome, menopause, chronic infections like herpes, and genetic risk factors like ApoE4.

25:20  Prionic nature of amyloid and tau.  Dr. Stanley Prusiner won the Nobel Prize in 1997 for his discovery of prions and Dr. Bredesen trained with him as a post-doc.  When amyloid and tau proteins get into the brain, they tend to accumulate and beget more of themselves much like prionic proteins. 

27:30  When you have infections, inflammation, and toxin exposures in your brain, your brain goes into a downsizing, protective mode and amyloid protein proliferates as a protective antimicrobial peptide, as Professors Robert Moir and Rudy Tanzi from Harvard published several years ago: Moir RD, Lathe R, Tanzi RE. The antimicrobial protection hypothesis of Alzheimer’s disease. Alzheimers Dement. 2018 Dec;14(12):1602-1614.   

29:57  Alzheimer’s disease is a chronic disease marked by a signaling imbalance much like osteoporosis. In osteoporosis, you have an imbalance between osteoclastic activity, which is greater than osteoblastic activity. In Alzheimer’s you have synaptoclastic signaling outweighing your synaptoblastic signaling.

 



Dr. Dale Bredesen is a neurologist and an internationally recognized expert in the mechanisms of neurodegenerative diseases like Alzheimer’s Disease and the Chief Science Officer at Apollo Health. He is the author of the best selling books, The End of Alzheimer’sThe End of Alzheimer’s Program, and The First Survivors of Alzheimer’s. Dr. Dale Bredesen’s career has been guided by a simple idea: that Alzheimer’s as we know it is not just preventable, but reversible. Thanks to a dedicated pursuit of finding the science that makes this a reality, this idea has placed Dr. Bredesen at the vanguard of neurological research and led to the discoveries that today underlie the ReCODE Report.  Dr. Bredesen offers training for doctors and practitioners in his ReCODE system at his website at ApolloHealthco.com.

Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.

 



 

Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello everybody, welcome to the Functional Medicine Discussion Group meeting tonight with Dr. Dale Bredesen on how to prevent and reverse Alzheimer’s disease. I’m Dr. Ben Weitz. I want this meeting to be interactive, so please participate by typing your questions into the chat box, and then I’ll either call on you or ask Dr. Bredesen your question when it’s appropriate. Thanks for joining our Functional Medicine Discussion Group monthly meeting, and I hope you consider attending some of our future events on August 24th.

                                                Dr. Tom Fabian of Diagnostic Solutions will be talking about the link between dysbiosis, mast cell activation and IBS. And on September 28th, Dr. Peter Bongiorno will be discussing an integrative approach to depression and anxiety. We also have a closed Facebook page for practitioners only, the Functional Medicine Discussion Group of Santa Monica that you should join. I’m recording this event. I’ll include it in my weekly Rational Wellness podcast, which you can subscribe to on Apple Podcast, Spotify, or YouTube. If you enjoy listening to it, please give me a five star ratings and review on Apple or Spotify. Our sponsor for this evening is Integrative Therapeutics. Steve, are you on the call?

                                                Steve said he wasn’t sure if he was going to be able to make it, but I want to tell you about a couple of Integrative products. Steve wanted me to emphasize, Integrative makes a highly absorbable form of curcumin called Theracurmin. And there was a study published in 2021 done at UCLA in which Theracurmin improved memory and mood in patients with age associated memory decline. And there’s a current study that showed that Theracurmin stabilized progression in loss of cognitive function. And so Theracurmin is a water-soluble form of Theracurmin, and the effective dose is only two capsules. It’s a highly effective product for reducing inflammation.

                                                Our speaker for this evening needs no introduction, but I am going to try to introduce him anyway, Dr. Dale Bredesen. Dr. Dale Bredesen is a neurologist and an internationally recognized expert in the mechanisms of neurodegenerative diseases like Alzheimer’s disease, and he’s the Chief Science Officer at Apollo Health. He’s the author of three bestselling books, The End of Alzheimer’s, The End of Alzheimer’s Program, and The First Survivors of Alzheimer’s. Dr. Dale Bredesen’s career has been guided by a simple idea that Alzheimer’s as we know it is not just preventable, but reversible. Thanks to a dedicated pursuit of finding the science that makes this a reality, the idea has placed Dr. Bredesen at the vanguard of neurological research and led to the discoveries that today underlie the ReCODE Report.  Dr. Bredesen offers training for doctors and practitioners in his ReCODE system at his website at Apollo Health.

I’d like to say one more thing, Dr. Bredesen before you get started. On behalf of the functional medicine community, if I may be so bold, I would like to thank you. There are many giants in the functional medicine community, including the father of functional medicine, Dr. Bland, Dr. Pizzorno, Dr. David Jones, Dr. David Perlmutter. So many others have mapped out many of the scientific bases of functional medicine. Dr. Mark Hyman has brought functional medicine into the Cleveland Clinic.  But really you, Dr. Bredesen, have really published some of the most important academic research and academic journals proving for the first time that a functional medicine approach is an effective first-line treatment for such a serious condition as Alzheimer’s disease. And this is really a landmark accomplishment. So from the functional medicine community, I thank you.

Dr. Bredesen:                    Thanks so much, Ben. Thanks very much everybody for having me. Please forgive me if I’m a little bit slow tonight. I’ve just had surgery and I’ve got a surgical drain in currently, so I’m a little bit out of it at the moment, but hopefully we’ll get through everything. But I think this is great timing. I’ll show you why. Let me just share the screen here. There’s just so much amazing stuff going on, and so I’m really thrilled. There’s just so many good things. So you can see this, okay, hopefully.

Dr. Weitz:                          Yes.

Dr. Bredesen:                    We’ve really gotten to the point that Alzheimer’s is now optional, and I’ll show you why. And what’s exciting is we hope now that we’re going to be able to extend this to all of the major neurodegenerative diseases and that these will really be, they’re going to literally we’re in a period in which we will see these transform from impossible to treat terminal life sentences, terminal illnesses, which they’ve always been. Lewy body disease, frontotemporal dementia, ALS, Alzheimer’s. These are all terminal illnesses. We’re seeing them right before our eyes transform into illnesses that are preventable and reversible. So let me show you why we believe that. We spent 30 years in the lab. We published over 220 peer-reviewed papers on the underlying mechanisms of neurodegeneration. And then back in 2011, 2012, we started to translate these into ways that you can actually make people better.

                                                And as you mentioned, we are seeing this again and again. So lots new going on. Let’s talk about that first. A lot of people have heard about lecanemab now called Leqembi as the trade name, and now donanemab, another one coming down. So what’s happened is after all of these different antibodies failed, bapineuzumab, solanezumab, gantenerumab, crenezumab, all failed, aducanumab had a minimal effect, and now lecanemab has a measurable effect. But as I’ll show you, what it does is it doesn’t make you better, it doesn’t stabilize you, but people with Alzheimer’s early on, people with MCI that what it’ll do is it is a 27% slowing, and actually if it’s a female patient it’s only 12% slowing.  So it’s a very minimal effect and unfortunately has some negative side effects like brain bleeding and brain swelling, and in a couple cases death. But there’s been so much PR around this without recognizing the fact that there are lots of things that are actually better. Homotaurine, I don’t know if anybody uses this, but it’s been very interesting. It prevents and is currently in clinical trials. It prevents the oligomerization of Abeta. So it actually looks like it may be a very interesting adjunct to other parts of the protocol. And then-

Dr. Weitz:                          Doc, is that a nutrient or is that a pharmaceutical?

Dr. Bredesen:                    Actually, it’s a supplement. So you can get Homotaurine as a supplement. Now they’re trying to do a precursor of this that will probably be sold as a drug. It’s in phase two trials right now. If this all works out, they will probably try to turn it into a drug. We’ll see. But you can use Homotaurine right now as a supplement. And they were using either 100 milligrams three times a day or 150 twice a day. Then you may have seen the paper on combined metabolic activators. Very interesting. And as you’ll see, it makes perfect sense based on the research that we published. And then we are just starting a randomized controlled trial. You can look at our proof of concept trial, which is freely available online. We published last year in the Journal of Alzheimer’s Disease. Very successful, 84% of the people actually got better.

                                                The randomized controlled trial, very excited about that. It’s with six absolutely fantastic clinicians. Craig Tanio down in Hollywood, Florida. Nate Bergman in Cleveland, David Haase in Nashville, Kristine Burke out here in Sacramento. Kat Toups, who’s over in the East Bay, and then Ann Hathaway, who’s right near here in Marin County. So very, very honored to be working with this absolutely great group of physicians. And then one of the big complaints we’ve had is, hey, it’s not that easy to get the right food, to get the right organics, to get the right plant rich ketogenic diet, make sure it has the right sourcing and so forth and so on.

So we worked with KetoFLEX, with a group from Nutrition for Longevity. This is Jennifer Maynard and her group.  This was a group founded actually by Valter Longo. It’s been months and months and months. And finally they’ve actually got this, it’s now ready for delivery. I’ve had it myself. It’s actually quite delicious. So they did a great job. So they have a KetoFLEX, 12/3 that’s available for delivery. And this is in the 48 states, so you can’t yet get it yet in Hawaii or Alaska, but you can get it everywhere else in the country.

And then you may have seen an interesting paper from a few months ago. This is the work of Professor Rick Johnson in Colorado. And David Perlmutter and I were co-authors as well as several other people. And what he showed was quite interesting, and he’s been working on fructose mechanisms for years. And what he found is that fructose, because it’s associated with massive amounts of fruit intake in the fall, it actually is getting you ready for winter. So what it does is it turns down your energetics, turns down your ATP.

                                                And as I’ll show you, the two big players in cognitive decline are energetics and the innate immune system, essentially inflammatory pathways. And so that’s the last thing you want to do, is turn this down, it makes things worse. And he has a very interesting point where he just listed all the different characteristics of Alzheimer’s and all the different characteristics of what happens to your biochemistry, your cellular biochemistry and mitochondrial biochemistry when you have large amounts of fructose, and they line up remarkably well. I think he’s onto something important. I don’t think it’s by any stretch the only cause of Alzheimer’s, but I think it’s a relatively common contributor.

                                               And then interestingly as you may have seen, there is a whole new set of blood tests. People in the past have had to do spinal taps or PET scans to determine where you stand with your Alzheimer’s disease and do you really have it or not?   Now you can do blood tests. P-Tau 181 is already available. I believe it’s now available from LabCorp. P-Tau 217 is not yet available, but it’s coming soon. Both of them very helpful. What they’re really telling you is that you have the type of signaling that is associated with Alzheimer’s disease, so you don’t have to do the spinal taps, you don’t have to do the expensive PET scans. Abeta 42 to 40 ratio also helpful, and that’s available from a couple different groups. And then interestingly, Neurofilament light, also online is available. And then GFAP, not yet available, but is coming. Now, they each tell you something different. So the pTau is telling you that you have the associated signaling of Alzheimer’s. It’s relatively specific. Same thing for 217.  Abeta 42 to 40 is telling you whether you have a condition where you are making Abeta, which is typically associated with inflammation and Alzheimer’s. Neurofilament light, not specific for Alzheimer’s, but it is telling you you actually have neuronal damage from whatever. It goes up in frontotemporal dementia, it goes up in ALS, things like that. And then GFAP again is complimentary, is different. It’s not as specific at all. It’s just telling you you have reactive astrocytes, but it’s very sensitive. So you see changes first in GFAP. So my feeling is anyone who’s 40 or over should find out their GFAP, and it’s going to be available presumably within the next few months, because you can get an idea, am I heading toward anything? The future is going to be, none of us is going to wait to have dementia.

                                                Frankly, it’s just so silly the way medicine is currently practiced where people wait and wait and wait and wait and wait, and then finally say, oh yeah, you got dementia. There’s nothing we can do. You can see this coming years and years ahead of time. And we’ll talk about the four major stages. And then it’s interesting you mentioned Santa Monica, Ben. We are just going to open later this year, the first precision medicine program for neurodegenerative disease in the world. So we’ll allow people to send people from all over the world who have various neurodegenerative diseases, be they Alzheimer’s, frontotemporal dementia, ALS, Lewy body, what have you, and have real hope.      And this is going to be at the Pacific Neuroscience Institute, PNI, within one of its centers called the Pacific Brain Health Center. So very enthusiastic about that. And I’ve been working with-

Dr. Weitz:                          Is that affiliated with Providence Hospital?

Dr. Bredesen:                    Yes, yes. Will be affiliated with Providence. Yes. And you probably know Dan Kelly, who’s the neurosurgeon who runs PNI and David Merrill, actually one of the guys who took our training early on has been doing a great job and founded the PVHC. And so I’ll be working with David and his team and we’ll be now adding new features there. So very enthusiastic about that.

Dr. Weitz:                          That’s great.

Dr. Bredesen:                    So as I said earlier, we are literally witnessing the transformation of neurodegenerative diseases. For my whole career and for my whole time in the lab, there’s nothing you could do about these things. And we’re seeing them go from hopeless to preventable, reversible, and ultimately optional. We’re far ahead on Alzheimer’s. We’ve got some good results with Lewy body. We’re beginning to see some good results with dry macular degeneration. But I hope that we’re going to now see the same sorts of things with ALS, with frontotemporal dementia. We’ve got an interesting case, for example, with Dr. Craig Tanio down in Florida, and he’s had some wonderful results with a person recently who has corticobasal degeneration, which is a death sentence.  This person had already been told, get your affairs in order. There’s absolutely nothing to do. And Craig has had wonderful results. Similarly, posterior cortical atrophy, which is one of the presentations of Alzheimer’s, which Kerry Mills Rutland, you may know from New York, has a patient with PCA, just beautiful results, doing very, very well. It’s so wonderful to see these things which were simply never possible before.

