February 2024 – Weitz Sports Chiropractic and Nutrition

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Dr. Rand McClain discusses Testosterone Replacement Therapy at the Functional Medicine Discussion Group meeting on February 22, 2024 with moderator Dr. Ben Weitz.

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Podcast Highlights

4:33 Some of the most common symptoms men complain of that might indicate the need for testosterone replacement therapy are a lack of energy and a lack of libido. Other symptoms include cognitive problems, sleep problems, and difficulty improving your body composition.

6:06 Testosterone and prostate. Dr. McClain feels that testosterone therapy does not increase the risk of prostate cancer risk, though estrogen might increase prostate cancer risk, as well as cancer of the breast, cervix, and uterus. Dr. McClain feels that while testosterone does not increased prostate cancer risk, the metabolite, dihydrotestosterone is related to prostate problems. And placing a man on Lupron for metastatic prostate cancer makes the man miserable.

10:18 PSA. While androgen deprivation therapy for prostate cancer will lower PSA levels, but Dr. McClain argues that PSA is not an effective test to screen for prostate cancer risk and the American Urological Association no longer uses it as a cancer screening tool. Dr. McClain also mentioned that he has several patients who have had a PSA level above 13 for most of their adult lives and based on multiple biopsies and multiparametric MRI, they do not have prostate cancer. And some patients have a normal PSA and have been found with prostate cancer.

21:34 Transdermal testosterone. Dr. McClain feels that transdermal testosterone is a good option for females but not for males. Men do much better with a timed release version of an injectible testosterone.

22:42 Free vs Total Testosterone. If free testosterone is low because the Sex Hormone Binding Globulin is high, we can lower SHBG through a high protein diet, by taking stinging nettle, with estradiol, or by using a small dosage of an anabolic steroid.

Dr. Rand McClain is a Doctor of Osteopathy and a Regenerative and Sports Medicine specialist. Dr. McClain is a leader in alternative and regenerative medical treatments at his Regenerative and Sports Medicine Clinic in Santa Monica, California. He utilizes various anti-aging therapies in his practice, including Bioidentical Hormones, stem cells, peptides, hyperbaric oxygen, cryotherapy, and nutritional supplements. He wrote a best-selling book, Cheating Death in 2023. His office website is psrmed.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.

Welcome everybody. It’s a small group tonight. Since after the pandemic, we’re not getting quite the number of people showing up in person, so please tell your friends. These meetings are great networking and trying to bring the functional medicine community together. So we meet on the fourth Thursday of every month, and please join some of our upcoming meetings. Our next meeting is March 28th on an Integrative approach to Cancer with Dr. Nalini Chilkov. And April 25th is Dr. Maggie Ney on bioidentical hormone replacement. So I encourage everybody to ask questions. And after you ask the question, we’ll repeat it. And if you’re not aware, we have a closed Facebook page, the Functional Medicine Discussion Group of Santa Monica. So please join that so we can continue the discussion. I’m recording this event and you can see it on my Rational Wellness Podcast, and so please check that out. And if you do like watching it, please give me a positive review on Apple Podcasts or Spotify. And our sponsor for this evening… Oh, there we go, is Integrative Therapeutics. So Steve, would you come up and tell us about a few of the Integrated products?

Steve: Hi there. This isn’t really our wheelhouse, but we do have a really nice product called Testosterone Formula that has Panax Ginseng, Ashwagandha, Tribulus, a few other things that have been in clinically significant doses. So that’s a top-ten product for us. And then the big news is the cortisol manager is now allergen free, so it’s not news to you, but. So we’ve turned it into a capsule, removed the soy, removed the mag stearate and titanium dioxide, so it’s much cleaner. That’s kind of going to be a trend for us is, if you guys are aware that some of the ingredients that are typically in tablets are being phased out in California. We don’t have two different products for California versus other states like the Prop 65 warning. All of our products are Prop 65 compliant. Is that right, 65?

Dr. Weitz: Yes.

Steve: So we’re changing a lot of tablets into capsules where we can’t do that. We’re removing those ingredients anyway, and that’s going to be all over the country. So that’s kind of it for now.

Dr. Weitz: So our topic for tonight is hormone replacement with Dr. Rand McClain. Dr. McClain is a regenerative and sports medicine specialist who works with patients at his regenerative and sports medicine clinic in Santa Monica. Dr. McClain is an osteopathic physician and a bestselling author of Cheating Death. Dr. McClain is an expert in hormone replacement therapy as well as with regenerative medicine. So Dr. McClain.

Dr. McClain: Thanks for the introduction. By the way, I know it’s billed as a male hormone replacement therapy session as it were, but I deal with female and male hormones, so I imagine you guys might’ve figured that out. So ask away, really. And I don’t want to take any thunder away from the gals coming a week from next or…

Dr. Weitz: A couple of months. Yeah. That’s fine.

Dr. McClain: Couple of months. Yeah, please. As matter of fact, I was telling Doc earlier tonight that I started practicing with females being the larger percentage of the population for the longest time before it flipped on me. And now I think more than ever, women are getting the gyp in terms of attention to the therapy they need. So anyway, ask away, please.

Dr. Weitz: So I’ll start with the questions.

Dr. McClain: Okay. Sorry. Please.

Dr. Weitz: Let’s start with men. When you see a man in your office and they come in complaining, what are some of the complaints that would make you think about prescribing testosterone for men?

Dr. McClain: That’s an easy one, most people complain about a lack of energy. That’s probably number one on the list. With males and females, though libido is an issue, people are still in their thirties and wondering why that magic has gone away. Sometimes it’s cognition and that makes sense if you think about the light bulb not getting enough energy, it’s not a problem with a light bulb, it’s just you’re tired all the time so how can you think straight. Body composition is the one that comes up too, because you know what you do, especially a lot of the patient population I have here in California, they work out like we all do in Southern California, and the tricks that used to work, something as simple as not having beer for three weeks or whatever brings your abs back, but not anymore. And you’re wondering why if I’m doubling up my cardio, can I not get the results anymore? Well, you don’t have the leverage of testosterone. So those are just a few of the ones that bring people in really. Trouble sleeping too for a totally different reason that testosterone tends to be nature’s antidepressant. And for a lot of people, it’s hard to get a good night’s sleep if you’re worried about the 2.3 kids and a mortgage and don’t have the ability to, like you did when you were 20, to shut off your brain and say, “Be quiet. I’m going to go back to sleep and handle this in the morning.” So those are a few.

Dr. Weitz: So when you see a man, let’s say a guy comes into your office and they’re interested in possibly getting on hormones, when do you think this person shouldn’t be on hormones? What are some of the risk factors, reasons why you wouldn’t want to prescribe testosterone, say to a certain guy?

Dr. McClain: If he or she’s really bent on feeling bad, then I won’t give them any medication. But really if you’re referring to the potential side effects, the potential side effects are, first of all, things that we can control and typically do not reflect testosterone per se, but a metabolite testosterone called dihydrotestosterone. That’s the bad guy. And men have known about that for a while for accelerating hair loss. Women for acne. That’s why we used to prescribe spironolactone, which is actually a diuretic, but it has a secondary benefit to females to block the conversion from testosterone into dihydrotestosterone. So that’s an easy fix if you think about it, if you’re one of roughly the 20% that does get acne, or not only hair loss in the head, but hair in the wrong places, it is driven by dihydrotestosterone and we can just block the formation thereof and you’re happy.

So those are really the… Now you might read about, if you go on Dr. Google, some of the side effects that have been presented over the years or contraindications, for example for men, prostate cancer, oh, it’s going to give you prostate cancer. Legend. I challenge you as would Abraham Morgentaler, who really did a lot of the leading research, along with guys like Dr. Larry Lipshultz, to find a study that actually proves that. It’s been legend for probably 80 years now, and we actually know that testosterone’s protective to the prostate rather than the other way around. It’s the estrogens men and ladies have to worry about, again, a metabolite testosterone. But we can control those because we’ve identified that the estrogens you got to look out for, and write it down if you guys are planning on being on jeopardy, but the 16a-hydroxyestrones and the 4-hydroxyestrones definitely are associated with cancer of the breast, cancer of the cervix, uterus, but also the prostate. So that’s what we want to watch out for as metabolites.

Dr. Weitz: Well, I get that. I hear you and I’ve seen the studies that show that testosterone doesn’t increase the risk of prostate cancer, but there’s got to be some relationship because we know that patients who have advanced prostate cancer are often treated with androgen deprivation therapy. So somehow blocking testosterone has some benefit in inhibiting prostate cancer growth.

Dr. McClain: I’m glad you brought that up because that’s the saddest part of what I’ve seen with this association that’s been misplaced, because again, it’s not the testosterone itself, it’s the metabolites that cause the issues. Of course, cut out testosterone, you don’t have any more dihydrotestosterone, you don’t have any more of this estrogen made from testosterone. So it does work sometimes. Sometimes it doesn’t however, because you do lose the protective benefit of testosterone. And you put a guy through even more torture because ladies who are meant to have a pretty high level of testosterone can even, sorry, estrogen, beg your pardon, can attest to when it’s too much feeling not so good. Guys are not meant to have estrogen. And what little remains in the relationship, I should say, to the zero testosterone makes a guy miserable. And it’s not only that we’re cutting that off, but we are actually giving them Lupron. And so the estrogen levels can go way higher than they’re supposed to and guy’s miserable on top of having stage four prostate cancer. It’s really terrible. So I hope you were teeing me up for that answer, but yeah.

Dr. Weitz: Yeah, I generally think you’re right, but still there’s got to be… I mean you definitely see PSA levels go down when they get on the Lupron.

Dr. McClain: Are you teeing me up again? I think you are. PSA has never been and never will be a cancer screening tool. It can be useful for prostate cancer if you’ve had a radical prostatectomy because obviously if there’s any prostate tissue left over, we have an issue. But prostate specific antigen has been touted as a cancer screening tool since the guy invented it and went to committees that sort of glossed over the fact that it really had no relationship. The guy who invented the tool actually, to detect prostate specific antigens, first went to The Wall Street Journal and then nobody listened. He was screaming, “Don’t use my tests to screen for cancer. That’s not what it’s for.” So he had everything to lose, so to speak, and nothing to gain from that. Actually ended up writing a book called The Great Prostate Hoax. But finally, I believe it’s official, the American Urological Association no longer uses it as a cancer screening tool anymore because they realize it doesn’t work. You can have prostate specific antigen elevations because you passed a large stool the day before, you had sex the day before, you rode your bike the day before and essentially manipulated the prostate so that it would express more prostate specific antigen. But it could be that those numbers are elevated simply because you have a large prostate or the three, I think, things I mentioned earlier.

Dr. Weitz: I would argue with that. I think that PSA is not as accurate a measurement as we’d like, but if a guy presents in your office with a PSA of 20, very highly likely has prostate cancer. Now you can have small changes, you can go from two to three or three to four, and that could be something benign. But I think very large changes in PSA are likely caused by prostate cancer.

Dr. McClain: The studies don’t bear that out. And in clinical practice, which I can speak to more so than the studies, I have two good friends who maintain a PSA somewhere above at least 13 for most of their adult life. And one of them has been through five biopsies of the prostate, which are not without risk and are no fun. They do not have prostate cancer as evidenced by the biopsies, but also through multi-parametric MRI, which allows you to visualize the prostate. So again, it does make some sense that you could expect to find a cancerous prostate associated with an elevated PSA because typically it’s going to be larger, right? Cancer grows out of control or undifferentiated cells. So a higher PSA could be related to that. But again, if it’s also because of enlargement for a benign reason, then you can’t necessarily say that is a sign. It’s pathognomonic, we would say, right, for prostate cancer.

So it does jive if you see a high PSA in certain cases. But then again, we have cases where the PSA was normal and we found prostate cancer. So I don’t use it as a tool. Actually, what I do use it for is a tool to manipulate insurance companies with their rules and say, “Hey guys, if it’s over four, let’s get a multi-parametric MRI so we can actually see what’s going on there.” You can visualize a lesion as small as three millimeters if you send it off to a special place in Holland, but even five millimeters is pretty small, and if we catch it early enough, we have about a 97% cure rate with prostate cancer. So that’s the name of the game. But I know I’m getting off topic with the PSA.

Dr. Weitz: Oh no, that’s fine. I mean it’s an important topic. Prostate’s an important topic. Why don’t we talk for a few more minutes about prostate? What do you think about localized prostate treatments?

Dr. McClain: Like [inaudible 00:14:40]?

Dr. Weitz: Like using the HIFU or some of the other techniques to… Let’s say you have a localized prostate cancer, localized to say one lobe of the prostate and after the MRI and it’s a lower grade, let’s say a Gleason six using a localized therapy as opposed to radical prostatectomy?

Dr. McClain: The jury’s still out. I have some patients that have gone through with that and so far so good. I would expect nothing but success if the entire lesion was removed and the margins, etc. Because it does make sense. And of course you can preserve a good portion of the prostate so that the patient is not harmed in any way by a loss of prostate function because it’s gone. So I think there’s a lot of potential for success there for people that don’t want to do what we call watchful waiting to see if it’s in a section like that that you can isolate, and it’s not near the edges of the prostate, some people like to just watch to see if it’s going to grow any further. But some say, “Hey, let’s get rid of it.” And that’s a procedure that seems to be working well so far. But they’re new so we don’t have long-term studies that can say, “Hey, when I removed it with this particular technique, I had a 20-year survival rate or more hopefully. But it makes sense

Dr. Weitz: Obviously when anybody gets that treatment, you don’t just forget about it and you got to be monitoring them carefully. So you’re going to prescribe testosterone to a man. What type of treatment do you typically recommend?

Dr. McClain: That’s kind of easy too. I like to joke self-deprecatingly that a monkey could do this if he gets enough practice because believe it or not, the starting dose is typically the same. I was sharing the story with the 83-year-old woman with you before and early in my career I made the mistake of saying, well, gosh, she’s 83, maybe I should cut back on the dose a little bit. And boy did I get an earful when six weeks later she was complaining that, hey, it hadn’t kicked in and it’s not doing anything for her. And it ain’t like she has a whole lot of time left. She wants to get to the garden and have enough energy to do her gardening. So I learned early on that, at least at the start, and it’s rare that I would say this, but one size does fit all. And then you can adjust it from there depending upon someone is what I call a cheap date or an expensive date, they need more or less. And we can adjust that roughly 90 days. But the interesting thing about testosterone replacement, and I’m assuming you’re talking about testosterone because the ladies need estrogen modulation as well, and progesterone perhaps, depending upon each individual. But with testosterone, you’re trying to get to a therapeutic minimum threshold and remain above that rather than find a sweet spot like you would say thyroid where you’re looking for the same reference intervals with exogenous thyroid that you would with the body producing its own. With testosterone, you’re not looking for that. And we’ve known that since roughly the 1950s, although that’s not widely published either anymore or at least known. But you get to that level, stay above it, and you’ll be fine. Well, I should say you’ll have resolutions of the symptoms that you’re trying to resolve. So that’s one thing that’s unique about testosterone.

So you can start with that dose and then, as always, ask the patient how he or she is doing in roughly, I wait 90 days because it takes six weeks. We don’t know why it works this way with certain antidepressants too, but at six weeks they’ll feel better typically, the symptoms will resolve. But you go through what I call a honeymoon period, because the body, and I know I make myself into a nerd even more so every time I say this, but it’s really cool if you think about it, you can’t make more keys, so you make more locks with the same keys, you make more receptors, it’s called upregulating receptors, to take care of the business of not having enough testosterone around. Well, now we fix that with replacement therapy. So it takes the body a while to downregulate the receptors, and in that time you enjoy the benefits of having what would be considered more testosterone effect.

So roughly 90 days I like to check back in. And then again, how are you doing? That’s the most important thing. Have the symptoms resolved? If not, what isn’t there for us yet? And then look at the labs, arguably secondarily, to see, okay, do you have more testosterone than you need? Do you have less than you need? Again, in combination, most importantly with the symptoms, because you don’t treat numbers. And I see plenty of patients… And Morgentaler, by the way, deserves credit for this because early on I read his material and he would give a cutoff. Do you remember those days when 450 total testosterone… By the way, they weren’t even looking at free testosterone, which is important because the free is what is real to you. That’s what’s available for use. But 450 nanograms per deciliter or below, then you’re a candidate. If not, you’re not. Well, what if you’re 447? You’re out of luck? Let’s try measuring again. Let’s try that again. Anyway, and what happens once you’re above or below that range for other reasons? So he has come around along with at least 20 other experts in the field worldwide. They published a consensus in 2016, they published through the Mayo Clinic, basically saying what I’m now repeating, you treat people not numbers. And if someone is symptomatic and they don’t have a ridiculous testosterone of say, 1200, which is very, very high, then treat them whether it’s 450 or 650 if they’re suffering from low T symptoms. So anyway, I’ll stop there.

Dr. Weitz: Yeah, for those who aren’t familiar, Abraham Morgentaler is a world-famous researcher and doctor who’s written a lot of papers about the safety of testosterone and argued and shown in papers that testosterone doesn’t increase the risk of prostate cancer, and it’s even safe in some cases with patients who’ve had prostate cancer.

Dr. McClain: It’s actually been used, a very small study, I will say, in NF-15 to treat prostate cancer. They called it bipolar testosterone use where they put people on, they took them off, put them on, albeit it a small dose and it was transdermally applied, but it worked. So yeah, he’s been a great proponent of testosterone use and making sure that a lot of these rumors were dispelled. But again, in that consensus statement, he incorporated the expertise of those worldwide. So that’s one of the reasons I mentioned it, because it’s not just him.

Dr. Weitz: What about transdermal testosterone?

Dr. McClain: So that’s a good option for females, and I can’t tell you why it works for females but not males, except that it just doesn’t work as well when it comes to resolution of symptoms. Guys tend to do much better on an injectable where you’re using what we call an esterified form of testosterone, a time-release version. And it is more than just effectiveness, which is defined one way differently than efficacious is because effectiveness implies compliance. And guys and creams don’t work well, certainly don’t work well with me, I hate shaving as it is. Obviously you do too, look like you got [inaudible 00:22:18] today. And I joke, and I don’t mean to sound… this is going to sound sexist, but my wife, I drop my candy by not invested in Sephora because she loves creams and gels and stuff like that every day. But compliance is an issue in and of itself. But beyond that, as I’m trying to say, it’s much more efficacious in men to use the injections rather than the cream. But for females, it seems to be no difference.

Dr. Weitz: You mentioned free testosterone versus total testosterone. And so if the free testosterone is low often because the sex hormone binding globulin is high, how do you address that?

Dr. McClain: So if that’s the only issue, in other words, it doesn’t appear that the gonads, whether they’re ovaries or testicles, are producing insufficiently if there’s plenty there, but it’s just a matter of getting that free testosterone up. We can lower SHBG through a couple ways. One is to maintain a high-protein diet. The other is to keep… And this is for a male now-

Dr. Weitz: How does a high-protein diet help?

Dr. McClain: That’s a good question. I don’t think we know the mechanism of action, but maybe you do?

Dr. Weitz: I don’t.

Dr. McClain: I don’t know anybody who does, but we’ve observed that. Well, I got one for you. Let me skip to stinging nettle. It’s a supplement, right, stinging nettle?

Dr. Weitz: Yeah, stinging nettle roots.

Dr. McClain: Yep. Right.

Dr. Weitz: Not stinging nettle because then you’re wondering, how did they figure that one out?

Dr. McClain: No, stinging nettle root, excuse me. That tends to lower SHBG. So does maintaining estrogen, and we use estradiol, the most prevalent in a male and female, as a surrogate marker for all those. So if we can get the estradiol in a male down to about 15 to 20 picograms per milliliter, roughly below 21 or 22 to be more precise, he will drop the SHBG and typically we’re looking at an average of about 2% free testosterone will be available, therefore. There’s one other way to do that that I’m aware of, and that’s to use a very, very small dose of what we refer to as an anabolic steroid.

Which by the way, segue, unless you tell me not to, an anabolic steroid is simply a… a lot of the ones are derived from dihydrotestosterone molecules that I talked about earlier, but don’t have anything close to the same effect. As a matter of fact, the opposite. Because all you have to do with a molecule is change one ligand. It can look very similar, but change one little post here and it can change the effect demonstrably. As a matter of fact, anabolic steroids that are used by women, not just female athletes who are trying to win a race, but for example, for females who have estrogen-sensitive cancers and need the effects of testosterone to feel better, but don’t need the risk of it converting to something that can harm, they’re magic. And they have less side effects like we were talking about earlier, hair in the wrong places, losing hair in the right places, getting acne, than would dihydrotestosterone, even testosterone itself. So testosterone, estrogen, they’re all steroids, we know that, right? Because they’re made from cholesterol. Okay, just want to make sure. But adding a small dose of an anabolic steroid, something that would have no effect anabolically, in other words, the way that is intended to be used otherwise, will lower SHBG also. So those are the four things I just mentioned, right, the ways to lower SHBG.

Dr. Weitz: Let’s see, what about other male hormones like DHEA, androstenedione?