So as I mentioned earlier, it’s important to compare what actually happens with these drugs and the one that’s just been given FDA approval and the reason that for all of us who are paying Medicare, we’re all going to be paying more because this is a multi-billion dollar drug, it will cost the patient about $40,000 a year. Medicare will be picking up 80% of that. The person will still end up paying close to $10,000 a year.   So here’s lecanemab. What it does is if you have no treatment and you have MCI or Alzheimer’s, you go downhill about three and a half points on a 30 point scale per year. Lecanemab slows that up by 27%. As I said, if you’re a woman, it’s 12%. In our trial that we’ve published, you can see here, we actually made people get better, didn’t simply slow their decline. So huge difference.

Dr. Weitz:                          Essentially Dale, what they’re saying with that drug is that your mother is going to spend a longer period of time in the memory care center. The goal is to get her out of it and not spend more time there.

Dr. Bredesen:                    It’s really impressive to me. The PR for this, it just keeps saying, well, there’s nothing else you can do. Well, there’s published results that say the opposite of that, but they just literally just ignore published results. So it’s interesting to me, this has really been many, many, many millions of dollars paying consultants to write good things about this drug, which is really not such a great drug. I think as we’re all aware, we are seeing the kind of medicine that I learned many, many years ago back in the 70s and 80s, literally the Titanic of mainstream medicine is going down right in front of us, sunk by the iceberg of chronic illnesses. You talk about Alzheimer’s or vascular disease or ALS, you just go right down the list.   And we saw this with our own daughter years ago who developed early lupus, and we took her to two world experts on lupus who said, yeah, she’s got early lupus, nothing you can do. When she gets worse we’ll give her some steroids. And we said, well, why did she get this? And they said, we don’t know. Nobody knows. So we then took her to a functional medicine physician who said, yeah, I know exactly why she got this and I can do something about it. And she’s had virtually no problems in the last 10 years. And it really shows that the new era is about why did you get these problems?

                                               But as you know today if you go to a standard of care doctor, you go to a memory center of excellence, what they tell you is it is probably not Alzheimer’s. We’re only going to treat you if it gets pretty significant.  They get small data sets. There’s no attempt to identify what’s actually driving the problem. They adhere to this outdated claim that there’s nothing will prevent or reverse or delay Alzheimer’s. If you’ve got someone in a nursing home, they don’t tell all the children, hey, wait a minute, all of you should be on active prevention. Why are they not doing that? And the statistics show that the patients spend an average of $350,000 before they die. Most of it on nursing homes of course. And of course this insistence on treating with mono pharmaceuticals, this stuff is really, really out of date unfortunately. One of the big problems is people say, you only have mild cognitive impairment. This is a analogous to telling someone, don’t worry, you’ve only got mildly metastatic cancer. This is a relatively late stage of the underlying pathophysiology.

                                                So you go through four stages when you get Alzheimer’s disease. Phase one, you’re asymptomatic but you can already see abnormalities on spinal fluid and PET scans. And the good news, you can now see the abnormalities on those blood tests that I just mentioned. So just as everybody, we all want to know our blood pressure, our HRV, our lipid panel, we should also want to know our Alzheimer’s panel. Really good idea. If you don’t find that out and you continue downhill, you start to develop some, what’s called SCI, subjective cognitive impairment. And by definition, this means that you’ve got some changes where you notice there’s something that’s not quite right. Often your spouse and coworkers may notice that something’s not quite right, but you’re still capable of scoring in the normal range.

                                                The good news, SCI lasts about 10 years on average, and it’s 100% reversible. We see these people reverse all the time. So if we could get everybody to come in for active prevention, I.e phase one, or even before phase one or phase two with SCI, there would be virtually no dementia. Now if you don’t do something about this, this you then progress to mild cognitive impairment, which as you can see is a relatively late stage of the disease. So it’s too bad they called it mild cognitive impairment. By definition now your cognitive testing is abnormal, but you can still perform your ADLs. Five to 10% of those people convert each year to stage four, with phase four, which is Alzheimer’s. And by definition, that’s really the dementia phase of Alzheimer’s. It’s all Alzheimer’s, but this is the dementia phase.  And so that means your activities of daily living are affected. And so what that means is the diagnosis of Alzheimer related dementia is typically made about 20 years after the beginning, biochemical changes. And that’s well documented. So we can do so much better if people simply won’t wait.

                                                And I don’t know how many people have looked at the brains of Alzheimer’s patients, but you can see striking differences. One thing you can see, for example, here are your SCI here, and you can see here that they widen. You can see right here versus here. And then interestingly, of course the brain shrinks. You can see the huge difference in the ventricles here, here versus here.  And then interestingly, the very first area that is damaged even before the entorhinal cortex, which is often said to be the first area, happens to be this locus coeruleus, which is in the brainstem right here, which literally means the blue spot. And this is the site where there is noradrenergic projection to your cortex. And so no surprise, one of the things you see early on is people lose their way, they lose their verve, they lose their interaction. And one of the things we hear commonly when people are starting to get better, is that their spouse will say, wow, they’re just more engaged. They’re really more with it.

                                                And then of course, if you look under the microscope, we’ve all heard about amyloids. You can see here collections of amyloid. This is largely from a peptide called amyloid beta. We’ll talk about that in just a second. You can see here these neurofibrillary tangles, and this is where you find the phosphorylated tau. So these are two different pieces here, the amyloid and the tau, and then of course there’s inflammation. So you see reactive microglia, and you also see reactive astroglia as well. So these are all part of this. So if we want to ask, well, what is this thing? And this is basically what we spent all these years in the lab looking at, because all these models that had been generated, none of them led to any approach that actually gave you good treatment. So we have to explain a lot of things to explain this disease.

                                                We have to explain why it is hugely different risk factors, whether it’s a change in your oral microbiome with P. gingivalis or type 2 diabetes or metabolic syndrome or menopause, low vitamin D, herpes simplex, mycoplasma, APOE4, which is the common genetic risk, down syndrome, just on and on and on. These risk factors are so different. So whatever we come up with has to explain those. There are about 100 risk associated genes, as I mentioned, APOE4 being the common one, but there are many, many. Why is that? What does that mean? The fact that amyloid is in the brains, it’s been implicated repeatedly, and yet when you remove it, you don’t get much of an effect in clinical trials. Why is that? The age associated risk, this dramatic increase as you get over 65.

                                                And by the way, we’re seeing a lot of people in their 40s and 50s now get diagnosed with Alzheimer’s. When I was training, we never saw people in their 40s or 50s with Alzheimer’s. And in fact, the epidemiologists have pointed out that this is what’s been on the rise more than anything else in Alzheimer’s. It’s the 40 somethings and the 50 somethings that are really increasing. And then there’s a very interesting mouse that has in its genome the instructions for a monoclonal two nerve growth factor. So what it does is it reduces the nerve growth factor, not to zero, but it reduces it. And interestingly that mouse develops Alzheimer’s pathophysiology. Why? Again, we got to explain that. And then all these aggregated proteins, so many people just say, Alzheimer’s, all it is aggregated proteins. Well, there are lots of aggregated proteins in the disease, but it doesn’t tell you what the disease is.

                                                And then of course, the remarkable failure, greater than 400 clinical trials, the prionic nature of Abeta and tau. So I trained as a postdoc with Stanley Prusiner, who won the Nobel Prize in 1997 for his discovery of prions. And it turns out that Abeta and tau both have this phenomenon where they are proteins that beget more of themselves. And then the high incidence and prevalence, about 15% of the population will die of Alzheimer’s. We’ve had over a million people now die of COVID-19 in the United States. But if you look at the in country as a whole of the currently living Americans, about 45 million of us will die of Alzheimer’s if we don’t have a better treatment and prevention. So this is a huge area.

Dr. Weitz:                          Hey doc, could you just clarify what you mean by the prionic nature of amyloid and tau?

Dr. Bredesen:                    Yes, absolutely. So what this means is if you put these into a brain, they will beget more of themselves. So they act like infectious particles, even though they have no DNA or RNA. That was the big finding that won Stan the Nobel Prize. He pointed out that these are infectious agents. In this case it was a prion protein, PrP, which he discovered, cloned, characterized, et cetera. And he showed that this begets more of itself. So if you put this into a brain that has PrPC, the normal isoform, you will get this abnormal isoform. And the same thing happens with Abeta and tau. You put enough of it in a brain, it will beget more of itself. Now the good news is if you don’t have too much, you can actually damp it down and you will then lose. You won’t go on to have this prionic effect.  So that’s one of the things we want to do. We want to remove all the things that are driving it, and then we also want to remove the prions themselves. So the point here is that any model that you come up with has to be predictive. It has to say, okay, this clinical trial’s going to work and that clinical trial is not going to work, and it has to be consistent. These other models that just say, well, this works for this group, but it doesn’t work for that group, that really doesn’t help us.

                                          Okay, so what we want to look at is under the hood, let’s look at what actually happens here. This is amyloid precursor protein. This is just now a diagram here of a single cell. So we’re looking at one neuron and we’re looking at the membrane here.  This is a protein that’s in neurons and other cells, but mostly neurons and mostly at the synapses. And this is the parent of the amyloid that you’re going to make. Now, what happens is really interesting. This stuff acts like a switch. This molecule sits, and you can see most of it is outside the cell, a little bit of it is inside the cell. It’s literally crossing the membrane. Now, when things are good, this thing literally recognizes that and is cut at a single site to give you two peptides, sAPP alpha and alpha CTF, and these things tell your nervous system things are good, grow, maintain, make new synapses, et cetera. Very much like what happens in our country, when things are good, the stock market is good, people are paying their taxes, et cetera. Then you build new bridges, you build new interactions with other countries, et cetera.

                                                On the other hand, when things are bad, for example, with the pandemic, we were told, hey, we’ve got an insult. In that case, SARS-CoV-2, we’re going to pull back and put our resources into protection. People aren’t going to go to work, they’re going to stay home, they’re going to socially distance, et cetera. And of course what happens, we go into a recession. And that’s the same thing that happens in your brain when you’ve got infections, inflammation, toxin exposure, all these sorts of things, your brain changes into this very interesting downsizing protective mode. So this amyloid, here it is right here. The amyloid peptide, which has been vilified in Alzheimer’s, is really a protective antimicrobial peptide. And Professor Robert Moir and Rudy Tanzi from Harvard published this several years ago, showing that this is actually a protective antimicrobial peptide.   It’s very different. This thing will literally switch from one mode to the other, and that this is the one on this side that’s associated with Alzheimer’s. And so now we understand what this is all about. This is not just trying to give you Alzheimer’s, it’s trying to protect you from these various insults. Okay.

                                                 So what that means is just as for these other illnesses, osteoporosis, right? We all know you have an imbalance between your osteoclastic activity, which is greater than your osteoblastic activity. Similarly for cancer, your sideroblastic cell signaling exceeds your cytoclastic cell signaling, so you make more cells. And we call that cancer. Well, what we found in the lab is that Alzheimer’s is no different. There’s a whole set of signals that are synaptoblastic that are going on that side of the APP that I mentioned.  There’s a whole set of things that are synaptoclastic, and Alzheimer’s is nothing more than you’ve gone to the synaptoclastic side. So what that means is it’s a network insufficiency. It’s your synaptoclastic signaling outweighing your synaptoblastic signaling. And the good news is it’s really about four major things, inflammation, toxins, energetics and trophic activity, and really the vast majority, and this is the take home lesson which will help you treat every patient with cognitive decline or risk for decline. Alzheimer’s is pretty much boiled down to just two things. The innate immune system, so ongoing inflammation and energetics. And so normally you’ve got low inflammation and plenty of energetics, good blood flow, good oxygenation, good mitochondrial function, ketone your metabolic flexibility, you can burn glucose, burn ketones all good.

                                                But of course what happens with patients over time is they started getting some inflammation from many different sites and they start going down on the energetics. They may have poor blood flow, they may have sleep apnea, they may have poor mitochondrial function, any of these things. And so now they’ve switched into this mode of downsizing. So it’s really important with all these people to look at what’s the energetic status? What is the inflammatory status? Bring the energetics up, bring the inflammation down, figure out why those two were abnormal and fix that. Do they have a chronic infection? I mentioned this patient with a posterior cortical atrophy. She’s done really well. Well, she had to be treated for herpes simplex. She had to be treated for Bartonella. It turned out she had a chronic bartonella infection she didn’t even know about.

                                                She had to be treated for mycotoxins. And then interestingly she started really improving when she did EWOT exercise with oxygen therapy. So as with so many other patients, she had multiple contributors when they were addressed, voila, she starts getting better and she’s continued. And her MoCA has gone from 21 to 29. Her symptoms have gotten much better. By the way, her MRI just spectacular improvements. Her parietal lobe went from less than first percentile to the 23rd percentile. So just dramatic improvements, because Kerry was actually able to find out what was driving this. And what that means is, yes, if we’re going to develop a perfect Alzheimer’s drug, that’s fine, but it’s going to have to do all these things.

                                                But what we really want to do is combine one or a few targeted drugs with a functional medicine or precision medicine approach. That’s clearly the way to deal with this complex chronic illness. So we’ve been telling people for years, imagine you have a roof with 36 holes that came from the early research that showed there were 36 different mechanisms. We know of a few more now, but it’s not thousands, it’s dozens. So we can address those, we can identify those. And of course, as I mentioned, the most common risk factor genetically is APOE4. And for years people didn’t know why that was. About two thirds of Alzheimer’s patients have APOE4. In fact, if you have zero copies, which is three quarters of our population, your lifetime risk is about 9%.