Dr. McClain: So I’m a big proponent of if you want to go from LA to San Francisco, don’t go via New York. A lot of physicians were using, for example, progesterone in the hopes that it might convert down the cascade to testosterone in the early days. No one wanted to touch testosterone, even though we had some really cool studies with testosterone in females. One of my favorite was a depression treatment study where they used it on, I think it was 50 females and at least 85% were able to resolve their depression using testosterone. I thought that was pretty interesting, especially back in the fifties. What happened with testosterone is one other subject, meaning the period between then and now. But I’m sorry, I’m getting sidetracked. What was your question?

Dr. Weitz: Oh, I was asking about supplementing DHEA or other male hormones like androstenedione.

Dr. McClain: The problem with that is they can convert to things you don’t necessarily want. And while they’re-

Dr. Weitz: DHEA, that’s pretty safe, isn’t it?

Dr. McClain: Well, it can convert very easily to any of the others. It depends upon the individual. Unless you use 7-keto DHEA because, of the three DHEA metabolites, that one will not convert to another androgen or estrogen for that matter. So that one’s safe. But yeah, the others can convert just like they were trying to use progesterone back in the day hoping it would convert, but not knowing if it would or not, and everyone’s different. Some people, the ladies unfortunately, would not convert. They’d blow up. That’s one of the side effects of too much estrogen, you get bloated and moody or really, really tired because progesterone can convert to, particularly if it’s oral dihydroprogesterone or 5alpha-Pregnane, which works on the GABA receptors, those same receptors that you’re trying to activate when you have a shot of whiskey or a Valium or a Xanax or something like that. So yeah, you can run some risks doing it that the indirect way by using some of these other substances that you don’t know where they might end up.

Dr. Weitz: I think it’s generally thought that DHEA in women will convert into testosterone, but not likely in men.

Dr. McClain: I don’t know what the statistics are when it comes to polling and seeing what’s going to convert to what, particularly with regard to gender. What I’ve observed is in men, yeah, it tends end up spoiling your estrogen control. In females though, what I’ve found is that it either stays as DHEA or will turn into another antigen because when I add DHEA to the regimen for whatever the reason might be, we can go into that if you want, but I see acne development and sometimes hair loss, so I’m a little resistant to use DHEA unless it’s 7-keto DHEA, and even then I don’t unless I have to.

Dr. Weitz: Let’s say a 30-year-old guy comes into your office and let’s say they have the symptoms that would indicate the need for a testosterone, and let’s say their total testosterone level is 250. Are you hesitant to use testosterone in a younger guy because now he might be on testosterone the rest of his life, might affect his fertility?

Dr. McClain: So you asked actually a few questions in there. The first thing I would address is whether they’re 30 or youthful… that’s not the right word. If they’re what we would normally be considered early candidates for therapy, the first thing I would check to see is whether it’s indeed primary or secondary. Meaning is it the testicles that aren’t working anymore or is it a signal to the testicles that’s not working anymore? So if there’s something like a what’s called a pituitary micro adenoma, which is the fancy way of saying you have a little growth in the pituitary, and typically they’re benign, they’re not often found, but you could also have damage to the pituitary. Say this guy was a fighter and had been concussed too many times. Once it’s enough, sometimes. Been in a motor vehicle box and whatever it might be, we can do an MRI of the brain to visualize the pituitary and see if there’s something called an empty cell. It doesn’t appear to be there anymore.

We can also look at some of the hormones that are supposed to be sent by the pituitary to the testicles that say, hey, make some testosterone. Luteinizing hormone is what we’d be looking for. We can do a stem test if we don’t trust just seeing what levels come up, we can give them ACG. In other words. We can give them enclomiphene. There are certain drugs that we can use, in other words, to identify and differentiate between secondary versus primary. Because yeah, if it is secondary, then most guys, at least that I’ve observed, tend to want to keep riding that wave of natural production for as long as they can just because, for another reason, rationally or not, it sounds good. “Hey, I want to keep using mother nature for as long as I can,” is typically what I hear, even though oftentimes the results won’t be as good because, by definition, 35 is the start of what we call peri andropause, like when we talk about peri menopause for females. So you’re getting close to where the testicles are going to say, “We’ve set the pace here long enough. Okay? We’re done. If you have procreated by now,” or whatever your theories are as to why it starts to peter out, that’s when it happens typically. But stress can bring it on more quickly too, males and females. So that’s the other thing I have to look at with this 30-year-old, is there physiologic damage or is the guy working three jobs, not getting but four or five hours of sleep a night and we need to correct a few things that will right the ship without having to add any drugs?

Dr. Weitz: Or they’ve got a significant exposure to environmental estrogen?

Dr. McClain: Absolutely. Sure.

Dr. Weitz: This phenol A, we can go on and on about all the environmental estrogens and other things that could affect-

Dr. McClain: Yeah, just being overweight. We know that fat is a big producer of estrogen because inside and around fat, you have aromatase enzymes which convert testosterone into estrogen. So again, another just pretty simple thing to look at and go, well, hey dude, let’s work on, see if we can drop a few lbs here of fat and correct the situation.

Dr. Weitz: As we’re discussing. Do we have questions? Yep.

Speaker 4: I have one. So with a patient that wants to stay natural, what do you do for them?

Dr. Weitz: Okay, so let me just repeat the question. The question is, for a patient who has symptoms of low testosterone and let’s say you measured their total testosterone and it’s low?

Speaker 4: Yes or on the lower end.

Dr. Weitz: Right. So in other words, shorter giving hormones, what else is in your toolbox to help these patients?

Dr. McClain: Well, to be clear with your question, are we talking about skipping hormones or skipping any type of drug treatment? Because there’s a big difference.

Speaker 4: Well, let’s say skipping any type of drug treatment first.

Dr. McClain: Then you try and figure out what could be causing the low testosterone, the things we mentioned, and this is all part of the history. I mean, if you’re a practitioner, you know this is where we get it all, or 80% of it, let’s find out what’s going on. Is stress the issue? Is this person carrying way too much fat? Is there again, a problem with pituitaries or some sort… Prolactinoma is another one. I mentioned a microadenoma. There’s different things that could affect him physiologically that wouldn’t involve drugs to fix. Sometimes they go in, they usually go in through the roof of the mouth and they find something on the pituitary and they scrape off this little piece and things go back to normal, so to speak, the function of the pituitary anyway, and its effect on Luteinizing hormones.

So yeah, you do some detective work and find out what could be the cause. Again, like you said, I skipped it and I shouldn’t, and I almost did again, but environmental exposures. This guy lived next to power lines, he’s lived next to a chemical factory. I mean, these are all important things. He’s a mechanic. So exposure, believe it or not, to oil, if he’s not using gloves, I mean that was the only way of doing it. I mean, we didn’t do that when we were working on the car. Come on, that’s a nerd who puts on gloves. Well now you better because long-term exposure to just motor oil can really mess you up.

Dr. Weitz: Now what about for the patient who has symptoms of low testosterone? Let’s say they do have low testosterone, but they don’t want to go on testosterone. What are the other drug treatments that you’ll use and what protocols do you find effective?

Dr. McClain: So even if the gonads are not working as they should, so to speak, like they did when they were 20. It should, that’s not the right way to put it. But we can still get the last bit of work out of them by using things to stimulate them to produce more testosterone such as luteinizing hormone, actually not analogs, but homologs, HCG human chorionic gonadotropin, it’s so close in nature, we have to call it a homolog rather than analog. That’s something that you would inject anywhere from two times a week or more typically to override the system and tell the testicles to do more work. The other way to do that is secondarily by blocking the perception of estrogen, something called SERM, selective estrogen receptor modulator. Tamoxifen is one that’s well known because it came to the floor with a treatment of estrogen-sensitive cancers.

Speaker 5: Is anastrozole the same like tamoxifen?

Dr. McClain: No. Anastrozole is an aromatase inhibitor known typically as Arimidex anastrozole the brand, but either one works to lower estrogen directly or the perception of estrogen tamoxifen in clomophene indirectly, and therefore if testosterone is low, the pituitary, speaking what they say, anthropomorphologically will say, “Hey guys, let’s send a signal to raise testosterone.” However, if testosterone’s high because estrogen is made from testosterone, you can block estrogen all day long and the body says, “Talk to the hand,” because testosterone’s still high, it’s not going to send a signal. So it only works when you have low testosterone present, and that’s a relative term, right? When I say term and relative assessment, it’s low for your body or not. So if you block estrogen, the pituitary will send a signal to produce more testosterone in the hopes that that’ll happen and the estrogen will right itself too. Does that make sense, the way it works? It’s secondarily, bottom line

Dr. Weitz: When prescribing… I’m sorry, did you have a question Roxanne?

Speaker 6: Yeah. How are you?

Dr. McClain: Hey, good. How are you doing?

Speaker 6: So good to see you.

Dr. McClain: Likewise.

Speaker 6: Do you have any experience using medical grade around therapy suppositories for PSA issues? I’m asking because I once attended a lecture with a urologist who specialized in this type of disorder, if you will, she worked down in Orange County. I sent a couple male patients when they had their PSA come in with a odd problem and they claimed it worked very well for them. So I hear what you’re saying about the injections. I certainly hear about compliance. But this is… I don’t know that they’re going to stick something up their butt either, but it works supposedly very well.

Dr. Weitz: Let me just try to repeat that question. So-

Speaker 6: This doctor down in Orange County, she’s a urologist, she was specializing in male disorders. And her primary way of treating was she actually manufactured them, but they do sell them, they’re medical grade aromatherapy suppositories. The theory is that they work transdermally very close to the area you’re trying to treat rather than swallowing something or applying something close to the area. So anyway, I just [inaudible 00:39:22].

Dr. Weitz: So the question is what about the use of aroma-

Speaker 6: Aromatherapy.

Dr. Weitz: … aromatherapy suppositories to-

Speaker 6: Treat PSA?

Dr. Weitz: … to treat IPSA?

Speaker 6: Yes.

Dr. McClain: I don’t know enough about it. I can only speculate that when you’re using things like that, there’s chemicals in what we refer to as the aromatherapy ingredients, which can include a lot of things, right? Herbs and things that are typically fragrant, you’re talking about aromas. And that they’re-

Speaker 6: [Inaudible 00:39:55].

Dr. McClain: So the quality is better. You’re not going to have some contaminants and you might have a higher concentration, but the point being that there’s chemistry involved there and because you’re putting it close to the prostate, it might affect… I remember, I don’t know if you walked in when I was talking about the PSA and what it’s for, but it would block, at a minimum, the theory would be would block the release of prostate-specific antigens into the bloodstream. What that means is open to interpretation. Okay? Is it shrinking the prostate over time so there’s less prostate to dump these antigens into the bloodstream? I don’t know. I can only speculate. And I don’t know. I haven’t heard about it, but it sounds like something that might be effective.

Speaker 6: [Inaudible 00:40:46] mechanism either. All I know is that these two patients came back, claimed that that was their primary mode of therapy and seemed to work for them. And it’s quite popular in France and Germany [inaudible 00:40:59].

Dr. McClain: Well, we don’t know if it was treating prostate cancer. We just saw the observation was that the PSA went down?

Speaker 6: Yes.

Dr. McClain: That’s plausible. I can see that happening. There was something there that shrunk the prostate or stopped it from… It could have been just quelled inflammation because that’s enough to release more prostate-specific antigens into the bloodstream. So that’s plausible. I just don’t know enough about it. I’ve never heard of that.

Speaker 6: Theoretically [inaudible 00:41:22].

Dr. McClain: Yeah, it’s definitely plausible.

Dr. Weitz: So what about potential risk for cardiovascular disease with testosterone therapy?

Dr. McClain: That was another myth and part of why I referenced the 2016 consensus that was led by Morgenthaler because that was one of I think nine resolutions that dispelled various things like that. There is actually a correlation between low testosterone and coronary artery disease, low testosterone and type 2 diabetes, low testosterone and osteoporosis, as I said earlier, low testosterone and prostate cancer, low testosterone and colon cancer. So yeah, more what legend to dispel. And the good cardiologists, the ones that are hip, up-to-date so to speak, will say just that. They used to say, “Oh boy, stay away from that testosterone.” Now they say, “Well, no, fine, keep going. You’re doing fine.” And it makes sense even if it’s not a direct mechanism, if you’re healthy otherwise, you’re exercising, your heart’s probably going to benefit from it rather than the other way around.

Dr. Weitz: Well, one of the mechanisms by which theoretically it could cause cardiovascular problems is it’s well known that men who take testosterone therapy are going to see an increase in red blood cell hemoglobin hematocrit production, so therefore your blood gets thicker and potentially that puts you more at risk for a heart attack or a stroke.

Dr. McClain: So with testosterone replacement therapy, dosages that are not super physiologic, not bodybuilder doses, we’ll call them, no dispersion toward bodybuilders, but with replacement dosages, we don’t have that issue. When you see elevations in hemoglobin hematocrit and red blood cell count, in my experience, there’s two reasons for that. Almost, I’ll say, and I used to bean accountant before, I’m a doctor, so presumably I’m honest and conservative, I would say 99% or more of the time it’s related to sleep apnea that hasn’t been diagnosed yet. And it makes sense if you think about it because… Real quick, the other one is a JAK2 gene mutation, which is very rare.

But as people age, they tend to have issues with sleep apnea. Even people as skinny as olive oil can have sleep apnea. They don’t have necessarily a big neck, but the soft tissue of the palate starts to collapse over the area, whatever the reason is. And so hemoglobin and red blood cell counts tend to rise because basically you’re training in your sleep, the same training effect you’re looking for when you go into oxygen debt on a treadmill, but you’re doing it for hopefully at least seven to nine hours a night. That potential rise is modulated by the decrease in testosterone that happens about the same age, and so they cancel each other out and the typical primary care physician goes, “Yeah, everything looks fine. If you’re a male, your hemoglobin is 15.5, red blood cell count’s below five and everything’s hunky-dory.”

And then you have the testosterone, which is absolutely necessary. You can become anemic without enough testosterone. That’s the opposite of high H&H. And you put the testosterone in the engine and all of a sudden, oh look, that doggone testosterone’s causing a problem. Hemoglobin’s going up, red blood cell count’s going up. It’s that testosterone. No, it’s the undiagnosed sleep apnea. And you treat the sleep apnea and hemoglobin hematocrit come back down.

Now, if you do use super physiologic dosages, well above TRT levels, you’ll typically see a bump of about at least, it’s roughly one point of hemoglobin. That’s strictly because you’ve got way too much testosterone in the system, the idea of, what do you call it, stoichiometry, right? A plus B equals C, as long as B is not a limiting factor. You [inaudible 00:45:25]. That does apply, but 100% of the time, or almost I should say, I said 99%, above 99% it’s because of sleep apnea. We treat the sleep apnea and it comes back down. Otherwise, and I know this is a crummy example and people do it all the time, and I’m doing it now, medicine is much more complicated than this, but if it were the case that high testosterone levels caused high H&H, like we’re talking about that every 16-year-old kid would have hemoglobin or red blood cell count off the charts. It doesn’t happen. It’s because you’ve got a stressor, lack of oxygen at night, that’s causing this.

The other point though is that the one issue I will agree on, if it does go high like that, and again, it’s not because of testosterone, it’s because of sleep apnea, but if you do have high H&H and the blood viscosity, you’re talking about the blood thickness goes up. That is not good for the heart. It’s kind of akin to hypertension in the way the heart has to work harder, the left ventricle, and you’ll get the wrong kind of enlargement of the heart, not an athletic heart. But that’s bad, just like hypertension’s bad, but it does not lead to stroke. And the hematologist, a good one will stand up and go, “I agree, stop calling viscosity the same as stickiness.” At a certain level of thickness, then yes, I can’t deny if you had a hemoglobin, and I’ve had a patient like this in my practice of 23 because he had [inaudible 00:46:57] an autoimmune disease and a hematocrit of whatever is associated, three times that, then you might be at increased risk of a clot formation. But there’s a huge difference between viscosity and stickiness. But I will agree with you or whomever you’re citing as well, blood thickness at that level becomes a problem over the long term if you don’t treat it, but it’s not linked directly to testosterone for the reasons I explained.

Speaker 5: On that subject, the local hematologist friend suggested every three months to do phlebotomy. What do you think about that?

Dr. Weitz: So the question is, should patients who take testosterone get a therapeutic phlebotomy periodically?

Dr. McClain: My opinion is generally no unless you’re having symptoms associated with it. So what I’ve found in my practice simply is for a male, again, with a hemoglobin of roughly 18.5 and above, and a commensurate hematocrit, which is really more related to the thickness, and that’s a general multiplier of three. Patients will say get up out of a chair, and whoa, I need an extra beat or two literally of the heart to get the blood from the legs up to the head. Well, that’s a reason to go ahead and treat, so to speak, with a therapeutic phlebotomy.

But otherwise, and your hematologist friend, I’d love to hear what he responds to this, because I learned about this from a hematologist, and I apologize, I don’t remember his name because he deserves credit, but what about the stem cells in your bone marrow that you’re taxing, you’re using up every time you bloodlet, your body says, okay, great. Now I got to start over again. And until you fix the reason, again, 99% of the time in my experience it’s sleep apnea for the elevation, your body’s going to come right back and make more, and so unless you have a reason, meaning symptomatically, to treat it, then I don’t recommend a therapy to phlebotomy. Again, for the reasons I said I’ve never seen an issue with clots because of it, and you’re taxing your long-term stores, as it were, of stem cells and bone marrow that are going to be needed to make those cells again.

Dr. Weitz: Another common effect of testosterone therapy that I’ve seen is you typically see the HDL level come down quite a bit. Isn’t that an increased risk for cardiovascular disease?

Dr. McClain: Another loaded question. But thank you. So the HDL decreases typically because of what comes with most therapy for a male. Okay? I haven’t seen it with a female necessarily, but with males, we have to modulate the estrogen downward so that you don’t have side effects of excess estrogen. When that happens and you err on the side of oversuppression, you will see HDL drop. Okay? No doubt. The poison as it were, is in the dose, so you have to modulate the estrogen effectively so you don’t drop the HDL. Does that-

Dr. Weitz: Wait, hold on, hold on. So you’re saying the reason why the HDL drops is because estrogen goes up? You’re saying higher estrogen levels-

Dr. McClain: No.

Dr. Weitz: No. Okay.

Dr. McClain: No. Estrogen levels are, it’s iatrogenic. We give them too much of an AI, for example, to modulate estrogen too low. It’s oversuppression estrogen that does it. That’s what I’ve seen.

Dr. Weitz: So low estrogen is reducing HDL levels?

Dr. McClain: Yes.

Dr. Weitz: But that’s not from testosterone. You’re saying that’s from?

Dr. McClain: It’s what comes with therapy, that we’re trying to modulate the estrogen downward. And a matter of fact, aromatase inhibitors get blamed for it. Oh, I can’t take anastrozole, that’s bad for you. Try not taking it, and then you got to have surgery or remove breast tissue. I mean, I’ve heard some crazy stuff.

Dr. Weitz: But without taking an aromatase inhibitor, don’t you see HDL levels come down with testosterone therapy?

Dr. McClain: No. If you use a super physiologic dose, I’ll see LDL levels go up. But I don’t see HDL levels go down. If it goes untreated, meaning you let estrogen rise, there’s no reason for an HDL to drop. Anyway, that’s just been my experience. Now, a huge can of worms you opened up, and I’ll be brief because I’m not a cardiologist, is does that affect your risk of coronary artery disease specifically?

Dr. Weitz: Sure. Yeah.

Dr. McClain: Okay. My answer is no, and I will protect myself a bit, although I’ll accept it as my own dogma as it were. But Marc Penn, and I have it on a Zoom tape because it was during COVID, Marc Penn is one of the leading cardiologists in the world, he used work with Cleveland Clinic, but I have him quoted as saying 95% of cardiologists, not just primary care physicians, don’t get this right. Cholesterol is not what drives coronary artery disease. Inflammation does.

So let me jump ahead and say if someone has extant coronary artery disease, then yes, we found that lowering cholesterol is very helpful, whether it’s through statins or some of the new drugs they have or just dietary changes. But if they do not have extant coronary artery disease, which is driven by inflammation, but evidenced by extant coronary… plaque in the arteries, then to lower cholesterol makes no sense to me or apparently 5% of the cardiologists who actually understand this, like Marc Penn says they should, and there’s so much evidence to that. I don’t want to go into it too much because I am not the cardiologist, not the expert, but it makes sense to me.

If you look at textbooks even that go back in time and show the lumen of an artery or lumen of a vein for that matter, there’s not that much difference. It makes no sense that cholesterol coming through the lumen would be causing the problem. You can look at the changes in the intima versus the media and you can see the way hypoxia is what the issue becomes and the way the body reacts and starts growing vessels into the media to try and make up for the hypoxia. At any rate, I’m sorry. I’m way out of my league here in terms of being able to explain this like a good cardiologist.

Dr. Weitz: No, no, no. You’re totally explaining this. In fact, I just had a discussion this afternoon [inaudible 00:53:40].

Dr. McClain: You’re on the same page. Oh yeah, you went into finer details.

Dr. Weitz: And We had a discussion about hypertension for the podcast, and the focus is all on the endothelium and the glycocalyx, and that’s really what sets up cardiovascular disease.

Dr. McClain: Hypertension causing the inflammation, and then you have the brick and mortar, as it were, of the cholesterol being there that is part of what the body uses to treat-

Dr. Weitz: The inflammation and the [inaudible 00:54:07] stress, it damages the lining on the artery, the endothelium, the glycocalyx.