                                                If you’ve got one copy and that’s 75 million Americans, your lifetime risk is about 30%. And if you’ve got two copies and that’s seven million Americans, unfortunately most don’t know it, your lifetime risk is about 70%. Most likely you will get Alzheimer’s disease. And there’s a wonderful website, which is called apoe4.info, started by a woman whose APOE4 herself, had symptoms, has done beautifully. She’s been on the program for now over 10 years. She’s gone from 35th percentile to 98th percentile in her cognitive testing. She’s just amazing. She actually wrote a part of the second book, and her story actually appears in The First Survivors of Alzheimer’s. And so she’s got a wonderful website where people share information who are APOE4 positive. I think they have now something like 7,500 people on that site.

                                                So the problem had been how does this work? Why does this thing that simply carries fat? It’s like your butcher. It’s the guy who carries the fat around. How the heck does that give you Alzheimer’s? And so we launched a project, now it’s over 10 years ago in the lab. And all we found is really fascinating. And this is a thing that turns out to have to do with our evolution as hominids. And so up until five to seven million years ago, of course there were simians, but there were no hominids. And the first hominids appeared about five to seven million years ago. And what’s interesting is our DNA is very similar to the simians. There aren’t that many changes. It’s over 98% similar genes. And interestingly, the genes that did change between the simians and the hominids, many of them, outsized proportion of them were related to being pro-inflammatory, including APOE4.

                                                APOE4 appeared and was the primordial gene for the hominids, and it is a pro-inflammatory gene. And interestingly, why would that be? Well, as Professor Tuck Finch from USC pointed out, it allowed us as hominids to come down out of the trees to walk around the Savannah, to puncture our feet, to get infected, to eat infected meat full of microbes, to fight with our brethren, to fight with our food. We’re very good when we’re APOE4 positive, at healing, very good at dealing with infections because of this pro-inflammatory state. But it also because of the ongoing inflammation is associated with heart disease and with Alzheimer’s later in life. So just recently then, so you can see here, God came down, changed a few genes, and of course we ended up as amazing hominids.

                                                So if you look at the original APOE4, you can see here, it looks like columns on a house. And that’s because this arginine 61 and the glutamate 255 interact, the arginine has a positive charge, the glutamate has a negative charge, and they interact here. And this was actually shown by the discoverer of APOE. And then on the other hand, just 220,000 years ago, APOE3 appeared. And now what happens? Cysteine 112 appeared as a mutation, interacts with arginine 61. So now this swings free. And Dr. Mey Lee, the discoverer of this, called this domain interaction. So you can see they’re quite different. So for 96% of our evolution, everybody’s been APOE4 4. Just in the last 220,000 years, APOE3 appeared. And then just in the last 80,000 years, APOE2 appeared.

                                                So to make a very long story short, what we found is APOE4 does something really interesting. It had been known, it binds to a number of receptors like LRP, for example, on your cell, enters the cell. But what we found is that it interacts with a pro-inflammatory molecule called Rel. This is part of NF-kappa B, and it enters the nucleus and it interacts with 1700 different gene promoters. And if you map those out, you could not tell a better story for Alzheimer’s disease. So it has to do with synaptic changes, it has to do with CT, for example. It has to do with inflammation. It has to do with glucose homeostasis. So it’s really changing. So it’s not just your butcher that’s carrying around the fat, it’s also your senator that’s making the laws land.

                                                Literally APOE4 reprograms your cells toward a more pro-inflammatory state. So when we look for these different things, we now start looking at them, identifying them, and actually addressing them. We see some remarkable examples. So let me just give you a couple examples here. Here’s a 68 year old woman presented with cognitive decline. Her first thing was she started making paraphasic errors. She also had some depression, struggled with computer work. She couldn’t complete a gingerbread man. She confused clock hands, forgot to pick up her granddaughters, which really scared her. She went in, she had an amyloid PET was positive. She was APOE4 single copy, had a MoCA of 24, so already well into MCI, that third of four phases. Hippocampal volume was already down. This is a professor. Hippocampal volume was already down to the 14th percentile. So her diagnosis was MCI due to Alzheimer’s disease.

                                                She actually went on a clinical trial for an anti-amyloid drug. And interestingly, as we’ve seen with some other people, she got worse with each injection instead of getting better. So after eight treatments, she said, I am not doing this anymore. She quit the trial and she actually contacted me at that time. So we looked further. I worked with her physician actually. She failed her visual contrast sensitivity. Her C4a was high, her TGFβ-1 was high, MMP-9 was high. Her urinary mycotoxins were increased. She was MARCoNS positive. Her hsCRP was a little bit up 1.1. Triglycerides were very low as we often see with people who have mycotoxin related cognitive decline. Her zinc was also very low, another thing we see. So she began on the ReCODE protocol. She did great. She’s actually now seven years into this. Her symptoms resolved. She could speak again, tell time, build a gingerbread man, no longer problems with her granddaughters.

                                                And by the way, she’s actually part of a documentary that’s called Memories for Life: Reversing Alzheimer’s. It’s come out from the Japanese NHK that’s making its rounds around the country. It was just at the Manhattan Film Festival a couple of weeks ago. Her MoCA score became a perfect 30. Hippocampal volume went up to the 28th percentile. She’s remained stable. As I said, she’s now in her 7th year, so she’s done absolutely great. Here’s a 66-year-old man family history. Both parents died with Alzheimer’s. Single copy APOE4, amyloid PET markedly positive. So classic case of a guy with Alzheimer’s disease. You can see why his homocysteine is high. His hsCRP is very high, vitamin D is low. His testosterone’s low, his free T3 is low. He responded metabolically, cognitively, volumetrically to ReCODE. His neurologist said he’s now normal. He’s done very well.

                                                You can see here his MRI hippocampal volume went from 17th percentile to 75th percentile. So he’s done very, very well. And you can see his hsCRP is still not perfect. His fasting insulin is still not perfect, but it’s so much better than it was. And we see this commonly. His gray matter volume went up by 23%. So just say a little bit about the trial that we published last year. You can read the details in the Journal of Alzheimer’s Disease. So instead of predetermining a treatment, we just flipped the script here. As you know with all these trials, people say ahead of time, we’re going to treat with X. We said, instead of telling you ahead of time what we’re going to treat with, we’re going to look to see what’s causing it, and then we’ll address those things.

                                                You can see it on clinicaltrials.gov. We were denied for this trial in 2011, again, in 2018. We finally got approved in 2019. Small proof of concept trial with 25 patients. We compared personalized precision medicine approach for nine months to historical controls. And looked, again, just a standard a functional medicine approach. Looking at what’s actually driving this. We used MoCA scores. We used CNS Vital Signs because it’s more sensitive. So we got a good dynamic range. The MoCA scores were better for people who were farther along. And the CNS Vital Signs were better for people who weren’t so far along. People had MRI with volumetrics, they improved their neurocognitive index. You can see here, actually the pandemic started right here. So we had a few people who actually stopped doing things and were not doing as well. But actually they still showed improvement overall.

                                                And these are highly statistically significant. You could see improvements in hsCRP, hemoglobin A1C, the HOMA-IR a little improvement, but we didn’t have enough data on that. And so it didn’t reach statistical significance. Triglyceride HDL ratios, homocysteine, vitamin D, all of these were statistically significant in their improvements. So all of these things, MoCA, 76% improved. Neurocognitive index, 84% improved. Improvement on subtests, improvement in a change scale where you ask the spouses if they’d improved or not. That was statistically significant as well. All of them improved on their brain training. Their MRIs, interestingly their gray matter, which even in normal aging slowly shrinks and with Alzheimer’s rapidly shrinks, these people actually increased their gray matter size. And then their hippocampal volume had a minimal decline.

                                                But again, it was actually less than normal aging and far less than Alzheimer’s. So lots of improvements in these people. And interestingly when you look at patients as a whole, the ones who tend to do the best are the ones that come in a little bit early. As I mentioned, SCI, they all improve. People with MoCA scores of 18 or above are easier to improve. We had a couple people in the trial who went from MoCA scores of 18 to perfect 30, clearly addressable metabolic abnormalities. That tends to be easier when you can actually find what’s causing the problem. If you find a chronic infection, if you find specific toxins. The ones who had supportive families and work with health coaches, the ones who had a positive attitude and actually were compliant, the one who just continued, they didn’t give up, okay, you make them a little better, now You keep looking at how can we make this better and better. So keep tweaking, keep optimizing, and they do better.

                                                The ones who did get into ketosis, whether endogenous or exogenous, tended to do better. The ones who didn’t have massive amounts of toxicity tended to do better. And the ones who had symptoms for less than five years. So again, we encourage people, please, please don’t wait. Come in early if you can. And then the ones where we did see improvement in their metabolic markers. And on the other hand features associated with continued decline, poor compliance, lack of interest, so we had one person in the trial, one of the few in the trial who didn’t get better, was someone who turned out to have massive mycotoxin exposure in their house and just said, I’m not leaving and I’m not remediating. I’m just going to sit here. And no surprise, she did not improve.

                                                Severe toxicity, continued exposure. MoCA scores less than 10. They’re tougher. We have had people with scores of zero who do improve, but they don’t go all the way back to 30. We’ve seen them go from zero to nine, and we’ve seen them go from 18 to 30. My goal is can we ultimately get someone to go from zero to 30? Haven’t done it yet. It’ll be interesting to see what does it take to do that? Does it take stem cells? Does it take intranasal peptides? We don’t know yet. Many years of decline also tougher. Lack of support from family and health coach. I see this almost every day. I just got an email today from a woman who said, in fact, actually she posted this on Facebook. That’s right. There is a woman who said, I’m trying to help my mother, but the rest of the family just says, forget it. There’s nothing you can do.

                                                She’s gone through the whole protocol and said, let’s do the right things. And everyone says, no, no, no, no, no. Let’s just give her some hot fudge sundaes and let her go. So yeah, when you don’t have support, that doesn’t work as well. I do think health coaches are really important and really helpful. And then finally, failure to identify key contributors. Many times we’ve had someone who improved and then after a few years started to have a little bit of sliding and we say, wait, what’s been missed here? And then you find something new and now they go right back again. And that’s really important. So don’t give up. And again, some surprising responses people, I got an interesting email from a guy a couple years ago whose wife had a MoCA score of zero, and he said she’s in a nursing home, but she’s responded beautifully.

                                                She’s part of the family again. She talks to us, she dresses herself again. She’s doing so much better, but she’s still in the nursing home. She still has dementia, but she’s much more interactive. So can we now make this optional? We got to encourage people to come in earlier. We encourage everyone, please get a cognoscopy at the age of 40, just like you’re going to get a colonoscopy at 50, and identify factors and get on active prevention, those people who then fall through the cracks. Okay, it’s a multi-tiered approach now, if you now start developing symptoms, get in with at SCI. And ten if the people continue to fall through the cracks, you want to do a more and more extensive evaluation so that we can really make a big impact on a whole population.

                                                And then ultimately over time, AI will help us to identify what are those things that are making the biggest difference and what are the things that are making the least? And I mentioned the KetoFLEX. So we want, here’s the critical paradox, and this is something that many people don’t recognize. So it’s important to know this. The disease is a network insufficiency, so something is not enough. You don’t have enough support, blood flow, oxygenation, whatever it is. On the other hand, it started often by excess because you had lots of carbs and you developed insulin resistance. So you’ve lost the ability to burn the glucose and you’ve lost the ability to make and burn ketones. So we want to get both of those back to normal. So we want to be careful.

                                                If we starve people to get them to be insulin sensitive, that often makes them worse. So which is why I usually say just start, give them some ketones at the beginning. Give them some exogenous ketones for a couple of months. And during that time, you can restore their insulin sensitivity. Now they’re doing better. Be careful for the people who are frail. This is a common problem. If they don’t have fat to burn, to make ketones, help them out, give them some ketones. So that’s the important paradox. And this is why we work with Nutrition for Longevity, to make it so that they made appropriate meals, appropriate sourcing, appropriate organics, appropriate ability to get into ketosis, all the appropriate things to get the best outcomes, appropriate caloric income, et cetera.

                                                So we want insulin sensitivity and ketosis, I.e metabolic flexibility. We want to plant rich, mildly ketogenic diet with fasting periods 12 to 16 hours. You want to be careful, you go too long, you’re getting back again into insufficiency. High fiber, high phytonutrients, anti-inflammatory, et cetera. High fat, intermediate protein, low carb, no simple carbs. And many people like to cycle off once per week or twice per week. That’s fine. No problems. Grains and dairy, we stay away from. Wild cat fish, great pastured eggs, great pastured chicken, grass-fed beef, all of those are fine. As I mentioned, this says coming soon, but it’s actually here. So as you know, a couple of books on this that are available. And just to finish up here, the ARC project, very excited about this.

                                                And so the idea here is to take people with different neurodegenerative diseases, and we’ll be doing this at this new group at Pacific Neuroscience Institute as well. And then to do deep dive looking at genomes, looking at epigenomes, looking at all the things that are driving these in just a couple of people, hence ARC, like two by two by two, so that we can actually look to see what is driving the problem in each of these diseases, and then address those things. I’m very enthusiastic that we should be able to prevent and reverse many different neurodegenerative diseases in the near future. I recognize, I’ve been doing this for a long, long time, I’m an old guy now, I’m now 71. So as they say, you’re not expected to complete your life’s work during your lifetime. Neither are you excused from it.

                                                I recognize it’s you guys that are going to be doing this. It’s you guys that are going to be taking this forward and making it better long after I’m gone. And I really hope that we will see a world with far less neurodegenerative disease, because it’s been a huge problem. I’ll end there. Happy to take some questions. How are we doing on time here?

Dr. Weitz:                          We’re doing fine. We have as much time as you want. I wanted to ask-

Dr. Bredesen:                    Would love to answer questions, and I think we’ll stop sharing there.

Dr. Weitz:                          I wanted to ask a question about the use of statins and about cholesterol in general. We know statins have been a huge benefit for reducing cardiovascular risk and we know that blood flow is really important for brain function. And this is important also because recently in the medical community, it’s been a big push to really try to drive cholesterol levels down as low as possible. There’s a prominent practitioner who has a very popular podcast, and he said that we should drive LDL down below 40 and we’ll eliminate all heart disease. And he also said that we don’t have to worry about these drugs that reduce cholesterol affecting the brain, because the cholesterol in the brain is made in the brain.  And yet we know that at least 25% of the cholesterol in the body exists in the brain. And I’ve looked at some of the studies, and there’s at least, there was a study a couple of years ago that showed that PET scans showed that there was a decrease of blood flow to the parts of the brain that are associated with Alzheimer’s in those particularly who took lipophilic statins.

Dr. Bredesen:                    Yeah, no question. There’s a nice study from UCLA that showed that lipophilic statins were associated with brain atrophy and with a greater likelihood of developing dementia. I assume you’re referring to Peter Attia who’s pushing.

Dr. Weitz:                          Yes.

Dr. Bredesen:                    I get it. He’s very concerned about heart disease. Fine. Of course, Dr. Esselstyn, Caldwell Esselstyn has done a great job with showing that, hey, if you don’t have any fat around, you can’t make those plaques. Unfortunately you can make dementia. That is the problem. So if you look at the literature, you’ll see half the papers saying that statins reduce your risk of dementia, and half the papers saying that it increases your risk for dementia. How can that be? And the reason is because they have both a positive and a negative effect. So sometimes one wins out, sometimes the other wins out. So for example, they have an anti-inflammatory effect, great, but they also reduce your cholesterol so much that you can increase your risk for dementia.

                                                My argument is why don’t you get the best of both worlds, use other anti-inflammatories, use appropriate diet and exercise and lifestyle approaches to get your cholesterol lined up. And if you need a little help, then there are other things you can do. There are other ways to go about this. You can even try with these PCSK9 inhibitors like Repatha. That’s another way to consider, probably better for you. But here’s the problem, when we’re seeing people coming in with cognitive decline, we see that they’ve been overtreated with these statins, and they come in with total cholesterols of 105, 110. Anything below 150 is associated with brain atrophy. And in fact, interestingly, you may know Dayan Goodenowe, who’s an excellent biochemist. He’s the one that developed the plasmalogens and initially found that people with Alzheimer’s disassociated with people with low plasmalogen levels.

                                                And he pointed out the healthiest profiles he sees are when people end up with total cholesterols 220, 225 that’s kind of typical. So you’re right, we want to look at the critical ones like LDL particle number, small dense LDL, oxidized LDL. ApoB now has become probably the most common one. And actually something that my wife, Dr. Lasheen taught me about months ago, and saying, hey, ApoB is really the way to go. So, okay, fair enough. I’m agnostic, whatever helps people to get better outcomes. And I totally understand we don’t want to have myocardial infarctions, so we recommend that people get calcium scores or get CT angios. So you make sure you’re okay. But if you’re looking good, if your score is zero and you’re developing some cognitive decline, you should be thinking way more about your brain than your heart. You’re probably going to do fine with your heart.

                                                There’s a lot you can do for your heart. So again, this is why I like to, if possible, avoid statins or at least minimize the statins and do the things that are good for you for the statins. Things like anti-inflammatory, you can do that with lots of other things. Curcumin is one of many. Cat’s claw is another one. What’s really interesting to me as someone interested in cell biology, is that the amyloid that we make in our brains is part of your innate immune system. It is part of your body saying, oh, I’ve been invaded, something is not quite right here. So it actually it makes perfect sense. And interestingly, if you look at what part of the innate immune system it is, it is part of your innate system’s memory, and your memory lives in three places. It used to be thought your innate system didn’t have a memory, your adaptive system had the memory.  But it turns out your innate system has a memory as well, and it lives in three sites. It lives in your bone marrow, it lives in your endothelial cells, which is why these people unfortunately get increased thrombosis and poor blood flow. And it also lives in your tissue macrophages, which is why you end up having this in your microglia as well as your neurons.

Dr. Weitz:                          Interesting.

Dr. Bredesen:                    So it’s very interesting system, and when you understand Alzheimer’s in this way, that it is a physiological response to these insults, suddenly everything makes sense. You can see how to prevent it. You can see how to treat it and reverse it, and all these crazy ideas. One of the standard things they say is amyloid is the thing that causes Alzheimer’s. Then they found out that it’s an antimicrobial. They said, well, sometimes it’s good and sometimes it’s bad. It just like it is hand waving. Whatever you come up with has to make sense in all situations. And this model does.

Dr. Weitz:                          Lynn asked, why are we seeing an increase in dementia in 40 to 50 year olds, in younger patients?

Dr. Bredesen:                    A great question. The answer is nobody knows for sure. No one’s proven it. But the leading contenders are the changes with ultra processed food. The fact that everybody’s, so many people now have metabolic syndrome. We have something like 80 million Americans with metabolic syndrome, that dramatically increases your risk for Alzheimer’s disease. And interestingly, the ones I see in their 40s and 50s are usually associated with toxin exposure. It’s this overwhelming toxin exposure. It’s the mycotoxins, it’s the air pollution, it’s the mercury, it’s the organics. When you look at these toxins that are associated with cognitive decline, they come in three groups. Inorganics like air pollution and mercury and heavy metals. Organics like glyphosate, toluene, benzene, formaldehyde. And then thirdly, biotoxins.  So many people without knowing about it, as you know, they either live in or work in an area that is just filled with mycotoxins and they don’t know it until they start having cognitive decline. And when you start detoxing them from those mycotoxins, they start to get better.

Dr. Weitz:                            And when you mentioned metabolic problems, we now know there was just recently a study published showing that statins increase your risk of diabetes.

Dr. Bredesen:                    Absolutely. And that’s another big issue. And of course diabetes just gives you increased risk for cognitive decline.

Dr. Weitz:                          Let’s see, you mentioned exercise with oxygen. Can you explain what that is?

Dr. Bredesen:                    Yeah, that’s one of my favorite things now because we’ve had such good responses to this. So again, as we get a little older, we are perfusing areas of our brain less perfectly than we did. We’re getting a little less blood flow, a little less oxygenation. Some of us developed some sleep apnea or some upper airway resistance syndrome. We’re just not quite firing on all cylinders and we may notice it. What does EWOT do? Well, you’re now combining exercise with oxygenation. So you get this wonderful benefit where you’re perfusing areas of your brain and you’re providing oxygenation. And people have done very, very well with that. Now, some people like to use HBOT instead. Great.  But HBOT, it’s expensive and it’s not active. It’s a passive form. So you’re not getting that exercise to help with the circulation. Yes you are getting more oxygenation, no question. You now got it under increased pressure, but the two have somewhat similar effects, but one of them is a more active and one of them is more passive.

Dr. Weitz:                          What exactly is the device? And this is something that you’re turning up and down as you’re exercising.

Dr. Bredesen:                    So the device is, and you can get it from different groups like MaxO2 or LiveO2 or things like that. So this is basically, it’s basically an oxygen concentrator. So you basically do 20 minutes of exercise with this pure oxygen. And some people like to do it with stationary bikes. Some people like to do it with cross country. Any sort of exercise that you do. Now, to be fair, it’s missing one thing. It’s better to do your exercise outdoors than indoors, unless you live in a place that’s heavily polluted, you want to get out of those mycotoxins in the house. So that’s the one negative. But yeah, hey, you could put it out on your balcony if you want to do something like that. But getting that oxygen with the exercise, again about 20 minutes and then it will run out, is actually quite helpful.

Dr. Weitz:                            Somebody asked, would you be willing to share your slides with us?

Dr. Bredesen:                    Oh yeah, sure. You can have a copy of the slides. Can I send them to you as a PDF? Is that okay?

Dr. Weitz:                          Sure, yeah.

Dr. Bredesen:                    I’ll send you a PDF of the slides.

Dr. Weitz:                          Okay. Great. Somebody asked that, Dr. Sherry Viensech said that she’s a certified ReCODE practitioner and she’d like to connect with other ReCODE practitioners. Do you have a Facebook page or something like that just for ReCODE practitioners?

Dr. Bredesen:                    Yeah, just go on the forums. We have the forums at Apollo Health. Just go on the forums, there are other practitioners there, so you’ll connect with them there.

Dr. Weitz:                          Somebody asked about book suggestions. Well Dr.Bredesen has three of them.

Dr. Bredesen:                    Someone asked for book suggestions? The first one was really about how we came to this conclusion. That was The End of Alzheimer’s and that’s in 33 languages. Then the second one we got, people said, we’d like more day-to-day specifics. Where do I buy the food? Where do I do this? Where do I go? And so I actually worked with the woman I mentioned earlier, who’s Julie G, and my wife, Dr. Aida Lasheen Bredesen. And they wrote a whole section of essentially a handbook. And this was called The End of Alzheimer’s Program. So now this was the program for that. That’s the second book. Came out in 2020. And then the third one is The First Survivors of Alzheimer’s. And these seven different people talk about their own stories.

                                                And then there’s going to be a book coming out by Dr. Heather Sanderson. And by the way, she just did a trial, which came to very similar conclusions, used the same approach. She was one of the first trainees when we first started training people back in 2016. And so she’s now done a trial, as I said, reached very similar conclusions. She did take people all the way down to MoCAs of 12. Although to be fair, what she found was the ones below 16 didn’t do as well as the ones above 16. So that’s something we really need to work on to understand how do we do better for people who are in those later stages. And hers is also freely available online also in the Journal of Alzheimer’s Disease, as you’ll see.

Dr. Weitz:                            And check my podcast, last week I had a wonderful interview with her.

Dr. Bredesen:                    Great, great. I should also mention Marama. So she opened an assisted living facility in San Diego and it’s been fantastic, because people in the assisted living facility for the first time, they’re not getting worse. Some of them are getting better, some of them are very stable, but nobody’s getting worse, and it’s really striking. That’s just unheard of in assisted living.

Dr. Weitz:                          I don’t know if you might want to comment on this, but I just got an email a couple of days ago from a group called the Alzheimer’s Centers of America, and it’s run by a guy who ran Pizza Hutt.

Dr. Bredesen:                    I know the group well.

Dr. Weitz:                          It looks to me like this is part of what I have seen is I think a poor trend or dangerous trend, which is financial firms buying or starting medical centers with the wrong incentives in place, and it looked very much like that sort of place.

Dr. Bredesen:                    You know what, this comes up a lot. People say, I’ve got something that’s really great. Okay, show us your peer-reviewed published data and all these business things just shrink right back. And they say, well, we’re going to publish it someday. We’re going to do this. When you do it, please contact us.

Dr. Weitz:                            Okay, great. Sarah asked, how do we get the testing? Sarah, are you talking about getting it for you or are you talking about for your patients? Are you there, Sarah?

Sarah:                                 Yes, I am. For myself, yes, and also for my patients.

Dr. Bredesen:                    Easy. So just go to mycognoscopy.com and you can actually do this over the internet and you don’t even have to go to a specific physician. You can get a report. And again, happy to go over the report with anyone. But that also shows you where the trained ReCODE practitioners are. So you can see that. The health, the coach network, all that stuff is online. And by the way, one of the most valuable things I think is over a hundred guides that have been written, again by Julie and my wife. Really, really helpful to look at what are the things that actually work the best. So those are also available online through Apollo Health.

Sarah:                                   Wow, thank you so much. And also had another question. Do lesions and or ischemic changes on an MRI represent potential for future AD, Alzheimer’s?

Dr. Bredesen:                    That’s a really good point. It depends on what kind of lesions, and this is again why I think all these things like the blood tests are going to be very complimentary. If you’ve got a couple of lesions, but your GFAP is normal, your phospho tau is normal. Your 42 to 40 ratio is normal. Your NFL is normal. These are probably inconsequential lesions as far as any cognitive change. If you’ve got lesions on the other hand and these things are starting to change, you’re moving the needle there, then there are things that you should address further. So as you know, you kind of alluded to there, these can be ischemic, these can be white matter changes, these can be autoimmune, these can be beginning of MS, there all sorts of different things that can be seen.

                                                And as you know, one of the most common findings on MRIs is so-called unidentified bright objects, UBOs, you see them on a lot of these MRIs. And we’re starting to understand better this white matter disease is often part of Alzheimer’s disease, often part of cognitive change. So great idea to know and to quantitate that. So you should have the radiologist give you a physica score, which is zero, one, two, three, or four, that tells you how significant the white matter lesions are.

Sarah:                                   So helpful. Thank you.

Dr. Weitz:                            Sherry, you want to jump on? You have a question here about Dr. Ray Dorsey, substantia nigra in Parkinson’s disease due to poor myelination of highly branched amino acids, juicy damage of the substantia nigra with the toxic type of Alzheimer’s.

Dr. Bredesen:                    Great point. I know Ray and I love his book, A Prescription for Action, which is all about ending Alzheimer’s. In fact, he told me that they wrote that book about ending Parkinson’s based on what I’d published on ending Alzheimer’s disease. So love that. I’d love to see less Parkinson’s. There are about a million Parkinson’s patients in the United States. There are about a million Lewy body patients in the United States. Of course with Lewy body, you have parts Alzheimer’s and part Parkinson’s, essentially. Typically you don’t see damage. But again, what we’re finding, what we’ve separated as, okay, this is Alzheimer’s and this is Parkinson’s. With the classic presentations, you don’t see damage to the substantia nigra in Alzheimer’s.