Dr. McClain: But it’s not the cholesterol itself. And I would posit one thing here too, that if it were the case, then hopefully you guys were having this discussion too, why is it that people with high cholesterol, or anybody, why is… And by the way, I’ve seen, and I can tell you a good story if you want to hear, I have three individuals with perfect lipid panels. Forget about triglycerides. Their cholesterol was 80 LDL 60 HDL plus or minus two in all three patients. I told you I was a CPA before, so I’m prone not to lie or exaggerate, I’m just telling you. Because I went back and looked and I couldn’t believe these super healthy guys had, one of them had 99% blockage in, they called the widow maker, the left anterior descending coronary artery, and the other two had 98% blockages. All three were on their way to go do something, some form of exercise, and their wives talked to them into going to the emergency room and they survived. But they had this great physique. They were all into exercise and eating right, et cetera.

The point being, they didn’t have crazy cholesterol numbers, but they all had major plaque. If cholesterol was a problem, how come there’s no plaque in the veins? Think about that one for a second. Going back to what you said, hypertension drives this. You can’t have that kind of pressure, one way anyway, in the veins. You can have the arteries and where it’s tortuous, you have a curve, in other words, that turbulence causes the inflammation. That’s the start where the cholesterol is used to block it off and go through the body’s processes, right, but it doesn’t cause it is my point.

So the point to your question is if testosterone were to raise, which I’m not saying it does, but if it were, it would not drive directly the formation of plaque. Only if someone had an issue. By the way, people that… I shouldn’t do anything. You just talked about those three guys, the epitome of health, one thing, they don’t tell you, the cardiologists, is there are other ways that you have no control over that can seed inflammation in the arteries. How about a GI bug when you were 30? How about an abscess tooth when you were 25 and couldn’t afford to fix it, right? That can seed in the heart. And we know that already. Think about it. Oh, this patient has a heart murmur. I’m going to do a dental procedure. You got to take some prophylactic antibiotics. How come? Because there’s a connection there folks. And so something you have no control over could have led to the formation of plaque and then the cholesterol adds to the problem.

That’s the pitch for energy and being proactive about everything we can do to find out beforehand. So energy, meaning carotid alpha and ultrasound to see if there’s plaque there, whether you’ve been the epitome of great health or not. All right, I’ll stop.

Dr. Weitz: Do you [inaudible 00:57:11] patients get a coronary calcium scan?

Dr. McClain: I do not. As a matter of fact, it upsets me when they do because the calcium score is, to my mind, a waste of time. There is some correlation, obviously it means there was plaque there at one time, but it’s been calcified, it’s been walled off. It’s old news. And there’s really nothing you can do about it anyway. Soft or fibrous plaque, however, is new news. It’s a current problem and there are things you can do about it including reducing cholesterol and inflammation, et cetera. So-

Dr. Weitz: Do you have your patients get a CT angiogram with artificial intelligence?

Dr. McClain: I ask them to do a coronary CT angiogram with and without contrast so I can see everything, not just the calcified plaque. I start though with a bilateral carotid Doppler ultrasound… And by the way, I can’t take, I’m saying this as this is what I do, but I’m not a cardiologist, but I do take note of what people like Marc Penn say, Stefan Ruehm over here at UCLA, our famous driven, important head of cardiothoracic imaging at UCLA for 30-something years, and it hasn’t changed. A bilateral carotid Doppler ultrasound to evaluate the intermediate thickness here will let us know if there’s a problem typically because there’s 95% correlation between what we see here and what’s in the coronary arteries of the heart. So it’s a good first pass, non-invasive, takes 10 minutes if they’re slow, and if there is something there, then I say, yeah, let’s do the gold standard, I would call it as a coronary CT angiogram with and without contrast.

The calcium score is too misleading. I can, without breaking any privacy laws, tell you, I was one that had the abscess tube that I nodded on when I was in my twenties. In my early thirties I had plaque in the carotids. Early thirties, I didn’t care. In my fifties, I knew too much and I went and had the coronary CT angiogram with and without contrast, I still had the calcium here. I had a little bit in my heart, but I had not a speck of soft or fibrous plaque in my arteries. Otherwise. Did I treat as though I had coronary heart disease that needed cholesterol lowering drugs, whatever? No. Why? I didn’t have any other of inflammation that I could see. I knew it was from 20 years ago, I assume, I should say for good reason. And so why would I lower cholesterol just because of that, something that it’s done? Lowering my cholesterol would do nothing for that calcified plaque. Does that make sense?

Dr. Weitz: Yeah. The point that he’s making, if everybody’s not following, is that when you have plaque in your arteries, after a period of time, the body will calcify that plaque. And generally speaking, calcified plaque is considered stable, whereas soft plaque is considered potentially unstable, can break off and can lead to a myocardial infarction or a stroke.

Dr. McClain: Thank you.

Dr. Weitz: Jeff?

Speaker 7: Are there variants of testosterone in the organs? Just [inaudible 01:00:20] like we have with the thyroid, we have reverse thyroid, active, inactive. Is testosterone just [inaudible 01:00:28] across the board testosterone or are there some variants?

Dr. Weitz: You’re talking about therapy or testing?

Speaker 7: Testing.

Dr. Weitz: Testing? Well, we have total testosterone and you have free testosterone.

Dr. McClain: Are you thinking about different forms of exogenous testosterone? For example, you might’ve heard of testosterone cypionate versus testosterone enanthate or propionate, is that what you’re talking about?

Speaker 7: Well, both of them. What’s the difference between those three exogenous versions of it? And then also, so we just have total testosterone and then what was the other version?

Dr. Weitz: Free testosterone.

Speaker 7: Okay, so which one’s the active form.

Dr. Weitz: The free testosterone.

Speaker 7: Okay. That’s what that’ll find then? So the inactive one would be the total minus?

Dr. Weitz: Yeah. It’s bound up with proteins that bind it like albumin and sex hormone binding globulin.

Speaker 7: So what therapies are there to help? Maybe just increase the free testosterone by increasing the binding protein.

Dr. Weitz: Dr. McClain addressed that, I think before you came in, but maybe-

Dr. McClain: Real quick though, to review. High protein diet, keeping your estrogen modulated below, roughly you’re estradiol sensitive at about 21 milligrams per milliliter or below, stinging nettle supplementation, or a very, very small dose, what would normally not be used for anabolic effect, but an anabolic steroid in a small dose will also lower your SHBG.

Dr. Weitz: If you do that, they won’t be crying at movies.

Speaker 8: I have a question then. What about the European testosterones? I work at a gym and a lot of the bodybuilders there take all kinds of different things that-

Dr. Weitz: I think you’re talking about anabolic steroids?

Speaker 8: Is that a difference?

Dr. Weitz: Yeah, so basically anabolic steroids are in science is taking the testosterone molecule and manipulating it to try to have more of the say, muscle building effects, the anabolic effects without some of the other androgenic or the effects you don’t want.

Speaker 8: Yeah, so there’s, and I don’t know the names well, but-

Dr. Weitz: I think there’s a lot. Why don’t you talk about it?

Dr. McClain: No, go ahead. Are there names you might recall or come close? I can help you there.

Speaker 8: I don’t know the name, but he was saying that it cannot convert into estrogen or DHT because the way molecules are designed.

Dr. McClain: Right. So testosterone conversion, meaning the development, these anabolic steroids from testosterone is maybe considered maybe some of the initial molecules. But what we’ve taken now, and I mentioned this earlier, the DHT derivatives, I call them three cousins. And the names you would’ve heard at the gym, I’ll tell you, even though the generic are what’s out there… Actually, there’s one brand that’s still out there called Primobolan, which is a DHT derivative, the others, Anavar and Winstrol, are no longer available in this country. Winstrol is available for veterinary use, I beg your pardon. But those are three molecules that started as a dihydrotestosterone molecule. And then by adding or subtracting those little ligands I was talking about, just one sometimes, it turns into a totally different molecule in terms of the properties like he was referring to where DHT we talked about earlier can drive the hair growth on your ears and stuff, if you’re a guy. Maybe even if you’re a gal, we forget, women and men have hair in the same place just women a lot less.

But the Anavar, for example, one of these cousins that is made from that initial dihydrotestosterone molecule has roughly eight times more effect on muscle tissue growth, the anabolic effect we’re looking for, but I don’t know the percentage. It would vary upon the side effect, but much, much less effect on the hair growth. We were talking about the unwanted hair growth or the acne, and that’s why ladies often use, whether it’s in sport, or like I said, someone who has estrogen sensitive cancer will use one of those products because of the lack of the androgenic side effects, the bad ones that you don’t want the hair in the wrong place and stuff.

Now, just because he brought it up as well, you might hear other names of the form in which testosterone is being held. It’s being bound up purposely, designed by an ester. I don’t know if you remember your double bonded oxygen from high school chemistry? But basically it takes more energy to break off these binding molecules so that over time some of that testosterone, no longer bound, the free testosterone will be released. So it’s a time-released form that enables you to apply it weekly, for example.

The ones in Europe, I think you mentioned Europe, there’s one over there, it’s actually technically available here, but try finding it. Undecanoate, which is a much stronger bond, and so it takes even longer to release and enable you to go at least three weeks without having to shut. So that might be what they’re talking about, these different esters I mentioned earlier, cypionate, propionate and enanthate, that boils down to testosterone though, not an anabolic steroid, which is different… It really is a different substance altogether because it’s rare you can say this, but every anabolic steroid, we can say that in life much less in medicine, every anabolic steroid will raise LDL. I mean that’s what you were talking about, and lower HDL. Hands down. Some more than others. Whereas testosterone, when used appropriately, meaning not super physiologic dosages, doesn’t do that.

Dr. Weitz: Does testosterone therapy promote longevity?

Dr. McClain: We can’t say that for sure. There’s a lot of things we can’t say but can only conjecture about longevity based upon what we see with other markers we believe are biomarkers for good health and longevity. But it seems to improve what we call our health span, our time on the planet that’s healthy based upon the biomarkers we use. We see, and we talked about earlier, about how it makes sense, if you’ve got more energy to exercise, let’s say because of testosterone, well that’s going to improve your health. And so whether it’s a direct cause of testosterone affecting these biomarkers or indirect because you’re doing all the right things more because if nothing else, you have the energy to do it, we believe the testosterone is going to prolong our health span.

Dr. Weitz: On this theme of longevity. It seems to me that there was a period of time where the longevity space, it was very popular to recommend testosterone, growth hormone, things like that because the thought was, as you get older, you lose muscle, you lose bone, you don’t replace your cells as quickly, and things that promote growth are beneficial for longevity. And recently those things have sort of fallen out of favor. And a lot of the emphasis in longevity has been on trying to reduce things that promote growth. So for example, you have Dr. Valter Longo saying that you should have a lower protein intake because you want to have a lower IGF-1 level because you want to reduce things that cause growth because anything that promotes growth is going to increase cancer risk. So the key to longevity is an inhibiting growth. And then you want to inhibit mTOR, which is more of a growth signal. So you want to use things like rapamycin, all these things are to inhibit growth and that being the key to longevity.

Dr. McClain: That’s great. And that’s the reason I wrote the book because yeah, it ties together all these concepts. You’re absolutely right. That’s where we’re headed. And I think that the answer is, like so many things, I mean we talked about, you and I, before we started on our thesis and finding the right dose with, and I always get his name wrong, but he’s over at USC, the ProLon diet guy.

Dr. Weitz: [Inaudible 01:09:13].

Dr. McClain: Right, right. Sorry, I’m terrible with names. But he makes a point. But it’s retrospective and so many retrospective studies. You can poke a billion holes in, in the ones that support what you want or not. But my opinion, because it’s only opinion, we don’t have enough lifespans to observe yet to be able to make a conclusion for certain with the right kind of studies prospective, et cetera. But if you’ve got someone who’s riding a desk all day, why do they need extra growth hormone/IGF-1? Just so you know, growth hormone loan gets released first. When it hits the liver, then the liver makes IGF-1. And arguably IGF-1 does most of the yeoman’s work and credit goes all to growth hormone.

But anyway, if you’re working in oil rig, I think you probably are going to have a problem with the ProLon diet and Longo’s concepts of low IGF-1 because you need the regeneration. Whereas if you’re riding a desk, what do you need that for? I almost, and it’s a terrible analogy, but it’s the only one I can think of off the top of my head, but if you’ve got some bacterias in a dish and you load it up with a bunch of sugar, well they’re going to grow out of control. And of course the propensity for cancer exists more in that situation than if it’s very lean in there in terms of fuel, no bacteria can grow. Again, that’s a terrible example, but if you don’t need it, then it doesn’t make sense to have it and there’s a potential for things to go awry, and that’s the desk jockey. Whereas if you’ve got a guy working the oil rigs, he needs as much help as he can get. So you got to find the balance between the right amounts.

Isn’t that the key to what we all want and what we all try and do as physicians, you got to find the right balance for the individual. And that’s why I… I’ve never gone back and looked at any of these things, but I think about what I said, I go, why did you say that so sweepingly? Because you got to be careful. You can’t always make such general statements because it’ll come back and bite you because you have so many different circumstances. And that’s where I think, and not to give us credit, it’s just understand where we’re coming from, we as physicians, that’s our job, we got to figure out what works for you, the individual.

So I appreciate his work and I mean that most sincerely, I think he’s got a point, but for certain individuals it works, whereas for certain it doesn’t. And so there are people, I mean if someone were to break a femur and I think they could probably use some growth hormone to help them heal. At least the surgical one for sure, and possibly also for bone unionization. But yeah, I mean I can go on and on and I’m not sure I’m really addressing your question, but-

Dr. Weitz: Yeah, no, it’s okay. Look, it’s a complex concept.

Dr. McClain: It is. And you can’t oversimplify it.

Dr. Weitz: And I think clearly there’s got to be a balance. It’s clear that as people get older, suffering from sarcopenia, the loss of muscle, there’s a lot of people whose life ends because they fall and break their hip and never recover.

Dr. McClain: Number three on the list.

Dr. Weitz: Yes. So there’s no doubt that being able to have regenerative power is being able to replace your cells, being able to maintain your muscle mass, your bone mass, those are key longevity from a certain perspective. On the other hand, too much growth is potentially going to increase the growth of cancer. So there’s got to be a balance and exactly how you find out what that balance is. I don’t think we quite know, but.

Dr. McClain: Well, and if I may, because you brought it up and I think it’s going to become more relevant as people look into the latest research, which is exactly what you say, the reverse of growth and the mTOR antagonism. And if you think about that, it’s like our night and day cycles where we go out and we exercise, we do what we do all day, and then we rest at night. We have too much of that daytime activity and not of nighttime activity. And I could liken that as probably another terrible example to growth hormone versus mTOR. And you got to give your body time to clean up the mess. I use the restaurant example where if all you did was sling food all day, eventually the pots and pans are going to pile up, they’ll become dirty and the food won’t be clean.

So you got to let the cell heal itself, so to clean up the mess and get ready for the next day. That makes sense. Again, some of these things that make sense, don’t necessarily [inaudible 01:13:53] medicine at all, but really I think is where we’re headed with this, which is, hey, you don’t just do growth hormone all the time. Just like we have seasons where we might exercise more, work longer days versus the opposite, there’s a time and a place for everything. And if we focus only on the growth, human growth was the founding youth for a while, we realized not so much, and not the repair mechanism, what we call autophagy and the activation of mTOR… or sorry, the antagonism, then we’re going to have a problem like the kitchen example. And that’s I think where we’re headed to trying to figure out what that is for each individual, but changing direction more toward focus on the repair or the autophagy we were talking about.

And you have guys leading the way with this that it’s interesting. Sinclair, who is, I’d say the first third of his book is worth three. The rest of it’s more activism. But his perspective, like all of ours are going to be, it’s a little slanted because if you read between the lines, he exercises maybe once a week. And exercise in and of itself, I call it the great equalizer, will activate these same things that we’re talking about rapamycin will do. It helps activate the systems of clean up the mess once you go to bed versus again if you don’t do anything but sit all day. So I guess what I’m trying to say is we’re on one end now the other, and I think we’re going to find a happy meeting in there. That again goes back to, well, depends upon the individual or what he or she does. Sorry.

Speaker 7: Touching on exercise. So we learned recently the last few years about muscle contraction, produce musculin, it’s a hormone that muscles secrete. Is there any correlation or anything that you’ve noticed about increased exercise and the secretion of musculin and its relationship with the testosterone?

Dr. Weitz: So the question is there’s a hormone… I am not aware of this. This is some new data. A hormone secreted by muscles known as musculin?

Speaker 7: Yeah.

Dr. McClain: Don’t know that one either. It sounds like it works on the muscle, they’re calling it musculin. But I don’t know the effect. But to your question, without knowing what muscle it is, does muscular activity affect testosterone production?

Speaker 7: Okay. So yeah?

Dr. McClain: I don’t think we can say that for sure. As a matter of fact, too much activity using your muscles too much, can actually reduce your production of testosterone. But don’t take that the wrong way, let me finish and say this, that I see a lot of pro athletes, a lot of even college athletes that are in such great competition that they’re overtrained. And that stressor like any other overstressor, I guess I should say, will cause a decrease in production of testosterone. So a lot of these athletes that you see oftentimes don’t have the testosterone that you would think because they’re overdoing it. But again, the concept of hermesis keeps popping up. The proper balance of exercise tends to make you healthier and tends to at least get you to whatever your point is on the scale, the highest level of testosterone that you can make for you because you’re in the best health.

Dr. Weitz: But I think heavy weight-training has been shown to increase testosterone levels as well as growth hormone levels, I think.

Dr. McClain: Well, I would argue that has to do again with how much work it takes. When you say heavy lifting, if you’re talking about literally heavy weights, you can’t lift heavy weights to the point where you’re releasing… An endurance athlete might go for three or four hours and produce a bunch of cortisol, which is not necessarily conducive, excess cortisol is what I’m implying, to testosterone. But someone who goes in and does a 45-minute weight workout, probably that’s the sweet spot. And so yeah, I can see how those results would be, I’m not saying they’re skewed, but would represent, oh yeah, these people are all super healthy and have higher level testosterone than that Tour de France athlete who’s climbing hills six hours a day.

Speaker 7: Maybe this discussion’s more for Dr. Penn. You look like you’re in good shape. What does the research say about how many times a week to work out and how long for having optimal levels of the different estrogens and testosterone?

Dr. Weitz: Yeah, I mean it depends on the study, but I think from what I’ve seen, doing an hour of exercise a day, five, six days a week, I think is considered a pretty good level.

Speaker 7: Yeah, I’m sure it is.

Dr. McClain: Well, to add to that, as Woody Allen said, what was it, 95% of the success there just showed up. To what intensity level you take is going to be dependent upon the individual too. Would you say, Doc?

Dr. Weitz: For sure. Yeah. Obviously weight training, cardiovascular exercise, flexibility training, balance are all important components of exercise.

Speaker 7: Have you seen some studies, because I know you’re big on of course, exercise and exercise chiropractor, studies that have taken a bunch of athletes and they help do a certain kind of exercise and other ones and what the results show in their energy levels [inaudible 01:19:38] I’m not sure you ultimately measure.

Dr. Weitz: Yeah, I think as far as hormone levels, weight training has been shown to be especially beneficial, especially heavier weight training or intense weight training. Endurance athletes like marathon runners typically will have lower testosterone levels. Women marathoners will have lower estrogen levels. So I think more than a certain amount of exercise, especially endurance exercise, tends to decrease hormone levels.

Speaker 7: I know somebody who’s training be a triathlete and he’s in his fifties. Do you think [inaudible 01:20:23] to recommend additional testosterone and estrogen as he’s training for the triathlete competition? But you’re saying that these people who are overdoing over training he’s in, he’s got three different trainers, but really push him-

Dr. Weitz: Yeah, I think the reality is it is great to exercise probably for ideal long-term health training and running a marathon is probably bad, not good, unfortunately.

Dr. McClain: I would say almost definitely, not even probably, I’ll go on the limb there. Over training is not your friend. And to run a marathon and really any sort of competitive sport these days, you’re probably not giving yourself the best shake when it comes to health span, that healthy longevity. But that doesn’t mean you shouldn’t necessarily do it. Obviously that gets philosophical because hey, maybe you just enjoy it and you live a little bit longer just because you’re happier. But physiologically, when you go to those extremes, you’re beating yourself up. Now, I will say this real quick. There are three things that we have definitively linked health and longevity. One is a higher VO2 max, another is grip strength, and the third is muscle mass.

Speaker 9: How do you dose Primobolan for women and men?

Dr. Weitz: Can you speak up?

Speaker 9: How do you dose Primobolan for men and for women?

Dr. Weitz: How do you dose Primobolan for men?

Speaker 9: And women?

Dr. McClain: So Primobolan is an anabolic steroid I referred to earlier that’s a DHT derivative, and it’s injectable, which is definitely an advantage, I believe, over an ingestible because it bypasses the liver, obviously. So it would depend upon what the, let’s say female is interested in doing a course. And I don’t mean to put the question back on you, but feel free to give me a specific example, but in general, whether it’s male or female, it’s, okay, what are you doing this for? Are you 80 years old and at risk of a fall? Are you 40 years old and trying to compete in the CrossFit Games? In which case we have a no whole other perspective on that and legalities and that sort of thing. But physiologically, medically speaking, roughly, Primobolan typically comes in 100 milligrams per ml, and a male might dose anywhere from 100 to 200 milligrams per week. Whereas a female would do about one-tenth of that as a general rule.