                                                You do see it in Parkinson’s. But here’s where things get a little bit tricky. It’s been shown now that when you look at alpha-synuclein, so this is Lewy bodies, which are the hallmark of Parkinson’s. You see Lewy bodies in over half of Alzheimer’s cases now. They’re not in the substantia nigra though, but they’re around the brain. So Lewy body disease, which essentially sits in between Alzheimer’s and Parkinson’s, is often a toxin driven type of cognitive decline. And in that case, you do see changes and you do see sometimes changes in the substantia nigra. So these things, it depends. And we’re starting to be able to look at these. You have to remember, all of these have been defined based on pathology.

                                                This all comes from the 19th century pathologists. People like Charcot who are saying, okay, this is what we’re going to call this diseases, we’re going to call that disease. Okay, great. But now we’re looking much more at metabolics, metabolic profiles, epigenetics, genomes. So we’re going to get I think, a reclassification of these diseases. And as you alluded to, what we see is that a toxic form of Alzheimer’s type three often looks more like Lewy body disease and a little bit less like classical Alzheimer’s disease.

Dr. Weitz:                            David Trader asked about Parkinson’s disease. I wanted to point out, we had Dr. Karen Duncan at our meeting several months ago, and you can see the recording on the YouTube channel or listen to it. And she’s talked about how she’s using a functional medicine similar approach for Parkinson’s disease with really good results.

Dr. Bredesen:                    Fantastic. I have to say, there’s nothing better than hearing about someone who has a neurodegenerative condition, which typically you’re told there’s nothing that can be done, and now they actually are getting better. It’s just so fantastic to see. Now, in the ARC project we’re looking at all neurodegenerative diseases, so that will include Parkinson’s. However, it wasn’t one of the early ones we approached for the simple reason that all the others have nothing to offer from classical medicine. So there is nothing to do, even for age-related macular degeneration, dry macular degeneration, it’s AREDS 2, which has virtually no impact on it. For Lewy body, nothing. For frontotemporal, nothing. For ALS, nothing. But for Parkinson’s, that’s the one where you actually have a pretty good pharmacological armamentarium.

                                                You can make people better. You don’t change the disease outcome, you still are losing your substantia nigrostriatal pathway, but you at least have some positive impact. And even things like glutathione can be very, very helpful. So that wasn’t one of the earlier ones that we did, because there’s an alternative, but we will include that with this new center that I mentioned earlier.

Dr. Weitz:                            Let’s see, Shadi, any idea of certain types of dementia like frontotemporal or primary progressive aphasia are more challenging to reverse?

Dr. Bredesen:                    I should mention this other part about how long did it take people in the study to see improvements? We saw statistically significant improvements within three months. We saw better improvements at six months and still better improvements for the ones who stayed on the program at nine months. And we’ve had people where even after two or three years, they’re continuing to get better, tweaking, tweaking, getting better and better outcomes. Now, as far as others, primary progressive aphasia, as you know, is interesting. That can be due to frontotemporal dementia or it can be due to Alzheimer’s and sometimes neither. But those are the two common ones. We definitely see improvements with PPA, primary progressive aphasia in Alzheimer’s, and with PCA in Alzheimer’s as I mentioned earlier, posterior cortical atrophy.

                                                With frontotemporal dementia we have very little outcome data yet. It’s much less common than Alzheimer’s disease. And so we just don’t have the data yet. My hope is as we study it further and as we understand better what’s actually driving the process, we’ll begin to see some improvements, but we just don’t have the data yet. So if it’s PPA associated with FTD, don’t know yet. If it’s PPA associated with Alzheimer’s, yes, we’ve seen some good improvements.

Dr. Weitz:                          David asked about a test from LabCorp. David, what test are you talking about?

Dr. Bredesen:                    Maybe Phospho Tau 181. That’s a new LabCorp test. One of the ones-

David:                                Yeah, that’s the one that you mentioned.

Dr. Bredesen:                    Yes. And we’re using that on everybody now. And we are seeing what you’d expect. People where we thought it was probably not Alzheimer’s tend to be as low, I think the upper limit of normal in that particular test is 0.95. We see people up above two who clearly have an Alzheimer’s associated dementia. Now, what we’re really interested in seeing is that the reason that your tau gets phosphorylated, is because you are telling your tau, I want to pull back my neurites. I’m under stress, I’m under assault, so I am now going to phosphorylate my tau. The tau is what holds the microtubules steady. Basically it supports them. So just like if you want to tear down a part of your house and you’ve got all these rafters, you got to take off the bolts. And so when you phosphorylate the tau, it pops it off the microtubules, which can then collapse.   So what you’re really seeing with that increase in tau, is you’re seeing your brain tell itself, pull back, pull back. Now what we’d like to see is as we treat people, it goes down. And interestingly, I just got an interesting email from a woman who did go on our program partway. Unfortunately she didn’t go on the whole thing a few years ago, and so she’s now looking to do more. But what happened was she had a high phospho tau, when she went back after being on the program it was much lower. We’d like to get it completely down to completely normal if we could, time will tell. So our current trial that we’re doing is looking at phospho tau throughout the trial to see whether we can bring that back down. It takes about six months to show some improvement. It doesn’t happen overnight. But you’re looking at that change in the brain signaling to tell you, is your brain signaling synaptoclastically or is it signaling synaptoblastically?

Dr. Weitz:                          David, what are you asking about phosphorylated tau from LC?

Dr. Bredesen:                    LabCorp, yeah, that’s the one. So they have Phospho Tau 181. I suspect they’ll come out with 217 at some point, but I don’t think it’s available yet.

David:                                Okay, cool. I just want to know which lab test it was from LabCorp.

Dr. Bredesen:                    PTau181.

David:                                   Awesome. Thank you.

Dr. Weitz:                            And Karen wanted to know, have you had success helping to reverse tremors so that patient’s writing improves?

Dr. Bredesen:                    That’s interesting. With this corticobasal person recently, Craig Tanio has some wonderful results where one of the things that improved the alien hand that they have. Tremors in general, of course they are different. Are you talking about a sustention tremor, an intention tremor, or a Parkinsonian tremor?

Dr. Weitz:                          Karen, are you there? You want to unmute yourself?

Karen:                               Yeah, I am here. It’s an intention tremor, when they go to write, when go to eat, any purposeful movement.

Dr. Bredesen:                    Those are not typically part of Alzheimer’s disease. But yeah, there are multiple things you can use. People use everything from primidone to propranolol to clonazepam, to all sorts of things you can use for those sorts of tremors. You want to make sure it’s not a resting tremor obviously, because that’s associated with Parkinson’s disease. But those tremors tend to respond pretty well. It can be of course benign essential tremor. You can hear it in their speech typically. You can see it sometimes in their heads as well as their hands. And those tend to respond to simple pharmaceuticals like those.

Dr. Weitz:                          What peptides have you been using on patients? Have you?

Dr. Bredesen:                    Good point. And it just depends, again, on what we believe is driving the problem. But people have used thymosin alpha 1 and thymosin beta 4. Epitalon has turned out to be quite interesting. And so again, as you know, there are hundreds of these things. So it’s going to be what do you think is driving the problem? I’m interested, is Cerebrolysin going to be turning out to be something really good? One of the ones I’m most excited about failed in its trial, and that’s davunetide, which is an ADNP derivative. So ADNP activity derived activity dependent neurotrophic peptide is extremely potent in the brain, really helpful. And yet, I think because they used it as a monotherapy, it just didn’t move the needle. And so I’m hoping it’s going to make a comeback at some point because I think it could be very useful.

                                                And then of course there’s intranasal insulin. There’s also non peptide synapsin, which is another nice intranasal approach. Intranasal glutathione, there’s so much that can be done with intranasal treatments because you get such good brain penetration. I’m hoping at some point that someone will come out with a derivative of Netrin-1. We actually worked on that in the lab for a while and developed a little peptide that works like netrin, full length netrin, no penetration, just doesn’t work. It’s just too big. Does not get into the brain if you use it intranasally. Of course there’s intranasal insulin as well, but you have to be careful about insulin resistance. So those are just some of the many that people are using and I think are going to be very valuable.

Dr. Weitz:                            Lynn is raising her hand. Go ahead Lynn.

Lynn:                                     I was just interested, talking about central tremor and the tremors. What do you feel about deep brain stimulation?

Dr. Bredesen:                    I think for people who are literally incapacitated due to severe uncontrollable dystonia or tremors or hemiballismus or severe Parkinson’s, things like that, that’s where deep brain stimulation really works well. For people with Alzheimer’s, yes, there’s been a report. I don’t think you need to go there for most. I think there’s so many other things that are better that I wouldn’t go there unless everything else had failed in someone with cognitive decline. So far it’s better for movement disorder, severe uncontrollable movement disorders.

Dr. Weitz:                            What about some of the other forms of brain stimulation, like different colored lights and similar type approaches?

Dr. Bredesen:                    Absolutely. So one of the things, again, going back to this is about energetics and this is about inflammation. And one of the ways to do both. That you can reduce some of the inflammation with red light, for example, and you can enhance support. So absolutely, we have a whole section on brain stimulation, and it includes everything just from brain training, which was developed by Professor Mike Mesnick, has been very helpful. We use it in our trials to MeRT, Magnetic e-Resonance, which works very well. Transcranial magnetic stimulation, microcurrent, all of these things have their place and people are getting good results with them.

Dr. Weitz:                          Thank you so much for your time, Dr. Bredesen. This has been awesome.

Dr. Bredesen:                    Great to talk to you guys. And Ben, give you some followup. I’ll send you the slides and let me know if anything else comes up. Okay?

Dr. Weitz:                          Great. And we’ll see everybody next month. Thank you.

Dr. Bredesen:                    All right, take care guys. Bye-bye.

 


 

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.  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. Steven Sandberg-Lewis discusses Healing Reflux with Dr. Ben Weitz.

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

 

Podcast Highlights

2:50  Heartburn.  Heartburn is a subjective sensation of burning, usually over the sternum, and it can be intense and sharp. People can even feel like they are having a heart attack.  Not all patients who have heartburn have reflux, though the majority do have reflux.  Regurgitation is when fluid or food comes up into the throat or mouth and this can be related to reflux.

4:57  Reflux.  Reflux can have to do with any fluid going through a tube in the wrong direction.  When the contents of the large intestine move from the large intestine to the small intestine instead from the small intestine down to the large intestine, this is called cecoileal reflux or ileocecal reflux.  If things move from the small intestine up into the stomach, that’s called bile reflux. If things move from the stomach into the esophagus, that’s called gastroesophageal reflux disease, GERD.  There is also GER, which is a normal reflux that occurs say three times after every average meal when some food or fluid from the stomach will move up into the lower esophagus and it doesn’t cause symptoms.  This is not a disease and considered normal.  Reflux doesn’t have to cause reflux disease, but it can if it’s prolonged or if the esophagus is not able to protect itself with various protective factors. Normally our saliva, which is slightly alkaline and which is being swallowed every minute and helps to neutralize any acid that comes up. There are secondary contractions that contract the lower esophagus to move things down. There’s also mucus production that coats the mucosal membrane of the esophagus.  If these mechanisms fail, then you can get Gastroesophageal Reflux Disease.  Therefore it is important to naturally bolster the protective factors in the esophagus.

7:32  What causes reflux?  For one thing, while it is often called acid reflux most patients do not start out having too much acid production.  In fact, many of them have too little stomach acid production. But after being on proton pump inhibitors like Prilosec, AcipHex, Prevacid, Protonix, and Nexium for a while, if they stop them even for short period of time to get the Heidelberg test that Dr. SS-L often performs, they will often get a rebound hypersecretion of acid, which makes it difficult to accurately test their acid levels in their stomach.  While the proton pump inhibitor is preventing the parietal cells in the stomach from making acid, the body keeps secreting more and more gastrin to stimulate those parietal cells to make acid.

10:25  The major causes of GERD include a sliding hiatal hernia.  This is when the upper 2-3 cm of the stomach slides up through the diaphragm that engages the lower esophageal sphincter that normally protects from reflux.  When the stomach moves up, you lose a lot of that anti-reflux muscle function.  Another reason is people who overeat or who eat rapidly will more likely have reflux.  When you eat too quickly, you don’t get the signal to your brain that you’re full.  Overeating or anything that causes distension of the stomach, such as gas, will lead the lower esophageal sphincter to relax and stay open for up to 20 seconds.  This is why SIBO can be a trigger for reflux.  Food sensitivities can also lead to reflux. Atrophic gastritis, those who don’t make enough stomach acid, can lead to heartburn symptoms. 

18:25  H. Pylori is generally protective against reflux.  H. pylori is a bacteria in the stomach that is a major cause of ulcers and many feel that it is a cause of reflux. While H. pylori can cause a type of lymphoma in the stomach called MALToma and it can cause gastritis and it can increase the risk of stomach cancer. H. pylori can live in the entire stomach or just in the antrum, or bottom part.  Since H. pylori was discovered in the early 1990s the dictum is to test and to treat, though Dr. SS-L generally does not agree with this.  H. pylori is treated with two antibiotics and a proton pump inhibitor.  But H. pylori is actually part of the microbiome of the stomach and it has a lot of benefits, including protecting against allergies, eczema, asthma, hay fever, and it also is a major protector against reflux and the complications of reflux, which include Barrett’s esophagus and cancer of the esophagus.  80% of the time H. pylori is all over the stomach and these patients usually make too little acid, but if H. pylori is in the antrum, which is 20% of the time, that tends to trigger gastrin secretion and increased acid production, which can cause ulcers in the stomach or the duodenum. 

24:52  How to examine, analyse, and work up a patient with heartburn or reflux symptoms.  If the patient has been to see a gastroenterologist and had an upper endoscopy, you should get the results and the biopsy report and look at it and get used to reading them. There are cases of erosive esophagitis where there are erosions of the membrane in the esophagus and then there’s NERD, non-erosive reflux disease.  If the patient has also had a Bravo pH monitoring test you can determine the degree of erosive esophagitis–grades A, B, C, D.  Patients with grade D should definitely be on a proton-pump inhibitor medication.  These are patients who are having severe damage and at strong risk for Barrett’s esophagitis, which is precancerous.  If they are NERD or Erosive grade B or A and are willing to change their diet and make lifestyle changes, we have them start with all the basics listed in Dr. SS-L’s book, including eating slowly and mindfully and not eating within three hours of going to bed. If they are a side sleeper, there’s less reflux if they sleep on their left side because of the shape of the stomach and the esophagus. You should be well hydrated, but ideally you should drink most of your water away from meals. If food is well masticated by chewing 20 or 30 times, you should not need water to wash it down. In particular, you should not drink ice water while eating, since cold will slow down gastric emptying.  It is more likely to cause reflux if you only chew four or five times and then take a sip of water to wash the food down.

34:31  Let’s continue discussing our patient with reflux.  Let’s say we found out they’re sensitive to tomato or we found out they’re sensitive to gluten and removing that could be enough to normalize their vagus nerve connection.  Then let’s say that we do labs and find out they have high blood sugar or high hemoglobin A1C.  If your blood sugar is too high, your digestive tract can malfunction and this can lead to reflux.  We should also do flexibility testing to see if they are hypermobile.  Such patients with ligamentous laxity tend to have a high incidence of sliding hiatal hernia and laxity of the ileocecal valve.  We also need to see if they have a lack of stomach acid, hypochlorhydria.  When can do the challange with betaine hydrocloride capsules or we test with a Heidelburg test.  Bitter herbs can also be used to stimulate stomach acid and apple cider vinegar can also work. On the other hand, if the patient has erosive esophagitis, this would not work well.

 



Dr. Steven Sandberg-Lewis has been a practicing naturopathic physician for nearly 40 years and he teaches gastroenterology at the National College of Natural Medicine.  Dr. Sandberg-Lewis: is a well-received presenter at educational seminars around the world and he has authored or co-authored multiple articles and is frequently interviewed on digestive health topics.  Dr. Sandberg-Lewis: wrote the second edition of his textbook, Functional Gastroenterology in 2017 and in 2023 he published Let’s Be Real about Reflux: Getting to the Heart of Heartburn, intended for the general public as well as practitioners. You can find out more information about him at FunctionalGastroenterology.com and at his office website, HiveMindMedicine.

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 listeners. Today I’m very excited to be speaking with Dr. Steven Sandberg-Lewis about reflux, which is a very common, mostly functional gastrointestinal disorder. Heartburn is the main symptom in reflux and is often described as a discomfort or burning pain felt in the chest or throat. It occurs at least once a week in about 30% of most Americans, and in up to two third of those with IBS. Heartburn can be caused by reflux of the gastrointestinal contents up into the throat or esophagus, or it can occur without reflux. Other symptoms of reflux include: regurgitation, chronic cough, sore throat, vomiting, hoarseness, chronic throat clearing, et cetera. Reflux is often used interchangeably with gastroesophageal reflux disorder or GERD, but there are other forms of reflux, including bile reflux and silent reflux, which is also known as laryngopharyngeal reflux.  The NIH website has now introduced a new term, G-E-R as distinguished from G-E-R-D to confuse us even further. This condition is very complex and confusing, and I’m hoping that Dr. Steven Sandberg-Lewis will help bring some clarity on this topic for us.

Dr. Sandberg-Lewis has been a practicing naturopathic physician for 40 years. He teaches gastroenterology at the National College of Natural Medicine and lectures around the world, and he wrote an awesome medical textbook, Functional Gastroenterology, which is now in its second edition, and everybody in the functional medicine world should have. And his new book is, Let’s Be Real About Reflux, Getting To The Heart of Heartburn. Dr. Steven Sandberg-Lewis, thank you so much for joining us today.

Dr. Sandberg-Lewis:          You’re very welcome, Ben. It’s good to be here.

Dr. Weitz:                           Great. Steven, let’s start by explaining some of the terms. What’s heartburn? What’s reflux? What’s GERD?

Dr. Sandberg-Lewis:          All right. So heartburn is a subjective sensation of burning, usually over the sternum, somewhere over the sternum. It can be really intense and sharp. People can feel like they’re having angina or a heart attack, and it has to be differentiated from that sometimes. It can also just cause chest pain. So some people, if they’re truly having some kind of distension of the esophagus, can either feel it as burning or as chest pains, just kind of depends on their nervous system. So that’s basically heartburn.

Dr. Weitz:                           And some of these patients are often wrongly diagnosed as having heart problems.

Dr. Sandberg-Lewis:          Or as having reflux when they really don’t.

Dr. Weitz:                           Right.

Dr. Sandberg-Lewis:          Probably the majority do have reflux, but there are many different types, so we’ll talk about that. But regurgitation is when fluid or food actually comes up into the throat or even the mouth, and that can be related to reflux. Of course, if material from the stomach is, that’s the next thing, reflux. If food or fluid from the stomach is moving up into the esophagus, if it continues to go up into the upper third of the esophagus or the throat, that’s regurgitation. People sometimes mistake that as vomiting, but vomiting is actually a whole separate thing. It’s a big process, but you can have regurgitation, which is kind of like when babies burp up their milk. That’s just called regurgitation and it’s a more minor kind of a thing, but can be quite disturbing.

Dr. Weitz:                           Okay. What are some of the causes of reflux and GERD?

Dr. Sandberg-Lewis:          All right, so you asked me to try to keep this simple.

Dr. Weitz:                           Yeah.

Dr. Sandberg-Lewis:          So tell me if I’m going off the deep end. So again, reflux can have to do with any fluid going through a tube. We talk about reflux, like you said, from the large intestine to the small intestine. That’s called cecoileal reflux or ileocecal reflux. Things moving backward toward the mouth instead of down toward the anus, which is the normal flow in the digestive tract. If things move from the small intestine, the duodenum, into the stomach, that’s called bile reflux. If things move from the stomach into the esophagus, that’s called gastroesophageal reflux, GERD.

                                                And the thing is, like you said, there is a term G-E-R, there is normal reflux that occurs. Some books say three times after every average meal, some food or fluid or gas from the stomach will move up into the lower esophagus and it doesn’t cause symptoms. So they don’t put the D on the end GERD, they just call it gastroesophageal reflux. Physiologic, it’s normal, but the saliva being swallowed every minute, a liter or more a day, excuse me, a liter or more a day of slightly alkaline saliva, pH seven and seven and a half, that helps to neutralize any acid that comes up. There’s also something called secondary contractions that contract the lower esophagus to move things down. There’s a lot of protective factors. There’s mucus production that coats the membrane.  So reflux doesn’t have to cause reflux disease, GERD, but it can if it’s prolonged enough or there’s enough volume of it, and especially if the esophagus and its lining is not able to protect itself. So that’s a lot of what I… You noticed I talk about that a lot in the book. Bolstering the protective factors in the esophagus.  So what causes reflux? Boy, I have that picture that I make. It has about 10 different things pointing all to heartburn and reflux-

Dr. Weitz:                           And by the way, it’s commonly referred to as acid reflux, but you’ve pointed out in your book and in your talks that only 20% of patients that you test actually have hyperchlorhydria or increased acid production.

Dr. Sandberg-Lewis:          Yeah, I got to say, not to make it more complicated, but I have to say when I do the Heidelberg test, I am noticing more people that make too much acid. But there are almost always people that have been taking proton-pump inhibitors and we have them stay off their proton-pump inhibitor whenever you’re doing any kind of acid testing, at least a week before you do the test. And I’m finding that so many of those people have rebound hypersecretion where they make too much acid now because their gastrin levels are so high from taking proton-pump inhibitors for a long time. It’s a real problem that I’m finding.

Dr. Weitz:                            Meaning the medication is trying to decrease the body’s production of acid. The body knows it needs acid, so it’s secreting the precursors to create more acid even though the drug is telling it not to.

Dr. Sandberg-Lewis:          Yeah. The proton-pump inhibitor prevents the parietal cells in the stomach from making acid. It blocks the proton pump in them that does that. And so the body, in its wisdom, it knows how important acid is in the stomach, will trigger the production of more and more of a hormone called gastrin. And gastrin, its job, its major job is to trigger the parietal cells to make more acid so that the gastrin level in the blood goes higher and higher and higher, but it can’t do anything because the parietal cells are inhibited by this medicine. You take the medicine away for a week and then do a test and all that gastrin is now stimulating a lot of acid production and it looks like they make too much acid. So what do you do? Oh, you better go back on that medicine because you make too much acid. Well, yeah, you do. It’s a real catch-22. So I prefer to mostly test people that have never taken proton-pump inhibitors because I think I’m getting a more realistic picture.

Dr. Weitz:                           There aren’t too many people like that with reflux now because that medication is handed out like candy and it’s over the counter now.

Dr. Sandberg-Lewis:          It is. I tell my students that it’s basically prescribed for any problem above the umbilicus. It’s not really a joke.

Dr. Weitz:                           No, I know.

Dr. Sandberg-Lewis:          So the major causes of GERD, let’s just make a little list here. A big one would be sliding hiatal hernia. And that of course is when the stomach, the upper two centimeters or three centimeters of the stomach on the average move up through the diaphragm into the chest that just engages the lower esophageal sphincter that normally protects from reflux. It moves it up a couple of centimeters, and now it’s not engaged with the diaphragm. The diaphragm is a muscle, if people don’t know that. It’s a big flat dome-like muscle, and it’s very important for a lot of things. Of course, it’s the separation between everything that’s in the chest or thorax from the abdomen.

                                                And the digestive tract travels through the chest, the esophagus, and then has to meet up with the stomach, which is below in the abdomen underneath the diaphragm. And so that diaphragm muscle is supposed to hug that connection where the esophagus meets the stomach, it’s called the lower esophageal sphincter, and that’s a really important relationship. So when you move the stomach up, you don’t have that anymore. You lose a lot of the muscle function of the anti-reflux valve.

                                                Another common reason is people who overeat and people who eat rapidly. And I guess part of it is when you eat rapidly, you can overeat because you don’t get the signal to your brain that you’re already full. But overeating or anything that causes more distension, rapid distension of the stomach, especially if there’s gas production in the stomach, people who have enzyme deficiencies and bacterial overgrowth in the small bowel or the stomach. When there’s more gas in the stomach, that valve, that lower esophageal sphincter will open to let the gas come out as a burp. That’s called a transient lower esophageal sphincter relaxation. It’s got that lower esophageal sphincter right in the middle of it. And when that happens, that valve can stay open for up to 20 seconds.

                                                Now, normally that valve is closed all the time, it’s right at the top of the diaphragm. It’s closed. The food moves through the esophagus, takes less than 10 seconds to come down. When it gets to the lower esophageal sphincter, it opens up, food moves through, it closes, a second, maybe two. But when it stays open for 20 seconds or up to that amount of time, and it does that periodically to let the gas out and people are burping, burping, you can have a lot of intense reflux during that. So that’s another important point.

Dr. Weitz:                            This is also why SIBO can be a cause because you get all this gas.

Dr. Sandberg-Lewis:          Yeah, there’s a whole chapter on that in my book about the differential and pressure from all those parts per million of gas below the diaphragm pushing things up.

                                                I’d say another important reason why people get reflux is food sensitivity. So individual food sensitivities. For one person it might be white potatoes. For somebody else it might be corn. For somebody else it might be dairy products. And if they find out what they’re sensitive to and remove it, they don’t have reflux anymore. So those are some common reasons. There is, of course, the whole question about is it acid reflux? According to some pathology books, over age 60, the incidence of atrophic gastritis in the US is over half the population. That means those people don’t make enough stomach acid in atrophic gastritis, chronic atrophic gastritis. And even so, you can have just the same kind of heartburn symptoms with not enough acid as you can with too much acid or normal acid. Most people have normal acid that have reflux. It’s not that they have too much acid, it’s it’s getting up into their esophagus, and if their esophagus doesn’t have the protective mechanisms to protect itself from that, they can have all kinds of severe heartburn and even esophagitis.

Dr. Weitz:                           And how many of them don’t have enough acid, so the food is not getting properly broken down?

Dr. Sandberg-Lewis:          Well, again, it depends. When we do a Heidelberg test, there are two kinds of hypochlorhydria, two kinds of not enough acid. There’s what we call frank hypochlorhydria, which means on a Heidelberg test, the patient swallows a capsule. The capsule has a low frequency radio telemetry device in it, and it feeds the pH of the surrounding solution in the stomach to a computer and we see the readout. If the patient swallows a capsule… Like the other day, I had a patient, he swallowed the capsule, the pH was 5.5 or six, stayed right there. Well, we could have said, all right, you don’t make enough acid because the pH should be definitely less than three. And usually it’s less than one. Very acidic. Seven is neutral for those that aren’t familiar with the pH scale. So what we do is sometimes when you see that, you have to give the patient one piece of popcorn to eat and have them swallow it with a little water because-

Dr. Weitz:                           One piece of popcorn.

Dr. Sandberg-Lewis:          … popcorn is… They’re fasting, so there’s no food in their stomach. One piece of popcorn when you swallow it with a little water will move the capsule down out of the esophagus into the stomach. It’ll plop into the stomach if it’s stuck in the esophagus. And that’s what we saw there. It works every time. It’s really great. So all of a sudden it goes from 5.5 or six, dunk, goes down to 0.5. It’s now in his stomach and he makes plenty of acid.  So then we periodically give him a small amount of bicarb solution to neutralize the acid and bring the pH… As soon as it changes, we see the pH go back up to six and we see how long it takes him to make enough acid to bring the pH back down to where it was at the first of the test. And if it takes longer and longer, and sometimes eventually it takes 20 minutes, 30 minutes, it’s just staying neutral at alkaline, that’s when we know that they have what we call hidden hypochlorhydria. So you can have frank hypochlorhydria right away, or you can see it when you test the stomach to see how well it can make acid and it fails to do it after a couple of challenges. So I’d say that’s the 40 to 50% of the population that has low acid production.