Speaker 9: So a woman who’s already in menopause who uses testosterone cream can’t really get the testosterone up or doesn’t like the side effects of the DHT, wants to try anabolic instead?

Dr. McClain: Well, the problem with Primobolan is it’s not legal in this country. It would be considered a contraband. And it is terrible because it leaves our choices to orals, which in this case would be oxandrolone would be my choice because that is legal. And that, you wouldn’t have the side effects because it cannot… well, some side effects because again, even though it’s a DHT derivative, it doesn’t have those androgenic side effects and it cannot convert to estrogen. So bloating is an issue with testosterone because you’re, I call it a converter, you’re converting to a lot of estrogen to begin with, then that’s an option.

Speaker 9: And that dose?

Dr. McClain: For oxandrolone, typically we will start with about five milligrams twice a day, and then there’s the expensive date that requires more, I call it the fitness model dose, closer to five milligrams three times a day or split twice a day, however it works for you. It’s got a very short half-life of nine hours so you definitely want a divided dose. And because it’s got such a short half-life, you can’t look at the numbers and determine, oh, it’s too low a dose. I hear that all the time. It’s not even showing up. And you can’t use the numbers for that.

Dr. Weitz: All right, any final questions? Okay, thank you. Thank you [inaudible 01:24:55].

Dr. McClain: Thank you very much. Thank you guys for listening.

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.

February 27, 2024/by drweitz

Dr. Weitz's Blog, Rational Wellness Podcast

SIBO with Dr. Mona Morstein: Rational Wellness Podcast 348

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Dr. Mona Morstein discusses Small Intestinal Bacterial Overgrowth with Dr. Ben Weitz.

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Podcast Highlights

4:15 SIBO is small intestine bacterial overgrowth and this diagnosis was brought to us by Dr. Mark Pimentel, based on his research at Cedars-Sinai.

5:38 It’s interesting that Dr. Pimentel, who’s really a conventional gastroenterologist, but yet his research was initially shunned by the conventional gastroenterology community and it was largely picked up by the Integrative, Functional Medicine community. While some gastros still don’t believe in the SIBO concept, some have bought a QuinTron machine and do testing in their offices but do not really offer a comprehensive form of care. Such gastros will often only prescribe Rifaximin and they do not retest for six months or so, since this is when insurance will consider paying for another test. And they do not offer a comprehensive form of care. They often do not address motility or biofilms or diet or food sensitivities, which are all important in getting patients better.

Dr. Mona Morstein is a naturopathic doctor who is practicing Functional Medicine at Arizona Integrative Medical Solutions in Mesa, Arizona with a focus on treating patients with autoimmune diseases, hormonal conditions, diabetes, thyroid, and gastrointestinal disorders like SIBO and IBS. She is the author of the best-selling book Master Your Diabetes: A Comprehensive, Integrative Approach for Both Type I and Type II Diabetes and she lectures frequently at medical conferences. She can be reached through the Arizona Integrative Medical solutions website, AZIMSolutions.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.

Podcast Transcript

Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.

Hello, Rational Wellness Podcasters. Today we’ll be speaking with Dr. Mona Morstein about SIBO, one of our favorite topics, Dr. Mona Morstein is a naturopathic doctor in Tempe, Arizona, who is practicing functional medicine at Arizona Integrative Medical Solutions in Mesa, Arizona. Right?

Dr. Morstein: Yeah, Mesa.

Dr. Weitz: With a focus on treating patients with autoimmune diseases, hormonal conditions, diabetes, thyroid and gastrointestinal disorders like SIBO and IBS. She’s the author of the bestselling book, Master Your Diabetes, and she lectures frequently at medical conferences. So, Mona, thank you so much for joining us again today.

Dr. Morstein: Thank you, Ben, for the invite.

Dr. Weitz: Yeah, we’ve had previous conversations about thyroid and about diabetes, so it’s about time we talk about the gut and SIBO.

Dr. Morstein: That’s fantastic. It’s a big part of my practice, so I’m happy to discuss it.

Dr. Weitz: Maybe before we get into exactly what SIBO is and how we test for it and how we treat it, how has your approach to SIBO changed over the years?

Dr. Morstein: Well, I think probably the biggest way that it’s changed is trying to figure out the best protocols to put together. New botanicals, come into play. I hear other docs, or even sometimes new medications come into play. So new ideas. Every quarter I meet with other well-known SIBO experts, and we go over what’s working and what’s not and how to adapt things.

Dr. Weitz: Wait a minute, wait a minute. How do I get into that meeting?

Dr. Morstein: I don’t have the key, but I can certainly give you the contact.

Dr. Weitz: What happened to the SIBO conferences? We used to have SIBO conferences.

Dr. Morstein: Well, of course now mostly there’s this SIBO SOS Summit.

Dr. Weitz: Right. With Shivan.

Dr. Morstein: With Shivan and Doctor-

Dr. Weitz: Siebecker.

Dr. Morstein: … Siebecker and so I think that’s what they’re really focusing on, and there haven’t really been a specific SIBO conference for physicians outside of that. Now I’m part of the Gastro AMP, which is a specialty organization in naturopathic medicine for gastroenterology, and we have a yearly conference. I spoke on bile acids back in October, but obviously SIBO can easily be a part of that conference.

Dr. Weitz: Maybe that would be a meeting to go to, because I miss the SIBO conferences.

Dr. Morstein: Yeah, those were very good. And potentially also Dr. Pimentel may be too busy, I don’t know. So it all crashed with COVID and then Dr. Siebecker…

Dr. Weitz: COVID messed a lot of stuff up. It really has.

Dr. Morstein: I know Dr. Siebecker is all the SIBO SOS and doing her own classes if docs want to join her lessons and so forth.

Dr. Weitz: It makes sense. It makes sense, economically especially.

Dr. Morstein: Yeah, I’m sure it does.

Dr. Weitz: Let’s talk about SIBO. What is SIBO?

Dr. Morstein: SIBO is small intestine bacterial overgrowth. And so for whatever reason, I remember at the very first conference we were discussing should it SIBO or SIBO, and I think everybody just went to SIBO. I think it’s easier to pronounce. So this is Dr. Mark Pimentel, The IBS Solution. He wrote a book coming on 15 years ago, bringing SIBO into the world, based on his research at Cedars-Sinai. And then it took a while, like some things do a few years, but then it started really entering the consciousness of physicians. And so this is when bacteria wind up, generally… The most common methodology is a bacterial wash from the colon to the small gut, generally based on the nervous system in the small gut called the migrating motor complex, not being able to effectively move things forward. So when things don’t move forward in the gut, then it’s likely things are going to move back.

Dr. Weitz: By the way, it’s interesting how Dr. Pimentel, who’s really a conventional gastroenterologist who went off track and his research was really largely picked up by the integrative functional medicine community and was initially completely shunned by the conventional gastrointestinal community.

Dr. Morstein: It’s very interesting. You still have a lot of gastros who don’t know about it, don’t believe in it, or if they do, they’ll give you a, “Here’s your dose of rifaximin and I don’t want to see you again. That should be it.”

Dr. Weitz: Exactly.

Dr. Morstein: And then we have the exact opposite of gastros who have a QuinTron in their office and they’re testing and probably because they can make a lot of money with insurance with it, but at least they’re embracing and testing patients. And then you have the whole spectrum of, in the gastroenterologist world, I will say this though, the vast majority of gastros who even if they know or are willing to treat it, they don’t treat it well, unfortunately. So patients are not getting that comprehensive care that they need.

Dr. Weitz: Like you say, basically, “Here’s some rifaximin,” maybe, “Here’s some rifaximin and neomycin.” “Here’s a tear off on a low FODMAP diet. Maybe follow the low fiber Cedars-Sinai diet,” and that’s about it.

Dr. Morstein: And because I think it’s probably related to insurance, if they do test in their office, they don’t retest, they have to wait, I think it’s three or even six months before insurance will allow them to retest. I think it’s very important to retest after treatment. One, to analyze is it eradicated or not? And two, to analyze was this protocol effective? “Did you get a lot better but not cured? Well, we can stay with it.” “Did it really not treat it? Then we need to change it.” But there’s a lot of patients unfortunately, that waste a lot of time doing a protocol and not having any idea if it’s effective or not without getting the retest. And they may be on protocols, oftentimes that are not effective, but they’re wasting time just because they can’t get a retest.

Dr. Weitz: Once again, we have the healthcare system being run by insurance companies. Patients, a lot of times, don’t understand this. They were like, “Okay, why do I have to? How?” They have no idea, and the doctors don’t actually tell them. That’s one of the interesting things. It seems like it’s wrong, but I understand why they do it, which is when medical doctors know something’s not covered, but they think it would be a good thing. Why don’t they say, “I would like to do this test, or I would like to order this test, but your insurance won’t cover it. Here’s how much it would cost.” Because when they do that, then the insurance companies send them threatening letters and they don’t want them telling the patients, “Don’t use this alternative lab,” et cetera, et cetera. So there we have the insurance companies behind the scenes running things, and patients don’t even realize that.

Dr. Morstein: Yeah. Well, I think they do. A lot of times now with medications they’ve been on for years, all of a sudden, “We’re not going to cover it,” or, “You need to have it pre-auth.” Like, “I’ve been taking it for years,” and now, “You can’t take it anymore.” And I think there’s a lot of good-hearted docs who would love to practice in a better way in their hamstring by their corporate clinic or insurance and I think a lot of patients really understand how frustrating insurance can be at times.

Dr. Weitz: When you say the corporate clinic, what you mean is that most of these medical groups have been bought by the hospitals and then they’re run like corporations?

Dr. Morstein: It’s true. And a lot of it is because it’s just very difficult for any individual MD relying on insurance, and with the minimum wage going up, which I’m not against an elevated minimum wage, I’m just saying that it’s very hard for a single doc. I just had screws taken out of my elbow and my orthopedic surgeon said he’s probably going to earn around $200 for that surgery.

Dr. Weitz: Oh, I know. It’s a travesty.

Dr. Morstein: He’s wondering, can he stay in business because of the amount of money they get back from insurance?

Dr. Weitz: I had a hernia surgery and the surgeon got $400 for all that time, expertise, including the co-pay. It was embarrassing.

Dr. Morstein: It’s embarrassing. So now luckily, however, there are you, me, there’s integrative physicians, naturopathic that are outside of that. And while it does cost a little bit more out of pocket for patients, they do get the really high quality care that they need. So it is worthwhile.

Dr. Weitz: Good. So let’s continue. So SIBO is a small intestinal bacterial overgrowth, pioneered by Dr. Pimentel, and I’m not so sure that we necessarily accept that the bacteria overgrown from the large intestine anymore. We think that some of the bacteria have come down from above and just take up residence there.

Dr. Morstein: No, no. We actually can identify now pretty much which bacteria are causing SIBO and no, they’re large intestine bugs. So the oral bacteria obviously do get into the gut, but they’re not overgrowing and they’re not in the list of the bacteria or the archive with methane, not quite bacteria, that are the most associated with SIBO.

Dr. Weitz: Right. And then we believe that SIBO is the main cause of IBS in the majority cases.

Dr. Morstein: I don’t know if it’s the majority. Maybe Dr. Pimentel wants to believe that. I think there are many reasons. I think fungal overgrowth is probably-

Dr. Weitz: I think 60% to 70%, numbers been thrown around quite a bit by Dr. Pimentel, and some of those data indicates that.

Dr. Morstein: I take some of the things, God bless him, Dr. Pimentel, says with a grain of salt, personally.

Dr. Weitz: So what percentage of IBS cases do you think are caused by SIBO?

Dr. Morstein: I don’t know. I don’t really think in… It doesn’t matter to me what percent.

Dr. Weitz: I’m just curious.

Dr. Morstein: Did you know that 15% of Americans, which is millions and millions have IBS? Whatever percent is SIBO, it’s pronoun and it is millions as well.

Dr. Weitz: And IBS is basically the set of symptoms?

Dr. Morstein: Right. IBS is a umbrella of irritable bowel syndrome that can be caused by everything from food sensitivities to EPI to too much or too little bile, to fungal overgrowth, to bacterial overgrowth, to SIBO, to stress, to vagus nerve hypersensitivity.

Dr. Weitz: To LIBO, to dysbiosis.

Dr. Morstein: Exactly. So many things can impact onto IBS.

Dr. Weitz: So the symptoms of IBS are basically gas, bloating, diarrhea or constipation or alternating, abdominal pain. And then there’s a bunch of other non-intestinal symptoms. We have nausea, we have skin problems, we have, et cetera, et cetera.

Dr. Morstein: Yeah. I take some of those systemic symptoms with a grain of salt as well, just because I’ve had patients who had rosacea and SIBO and I’ve cured their SIBO and they have just as much rosacea as they did before. So maybe it’s associated with these things, but my experience is not that eradicating SIBO innately eradicates systemic symptomatology that oftentimes those have to be addressed in their own way as well. But yes, you are right. It’s very difficult to… A patient might come in and say, “Hey, I have diarrhea or I have constipation. I’d like to get tested for SIBO.” And I will say, ‘Do you have gas, distention, bloating?” And if they say no, that is taking away from my confidence in SIBO. However, I’ve had patients who just had microscopic colitis have SIBO. I’ll always test them. And I’ve had a few patients that when we eradicated SIBO that eradicated their diarrhea. So we really expect some gas and distention, but it doesn’t honestly seem that it’s in a hundred percent of the patients all the time as the key symptom we’re looking for.

Dr. Weitz: So when you have a patient that you suspect of having SIBO, what test and or tests do you run?

Dr. Morstein: So we have to be very, very, very, very clear on this. There’s only one way to diagnose SIBO, and that’s a breath test. Now you cannot do anything with the stool.

Dr. Weitz: Well, wait. What about IMO?

Dr. Morstein: That’s intestinal. IMO is intestinal methanogen overgrowth. So that has to be shown-

Dr. Weitz: That could be large intestine as well.

Dr. Morstein: No, you cannot diagnose SIBO. If you’re looking for a SIBO IMO, full diagnosis, it’s breath. That’s it. It’s breath.

Dr. Weitz: But if it’s not just in a small intestine, it’s part of IMO?

Dr. Morstein: You can say that, but talk to anybody in the group. It’s only the breath. That’s it. It’s the breath that diagnoses this and is what-

Dr. Weitz: But if it’s not just in a small intestine, and-

Dr. Morstein: Ben, you’ve said that three times now.

Dr. Weitz: Well, how else would you know it’s elsewhere?

Dr. Morstein: You have to see that in the breath. It has to be shown on the breath because-

Dr. Weitz: So what you’re saying is for it to be IMO, it could be in other parts of the intestinal tract, but it has to be in a small intestine.

Dr. Morstein: So here’s the deal. IMO, again, you’re working again off of Pimentel. Now, again, I take Pimentel, I respect him, but I don’t follow everything he says. I do a breath test if I’ve got-

Dr. Weitz: By the way, which breath test are you doing most of the time?

Dr. Morstein: So there’s really just two options. One is a QuinTron, and then one is the trio-smart, which is the Gemelli.

Dr. Weitz: And then we also have the use of different substrates?

Dr. Morstein: Yeah, but I mean, no, you really don’t. It has to be lactulose.

Dr. Weitz: Not everybody agrees with that.

Dr. Morstein: No, again, talk to Dr. Siebecker, talk to the group. The studies are clear. It has to be lactulose. It has to be ideally, Quin-Tron or trio-smart.

Dr. Weitz: Dr. Hawrelak has his patients get lactulose, fructose and glucose.

Dr. Morstein: He talked about that. We’ve talked about that. First of all, I don’t know how he can have patients spend $600 or if you’re doing trio-smart, $1,000. But in reality, this is really over. It’s lactulose. So it’s been decided. It’s a lactulose breath test. Okay? So the other ones, can I mention a lab not to use, or are you going to get… I don’t want to get you sued.

Dr. Weitz: No, it’s okay. I’m not being sponsored by any labs right now.

Dr. Morstein: So Commonwealth is the one lab. You blow in a straw, then you screw top it on. It’s just nobody would ever use Commonwealth who treats SIBO seriously. So you’ve got QuinTron, and then you’ve got trio-smart. And then different labs use QuinTron. I’m a fan of Aerodiagnostics, which is run by Gary Stapleton. You’re using a lactulose test. Ideally it should be a three-hour test. Now, what were we talking about? Oh, Pimentel. So here’s the deal. So generally there’s different ways to interpret a SIBO test. The classic is that from the smallest number to the largest number in 120 minutes. For methane it has to be 12 or above. For hydrogen, it has to be 20 or above. Now, Dr. Pimentel said, “No, we have to make the test 90 minutes, ’cause when it’s out of the small gut.” Well, that’s not when it’s out of the small gut for everybody. So the test was originated at 120 minutes.

Dr. Weitz: Wasn’t it 105, the cut-off at some point as well?

Dr. Morstein: No, the classic is 120. Now different labs will listen, obviously to Dr. Pimentel, who is obviously very respected in this world. So his trio-smart ends at 90, Genova ends at 90, s doesn’t end at 90 in terms of analysis. So you have to decide when you want to end the test. If we end-

Dr. Weitz: So you go till 120 minutes.

Dr. Morstein: Generally, I do.

Dr. Weitz: And you’re only measuring two gases rather than three?

Dr. Morstein: Well, yes, exactly. Now we can get into hydrogen sulfide and the accuracy of that testing.

Dr. Weitz: So for those who aren’t familiar with what we’re talking about. The gases are hydrogen, methane, and then the third gas is hydrogen sulfide, which is the one that’s only included in the trio-smart test.

Dr. Morstein: QuinTron is just the hydrogen and methane, and then hydrogen sulfide can be extrapolated with flat lines of both gases in the QuinTron analysis. Now we’re getting back to IMO. So Dr. Pimentel came out and said, “Here’s the deal. Methane should never be over 10. And if you ever see a box that’s 10 or above, they have intestinal methanogen overgrowth, whether in the small gut or the colon. And so I am not going to follow that rule personally because I’ll see people that have eight, eight, four, five, this, and then they’ve got one number in their colon that’s 11. This is going to overtreat, this is going to falsely send people down SIBO treatment.

Dr. Weitz: At one point I heard Dr. Pimentel say that he thought that even though this wasn’t accepted by the North American Consensus, that he thought anything over three was problem.

Dr. Morstein: That was way back when. But remember, the North American Consensus is not some scientific… This was the opinion of 17 clinics in North America.

Dr. Weitz: This is the way medicine is practiced. You have all these consensus groups that make determinations about when people should get colonoscopies, when they should get a PSA test, when they should get a…

Dr. Morstein: Yeah, but a lot of them have done more with analysis with large group populations, and then they create a consensus. Like the US task force, they’re not just all sitting around saying, “Well, what do you guys think?” They’re looking at the data of thousands and thousands of patients and what they had done and what the results were. So I’m just saying that the NAC didn’t have, that was just the opinion that was created years ago with these 17 clinics. So look, I have a brain in my head and I have thirty-five years of practice under my belt. So I am open to listening to other people, but I don’t bow down at anyone’s altar. I’m going to practice with my patients in the way I feel is best responsible. So that’s me. I am a pretty good [inaudible 00:23:40], and I’m going to work with my patients the best that I see. And if it fits what’s out there, that’s great and if it doesn’t, I still feel comfortable with it myself.

Dr. Weitz: Okay, so go on. How do you diagnose the SIBO breath test?

Dr. Morstein: So the SIBO breath test, so you’ve got the classic ways, which is the rise of 12, the rise of 20. You also have sometimes that people just have high numbers throughout the whole test, but they don’t reach 12 or they don’t reach 20. And this is what we call elevated and sustained. And elevated and sustained can be considered a positive if it fits the clinical picture of the patient. And then even without that classic rise, it can be elevated and sustained.

Dr. Weitz: So hydrogen starts out at 40 and stays at 40?

Dr. Morstein: Exactly. That’s just too high. And it’s the same with methane. Now methane, in terms of this 10 or above, I’m not going to ever treat someone with SIBO with one box at 10 or so. But half of it is 10 or above, based on Pimentel’s research, then I’m going to be more suspicious, especially if they do have constipation, they do have the gas and bloating and so forth.

Dr. Weitz: What if the test is negative and right at 120 it shoots up?

Dr. Morstein: So that is a great question because unfortunately that happens more than you think, and that’s annoying.

Dr. Weitz: I know.

Dr. Morstein: They either went in the colon and it’s a negative or it’s still in the small gut and it’s just right at the terminal ilium, they have SIBO or IMO or whatever, so that is… God, I hate that result. And you just have to talk with the patient and say, “We don’t know, but we-“

Dr. Weitz: Now, if the cutoff is 120, why do three hours?

Dr. Morstein: We do three hours to see that rise, and you’re just confirming that lactulose got into the colon. You want to see that rise.

Dr. Weitz: But we’re going to ignore everything after one 20. So why do it?