Dr. Weitz:                            Okay. One of the things I wanted to bring up is this concept of H. pylori, which I know you’ve discussed in the past on other podcasts. H. pylori is this bacteria in the stomach, and it’s common to think that this might be playing a role in acid reflux because the theory is that this is a major cause in increased acid in the stomach, and that’s how it leads to potentially ulcers. And therefore there’s this concept that we should test for H. pylori, and if we see it, we should try to eradicate it and that this might be beneficial for reflux.

Dr. Sandberg-Lewis:          Yeah. There’s a little bit of truth in that about increased acid production, but that doesn’t necessarily mean reflux. So the most important thing to understand is H. pylori was discovered as a cause of peptic ulcers, stomach and duodenal, especially duodenal. It can also cause a few other diseases, and it’s kind of a long list, but the major ones can also cause a type of lymphoma that occurs in the stomach called MALToma, and it can cause gastritis of course, and it can increase the risk of stomach cancer. So the thing that most people and most doctors don’t realize, and this is all over the research for H. pylori, is that H. pylori, it lives in the stomach. It can either take up residence in the entire stomach or just in the antrum, which is the very bottom.

                                                Usually it’s in the entire stomach. And we think until probably the 1920s or so, a hundred percent of the world’s population had H. pylori in their stomach. Since antibiotics were invented in the ’20s and ’30s, and more and more generations have lived through being treated with antibiotics throughout their lives, H. pylori has dwindled somewhat. And now since it was discovered in the early 1990s and now the dictum is test and treat, meaning if you test somebody and it’s positive, you find H. pylori, you kill it with usually two antibiotics plus a proton-pump inhibitor.   And the problem is H. pylori is actually… If you read the research on H. pylori’s protective effects, H. pylori is the major bacteria in the gastro biome, in the group of bacteria that live in the stomach. There’s esophageal biome, there’s gastro biome, there’s a small intestine microbiome and a large intestine microbiome, and there’s oral biome. There’s different bacteria and viruses and fungi in different parts, and they belong there. And H. pylori is the central bacteria in the gastro biome in the stomach.  It’s really important for newborns and kids in their first couple years of life to fully mature the immune system in their gut. And it turns out that besides protecting against allergies, eczema, asthma, hay fever, H. pylori in the stomach is a major protective factor against reflux and the complications of reflux, which include Barrett’s esophagus and cancer of the esophagus. So H. pylori is really important in reflux because it protects against reflux, not because it causes it. And the research is all clear about that.

                                                On the other hand, remember I said you can either have H. pylori living in the whole stomach or just in the antrum, the very end of the stomach. When it’s antral predominant, which is maybe 20% of the time, that can trigger more gastrin production and stimulate more acid to be produced. In that way, it can be a cause of stomach ulcers or duodenal ulcers from too much acid. The other 80% or so of people, they actually make too little acid.  And actually, according to the research, everyone when they first get H. pylori, which you should get when you’re a kid, but most people don’t anymore, they make too little acid for the first three months. They’ll make hypochlorhydria, too little acid. And then depending on whether it’s in the antrum or the whole stomach, they’ll either make too little, most people, or too much about 20%. So the people that have the antral type are more prone to ulcers. And the people that have what’s called pangastritis, their entire stomach having H. pylori, they’re more prone a slight increased risk of getting gastric cancer, stomach cancer later in life. And they’re more likely to possibly develop reflux from not enough stomach acid. Again, you can get reflux from too much or too little, but H. pylori in general is protective against reflux and its complications.

Dr. Weitz:                            So now I’d like you to do a little exercise where we go through a patient who comes into your office with heartburn reflux symptoms and how you would work them up. And then also keeping in mind that you’re a gastroenterologist. Most of the listeners are not, and if we’re practitioners, we’re often on the functional side of things and maybe the patient has seen a gastroenterologist who’s done maybe an endoscopy and maybe typically doesn’t see any erosive damage.

Dr. Sandberg-Lewis:          All right. First of all, if the patient’s already had an upper endoscopy, please get the results and look at them. And get the biopsy report and look at that and get used to reading those and being comfortable with the words in them and what they mean. Because again, there’s erosive esophagitis or reflux esophagitis where there’s actual erosions of the membrane, usually of the lower third of the esophagus. And then there’s NERD, non-erosive reflux disease. Patients that have heartburn, even proven heartburn if they’ve had pH impedance testing or what’s called Bravo testing, which actually measures to see does the person have significant amount of reflux occurring, not just do they have the symptom of burning because that can be caused by other things. But look at the endoscopy and figure out do they have NERD? Meaning the lower esophagus looked fine, it was normal. Or did they have erosive esophagitis, which can be grade A, B, C, or D.

                                                People with grade D esophagitis, they’re a really good candidate for taking a proton-pump inhibitor and in standard medicine, they’re expected to take it forever. It’s a miracle drug for grade D esophagitis because people go from feeling like they’re having a heart attack all day long and night to, “Oh, that’s gone.” It’s so great. Those are people that are really having severe damage from reflux and they’re at more risk to go on to have Barrett’s esophagus, which is precancerous.

                                                On the other hand, if you know your patient has NERD, their esophagus is completely normal, well, first of all, they might not even have reflux and that’s why they don’t have any damage. So there are further tests in medicine, like I said, the Bravo test and the pH impedance test where there’s actually a measurement of something called a DeMeester score that tells you how much reflux they’re having, how long it lasts, whether it’s acid, whether it’s alkaline. And if you know that they have reflux from some kind of testing like that, or they have erosive esophagitis like we just talked about, then you know that there’s reflux.

Dr. Weitz:                            How often are those tests you just mentioned, not the endoscopy, but the other two, how often are those done?

Dr. Sandberg-Lewis:          Well, they’re always done if a patient is considering surgery for reflux, like a Nissen fundoplication because no surgeon wants to do the surgery on a patient who actually didn’t have reflux because it won’t work. So they’re always done for that. But they’re also done for people that… 40% of the people that have heartburn symptoms that are put on proton-pump inhibitors don’t respond to that standard treatment for many reasons. And so that’s kind of the next step if then they double the dose, it still doesn’t work, and they send the patient to a gastroenterologist and they get more of a workup. So I can’t tell you how many patients out of a hundred actually get that test. I don’t know, but it’s not too many.

Dr. Weitz:                            Yeah. From what I’ve seen, the endoscopy is common. The other tests that you mentioned in your book are not that common.

Dr. Sandberg-Lewis:          Yeah, like I say, they’re more common when nothing has worked and they’re considering reflux surgery because it has to be done before you do reflux surgery to prove that it is or isn’t reflux. So the theoretical patient, they’ve come in, let’s say… Okay, let’s say we know that they have erosive esophagitis grade B, it’s not the D, the worst one. And they’re willing to make lifestyle changes. So first of all, we could do all the basic things that are in the chapter about lifestyle. I have them read that chapter and make sure they’re finishing eating within three hours before going to bed. If they’re a side sleeper, preferably they sleep on their left side, there’s less reflux with sleeping on the left side.

Dr. Weitz:                            Can you explain why that is?

Dr. Sandberg-Lewis:          Yeah. Well, the picture in the book shows it the best I think.

Dr. Weitz:                            I know. I know.

Dr. Sandberg-Lewis:          Basically when you’re lying on your left side, it’s very easy for the contents of your stomach, which are on the top to drain into the esophagus, whereas the stomach’s kind of moon shaped. So when you’re lying on your… Sorry, when you’re on your left side, the stomach is hanging down like a moon this way, and so it’s like a bowl that holds the material and it’s not going to reflux as much into the esophagus. But when you’re on your right side, the stomach can just empty into the esophagus like that. You can also of course raise the headboard six inches or so. You can use a wedge pillow that decreases the issue of gravity being lost when you’re lying flat instead of being upright during the day. They can also chew their food, take their time and eat smaller meals slower. And that’s been shown to really reduce reflux too. Even in people who don’t normally have reflux, if they eat a meal in 30 minutes versus the same exact meal in five minutes, significantly more heartburn even though they don’t normally get heartburn with the five-minute meal.

Dr. Weitz:                            By the way, that’s one of the problems with fast food. We know that fast food is unhealthy generally, but it’s also meant to be eaten fast. It’s often so you can hold it in your hand while you’re in the car. And so that unfortunately encourages that behavior more.

Dr. Sandberg-Lewis:          If you’re going to eat fast food, eat it slowly. Do it well. I mean there are a lot of factors. There’s the fact that cold food tends to slow down gastric emptying, whereas hot food tends to increase the speed. If the stomach holds onto food too long, it tends to encourage reflux. I mean, think of it like a bag filled with liquid and mixed up with food. If it’s slowed down and it can’t drain into this small intestine as fast and it stays in the stomach, it’s more likely to reflux up. It’s like a full bag.

Dr. Weitz:                            Is drinking water good or bad? You hear some people say drinking water will dilute your enzymes. Other people feel like water helps push the food down while you’re eating.

Dr. Sandberg-Lewis:          Okay, you don’t need water to push food down. You do need to be well hydrated, but ideally you do that away from meals. Now, if somebody wants to take a sip of water in between swallows of well masticated food, that’s not a big problem, especially if it’s not ice water to slow everything down. But I really think the big problem is when people instead of chewing 30 times to have the food be liquid so you can swallow it easily, but instead chewing four or five times and then taking a sip of water to wash it down. That’s a problem.

Dr. Weitz:                           My patients, it’s worked to get them to chew it four or five times.

Dr. Sandberg-Lewis:          That’s a problem because that actually turns on the sympathetic nervous system, fight or flight, and mostly shuts down digestion. Your brain thinks you’re being chased by a wild animal because why else would you be eating so fast? Why would you be so rushed?

Dr. Weitz:                           But that seems to be the best way to win the hot dog eating contest.

Dr. Sandberg-Lewis:          On July 4th, they did a little thing about that on the radio, and boy, is that a nauseating thing to hear about.

Dr. Weitz:                           Okay.

Dr. Sandberg-Lewis:          Anyway, so here’s our patient. Let’s say we found out that they’re sensitive to tomato or we found out they’re sensitive to gluten and removing that from their diet could be enough to totally normalize their nerve connection, their vagus nerve connection in their gut. What if we do a little more testing and we find out they have high blood sugar, their hemoglobin A1c is high? Well, there’s this thing called gastroparesis, and there’s another thing called diabetic enteropathy. Basically, when your blood sugar’s too high, your entire digestive tract over time, your entire digestive tract can start malfunctioning and reflux is a major symptom of that. Also, what if we do some flexibility testing, a Beighton score, and we find out the patient is hypermobile, their joints are hypermobile? Well, unfortunately, those people have a very high incidence of sliding hiatal hernia, which causes reflux, of laxity of the ileocecal valve, which causes cecoileal reflux. They have a high incidence of heartburn, abdominal pain, lots of other symptoms. So that’s a good thing to know about because you have to really take special measures. That’s a whole four-hour discussion. Hypermobility syndrome.

                                                What if they don’t make enough stomach acid like 50% of people after age 60? And some younger people too, especially younger kids with asthma and many people with autoimmune disease. So there are lots of ways to deal with that. If you know that they have frank hypochlorhydria, you can use betaine hydrochloride and you can actually test during the Heidelberg test. You can give the person a capsule of betaine hydrochloride or you can give them bitter herbs and see what does that do to the pH? Was that enough? No. You give a second one and then it brings it down where it should be. So betaine hydrochloride capsules when it’s indicated. People can use different kinds of bitter herbs. Gentian is one of the most bitter herbs, but fenugreek, bitter orange oil, there are many different ones.

Dr. Weitz:                            People will drink vinegar.

Dr. Sandberg-Lewis:          You can use one or two teaspoons of apple cider vinegar in a quarter cup of water, 10, 15 minutes before meals when you’re preparing your food. These are all things that can really help reflux and can really help the pH of the stomach if the person doesn’t make enough stomach acid. Now, if someone has that little test with drinking one to two teaspoons of apple cider vinegar and water, that’s a good little test. If your patient has erosive esophagitis, they’re going to tell you, “Wow, I’m never doing that again. That was like putting fire in there.” So you get a little clue. It’s just the opposite situation.

                                                And then there are people that if they’ve had their upper endoscopy, like you said, one thing you want to ask if you know your patient’s going in for upper endoscopy or you’re referring them for one, please ask the gastroenterologist to give you a reading of what’s called the gastric flap valve, gastric flap valve. It’s also called the hill criteria, H-I-L-L, and it’s just a way to grade how well the lower esophageal sphincter stays closed. And sometimes you read an upper endoscopy report and it says the lower esophageal sphincter was gaping or the lower esophageal sphincter was open, and you know there you can’t fix their reflux unless you do something about that lower esophageal sphincter. A number of things you can do. You can work with the vagus nerve. I’m sure those doctors out there know about different exercises people can do for their vagus and of course take care of their blood sugar if it’s off because that really damages-

Dr. Weitz:                            Yeah, we’ve been experimenting with an electrical vagal nerve stimulator. I’ve also used infrared light on the vagal nerve.

Dr. Sandberg-Lewis:          Yeah. And lots of simple exercises people can do too, but those are great.