Dr. Morstein: You don’t ignore it. If there’s tens or something before and then it shoots up, I’m more suspicious. But we do just need to ensure, one, believe it or not, it verifies that they actually drank the lactulose because sometimes people have forgotten to drink the lactulose. So it also can help confirm a hydrogen sulfide. If we have a flat line in the small gut and it goes up in the colon, that’s not hydrogen sulfide. But if we have flat line all the way across, now we can be looking at hydrogen sulfide. So there are really helpful ways of having that three hour.

Dr. Weitz: If we do the trio-smart, then we’ve already got hydrogen sulfide, so we don’t care about that.

Dr. Morstein: If it’s an accurate test and if it finds hydrogen sulfide

Dr. Weitz: And you have reason to think it’s not an accurate test.

Dr. Morstein: I just listened to a lot of other docs who haven’t found hydrogen sulfide positive on the trio-smart in a year. So I don’t know. For me, if patients have to pay out of pocket, the trio-smart is $369, Aerodiagnostics is $209. That adds up. So if I’m going to choose between the two, and I know hydrogen sulfide is not that common a gas at all, and that I am probably going to go with the much less expensive because I do want a follow-up test. You’ve got $400 versus $700. People are paying out of pocket a lot, and that can add up.

Dr. Weitz: Besides the breath test, are there any other tests that you regularly run on patients with [inaudible 00:28:04]?

Dr. Morstein: So if they come in to see me and they’re SIBO, IBS newbies, I do SIBO then I want to do a stool test to try to uncover the colonic health. So now we have all 25 feet of the intestinal tract. And I may also do a food sensitivity test. That’s the triad, walking in the door if nothing’s been done.

Dr. Weitz: Okay. And your favorite food sensitivity test?

Dr. Morstein: Oh, a hundred percent is Alletess, for sure. Absolutely. I’ve been using them for 20 years. I’ve been to their lab. I know. I’m a hundred percent set with Alletess, foodallergy.com.

Dr. Weitz: Let’s talk about treatment. You get a positive breath test. How do you treat it? How do you treat the different forms of SIBO differently?

Dr. Morstein: There’s five or so different treatments. If it’s hydrogen or methane, you can use antibiotics. Now with rifaximin, there’s been two good studies. One showing that just adding guar gum increased the eradication rate from 62% to 87%. So I always throw in guar gum, and there’s another study saying that using bile significantly increases rifaximin’s effect. Now, rifaximin is, for a naturopathic-

Dr. Weitz: So this is ox bile?

Dr. Morstein: Ox bile, right. So for a naturopathic physician, if a patient comes to me with a sinus infection or strep or bronchitis, I don’t do antibiotics because I can treat that naturopathically. And so do that. I don’t like antibiotics. But the reason so many of us are doing rifaximin is for three main reasons. One is it’s 99.9% active only in the small gut. So it is not really active in the colon. It doesn’t wipe out the microbiome like regular antibiotics do. In fact, one study said that what it did, its activity in the colon was to increase bifidobacterium. I’m good with that. So two, rifaximin is a large molecule, so it is a hundred percent unabsorbed by the human gut. It doesn’t get to the liver. You can’t have an internal negative reaction because it doesn’t enter the body. And then Pimentel said also that this research shows it does not cause trans-generational resistance. So bugs aren’t getting resistant to it. We’re not breeding super SIBO bugs with rifaximin. So for all of these three reasons, it’s why so many functional docs are so open to using rifaximin. But Rifaximin by itself is good with hydrogen. I’ll use guar gum, I’ll use bile, I’ll use a BioFilm Buster product, but if it’s methane, we have to add in something else.

Dr. Weitz: What BioFilm Buster product will you use? And does it depend?

Dr. Morstein: What?

Dr. Weitz: Does it depend? Do you use different BioFilm Buster products?

Dr. Morstein: For SIBO, I’ll use, generally, Advanced Two BioFilm.

Dr. Weitz: The Paul Anderson product?

Dr. Morstein: Yeah, his supplement, not his prescription.

Dr. Weitz: This is the one with bismuth?

Dr. Morstein: Yeah. So now his prescription formula is a little different, but Priority One makes his supplement version. There’s also InterFase Plus by Klaire that many people use. Some people just use NAC. But I like that Advanced Phase-2 product. So that’s what I’ll use in that regard. And then if it’s methane and you’re using antibiotics then you’ve got to throw another one in. I don’t use neomycin at all. I have had people get ear damage, ringing in the ear. I’m done. No more. Forget it. So metronidazole is such a big gut irritant and I don’t want to use it. So right now for methane, if I’m using medication I’m using Alinia, nitazoxanide, which is mostly antiparasitic.

So now it’s even more expensive than rifaximin, so generally I have to get both of those from Canada. And sometimes the rifaximin will go through if they have IBS-D, if they have IBS diarrhea. But if they have IBS constipation, you’re not going to ever get it then. You still have to pre-authorize it, and it’s still a pain in the butt. So a lot of times I’m getting it through Canada, and that’s for two weeks. Every now and then I might do it for three weeks, but it’s generally for two weeks. And then now also there are supplements. So there are many different supplements out there.

Dr. Weitz: So you may have some patients who see you who’ve already failed rifaximin or who don’t want to take.

Dr. Morstein: Yeah, exactly. Or we just decide, “Okay, let’s do the botanicals.” There are very good botanicals out there.

Dr. Weitz: And studies showing that some of these botanicals are comparable to rifaximin.

Dr. Morstein: Yeah. That one study with Dysbiocide and FC-Cidal was not [inaudible 00:34:13]

Dr. Weitz: And also CandiBactin-AR, BR.

Dr. Morstein: I’m just saying that one wasn’t fair ’cause the rifaximin was dosed only twice a day, so you can’t really say it was as equal to it ’cause they didn’t dose it correctly. So that was just a study that we’re just like, “Okay.” So we have these supplements and different supplements. We know, we have some supplements that are methane and hydrogen, and we have some that are just hydrogen and some that are just methane. So you have to put them together. And now we have newer ones, a little bit that I’m playing with. And so we have to create a supplement regimen.

Dr. Weitz: Tell us some of your favorite ones. Why don’t we start with hydrogen, then we’ll go to methane, then we’ll go to hydrogen sulfide.

Dr. Morstein: Hydrogen, berberine of course is hydrogen. Neem is hydrogen, clove, pomegranate, oregano oil, these are all good hydrogen. Garlic is a little more with methane. Oregano is also methane. Neem is also methane. So those type of products you can easily mix and match. The classic starter is garlic, berberine, and neem. But then I use now a lot of clove and pomegranate and that is from Hawrelak?

Dr. Weitz: Yeah, Hawrelak is really big on pomegranate.

Dr. Morstein: Yeah, he is. And I like it. And it’s easy, there’s-

Dr. Weitz: What is the pomegranate product that you use?

Dr. Morstein: There’s only one company right now that makes pomegranate peel capsules because it’s not pomegranate extract. That’s for your prostate or your antioxidants. But it’s pomegranate peel. Now there’s a bunch of products on Amazon where you can get it in a powder form, but in the capsules, there’s a company called Terravita that makes pomegranate peel capsules. So that’s nice and that’s convenient. A lot of people don’t like the powder. It’s not like it’s good tasting or anything. It’s not bad tasting, you can mix it with a yogurt or something. But anyway, the capsules are convenient for many people. So we do the botanicals for a month, and I also add in a BioFilm Buster, but there’s no need for the guar gum or the ox bile because-

Dr. Weitz: And what about after a month? Do you rotate botanicals?

Dr. Morstein: No. After a month, I’m going to retest.

Dr. Weitz: One month. That’s it?

Dr. Morstein: Yeah.

Dr. Weitz: You have patients on a short fuse.

Dr. Morstein: Well, that’s ’cause a lot of them get better. And also, I’m not going to continue a protocol that’s not effective. I get so many people, “Oh, I was on this protocol and I still had SIBO, and they put me on the protocol again, and I still had SIBO. I did it for eight weeks.” There’s many different protocols out there.

Dr. Weitz: But what if they feel like 50%, 60% better?

Dr. Morstein: If feeling is good, let’s see. If it’s working, we’ll continue it, but I’m not going to waste patient’s time and money on ineffective protocols ’cause they come to me. They’ve already been on ineffective-

Dr. Weitz: But now they got to wait until they see you. Then you got to send them for the test, and then it’s a couple of weeks to get the test results back.

Dr. Morstein: That’s completely untrue. First of all, we set up the protocol and I give them the test. When they’re done with the protocol, they do the test, they start on the prokinetic, which if it is eradicated, we’re just moving-

Dr. Weitz: Now, wait a minute, can they even do the test right away because they just didn’t take any antimicrobials? Don’t you have to have [inaudible 00:38:06]?

Dr. Morstein: If I take antimicrobials for my sinus infection, do I have to wait two weeks to see is my sinus infection gone? If I take antimicrobials for my bladder infection, do I have to wait two weeks to see if my bladder infection is gone? Where in medicine do we have to wait if we’re trying to kill something to see in that regard? So I used to wait, and now I just make it pretty short. And guess what? Some people still have SIBO, some people are eradicated. I don’t think it’s caused any irregular testing. And then I get my test back in five days and then we have a follow-up. So it’s a pretty seamless process for patients in that regard.

Dr. Weitz: What about the use of, you said bile, what about the use of digestive enzymes or HCL or herbal bitters as part of the protocol?

Dr. Morstein: No. Why would I do that in eradication? So you’ve, you’ve got prescription, you’ve got antibiotics. The third one is mixing these two together. Sometimes they don’t want to do [inaudible 00:39:20]. You can do an antibiotic and supplements together. There’s no reason to not do that. And when I have patients who come to me and they’ve been treating it for two years, I may do that and go nuclear, and that can be really effective. We also have, of course, either an elemental diet or I have done with two patients who didn’t want to do the elemental diet-

Dr. Weitz: How often do you do the elemental diet?

Dr. Morstein: Let me just finish this. Hold on. We have the elemental diet or we have a carnivore diet. I’ve only had two patients who did a carnivore diet and had success in eradicating SIBO doing that diet instead of the elemental. But these are all the treatment options. We just have to-

Dr. Weitz: When you’re treating the patient with the antimicrobials, do you change their diet?

Dr. Morstein: Personally, I do not. So here’s how I work. I work first on eradication.

Dr. Weitz: Because some docs will use a low FODMAP.

Dr. Morstein: I know. So I do eradication. After it’s eradicated. People are not generally symptom free. They still can have some… So that’s when I do, “Okay, we got rid of the bug, now let’s heal the gut. We’ll get you on a diet. We’re going to heal the gut, we’re going to help with digestion, and we’re going to get your gut now back on track, but we can’t get it back on track until the bugs that are causing it or eradicated.” So for me, I do eradication and then I do everything else to heal the gut, heal the leaky gut, get the digestion better, get everything needed that we need to have it be a really healthy gut again.

Dr. Weitz: What about the use of probiotics?

Dr. Morstein: I used to add probiotics into the eradication protocol, and there are studies that show that can help actually.

Dr. Weitz: There’s practitioners and that’s their first line treatment.

Dr. Morstein: Yeah. Right now I add it in. My eradication protocols are pretty successful, so I wait for the probiotic now at the end, unless the patient really wants one, then I am using very SIBO specific probiotics.

Dr. Weitz: Some docs like to use a spore-based probiotic.

Dr. Morstein: Yeah, I don’t like those, so I don’t use those. I know a lot that other docs. Personally I’m not a big spore person. Or if I did spore, I would still do a lacto bifidobacteria product. We all know that different docs do different things and have different results. I haven’t ever really seen a lot of supportive things for me and my patients using spores personally, but I know other docs find it very, very helpful. I use though regular type probiotics for SIBO patients.

Dr. Weitz: Okay. Do you address motility?

Dr. Morstein: Yeah. You have to. That’s like I say, my protocol is you do the eradication and then you’re going to retest. On the same day you retest, you start the prokinetic right away because if it is eradicated, I may take me five days or so to get the test back, we don’t want it to be coming back, so you have to get on a prokinetic immediately. And prokinetics can be supplements, compounded medicines or drugs. So you’ve got one or the other and you have to choose which one is best. And then with supplements, you’ve got stronger ones and then weaker ones versus ones to give a person with constipation versus ones to give a patient with diarrhea. So I would give a stronger one for the constipation and a weaker one for the diarrhea. But they’re both-

Dr. Weitz: What’s a weaker and stronger natural prokinetic?

Dr. Morstein: I think the strong, for me, the strongest supplement is SIBO MMC. That’s the one that I find the most success with. For just regular people that have normal bowel movements or diarrhea, then anything like GI Motility Activator, Motility Complex, just your ginger artichoke or when some people are so sensitive to ginger, then just artichoke extract.

Dr. Weitz: What does the MMC product tap besides ginger and artichoke?

Dr. Morstein: So has 5-HTP. It has ginger artichoke. It has a couple of herbs that other products don’t have jujube. I have to look them up. Off the top of my head. But there’s a couple of Asian herbs that other products don’t have.

Dr. Weitz: And you feel that’s a stronger product?

Dr. Morstein: I do, yeah, I do. Definitely, for my patients.

Dr. Weitz: Do you do anything else for the constipation with the IMO methane patients? Magnesium citrate, et cetera?

Dr. Morstein: Obviously I’m trying to not just dump people on laxatives. They can do laxatives on their own. Magnesium is a laxative.

Dr. Weitz: Oh, I mean, it’s a natural mineral.

Dr. Morstein: It’s a laxative. Like milk of magnesia. That’s not magnesium supplement, that’s a laxative. So they’re taking magnesium in these high doses as a laxative, I’d really like to work with them as much as possible and get their own guts working as best we can, before we just say, “Oh, you know what? Just here, take a bunch of magnesium and there you go.” And we’re not really healing their gut of constipation. Now, some patients, they may need to be on Motegrity and they have idiopathic constipation and they won’t have a bowel movement for a week or so at a time. So there are patients where that is their life, but I’m first going to try other things before I just say, “Hey, wind up on. Just take a laxative.”

Dr. Weitz: You mentioned elemental diet.

Dr. Morstein: I did mention elemental diet.

Dr. Weitz: What’s your protocol? How often do you use that?

Dr. Morstein: I don’t use it too much just because, one, patients don’t want to be on it. And two, the other protocols, I generally do elemental diet when there’s just been systemic failure with the other protocols or a patient is willing to do it or whatever. But I generally use the ITI physician-

Dr. Weitz: Integrative Therapeutics product.

Dr. Morstein: Right. And dextrose free. We have to always use dextrose-free. Elemental diets are not dextrose free, and that is going to grow a bunch of yeast and guts almost invariably. So if that has to be taken with an antifungal or just switch to a dextrose-free one. So then generally you’re just figuring out what their calorie need is. Say they need 1500, a woman, or I had one guy do 2,700 a day, that was his calorie needs, and two scoops is 300 calories. Mix it with eight or 10 ounces generally of cold water or chipped ice and sip on it with a straw for 30 minutes. You have to ingest it very slowly and then just repeat how many times you need to get your calories in for the day.

Dr. Weitz: Okay.

Dr. Morstein: Yeah.

Dr. Weitz: You find that often effective?

Dr. Morstein: It can be effective and it cannot be effective, like everything else. Or like with everything else with medicine. So it can be effective. There have been, Dr. Siebecker reported on people actually having worse methane sometimes with an elemental diet. So that was interesting. Generally when I’ve done it’s been successful. So my experience hasn’t been that patients have historically gotten worse on it.

Dr. Weitz: After the killing phase, what does your next phase consist of?

Dr. Morstein: After the killing phase, and they’re on the prokinetics, so I have a diet handout. I don’t do FODMAPs. I do a modified special carbohydrate diet starting out strict, and then each week getting less and less strict and the diet’s about five weeks. And then we’re going to try to start just eating normally again. And so I go through the handout with them. I add in product to help heal the gut lining, product SIBO-Rebuild. I might do for sure a digestive enzyme, a multiple vitamin, fish oil, the prokinetic, and then a probiotic as well. That’s its own entity. So I can’t really throw that in with the eradication.

And I also like this mind-body connection. So say for the first part, their whole thing is, “I’m eradicating, I’m eradicating,” connecting with their body versus, “I’m eradicating and I’m on the diet and I’m taking a [inaudible 00:49:06].” So I like it pure and clean with patients to have it so we eradicate, “And now I’m healing, I’m recovering, I’m getting my gut back healthy again.” I know there are docs that do it differently and that’s why medicine is so interesting and patients just have to find the right doc that they best resonate with.

Dr. Weitz: Now, you mentioned that you do a stool test as well. When do the results of the stool test come in? If you see, let’s say you see high strep and staph and you’ve eradicated their SIBO. Now, do you assume that’s probably reduced the staph and strep, or do you try to address that separately? Do you address some of the other things on the stool test?

Dr. Morstein: If there’s a pathogen, then they’re going to do sensitivity testing. And so I’ll know, say they had elevated klebsiella or citrobacter or proteus, those are going to cultured and I’m going to know what kills them. And so I’ll have a treatment sheet where we’ll say-

Dr. Weitz: Well, if you do a stool test, they’re cultures.

Dr. Morstein: I do. That’s the only one I do. Yeah, for sure. And that’s one of the best reasons I do it is I know for sure what-

Dr. Weitz: Are you using Genova or Doctor’s Data?

Dr. Morstein: I use Doctor’s Data generally. So then their treatment sheet will be, say, I also do send them home with a diet diary. So for a week and also a candida questionnaire, the original two-part questionnaire from Dr. Crooks book, The Yeast Syndrome from 1984.

Dr. Weitz: Do you also do food sensitivity test? Okay, let’s finish with the stool.

Dr. Morstein: No, let me finish.

Dr. Weitz: Sorry, I’m all over the place.

Dr. Morstein: You are all over the place. So with the stool, we’re going to have, “Okay, they’ve got SIBO.” We’ll have that protocol. Underneath, they may have fungus overgrowth. We know with SIFO, at least 40% of patients with SIBO has SIFO. We also know it can be in the colon as well. So I’ll set up the fungal protocol after SIBO, and then we also have then say there is klebsiella, well then we have healing the gut. Maybe they’re low on beneficial bacteria and we’ll have to do prebiotics after we eradicate the SIBO. Or maybe they have low butyrate or something. But there’s a triad. We’re going to start with SIBO. We’re going to do fungal after then heal up the colon as well. Or maybe if we have to order the medications from Canada, which can take a month, then I’ll just start with the fungal protocol. We’ll do that first. Why waste the month? My fungal protocol. So we’ll just start with that, and then we’ll follow up with SIBO when we have those medications. So there’s a lot of fluidity in that regard.

Dr. Weitz: It is your fungal protocol prescription or herbal?

Dr. Morstein: It’s a combo. I love nystatin. And then I mix it with Kolorex, the Horopito, which is an antifungal. And it looks like it has some capacity to also be a BioFilm Buster for fungus. So I mix that together within then a probiotic. Of course, if they have SIBO, I’ll give them a probiotic that is good for a SIBO gut and that they won’t react to.

Dr. Weitz: What probiotic is good for a SIBO gut.

Dr. Morstein: I usually do two. One is Klaire’s Lactoprime Plus, and then Xymogen has a Probiomax DF that has [inaudible 00:53:16], which is a good one for more constipated patients ’cause it helps move the gut forward. So those are the two that I usually choose from. And then food sensitivity. Now, I may or may not do all three of these at one time. At least if I’m doing SIBO, I want to do the colon. Food sensitivity, a lot of patients, they come in on these restricted diets, they’ve already pulled this and that and this out, and so it may be helpful or it may not be helpful. And so I have to analyze that with the patient. If they’re just eating a regular normal diet and they’re having IBS and just coming to see me, I may do that first before the SIBO and the stool and just see if we pull that food out that they’re all better. So I may start with that and say, “Let’s just do this for a month and see what happens.” And sometimes they come back, “I’m all good.” And if they don’t, then we can do the deeper other investigations.

Dr. Weitz: Good, good. A lot of really good information.

Dr. Morstein: I hope so.

Dr. Weitz: I’m ready to bring it to a close. Do you have additional things you want to talk about or mention?

Dr. Morstein: No, no. This was lively.

Dr. Weitz: I like to keep it lively. All right, Dr. Morstein. How can patients find out more about you if they want to work with you and have you help them?

Dr. Morstein: Basically I’m at drmorstein.com. And also I’m at nevyhealth.com. So I’m at both sites. I’m in Mesa. I do telemedicine 480-833-0302. So there you go.

Dr. Weitz: And do you have courses for practitioners?

Dr. Morstein: Yeah, I did a SIBO course through the AZNMA, that’s Arizona Naturopathic Medical Association, so aznma.org. They have a SIBO class that I did archive.

Dr. Weitz: And then you did one for SIBO SOS as well?

Dr. Morstein: Oh, yeah. I’m a regular speaker on SIBO SOS. I’m on their Gut Summit, which is coming up in I think April or so. I’m very honored to be a regular speaker at the SIBO SOS Summits.

Dr. Weitz: That’s great. Thank you Dr. Morstein.

Dr. Morstein: Thanks then. Hope you have me back one day.

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

February 20, 2024/by drweitz

Dr. Weitz's Blog, Rational Wellness Podcast

Iron Curse Part 1 with Dr. Christy Sutton: Rational Wellness Podcast 347

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Dr. Christy Sutton discusses the Iron Curse, part 1 with Dr. Ben Weitz.

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Podcast Highlights

1:50 High iron levels can negatively affect your health. Iron is so essential that your body has few ways to get rid of it and the body really likes to store it. The problem is that some people genetically are good at absorbing and storing iron and cannot eliminate it. The first place iron levels will go up is the liver and the liver has glutathione so it can protect itself from the oxidative stress of the iron, but then the iron spills over into other organs, which more easily get damaged by the iron. One of the first organs to be damaged by iron is the pancreas, which is why people with hemochromatosis are sometimes called bronze diabetics.

4:42 Most patients with elevated blood sugar will not typically have their iron levels checked. A full iron panel maybe costs $40 and yet it is rarely run. Most doctors will only order a CBC, a CMP and a basic lipid profile. The CMP includes a glucose level but often a hemoglobin A1C is not ordered. If there are elevated liver enzymes, you will not know that it is due to iron if you have not run an iron panel.

11:25 Lab testing. When we look at labs it is important that the recommended lab ranges reflect a healthy person and not a sick person range. When it comes to labs to look for hemochromatosis, which is to see if you have a combination of high iron saturation combined with a high ferritin. LabCorp considers iron saturation normal up to 55%, but the hematology society recommends a cutoff of 45%. The other part of the equation is ferritin, which is the storage form of iron. Ferritin should not be above 100, but many labs do not flag a ferritin till it gets to 175 or 200 and some labs consider a ferritin of up to 400 as normal. An iron panel should include not only a serum iron and a ferritin, but also the TIBC, the total iron binding capacity, and UIBC, the unsaturated iron binding capacity. TIBC is the number of transferring that your body is making to move iron from one place to the other in the body. While the ferritin is the storage form of iron, serum iron is just the amount of iron in the blood at the time of the blood draw. Dr. Sutton does not like to see any of the numbers our of range, though the numbers she focuses on most are the iron saturation and the ferritin. If the iron saturation is over 45% and the ferritin is above 100, then that is very problematic. Though, on the other hand, high ferritin can also reflect inflammation in the body.

Dr. Christy Sutton is a doctor of chiropractic who published her first book in 2018 on genomics: Genetic Testing: Defining Your Path to a Personalized Health Plan. She then diagnosed her husband with hereditary hemochromatosis, and high cortisol from a pituitary tumor, which she believes high iron contributed to. Her new book is The Iron Curse: Is your doctor letting high iron destroy your health, about the risk of high iron or hemochromatosis and the health consequences that can result from it. Her website is DrChristySutton.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.

Podcast Transcript

Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more check out my website drweitz.com. Thanks for joining me, and let’s jump into the podcast.

Hello, Rational Wellness podcasters, today we have an interview with Dr. Christy Sutton on The Iron Curse: Is Your Doctor Letting High Iron Destroy Your Health? Dr. Christy Sutton is a doctor of chiropractic who published her first book in 2018 on genomics, Genetic Testing: Defining Your Path to a Personalized Health Plan. She then diagnosed her husband with hereditary hemochromatosis and high cortisol from a pituitary tumor, which she believes high iron contributed to. Her new book is The Iron Curse: Is Your Doctor Letting High Iron Destroy Your Health? about the risk of high iron or a hemochromatosis and the health consequences that can result from it. Dr. Sutton finds that this condition is more common than most think, and it is often undiagnosed. I have to say that I’ve only diagnosed this a few times, so I assume I may potentially have missed it in patients, while I’ve seen many patients who have had iron deficiency anemia. So high iron, I think, is an important topic that’s rarely discussed, so Dr. Sutton, thank you for joining us.

Dr. Sutton: Thanks for having me.

Dr. Weitz: So perhaps we can start by discussing some of the negative health consequences of having chronically high iron. I think a lot of people realize iron is an essential nutrient and it’s very important, but I don’t think people realize that it can potentially contribute to poor health as well.

Dr. Sutton: Yes, absolutely. So like you said, iron is so essential that the body has very few ways to get rid of it. The body really likes to store it, almost like a hoarder. And the problem is that some people are genetically, and for environmental reasons, very good at absorbing more iron and getting more iron and storing that iron. Just like some people are genetically good iron stores and hoarders, other people, they have a hard time keeping enough iron in their body for one reason or another. So some of the risk factors with increasing your iron levels and getting high is that the body first stores it in the liver, that’s the natural first place to keep that iron, and that makes sense because the liver has a great regenerative detoxifying pathway, there’s lots of glutathione, and the liver can protect itself from the oxidative stress or rusting that iron can cause. So the liver is a great storage place, it’s like the big storage closet for the body.

The problem is once iron levels get high enough, then that iron’s going to spill out into other parts of the body. And there’s certain parts of the body, ultimately the entire body can be damaged, but there are certain parts of the body that tend to get damaged first. So the ones that tend to get damaged first are the organs that are particularly sensitive to high iron, that iron seems to have more of an affinity towards damaging, and one is the pancreas. So people that have hemochromatosis are sometimes called bronze diabetics because the high iron will damage the pancreas, causing type one or type two diabetes or insulin resistance, basically damaging the insulin producing cells in some way, shape or form, and then they also get this bronzing of their skin. So before we had really good and accessible lab testing, one way that this condition would be diagnosed is the doctors would say, “Hey, your skin’s getting very bronze and you have diabetes, this could be hereditary hemochromatosis.” Now we hopefully don’t allow people to get to that point, because that’s a preventable point, but this is an example of-

Dr. Weitz: On the other hand, how many people who have high blood sugar necessarily get their iron levels even checked?

Dr. Sutton: That’s a really good question.

Dr. Weitz: I would venture most of them don’t. It’s not part of a standard lab panel, and unfortunately insurance companies control the labs that are acceptable, and they’ve been stingier and stingier, and so doctors have been ordering fewer and fewer labs. So iron levels are typically not ordered unless there’s some reason to suspect a problem.

Dr. Sutton: This is one of my biggest pet peeves that you really just immediately jumped us into, which thank you for that. A full iron panel is maybe $40, and it is not an exotic, expensive, complicated lab to run. You can get this done anywhere, it’s not like you have to go to a specialty lab, this is any Quest, CPL, Labcorp can do this easily. Every doctor has the ability to order these labs easily. Having said that, they are not normally a part of routine testing even though high and/or low iron are common problems. And often doctors will maybe just order a serum iron, or maybe if they’re really on top of things a ferritin, but rarely do they order the full iron panel. The most common labs, as you know, but maybe your listeners don’t know, the most common labs that we see doctors ordering are a lipid panel with cholesterol, a CMP, which has your liver enzymes and electrolytes and stuff, kidney function, and a CBC, which has the red blood cells, hemoglobin, hematocrit, white blood cells.

So here’s the problem, a lot of people have elevated liver enzymes and their doctor is not looking for the iron, which like my husband, the high iron was, and this is very common, high iron destroys the liver, it’s very common to have elevated liver enzymes because of high iron. So you would think, oh, if we’re looking at the liver, and maybe the liver enzymes are high, wouldn’t it then be a natural step to then look at the iron? But no, that’s not the natural step that you would think. The other thing is in that CMP it also gets the fasting glucose. So if somebody has a high fasting glucose wouldn’t you think, oh, let’s order the hemoglobin A1C in the iron panel? No, that’s not often the case. And with the CBC, you get the hemoglobin hematocrit red blood cells. With high iron sometimes, as in my husband case, and many other patients cases, the high iron will cause high red blood cells, hemoglobin and hematocrit. So you would think, oh, let’s get the iron panel. With anemia it’ll cause low hemoglobin and hematocrit red blood cells, you would think, oh, let’s get the iron panel. Because really, if you want to be a good diagnostician and really know what’s going on, you have to have that full iron panel with the CBC, and I think you need the CMP too just to see what’s going on with the liver, and altogether that lab work is inexpensive, easy, this is not an exotic thing to happen. Can I go back to the original question about what does it do to your body?

Dr. Weitz: Sure, let me just point out one more problem with this whole situation is that when you look at lab tests, what they call normal, that’s what the typical doctors go by, is based on what the average American has. So liver enzymes actually have been going up in a normal range. So I was looking at a patient who had labs from UCLA, and their ALT was 60 and I thought, oh wow, you have elevated liver enzymes. But then I looked down at the bottom and it said normal now was up to 70. So as a result of Americans getting fatter and drinking more, maybe partially because of the pandemic, average liver enzymes have been going up, so we just change what the acceptable range is by calling a higher level normal, which is even scarier. So now you got even more patients with high liver enzymes that aren’t being flagged as high because they’re not red on the test and the average doctor just doesn’t even pay attention.

Dr. Sutton: Yeah, that’s a really good point, yeah. So the bell curve is, basically they’re looking at the bell curve, and if you get 10,000 people and you look at their labs and you say, okay, where are most of them? Then that’s where they decide the normal quote on quote range is. Well, if most people are failing the test because their health is poor, which is unfortunately the world we live in, then it’s just basically this lowest common denominator healthcare system where the bar just keeps getting lower and lower and it’s like, well, we’re not really getting sicker because look, statistically speaking not more people have higher elevated liver enzymes, or whatever. But actually, if we were to look at the same range from a decade or even five years before, we would be statistically much worse. And you don’t just see this with labs, you see this also, I’m slightly going to go off-topic here, but in the last year a lot of the developmental milestones for kids were changed, and this is a result of the pandemic, basically so many kids lost all of this developmental, these key developmental windows were ruined because of the pandemic.

Dr. Weitz: Wow.

Dr. Sutton: So they actually, they took crawling, they removed crawling as a developmental milestone.

Dr. Weitz: Really?

Dr. Sutton: Yes, yes.

Dr. Weitz: Wow.

Dr. Sutton: They removed crawl, one of the most important developmental milestones of all time, they removed it, and they also basically said, “You have a lot longer before you need to be able to speak,” and all of the developmental milestones were pushed back so that you wouldn’t have this explosion of kids that are missing their developmental milestones. Now it’s like, oh, we’re not missing developmental milestones, it’s the same, but really they just changed the way they’re grading the test. Which is stupid because the body hasn’t changed, the neurology hasn’t changed, the biology hasn’t changed, it’s just the grading system has changed because it might not look good for some people if suddenly all these kids are failing the tests, you know what I’m saying?

Dr. Weitz: Wow.

Dr. Sutton: Yeah, but good point, good point. So the other thing I want to say about this most recent point about the lab ranges is when you look at hemochromatosis this is particularly important, not just because you want to look in a functional range and not a sick person range, but also the ranges that labs allow are not at all accurate. For example, for hemochromatosis, you have to have a combination of a high iron saturation combined with a high ferritin. Now I order a lot of labs through Labcorp, and they allow that iron saturation to go up to 55% before they flag it. Having said that, with hemochromatosis the cut-off is 45%, so a lot of people are not getting flagged even though they are over the range that the hematology societies have decided is the cutoff. So this is not just an issue of the doctors having the bad range, this is actually an issue where the labs are misleading people away from what the hematology society say the cutoff is, which is 45% for the iron saturation.

Now the other part of that equation is the ferritin, which is a extremely important marker, it gets high with high iron and/or with inflammation. And if you have a high ferritin combined with that high iron saturation, that’s hemochromatosis. Now you can have a high ferritin not because you have high iron, just because you have inflammation. But a really big problem is many people allow ferritin to go extremely high before it’s flagged, and really, for many people, I don’t think anybody’s ferritin should be over 100, but hemochromatosis patients, when they’re being managed correctly, their doctors like to keep them basically below 75, some below 50 on that ferritin, and many labs do not flag a ferritin until it’s 175 or 200 or 300 or 400, they’re really all over the place. I’ve even heard some doctors say, “As long as you’re below 1000,” which kind of makes me want to vomit in my mouth.

Dr. Weitz: Wow.

Dr. Sutton: Because it’s like, okay, let’s just wait until our patient has permanent damage and is one foot in the grave before we say anything. So the lab ranges are important to know and understand and not be misled, so that’s one thing I wanted to say. Now, circling back around to the really important question at the beginning about what does high iron due to your body? So we talked about diabetes, but high iron also has a particular affinity for the brain and the pituitary gland. So if you have high iron you’re more likely to have Alzheimer’s, neurodegenerative diseases, Parkinson’s, bipolar, depression. Pretty much any neurological problem, you are more likely to have that with high iron. And then the pituitary gland, which is a part of the brain, the pituitary gland, particularly the anterior pituitary gland, not so much the posterior pituitary gland, is at a very high risk for damage from hemochromatosis. And the pituitary gland is where it secretes the hormones that control your growth, your testosterone production, your estrogen, progesterone, thyroid, cortisol, this is the part of the nervous system that’s really important for being able to have healthy hormones and be healthy.

The iron also likes to go and destroy the gonads, so it’s very common for ovaries and testes to be damaged, decreased fertility in men and women, significantly decreased sperm count, unhealthy sperm because of all that damage. The high iron also likes to go to the heart, increasing your risk, and not just the heart, but the whole vascular system, kind of rusting the whole body, the vascular system, creating inflammation, increasing your risk for clotting, increasing your risk for an acute heart attack, increasing your risk for cardiovascular disease, calcium deposits, atherosclerosis, fatigue, increased heart rate, decreased heart rate variability. These people tend to just be tired often, and they can’t exercise because their heart is so stressed out. And then ultimately the iron likes to go throughout the whole body. Once it’s filled up all those places and created damage, then it’ll deposit in the skin, increasing your risk for skin cancers, skin disorders. It really will deposit everywhere, but that’s just a little window into some of the problems that it can create.

Dr. Weitz: That’s pretty scary.

Dr. Sutton: Mm-hmm.

Dr. Weitz: Okay, so let’s go through some of the labs and enable us to better understand how we should be analyzing our patients. So let’s go through a whole detailed iron panel.

Dr. Sutton: Okay.

Dr. Weitz: Can you start with iron saturation levels?

Dr. Sutton: Yes. Okay, so iron saturation is really you’re looking at the TIBC. So there’s… First let’s talk about what’s in a iron panel.

Dr. Weitz: Okay.

Dr. Sutton: Okay, so the iron panel has a TIBC, a UIBC.

Dr. Weitz: So a TIBC is total iron binding capacity.

Dr. Sutton: Yes, so the TIBC is total iron binding capacity, and that’s basically the number of transferrin that your body is creating to move iron from one place to the other throughout the body. You can think of transferrin as these planes that your body is making to have iron hop onto the plane, and then transfer it basically from usually the digestive system where it’s being absorbed to another tissue, to the liver. Wherever the body needs the iron, the transferring is necessary. So if you have high iron, then your body is basically saying, stop bringing the iron planes. We don’t need any more iron, shut it down, I don’t need any more planes, stop making the planes, and then the TIBC goes down. Because basically even though your iron levels are high, you see a low TIBC because your body’s trying to shut down the transportation of iron. On the opposite side of that coin is if you have low iron you’re going to see that TIBC go high because your body’s saying, we need more iron, you need to figure out how to make more of these planes to get the iron to ourselves because we’re starving for iron. So these are confusing to a lot of people because a lot of people say, “I can’t be high in iron, I’m low on labs.” It’s like, you’re low on the TIBC, which is inverse of the iron levels. Okay?

Dr. Weitz: Okay.

Dr. Sutton: So then the UIBC, the UIBC is unsaturated iron binding capacity, and you think of the UIBC as the open seats on the planes. So, okay, with high iron all of those seats are full because you have all this iron, and the planes that are flying around the body, the iron’s already hopped on the seat, and now there’s not a lot of unsaturated or open seats. And so the number of open seats, unsaturated seats, on the planes is very low, so the UIBC goes down as well with high iron. And as with the TIBC, this is confusing because a lot of times people with high iron will have a low UIBC and they’ll think, I’m fine, I don’t have an issue because I’m low on labs. But actually that’s, in many cases, an early warning sign that your body has too much iron and it’s shutting it down by having a low UIBC and low TIBC. Okay?

Dr. Weitz: Okay.

Dr. Sutton: And then the serum iron is just the amount of iron that is actually collected in the blood at the time of the blood draw. So if you have high iron, if you have hereditary hemochromatosis or hemochromatosis that’s non-hereditary, then it is common to have high iron in your blood because you just have high iron everywhere, so yeah, it’s going to be high in the blood too. If they were to measure the amount of iron in your liver, you’d be high there too. So the serum iron is just looking at the iron that’s actually in the blood at the time of the blood draw. And then-

Dr. Weitz: What’s the important numbers you like to look at for the serum iron?

Dr. Sutton: With serum iron I tend to just let the lab range dictate it, because I don’t have as photographic as a memory as I’d like, and I really tend to focus on the iron saturation and the ferritin. Those are the two that I tend to really focus on. And with different ages the serum iron will vary greatly. Basically I don’t worry about the actual range as much, I tend to say, okay, you’re within range. The people who tend to have high iron, they’re going to be pretty high regardless of the range, is usually the problem. They don’t always have high iron on labs, but if you see any of these labs out of range that I’m talking about, then you need to go and look for a hemochromatosis gene. And if you have one of those hemochromatosis genes, then the key piece of the puzzle is there, now we know why you’re out of range, and we know where this is going and it’s not going in a good direction.

So then you have the iron saturation, which is just an equation that looks at the serum iron and the TIBC, and then it gives you a percentage. And like I said, you always want to be below 45%. So anybody that has a percentage over 45%, then the next step is look at the ferritin, so you’re always looking at the ferritin. And the ferritin is the stored iron, and whenever the body has too much iron and/or is inflamed, it will store that iron as ferritin. So like I said, I never like to see ferritin over 100, I’m always putting up flags in my head, there’s a problem, this person’s either inflamed or has high iron, and then I look at the other labs to figure out, is this inflammation? Is this an inflammation driven high ferritin, or is this a high iron driven ferritin? And sometimes-

Dr. Weitz: And as far is low ferritin, is 50 the cut-off, or what do you like to see?

Dr. Sutton: It depends on the person, honestly. So if I’m dealing with a person that struggles with anemia because of whatever reason, pregnancy, heavy periods, malnourishment from digestive issues, GI bleed, then I’m comfortable with them having a higher number. But those people struggle to get higher, and so I’m not focused on keeping it lower, I’m focused on, I’d like to get this up into the 60s and the 70s, that would be a great buffer for you.

Dr. Weitz: Right, but when does that trigger you to look for anemia? If you see a ferritin of 30 or 40 do you go, “Well, that’s okay,” or do you go, “Well, I should be worried about that”?

Dr. Sutton: I never like ferritin to get below 30 in anybody. Now, if it’s like a hemochromatosis patient that they’ve been treated and their ferritin’s gotten below 30, I’m not going to tell them, “You should increase your iron intake,” because they’re going to pop back up anyway, that’s just where their body’s naturally going.

Dr. Weitz: Right, but let’s say you have a vegan and their hemoglobin is on the low end, and their red blood cells are on the low end, where do you want to see the ferritin?

Dr. Sutton: I would like to see it around 60 or above for them.

Dr. Weitz: Okay.

Dr. Sutton: And if you’re looking at the person in their whole environment as far as their diet, their history, then a lot of times it’ll be very easy to see, oh, this person, their ferritins on the lower end, their red blood cells are low, or their hemoglobin’s low, or their TIBC is high, or just one of those things maybe. And then if I get this picture of, oh, this person has a history of being low in iron, maybe they’re now in an even higher risk category because they’re pregnant or whatever, then if I see any lab out of range in those categories then I’m often thinking, okay, we need to get this higher, we need to get this ferritin higher. Especially with women, I don’t want women going into a pregnancy with anywhere lower than a 60 on their ferritin, ideally even higher, because pregnancy is going to rapidly deplete iron. And there’s a lot of good research, and I talk about this in The Iron Curse, is there’s a lot of good research about how when you’re pregnant, if you’re iron deficient anemic, your child is more likely to have ADHD, severe learning disabilities, lower IQ, serious issues that are often not correctable later in life just because you miss this window of opportunity for brain development which iron is crucial for. So you have to live with the whole picture with each person.

Dr. Weitz: You mentioned in the book that you had to take pretty high levels of iron during your pregnancy.

Dr. Sutton: Yeah, yeah. So me, personally, it’s a little bit ironic that I wrote this book that focuses on high iron, and I had to include information about low iron within there and have some specific chapter focused on low iron because I have struggled with low iron. I have Crohn’s, I have celiac, I had part of my intestine removed. I’m a very complicated person as far as my health goes and I struggle with low iron, especially during pregnancy, I had to take a massive amount of iron, like 130 milligrams a day. I didn’t start out with a low ferritin, I started out in the 60s with my ferritin, but then it was remarkable to me how quickly I dropped down low. But the only reason I caught it as early as I did was because I was doing extra testing outside of what the OB GYN was doing.

Dr. Weitz: There’s another example, you’re going through pregnancy and they’re not actually measuring your iron as you’re going through it.

Dr. Sutton: They are not measuring it as closely as they should and they really let you get very anemic before they say anything, which is disturbing because when you’re pregnant you’re going through a massive amount of iron depletion every single day, and if your doctor waits until you’re really anemic to say anything about it, it’s virtually impossible to pull yourself out of that hole. And then this is where a lot of women end up having to get iron infusions or blood transfusions. And iron infusions, they create a large amount of oxidative stress to the body because when you give somebody an iron infusion you are putting straight iron into their blood, and the body hates that. The body knows that iron is this toxic substance that it needs and it has to have, but because unbound iron is so bad for the body, the body never allows iron to be unbound, and that’s why iron always has a chaperone. So when you absorb iron into your system, it is immediately put onto this transferrin protein, and the transferrin protein then takes it throughout the body, those are the little planes that take it throughout the body. The body does this because it knows that that iron is like a naughty child, and if you let it just go out without a chaperone it’s going to go cause damage. And so it makes sure that iron has that chaperone to prevent the iron from causing damage before getting to the tissue that it needs to go to.