                                                Another important piece here when the lower esophageal sphincter is open, is loose, is hypotonic, is to strengthen the diaphragm. Remember I said the lower esophageal sphincter is surrounded by the diaphragm muscle and it really is like… The diaphragm’s like the outer half of the lower esophageal sphincter. And if the diaphragm’s hardly ever being used because your patient doesn’t do diaphragmatic breathing, they’re always breathing shallowly in their chest, which also triggers the sympathetic nervous system and decreases vagal tone. If you can train them to do slow, full diaphragmatic breathing exercises every day, over time, the diaphragm gets really strong.

                                                There’s a great little exercise that I love to show patients where you stand a foot away from the wall and you put a single sheet of toilet paper on the wall, and then you take a nice slow abdominal breath and you breathe out with pursed lips. And you keep the toilet paper on the wall. And you do that every day and see how long you can do it because it takes a good diaphragmatic tone to keep that pressure of the air coming out for a long time. It’s a fun little exercise. Kids like it too, but toning the diaphragm, really, really important. Singing from the diaphragm. People know how to use their diaphragm to sing loudly, that’s a really good exercise for the diaphragm. Lots of things you can do.

                                                On the other hand, you can also work through the parasympathetic nervous system to tone the lower esophageal sphincter by using huperzine A, which is an extract of Huperzia serrata, an herb that has anticholinesterase activity, so it decreases the breakdown of acetylcholine in the body and raises acetylcholine. In addition, you can use [inaudible 00:41:40]-

Dr. Weitz:                            By the way, typically part of a brain formula.

Dr. Sandberg-Lewis:          Yeah, because people that get dementia don’t have enough acetylcholine in their brain either. And then you can also use things like phosphatidylcholine or acetyl-L-carnitine to support the choline production as raw material to give the choline to make acetylcholine. So that combination of… I usually use 420 milligrams of phosphatidylcholine twice a day with meals and huperzine A anywhere from 50 to 200 micrograms twice a day with meals. I haven’t done that with hundreds of patients, but when I know that they’ve had this hill criteria showing a real laxity of the LES, I’ve seen that work beautifully in six or seven patients that I’ve tried it with, especially younger patients.

Dr. Weitz:                            I know you’ve mentioned the use of demulcent herbs.

Dr. Sandberg-Lewis:          Yeah, well, there’s the other world you can go into and that is, can the lower esophagus protect itself from any normal reflux even, gastroesophageal reflux, GER, that’s going to happen after every meal? Can the lower esophagus protect itself? So what’s important there? Melatonin, one of the most important things for protection.

Dr. Weitz:                            In this context, is melatonin taken just as a capsule? Is it more important as part of a formula? Is it a similar dosage for sleep? Melatonin is… A lot of discussion about melatonin recently especially.

Dr. Sandberg-Lewis:          Yeah. It’s hard to say at this point except that we know that if you give rats melatonin supplements, it does concentrate in the esophageal mucosa. So it does get there where you want it, and it raises their blood level as well. Probably the best way to have normal melatonin is to sleep well, and it is proven that research shows that sleeping less than six hours is a risk factor for Barrett’s esophagus, which is one of the precursors to esophageal cancer in patients who have reflux. So getting seven or more hours of sleep, eight hours is ideal they say for most people, that’s real important. But of course, without going into adrenal function in a big way, high cortisol and/or low DHEA from the adrenals is a major way to suppress melatonin production because as cortisol…

                                                Cortisol is high in the morning, comes down, plateaus in the afternoon and gets to its nadir at midnight. As it’s going down, cortisol going down, that allows melatonin to come up and stay up during the night. So they have this dance where cortisol is doing this in the day, melatonin’s doing this at night. And they trade off. As the melatonin’s dropping in the morning, the cortisol is coming up to its peak. So, so many of your patients have an imbalance between cortisol and DHEA. They have high cortisol levels or they have very low DHEA levels. That’s going to suppress their melatonin. That’s going to be a risk factor for heartburn. So that’s just one of the things, but you can also do protective things like demulcents.

Dr. Weitz:                            By the way, if you use… Yeah, okay. I was just going to ask about the demulcents and if you use those… What I’ve done with some patients is have them use a slippery elm powder and have them try to slosh it around and keep it in their throat for a bit to kind of soothe that area.

Dr. Sandberg-Lewis:          Yeah, you can make a gruel with it where you mix it with just enough water, so it’s sort of like applesauce or something like that, or like oatmeal, and then they swallow it. They don’t take any other food or liquid afterwards and just let it sit there on the lining of the esophagus. And that can be a dramatic, almost instant relief from heartburn if they already have the heartburn. DGL is wonderful also. So licorice root that has the Glycyrrhiza removed from it so it doesn’t raise blood pressure or cause edema. Aloe vera juice for some people. There’s one study that shows it works as well as PPIs for acute heartburn relief. So it depends. You have a lot of options.

                                                You know about the interesting treatment. There’s a product that comes in the health food store. It’s 10 capsules in a blister pack, 10 capsules of d-Limonene, and the patient takes one capsule every other day for 20 days. And for some people, that has proven to totally take care of their heartburn. It’s sidal protective for the mucosa, and it’s also a prokinetic, so it helps the stomach and the whole digestive tract move things through better and is healing and protective against cancer-

Dr. Weitz:                            Do we want to use natural prokinetics as part of our protocol?

Dr. Sandberg-Lewis:          Well, definitely if your patient is diabetic or pre-diabetic, if your patient has SIBO, if you know your patient has slow transit constipation, a prokinetic can be really helpful. And some prokinetics are more focused on the upper digestive tract, some more on the lower digestive tract. So the ones that focus more on the stomach and small intestine in my experience are ginger and artichoke combination, and also something called Iberogast, also called STW-5 in some of the research. There are many research studies on it, a German liquid formula, herbal formula. I find that Iberogast is also especially good for that upper GI motility, which is really important with reflux. But then again, if your patient has IMO or SIBO, you got to treat that. Otherwise, you got all that pressure below pushing up. So these are some of the real common things that you can do.

Dr. Weitz:                            What’s the best diet for GERD?

Dr. Sandberg-Lewis:          So in the book, I have five or six diets that I discuss in that diet chapter, but basically when you look at lifestyle factors in diet, the thing that’s the best proven is that lower carbohydrate diets seem to be the most effective. Now, certainly if you have a patient with frank gastroparesis, fat is going to be really important because fat is what keeps food in the stomach the longest. So if someone has delayed gastric emptying, eating a lot of fat is going to be really problematic. But for everybody else, you can look at the research studies that I’ve talked about in that diet chapter and in the lifestyle chapter, reducing total carbohydrate is the thing that works the most dramatically. Even if people don’t necessarily lose weight, the weight loss is helpful, and of course, being overweight, especially around the waist, the apple fat is a risk factor for reflux and Barrett’s esophagus.

Dr. Weitz:                            But it makes it easy to keep that paper against the wall.

Dr. Sandberg-Lewis:          If your diaphragms in good shape. But on the other hand, especially for men having pear fat or gluteal-femoral fat around the buttocks and the legs, upper legs, that’s actually protective against reflux and protective against heart disease, cardiovascular disease, and diabetes.

Dr. Weitz:                            Benefits of being a fat ass.

Dr. Sandberg-Lewis:          Yeah. Yeah, I mean, it’s totally different. It’s totally different than the visceral apple fat, which is a risk factor for heart disease, diabetes, and reflux, and its complications. So for some patients, they say, “I got COVID. I didn’t eat for two weeks and I lost 20 pounds and my reflux is gone.” Or they did it intentionally. They lost weight intentionally. So that can be a big factor for some people. I’ve had at least two or three times, I remember now, men came in and they said, “I got rid of my reflux doc. Notice anything different?” “Well, you’re wearing suspenders.” “Yeah, I used to wear a belt. When I wore a belt, I had reflux all the time. Now I wear suspenders and no belt, and I don’t have reflux.”

Dr. Weitz:                            Okay.

Dr. Sandberg-Lewis:          My wife calls that designer gene reflux, because if you’re wearing a tight waist, if you have a tight band around your waist, it can suppress you from using your diaphragm when you breathe and you do more shallow chest breathing, which turns on your sympathetic nervous system, decreases vagal function, makes you more prone to reflux and other causes of indigestion. If you have a nice loose waistband because you’re wearing suspenders… Some people have said that. So it’s important, again, make your clothing more likely to allow you to use your diaphragm. And it’s pretty cool, some of the fabrics they make now for jeans, they have a little stretch to them instead of just being rigid, like the old-fashioned jeans. That’s helpful.

Dr. Weitz:                            So you are working with a patient and you’ve done an endoscopy and you know they don’t have Barrett’s or some erosive damage. What do you do about them being on PPIs? How do you get them off of them?

Dr. Sandberg-Lewis:          All right, well, the first question is does it help? Because if you ask your patients if [inaudible 00:53:09]-

Dr. Weitz:                            Well, it’s hard to know. If they’ve been taking them for a long time and then they stop taking them and it comes back, then they’re like, “Well, I have been with it, but when I stop, it gets worse.” That’s what I hear a lot.

Dr. Sandberg-Lewis:          Yes, yes. And that again is the rebound hypersecretion, and I’ll tell you how to get around that. But some patients will say, “No, it doesn’t really help.” They probably don’t have grade D esophagitis. It doesn’t really help. So it never really helped in the first place. So those people may not have much problem getting off of them. But if they have rebound hypersecretion like that where they get much worse when they stop it, first, treat the cause of the reflux-

Dr. Weitz:                            Of course.

Dr. Sandberg-Lewis:          … which could be a number of things, of course. And that’s why I wrote the book to really explain what to look for. And once you’ve done that, you don’t have it going on anymore. Maybe now your diaphragm is in good shape, your lower esophageal sphincter is in good shape, your hiatal hernia has been reduced and it’s back in the abdomen, the stomach’s back in the abdomen, you’ve normalized acid production if it was too low. Now what you can do is you can do a reverse titration, you can wean them off. And so, one way to do that is see if they respond to famotidine, which is the most common H2-receptor antagonist. All these things are over the counter, of course. So they can get some famotidine, Pepcid AC is the brand name, and they can see if taking famotidine instead of the PPI works just as well.

                                                So for instance, let’s say they’re on a PPI twice a day when you first see them and they want to get off of it. Treat the causes, get things as good as you can, and then go to just taking the PPI once a day. If they’re fine with that, they’re not having problems with heartburn, try going every other day where they take it. And on the day they don’t take the PPI, take the famotidine, which is much easier to get off and is much less likely to cause rebound hypersecretion. So it’ll be easy to wean off of that later. So they switch off where they’re taking famotidine one day, PPI another day, or maybe a combination of the two if they were on a higher dose twice a day of PPI. So you just kind of wean it down. Eventually then if they’re doing okay with that, they take the PPI every third day, Monday, Thursday, Sunday, something like that, and they’re taking the famotidine on the other days. They can also be taking DGL and other things that are happening, right?

Dr. Weitz:                            Right. There’s natural products.

Dr. Sandberg-Lewis:          Yeah.

Dr. Weitz:                            I love that exercise you had in a book where they drink a bunch of water and then go up on their toes and come down on your heels. That’s a really cool idea.

Dr. Sandberg-Lewis:          Well, heel drops exercise for sliding hiatal hernia helps to weigh the stomach down and move the stomach back down. I use that after exercise, after I do a correction on hiatal hernia, manual correction. Just helps it stay in place, but people can use that all by itself. Sometimes they’re lucky it’ll work. So yeah, so weaning off that way. Once they get to taking the PPI every third day, they can probably just stop it and now they’re just on the famotidine. And then they can just slowly remove that where they’re taking it every other day and if they feel just as good on the day they don’t take it, take it every second day, every third day, and then stop it. Even if the process of weaning off takes three to six months, really do it really slowly. Don’t change anything for two or three weeks at a time. That’s a good way to slowly bring down the gastrin levels because remember, their blood gastrin levels are very high, and so you have to gradually allow that to come down.

                                                But yeah, you’ve had patients on proton-pump inhibitors, omeprazole, the first one that was invented, probably for 20 years. They’ve been on it for 20 years. So if it takes six months to get off of it, that’s fine. It’s better than continuing it for the next 20 years if they don’t need it.

Dr. Weitz:                            Right. All right, Steven, this has been great. We’ve covered a lot of information. Obviously we could continue to discuss this topic for hours and hopefully in the future we’ll have more discussions about it, but perhaps you can tell our listeners and viewers how to get ahold of you.

Dr. Sandberg-Lewis:          So the website for my private practice Hive Mind Medicine, got to say that slowly, like a beehive, is either hivemindmedicine.org or for short, HMM, Hive Mind Medicine, PDX, which is Portland, it’s where my practice is, dot com, hmmpdx.com. And there’s a lot of great blog posts because my wife and I both write a blog post every month. There’s a lot of great blog posts on reflux and other GI topics in there if you want to enjoy those. And the book is available through any major booksellers website. Ben, held it up before, but let’s be real about reflux. I like telling people, hey, use barnesandnoble.com or powells.com because Powell’s Books is the best bookstore in the world. It’s here in Portland. You don’t always have to use Amazon. It is available on Amazon-

Dr. Weitz:                            I always put a link to the book with Barnes & Noble on my website because I agree, I would like to see the last few remaining bookstores stick around. By the way, this book is awesome. It’s really readable. It’s really [inaudible 00:59:54]-

Dr. Sandberg-Lewis:          It has limericks and cartoons.

Dr. Weitz:                            Every single chapter.

Dr. Sandberg-Lewis:          Yeah, and we wanted to make it fun. [inaudible 01:00:06]-

Dr. Weitz:                            NERD is a comical name for erosion-free reflexive theme. What leads into GERD instead of just NERD? This chapter is here to explain.

Dr. Sandberg-Lewis:          That’s a good one.

Dr. Weitz:                            Thank you, Steven.

Dr. Sandberg-Lewis:          All right, Ben, it’s been great talking with you.


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.