If you give somebody an iron infusion there is no chaperone, you just put a bunch of naughty little children into the blood and they’re going to wreak havoc, they’re going to create massive amounts of oxidative stress. This is why a lot of women that get iron infusions, they have these horrible histamine responses and it can severely damage their health. Of course their doctors are trying to play this balancing act where they’re like, I don’t want you to die of low iron, but you’re having bad problems with the infusions too. And so I talk about ways to mitigate that in the book, but the most important step for mitigating that is finding and correcting the underlying cause of the iron disorder. Whether it’s high iron or low iron, you always have to find the underlying cause of it and fix it. Is it a GI bleed? If it’s pregnancy it’s like, okay, this is just a finite period of time where we’re going to have to massively boost your iron intake and make sure your gut’s as healthy as possible. If you have high iron, do you have this gene that’s causing you to have high iron? We need to know that, because that means that your body can be battling this for potentially the rest of your life. And most people that have high iron don’t get diagnosed, the people that do get diagnosed, it tends to take decades and many doctors. So the lucky few that do get diagnosed, they’ve usually had this condition, permanent damage by the time they get diagnosed.

I recently read a story, this Scottish lineage royalty lady, extremely wealthy, we’re talking about princess, recently died at the age of 59 of undiagnosed hereditary hemochromatosis. It’s not that she didn’t have the money or the resources, it’s just that medical systems, even in Scotland where this gene is very common, are not screening for this like they should, and they’re trying to change the NIH system there so that they’ll screen for everybody with hemochromatosis. And even there, where they have the highest percentage of people in the world with the hemochromatosis gene, they cannot change the medical system to add this inexpensive lab. It’s crazy because they would save a fortune if they just… Think about, if you can prevent liver cancer, liver disease, heart disease, dementia, this is one of those things where an ounce of prevention is worth an elephant, tons of tons of prevention. But even there they can’t change it, and they have literally the highest percentage of people in the world with this gene. In Ireland they have 60% of the population has this gene.

Dr. Weitz: Wow.

Dr. Sutton: Mm-hmm.

Dr. Weitz: Okay, so let’s finish going through the labs and then we’ll go into genetics. So next, I guess, we want to look at the CBC.

Dr. Sutton: Yeah, okay, so perfect. So when you’re looking at the CBC, then you have, of course all of it is important, but the parts that are most influenced by… Well, we really need to talk about multiple parts. So the red blood cells, hemoglobin and hematocrit, they tend to get higher when people have high iron, because the body is trying to find a way to store that iron. Whereas with low iron they’ll often get low, red blood cells, hemoglobin and hematocrit. Now, it’s extremely important to have that CBC with the iron panel because you can have something called iron loading anemia, which is where you’re actually, you have a high ferritin, you have high iron saturation, you have hemochromatosis, but you’re anemic at the same time, because what anemia means is it means you don’t have enough hemoglobin and red blood cells.

So you could have low hemoglobin, low red blood cells, and have high iron. That’s called iron loading anemia. That’s a more complicated situation because in order to lower iron in those people, blood removal is not an option, and blood removal is one of the fastest ways to lower iron. So you’ve got to figure out, okay, what’s going on here? Why does this person have low red blood cells, low hemoglobin, and simultaneously lower the iron? And that’s a little bit more complicated a situation. That’s where you can’t use blood removal, you’re really going to have to look at diet, nutrition, lifestyle, those type of things. The other parts of the CBC that are really important-

Dr. Weitz: Well, why would somebody end up having that high iron anemia?

Dr. Sutton: Well, there’s multiple different reasons. One is if you have a lot of hemolysis, so if your red blood cells are breaking apart because, for example, if somebody has a thalassemia gene, or a sickle cell gene, that means that their red blood cells are not shaped like they should be shaped, and then as they go through the capillaries they get stuck and then they break, and when they break it releases a lot of iron into the body. And then they get a high iron saturation, and if they’re really absorbing a lot of iron, then they’ll get a high ferritin too. So this is where you can have a high iron issue with low red blood cells, low hemoglobin.

You could also have a cancer, a blood cancer where you’re not making enough hemoglobin red blood cells. With hemochromatosis genes, you could have a really great ability for absorbing iron, but simultaneously have a GI bleed or something where you’re bleeding out, but your body has so much iron stores that it’s not enough to really create, you’re not low in iron yet. That’s where you really have to look at the genes and understand why is this happening, there’s a lot of different reasons. And those are sometimes the most complicated cases because things don’t always match up really easily. Does that make sense?

Dr. Weitz: Yeah.

Dr. Sutton: Just a straight hereditary hemochromatosis patient that has a hemochromatosis gene, high iron saturation, high ferritin, high red blood cells or hemoglobin or hematocrit, that’s not complicated as far as a diagnosis goes, or even really a treatment, that’s not a complicated thing. Which is why it’s such a tragedy it’s not being diagnosed properly, this isn’t even that hard. The iron loading anemia is more complicated, that requires really figuring out why are you not making enough red blood cells and hemoglobin to keep up while your iron levels are high?

Dr. Weitz: Right.

Dr. Sutton: But you need that. And here’s the other thing, A lot of doctors will just order that CBC and they’ll say, “Oh, you have low red blood cells, low hemoglobin, you need to take iron.” And then they don’t order an iron panel. And then you go order an iron panel and it’s like, oh, no, no, no, no, you don’t need to take iron, you are high in iron, but you are anemic. This is not an iron deficient anemia, this is another type of anemia, there’s a lot of different types of anemias, and I go through all of them in The Iron Curse. But we have to be better diagnosticians than just saying, “Oh yeah, you’re low on red blood cells or hemoglobin hematocrit, you must just need iron.” No, we have to order that iron panel. We have to, yeah. So that’s a part of the CBC. The other part of the CBC that is also very important is looking at the white blood cells. So, for example, if you are going through an acute infection or even a chronic infection. But with an acute infection you tend to see the white blood cells pop up, maybe the neutrophils or lymphocytes will pop up, and you have to know that, okay, the body’s going through an acute infection and that is going to make that ferritin go higher, but it will also cause the iron saturation to go lower temporarily. Because when you have an infection the body is really wise and it knows that iron feeds infections, and it feeds parasites and viruses and bacteria.

And so the body says, okay, we are sick, we’re going to take away the fertilizer, we’re going to take the iron out of the blood, and we’re going to store it. And then the ferritin goes up, but the iron saturation goes down. And that’s like an anemia of inflammation type thing where you could see a low iron and a high ferritin, much lower iron than normal, much higher ferritin than normal, that’s anemia of inflammation. And a clue that that’s the problem is the high white blood cells, high neutrophils, high lymphocytes, any of those.

Dr. Weitz: We also need to look at the size of the red blood cells, correct?

Dr. Sutton: Yes, yes. So the size of the red blood cells is really crucial too. So if you have a high MCV, you’re going to be looking at somebody that has two large of red blood cells. And this can create a hemolytic anemia too because those red blood cells are too big they cannot get through the capillaries and then they break. And that can create the high iron saturation, all that, while you have this MCV, which is the red blood cells are too large. And that’s usually, there’s a couple different reasons for that. One of the reasons, the most common reason, I’m not going to say the most common, but a very common reason for that is low B vitamins, low B12, low B9, low B6. Okay, that’s a pretty easy fix, you just have to give them extra B vitamins and watch that MCV come down, the red blood cells get smaller. Because when red blood cells are-

Dr. Weitz: That’s what we call macrocytic anemia.

Dr. Sutton: Yes. But there’s another type of megaloblastic anemia, which is macrocytic anemia, which is it’s caused by liver damage. So in some people, they might have plenty of B vitamins, but they have a problem with their liver, and then that is stopping them from being able to have the proper size red blood cells. And these tend to be people that are abusing their liver with alcohol, is the most common issue, which is very common.

Dr. Weitz: So these people will also have elevated liver enzymes?

Dr. Sutton: Sometimes, sometimes. It’s weird, it’s weird, some people the liver enzymes are very indicative of how much abuse and damage they’re putting on their liver. Other people it’s like, how are your liver enzymes this good? The damage tends to show up in other places.

Dr. Weitz: Is there some other test that we’re not running for those patients?

Dr. Sutton: So, well-

Dr. Weitz: Would GGT be better than ALT and AST for those patients?

Dr. Sutton: Oh, I would always include a GGT on there because that is another liver enzyme that for some reason is not always included. But I think if you’re really being thorough, because for some people, yeah, that GGT is the high one, and it’s just because everybody is different as far as how their body’s reacting. There’s another test, which normally this test, the AFP, is high when the liver enzymes are high, but the AFP is alpha-fetoprotein, and that’s a really good liver health indicator. Basically anybody that has high liver enzymes, anybody that has been diagnosed with hemochromatosis, they need to get that AFP done, because if you have that high AFP, you are at a higher risk for liver cancer, and you want to watch that come down as your liver heals up.

Dr. Weitz: And I don’t think that test is normally run in adults other than in pregnancy really.

Dr. Sutton: No, it’s not very common. I mean, the main reason I order it for people is if they have liver damage.

Dr. Weitz: Okay.

Dr. Sutton: Yeah.

Dr. Weitz: All right, so… Go ahead.

Dr. Sutton: Another thing that I wanted to mention before we move on is in some cases people will have, with the infection piece, if they have a chronic infection, then you’ll see often low white blood cells, low lymphocytes, low neutrophils. You don’t have to have all three of those happen, but you’ll see one or multiple of those happening with a chronic infection. And that’s just because your body has been fighting this war for so long, it’s given everything it can and it’s really tired, it can’t keep doing this. And in those people you will often see also a high ferritin lower level of iron, and they tend to get more serious low in iron with a high ferritin because their body has been fighting this infection for so long, and that’s also a complicated situation.

Dr. Weitz: What about patients with mold and mycotoxins?

Dr. Sutton: Yeah, that’s never a fun situation, although it’s very common and easy to not diagnose. Mold and mycotoxins can affect the red blood cells, hemoglobin, hematocrit, and really mess up that CBC as well. I’ve also seen, me personally, having lived in a moldy environment unknowingly and then figuring it out and watching my CBC, I have learned that my neutrophils would go up and stay high when the mold levels were high, and then when we got the mold levels lower my neutrophils were able to come back down. But I tend to be more of a high neutrophil autoimmune T2 person. So for me, that’s as much about my immune system’s flaring, but mold was a big trigger. But it will, also you’ll see in combination with that low red blood cells, low hemoglobin, hematocrit, lower levels of iron, and mold is just a toxin that messes up your ability to make healthy red blood cells and iron absorption is affected. Lead too, lead can create a lot of anemia, and then copper deficient anemia can create low neutrophils, and you could also see in some cases a low ceruloplasmin, various… I have really good tables in the books that have all the labs,

Dr. Weitz: You do, you have excellent tables, yep.

Dr. Sutton: I probably need to study them more myself.

Dr. Weitz: Yeah, no, so copper is super important for utilization of iron, and some patients actually have a copper deficiency anemia. The interesting thing is copper is supposed to be in this ratio with zinc, and because of the last three years, all these people have been taking, a lot of people, I shouldn’t say all these, a lot of people have been taking extra zinc, and some are taking massive levels, and I think I heard Huberman mention that you need to take 100 milligrams of zinc to really charge your immune system to fight off some of these viruses, and that’s going to lead to a copper deficiency.

Dr. Sutton: 100%. And copper, you need copper to absorb iron, so if you don’t have enough copper then this enzyme called hephaestin is not going to work, and that enzyme allows you to absorb iron from your digestive system. So you become low in iron, but also you get iron loading in your tissue sometimes because copper is also required for this enzyme ceruloplasmin, and that enzyme basically carries the iron from one cell to the transferrin. So the transferrin is like the plane that escorts iron throughout the blood, well copper is holding your hand from the door and taking you to the plane so that the plane transferrin can take you to wherever you’re going. And then once you get to wherever you’re going and you land, then the ceruloplasmin, which requires copper, will take your hand and take you into that cell. So if you don’t have enough copper, you get too much iron in your tissues, but also you get iron deficient anemia. So yeah, we need to make sure we have plenty of copper.

Simultaneously though, some people can become high in copper, whether because maybe they have a Wilson’s gene, which is a genetic issue where you don’t remove excess copper very well, or more common I think is if you have some type of a liver bile issue where you’re not secreting bile like you should, then a big way that the body gets rid of extra copper is through the bile, the ceruloplasmin will go into the bile. But if you have a bile obstruction, or unhealthy liver that’s not making enough bile, then you’re going to have a harder time excreting that excess copper and then it’s more likely to clog up in the liver creating liver issues. So I’m not-

Dr. Weitz: Or you have copper pipes in your house.

Dr. Sutton: Mm-hmm, yeah. But if you have copper pipes in your house, then maybe you should take extra zinc just to protect yourself from it. That would be a cheap solution rather than moving or redoing the pipes.

Dr. Weitz: So let’s go into the hemochromatosis genes.

Dr. Sutton: Okay. Okay, so there’s three hemochromatosis genes, and the first one is the highest risk. I’m going to go from top risk to lowest risk. So the top risk one is… They’re all HFE, so before I go through each of them I want to explain what they do first. So all of them increase iron absorption, and it’s just some of them increase iron absorption more than others. So the way that they increase iron absorption is they cause a decrease in this protein called hepcidin. So your liver makes this hepcidin, and then the hepcidin will affect iron absorption. So people that have these genes, the hemochromatosis genes, they make less hepcidin, which means that their body’s going to absorb more iron. Now there’s also some genes that cause you to make more hepcidin, and then those people are more likely to be low in iron. I have one of those genes. I’m not sure exactly how much it affects my iron absorption, but it certainly doesn’t help. So the three genes are, this is where my photographic memory is going to fail me, but the first one is HFE C282Y, and that is the highest-

Dr. Weitz: That was pretty good.

Dr. Sutton: Well, I might need your help on the other two, because I always mix up words.

Dr. Weitz: I have them written down.

Dr. Sutton: Okay. I’m partly dyslexic and mixing up of letters is hard for me. So the HFE C282Y is the highest risk hemochromatosis gene because that’s the genetic mutation that increases the iron absorption the most out of the three hemochromatosis genes. Now you can inherit one or two hemochromatosis genes, depending on if one or two of your parents have a hemochromatosis gene. So if you have one hemochromatosis gene you’re at an increased risk for high iron. Some people like to say you’re just a carrier, that’s a myth, ignore that. If you have one hemochromatosis gene, you’re at an increased risk for high iron. If you have two, you’re at an even higher risk for high iron hemochromatosis. And some people say only people that have two genes develop hereditary hemochromatosis, ignore those people, they’re wrong, they’re confused, if you want the data look at my book. My husband was diagnosed with just one gene, I’ve seen so many patients that have high iron with just one gene, it’s a myth that you need two. So if you have two of these HFE C282Y genes, you are at an extremely high risk for getting increased iron absorption, high iron hereditary hemochromatosis. When I say hereditary hemochromatosis, that means that you have at least one hemochromatosis gene plus high ferritin, high iron saturation.

Now there is non-hereditary hemochromatosis, which is where you don’t have a hemochromatosis gene, you just have hemochromatosis from environmental reasons. You’ll have high iron saturation, high ferritin, just because this usually is something that happens in men, not as common in women, because women are menstruating and childbirth, they tend to get rid of iron almost too much. Now, nonhereditary hemochromatosis is more in men, and then you just have to figure out why, are you just absorbing too much iron? Whatever. And then the good thing about that is you can fix it and they now don’t have that gene that’s going to make them go back up quickly. Whereas the people that have one or two hemochromatosis genes, they’re going to go back up likely quickly.

Now, not everybody with a hemochromatosis gene’s going to develop high iron, but you’re at a higher risk. If you have a hemochromatosis gene and you have high iron, no surprises. If you have a hemochromatosis gene and you have low iron, there’s something wrong. You’re either a vegan/vegetarian that’s not eating any iron, you’re heavy periods, GI bleed, malabsorption, there’s a problem, you should not have low iron with a hemochromatosis gene because your body is naturally really good at absorbing it. The only people where that would make sense really is females that are maybe not eating very much iron and having heavy periods and pregnancy.

I see it a lot in pregnant women that have a hemochromatosis gene, they’ll become low in iron, and that’s because iron is just used so much in pregnancy, and in fact, the reason this hemochromatosis gene exists in such a large percent of the population is because it has protected people from death from low iron during pregnancy, death from low iron during famines, death from low iron during injuries. This is a protective shield for many people, it’s just now we live in a world where you can pick up a hamburger at McDonald’s any time of the day, and iron is in supplements and iron is in food and it’s fortified, and so now we live in a world where a lot of people are getting too high in iron because we live in an iron rich environment. If we lived in a low iron environment, this is like a warrior gene. This is a gene that really is going to fortify you and get you through a really tough battle, whether that’s a famine or a pregnancy, or whatever. But now we live in this world that it’s not helpful for a lot of people. So anyways.

Dr. Weitz: By the way, what’s the best way to test for these genes? I noticed in your book you mentioned 23andMe, but recently patients have been unable to get their raw data from 23andMe, they’ve blocked them from it because of some problems they’re having.

Dr. Sutton: Yeah, so they can still get the raw data, but they have to message 23andMe and ask for it. They have temporarily disabled the downloading feature, which is obnoxious and annoying, and hopefully that’ll come back. But they did get hacked, and the way that they were hacked was people got into accounts they shouldn’t have got into using the password that somebody had. So they didn’t get in through the back way, they got in through the way that it was designed to get in, and because of that, that’s why you’re seeing the two factor authentication blow up. Everything is two factor authentication now, and it’s obnoxious and it’s annoying, but that is because the hackers were able to penetrate the designed way to get in, so now you have to have the two-factor authentication. Now that 23andMe has that two-factor authentication, hopefully they’ll allow the downloading feature to come back. In the interim, you can still get your 23andMe raw data, you just have to message the company and then within a couple of days they’ll give it to you. It’s just another hindrance, it’s annoying.

Dr. Weitz: I see, okay.

Dr. Sutton: But you can still get it. That’s a good question, yeah.

Dr. Weitz: Okay.

Dr. Sutton: So 23andMe is one way. I know there’s a lot of people that don’t like 23andMe, and I’m not trying to defend them as a company, just like I’m not trying to defend a lot of companies out there that I use, whether it’s, whatever. But I think the reason that I have used it so much is because, first of all, a lot of patients come in and they’ve already done it, which is really nice because then I already have that information without having to wait for it. Secondly, it is really hard to beat the amount and quality of information you get for the price that they offer.

Dr. Weitz: $100, yeah.

Dr. Sutton: And I live in a world where a lot of my patients are working very hard to try to take care of their health on their own dime, and often I’m looking for the most cost-effective way to do it. Now, if you can’t do 23andMe, if you don’t want to do 23andMe, if you want another option, there’s other options. Probably, honestly, the best option outside of that right now is just if you can ask a doctor to order a hemochromatosis genetic panel through Labcorp or Quest, or whatever, that will give you the information. Having said that, a lot of doctors are not willing to do that for some reason. So if you want to get it yourself without your doctor’s help, 23andMe. If you want your doctor and insurance to be involved, you can get the Quest or the Labcorp, either way. I don’t really care how people get the information, but I think it’s really important to have the information, whether it’s the hemochromatosis gene or many of the other genes I talk about in the book.

Dr. Weitz: Okay.

Dr. Sutton: Okay, so the second hemochromatosis gene is, I always get the letters backwards here, HFE H63D. Is that right?

Dr. Weitz: Yeah.

Dr. Sutton: Okay, so that’s the second hemochromatosis gene. This gene, it dramatically increases iron absorption, but less dramatic than the C282Y. So you can have one of these, you could have two of these, you could have a combination of one of these with a C282Y, that’s called a compound heterozygote. Basically, if you have one or two of these, or one of these with a C282Y, or the other hemochromatosis gene we’re about to talk about, you’re at a higher risk for high iron because of this gene.

Actually my colleague, I tell the story of my colleague’s daughter who has two of these, HFE H63D hemochromatosis genes, and she, at the age of five, what happened was she got very sick, and then coming out of that sickness she had a lot of neurological deterioration. She reverted back to wearing diapers, her mom would have to carry her. So they work with the pediatrician while she’s simultaneously trying to figure this out to accelerate the figuring this out, because her daughter is rapidly declining. So she goes and she takes her in, she orders her daughter all these labs and she takes her in, carries her in to get all these labs done, that she ordered herself because she’s a doctor and she’s, while working with the pediatrician, also going to do her own thing because she’s not going to go at their pace.

And so she carries her daughter in to get all these labs done, and then she calls me later that day and she’s like, “It’s the weirdest thing, that afternoon after the blood work, she really perked up.” And I’m like, “I think your daughter has hemochromatosis.” Because we already knew that she had the gene, but this young girl who had a lot of blood drawn, that was enough to make a significant difference for her, because she’s a small body. So getting all these labs was enough, that was like a blood donation for her, basically. The labs confirmed hemochromatosis. She goes to the pediatrician, gives them the labs, they’re like, “Okay, you’re right, this is hereditary hemochromatosis, we’ve never seen this before.” And I think it’s just because they’re not running the labs to diagnose it.

Dr. Weitz: Of course.

Dr. Sutton: They’ve never seen it before. So then they refer her to the pediatric hematologist, which is very hard to get into. This is not just hard for pediatric cases, but also it’s very hard for me to get my adult patients in with hematologists. They’re very busy, it’s hard to get in.

Dr. Weitz: Right, so it takes months to get in, and meanwhile the patient’s suffering.

Dr. Sutton: So my colleague, what she does is we talk about it and give her supplements to lower iron in the meantime. So she gives her a large amount of curcumin, and she does this for months. She finally gets an appointment with the pediatric hematologist, takes her daughter, they do labs there to go over with her, and they’re like, “You know what? Your daughter’s fine. Her iron levels are fine, she doesn’t have hemochromatosis. But why don’t you just, we’ll check them again in a couple months, and then if it pops back up, then bring her in and we’ll treat her then.” Actually, I have these emails in the book if you’re interested, it’s kind of unbelievable, I had to put the emails because nobody was going to believe me.

Dr. Weitz: Right.

Dr. Sutton: And so a couple months late… Oh, also important, the hematologist says, “Take her off of that supplement, it’s not helping her lower iron.” And so my colleague, she dramatically lowers the dose but doesn’t take her off it all the way because she’s like, that makes me nervous. She dramatically lowers the dose, redoes the labs in a couple of months, and her daughter, the iron levels have popped back up to the point where they’re at the threshold that the doctor said, “If they go back up to this point, let us know and we’ll deal with it then.”

So she reaches out to the doctor’s office, she says, “Hey, we have met your threshold,” basically, “Will you please help me manage this with blood removal?” Because you can’t take a child to the blood donation center, they need a pediatrician to help remove that blood. Blood donation centers will not… There’s no way, it’s very hard to manage this in a child without a doctor helping them. So the hematologist nurse responds, this is in writing in the book, and the nurse responds and says, basically, “You need to go back to the pediatrician that referred you, and we don’t know why your child is tired, but she doesn’t have anemia, so we’re not sure why she is tired,” and basically, “We’re not going to deal with this, and usually people that have hemochromatosis are males in their 50s,” and just totally gaslights them.

And so she goes back to the pediatrician, and basically now she’s dealing with it herself with supplements, massive amounts of supplements. And she’s noticed the iron going up correlates with the deterioration in her daughter’s cognitive function, even, I don’t know if you check for primitive reflexes, retained primitive reflexes, but primitive reflexes tend to come back whenever the brain is in an unhealthy state, and her daughter will develop, retained primitive reflexes will come back when the iron’s high and then go away when the iron gets lower, which is a sign that this is really messing up her brain.

So I tell that story because one, she had that genotype of the two HFE H63D genes, but two, really it’s a warning about how kids are not being diagnosed properly because pediatricians are not screening for it. And ultimately there’s this window of time for females where once her daughter starts menstruating, she’ll probably be okay when she’s losing blood, but until she starts menstruating it’s going to be hard to really control that hemochromatosis. Okay, I digressed major there.

Dr. Weitz: That’s okay. I’m starting to run low on time.

Dr. Sutton: Okay.

Dr. Weitz: I was just texting to see if my staff is here, but I do have a patient, but we haven’t gotten into how to treat at all yet.

Dr. Sutton: Okay. Well, we also didn’t talk about the third hemochromatosis gene.

Dr. Weitz: Oh, yeah. So let’s go through that, and then is it possible we could wrap and maybe do a part two?

Dr. Sutton: Yeah, yeah, yeah.

Dr. Weitz: Okay, okay.

Dr. Sutton: Okay, so the third one is HFES, what is it? S5?

Dr. Weitz: S65C.

Dr. Sutton: Okay, S65C, okay. This is an interesting one because up until a couple years ago, this was not included on a lot of the hemochromatosis panels. A lot of people were told, “Oh, you have one hemochromatosis gene,” because they were only looking for the C282Y and the H63D, the two main ones, when in fact they had the second one that they were not looking for, but is statistically a risk for hemochromatosis. So even to this day, many people will think that they have one hemochromatosis gene when in fact they have two because their doctor didn’t check for this third one, which is a hemochromatosis gene, and moving forward that will stop. And even 23andMe doesn’t always sequence it. I’m sure they’re going to change that, because they have to, because now Labcorp, Quest, the hematology associations have decided we have to look at this third hemochromatosis gene, but a lot of people think there’s only two hemochromatosis genes. And so when I did the research for the book I realized that basically when I say 30% of the tested global population has a hemochromatosis gene, they’re only looking for the two that I talked about first, C282Y and H63D. They didn’t even include this third one, which means actually many more people than we think have a hemochromatosis gene. We don’t really know, we don’t know, but wouldn’t it be nice to figure that out?

Dr. Weitz: And interestingly, one more thing, you mentioned that having red hair increases your risk?

Dr. Sutton: Yeah, the reason that red hair increases your risk is because the hemochromatosis gene originated in a Celtic Viking ancestor thousands of years ago, and they must have had red hair for a large percent of their population. And they largely, this is why Northern European countries, especially the UK, there’s a huge amount of hemochromatosis gene there. And so just because you have red hair doesn’t mean that you’re going to have a hemochromatosis gene, it just means that statistically speaking you might have one of those hemochromatosis genes because you are closer in lineage to the Celtic Viking ancestor where this originated thousands of years ago.

Dr. Weitz: Great. So this is incredible information, we’re going to have to do a part two of this podcast to go over how to manage patients with either high or low iron.

Dr. Sutton: Yeah, absolutely.

Dr. Weitz: So for this podcast, give everybody your contacts so they can find out more about you if they want to work with you, or if they’re a practitioner and they want to learn about your courses and your books.

Dr. Sutton: Yeah, so my main website is drchristysutton.com, D-R-C-H-R-I-S-T-Y-S-U-T-T-O-N.com, and that has pretty much everything I’ve created as far as my books and my workshops. If you’re really just interested in this iron piece and not the other workshops that I’ve taught or the other book that I wrote, then ironcurse.com is a great reference because that gives information about the book, the Iron Curse book. And then also I have an Iron Curse workshop, which is a really valuable tool. It’s a five module workshop that is a valuable tool that helps to really break down the information and make it easy to assimilate and understand, and I add additional little clinical pearls in there. But that’s a video workshop. So ironcurse.com or drchristysutton.com, and then I’m on social media, Instagram, Facebook, all that.

Dr. Weitz: What’s your Instagram?

Dr. Sutton: @DrChristySutton.

Dr. Weitz: Great.

Dr. Sutton: Yeah.

Dr. Weitz: Excellent. Thank you so much.

Dr. Sutton: Thank 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. 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.

February 15, 2024/by drweitz

Dr. Weitz's Blog, Rational Wellness Podcast

Soma Breathwork with Niraj Naik: Rational Wellness Podcast 346

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Niraj Naik discusses Soma Breathwork with Dr. Ben Weitz.

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

Podcast Highlights

1:45 Niraj was working as a pharmacist in the United Kingdom and he felt like a legal drug dealer. Niraj got sick with ulcerative colitis and it was recommended that he have his colon removed. He discovered the power of breathing and he elected to trust in his culture of India, yoga, pranayama as well as using simple breathing techniques and he made a complete full miracle recovery.

4:42 Non-alcoholic Cirrhosis of the Liver is one of the rising causes of death and it is likely due to all the chemicals and drugs that we ingest these days.

6:07 Breathwork. Breathwork emerged in its modern form from Stanislav Grof, who was treating people with LSD and psilocybin, and he needed an alternative to LSD. He discovered rhythmic breathing that would get you out of your mind and you’d have a hallucinogenic-like effect and the same kind of emotional release and processing effects that LSD has. He invented holotropic breathwork, which is the basis for holotropic breathwork that we do today. Holotropic breathwork is fast hyperventilation two, three hours with full power music that gets you really tripped out your minds and you have emotional releases and you discover your truth a little bit.

Niraj Naik is a certified UK pharmacist turned holistic wellness and breathwork expert. Niraj runs a global breathwork community and trains hundreds of breathwork experts in his Soma Breath techniques, which is taught at numerous wellness centers in the US, Europe, and Asia, including the University of Cambridge. Niraj is working on a new book, Breath Works, which is soon to be released. His websites are NirajNaik.com and SomaBreath.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.

Podcast Transcript

Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates, and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello, Rational Wellness podcasters.

Today we have an interview with Niraj Naik, the Renegade Pharmacist and breathwork expert. Niraj is a certified UK pharmacist-turned holistic wellness and breathwork expert. He’s one of the world’s most sought-after spiritual ceremony facilitators. He leads breathwork workshops all around the world. His journey started in the midst of a burnout in his corporate career where he found himself bedridden with chronic illness for more than a year. Niraj healed himself using breathwork techniques, dietary adjustments and he felt motivated to share his knowledge with others. Today, Niraj runs a global breathwork community and trains hundreds of breathwork experts in his SOMA Breath techniques, which is also taught at wellness centers in the US, Europe, Asia and is now being studied at the University of Cambridge. And now, Niraj is hard at work on a new book, Breath Works, which is soon to be released. So welcome, Niraj.

Niraj: Great to be here, Ben.

Dr. Weitz: Excellent. So tell us a little more about your personal journey, how you went from being pharmacist to being a breathwork expert.

Niraj: Yeah, yeah, sure. So I was a pharmacist years ago, community pharmacist, seven years, worked in a cubicle, dishing out pills. I call myself a legal drug dealer, but that’s where I got taste of my own medicine. I eventually got really sick. I got disillusioned with the whole system. People going away with shopping bags full of drugs and that wasn’t really soothing the soul and people coming back with side effects and whatnot. So in the end, I had a bit of a nervous breakdown and got an autoimmune disease called ulcerative colitis and I was shitting blood 40 times a day for almost a year. That’s where I discovered the power of the breathing because I got two choices, either I have my colon removed or be a Guinea pig for a drug that hasn’t even tested before. And so they say gift of God is God coming to you in these desperate moments. I got gift from God and GOD, gift of desperation, and that came to me at the bright time where I made a bold choice to trust in my own culture of India, yoga, pranayama and I learned simple breathing techniques that became the catalyst for complete full miracle recovery because all the doctors who are like family friends, because in Indian culture, everyone’s a doctor or a medic of some form, right? So we have a lot of them in our family and they’re all telling me, “You’re crazy. You can’t stop taking the pills. You’ve got to do this. You’ve got to do that. You’ve got this disease for life. It’s not curable,” all this negative talk. And so I prove them all wrong. Thank God.

Dr. Weitz: That’s great.

Niraj: Yeah, that’s basically … Then that inspired me to do what I’m doing now. I created … I wanted to start … Well, it’s desperation. I had to find a way to make a living, so I couldn’t go back to my pharmacy job. So I realized, by going through the healing journey that it’s a job that was killing me after all, so I had to transition to something more worthwhile. And I thought the most worthwhile thing you could possibly do is just to share what helped you heal when the pharmaceutical industry clearly is not working, because most people I saw with ulcerative colitis in the pharmacy didn’t get better. So in fact, some died and that’s what really scared me, was actually that’s a potential route I could go down is … And you know what most people die of in this? It’s not the disease, it’s the side effects of the drugs.

Dr. Weitz: Right.

Niraj: In fact, adverse drug reactions is the number four killer in the world, right? And there’s another-

Dr. Weitz: Not to mention the adverse reactions to having your colon removed.

Niraj: Yeah. Yeah, but then also, one of the rising causes of death is a new phenomenon that we’ve had in this day and age. It didn’t happen before. Nonalcoholic cirrhosis of the liver. Because when you consume a prescription with a chemical, that drug goes into the body and the body freaks out, right? It knows it’s not natural. So it processes straight away in the liver. So it’s called the first pass effect. Every chemical you put into your body, whether it’s on food or medicines, drugs, they go into your liver to be processed.

Dr. Weitz: Yeah, no, absolutely. As well as related to eating ultra-processed foods and too much sugar and on and on and on.

Niraj: First pass effect. Anything foreign to the body goes to the liver for processing first.

Dr. Weitz: Yeah, including ultra-processed foods.

Niraj: Yeah, exactly because it’s not natural. It’s foreign to the body.

Dr. Weitz: Right, and then they-

Niraj: As long as there’s ingredients on the packet … Well, my rule is the no factory diet because anything that comes from a factory, guaranteed, you look on the label, there’s ingredients you can’t pronounce.

Dr. Weitz: Right.

Niraj: That’s not what your body recognizes as food.

Dr. Weitz: Right.

Niraj: So you’re going to toxify your liver. And toxic liver, over a long periods of time, will ruin your life. You’ll feel like shit.

Dr. Weitz: Absolutely. No doubt about it. So breathwork, now it’s often related to meditation. How should we think of that? Is breathwork part of meditation? Are they two separate modalities that are related?

Niraj: So let’s go through, if you want, I can talk a little bit of history of breathwork.

Dr. Weitz: Sure. Let’s talk about breathwork.

Niraj: So a definition of it. So let’s talk about what breathwork these days as people are familiar with because breathwork has become more popular recently, but it was around the time of Stanislav Grof when he was treating people with psilocybin, where breathwork emerged that we recognize today, we’re more familiar to, holotropic breathing, right? What Stanislav Grof needed was an alternative to psilocybin, sorry, LSD, to treat his psychiatric patients because that got made illegal. So what happened, he discovered this rhythmic breathing, fast rhythmic breathing for long periods, I think he got it from tantric yoga, would get you out of your mind and you’d have a hallucinogenic-like effect and the same kind of emotional release and processing effects that LSD has. So he invented holotropic breathwork and that became the foundation of a lot of what we know about breathwork today. Then there was Leonard Orr around the same time. Leonard Orr created.

Dr. Weitz: So what does holotropic breathwork mean?

Niraj: Just, I don’t know, this is what he called it, but it’s just fast hyperventilation for two, three hours with full power music that gets you really tripped out your minds and you have emotional releases and you discover your truth a little bit. Then there’s rebirthing. So rebirthing, Leonard Orr invented. He said he got it from Babaji in the Himalayas who told him this was a secret to immortality and he created his own Immortality Club, Leonard Orr. He was quite a wacky guy, but I quite like him. But anyway, so he came up with this thing. Again, it’s very similar to holotropic. So then this became what we know breathwork for quite a long time until Wim Hof came along and he blew up the importance of breathing around the world, right? Wim’s a good friend of mine and I made all the music to the Wim Hof Method and we work very close together. Anyway, Wim Hof is a superhuman dude and he uses these tantric yogic breathing exercises. Well, he claims that he made them up, but for sure, he got inspired, right? So anyway, these are different types of breathing techniques. They’re not like holotropic where you’re breathing for two hours and getting completely out of your minds. These are involving breath retentions where you’re holding your breath.

While doing rhythmic breathing for 20 to 30 reps, then holding your breath to create a physiological state called intermittent hypoxia. And this low-oxygen state that you get your blood into for a brief period triggers a strengthening response and adaptation to oxygen in the body that makes you more efficient using oxygen. So over time, you get better body tissue oxygenation. You need less oxygen to breathe, to live longer, right? And you live longer as a result. But here’s the thing, this breathing stuff isn’t new news. It’s been around since ancient times. So let’s go way back in time.

In the Vedic tradition, there was a time, the Rigveda, where it’s detailed in this ancient manuscript that’s a thousand years old. No one knows how old it is. There’s a golden age where the rishis, the gods on the planet would consume this concoction called soma. Nobody knows quite what it was, but it would give them immortality, it would give them divine bliss, ecstasy. It would give them everything. It was a pharmacy of everything, right? So like the ultimate drug, all right? But what happens if soma runs out? So all of the rishis freak out because they’re so addicted to this stuff that they’re like, “Wow, we have to figure out to make the soma from within.” Boom, that becomes the origin of tantric yoga and all the spiritual practices.

So then that turned into these breathwork cults, like original breathing cults who did a lot of breathing exercises, African shamans and whatnot. They all use a lot of breathing exercises. Siberian shamans, a lot of Mayan culture, there’s breathing associated with those practices. And then you’ve got yoga, tantric yoga. Then you’ve got Qigong. Qigong literally translates as breathwork, right? Qigong. So Qigong came from yoga and so on, Tai chi and all of these breathing exercises. So in yoga, we have pranayama. Pranayama means energy control, which is really like a pharmacy of different breeding techniques. If you master all of this and master asana and go through all of the eight branches of yoga, if you really understand it, really go deep into it, you will produce the soma from within and you will have a method for fixing all of the things you’d normally go to a pharmacy for, but through your own body, okay?

And then you’ll only ever need to go to a doctor in a serious emergency like if some asshole ran you over with his car or something and you might need to fix your broken leg or whatever or some bones, right? But otherwise, you should be pretty self-sufficient. So what I’ve done, because I went back to tantric yoga, is I have translated that into a language and a methodology that is accessible to this day and age. So I’ve put music to it, and in fact, music is a core part of the Vedic tradition. There’s a whole chapter of the, or actually a whole book in the Vedas dedicated to music with samayoga or natya yoga, all right? It’s completely all about the music, the power of the notes, intonations between notes and how to invoke different states and different mantras.

And mantra is simply breathing. Because when you recite a mantra, you are exhaling for a period of time, inhaling for a period of time That changes your breathing pattern and influences your state. So basically, what I’ve created is a pharmacy of breathing techniques based on this original literature, but also passed down from generation to generation. I have amazing teachers from the Himalayas, yogis, even Wim Hof, I’ve met so many amazing people. My own self-study by going through my own healing journey, curing myself, I put together the system and now science is starting to catch up with us. So there’s a lot of evidence backing up everything I teach. Cambridge University is studying us now and so on. So what breathwork really is no one single modality anymore. It’s really all of the breathing exercises that exist on the planet, and therefore, it’s a pharmacy, right? So some techniques get you out of your mind and trip you out and make you feel like you’re having acid and others can help you go to sleep and do the opposite, make you go into a deep restful sleep. So others are for strengthening your body, initiating healing, but not all techniques are equal. So each-

Dr. Weitz: Right, like tantric yoga and Wim Hof is more energetic and changing your mental state, but-

Niraj: No, no, no, no. They’re all in tantric yoga. Tantric yoga has all of these techniques, [inaudible 00:14:17], different things. So holotropic breathwork is in tantric yoga. Rebirthing, as I said, rebirthing, he got it from Babaji in the mountains, right? So rebirthing is a yoga technique, so on, so forth.

Dr. Weitz: So some breathing is faster breathing, some is slower breathing, some is holding the breath, some is longer on the inhale, longer on the exhale.

Niraj: Yup. There’s an amazing study, the physiological health benefits of slow breathing in a healthy human. That’s it. Look it up. That study has so much evidence for all the various forms of breathing, for slow breathing, slow diaphragmatic breathing. So we have slow breathing, fast breathing and we have holds, breath holds. So each one has now numerous studies. The breath holding techniques, Buteyko was the famous guy behind this.

Dr. Weitz: Right.

Niraj: Dr. Buteyko, in my opinion, he’s the ultimate guru who I wish he was still alive today, but he translated yogic text, the pranayama, similar to how I did, but he could put a lot of evidence to it. He’s a medical doctor and he made it for improving oxygen efficiency and getting oxygen to your body tissue cells. Because he believes that hyperventilation is the cause of most chronic diseases, people breathing harder and heavier than they need to. So he was all about slowing breathing down and improving oxygen efficiency and using controlled pauses, controlled breath holding to I improve your oxygen efficiency, because there’s a science why that works. I can go into that if you want. But Buteyko has incredible success stories and I’m very much the Buteyko advocate and everything we do in so and breath has a lot of Buteyko method and inspiration, but I make it fun. I put the music into it, I make it cooler for this day and age. The kids want to do it.

Dr. Weitz: Yeah, no, it’s interesting. I’ve taken some Buteyko training sessions and it’s also important to learn to breathe through your nose, whereas a lot of us breathe through our mouth.

Niraj: Yeah, totally. He’s all about trying to chain us how to breathe, how we should normally. Because when we are stressed out, we don’t breathe normally. We breathe like we’re reptiles on high alert, danger because our reptilian brain is the one controlling the breathing because breathing is the thing that runs on autopilot, but we also consciously control. So with conscious breath control, we can control the autonomic nervous system. But when we’re on high alert and we’re sensing danger at all times because we got a boss that’s a dickhead, we got a wife or a husband who’s annoying and pisses us off and then we’ve got an alarm clock that wakes us up every morning to do a shitty job that you don’t want to do and so on and so forth, we are basically wallowing in a sea of stress hormones all day long. So we’re in high alerts all the time. So what that does is-

Dr. Weitz: And by the way, in a functional medicine world, the concept is the cell danger response.

Niraj: Yes. So we are always in high alertness, so we’re breathing harder than we need to and that means we over-breathe and we let go of actually the most important gas CO2, carbon dioxide, which is what’s needed to get oxygen off your blood cells into your body tissue cells. So if you hyperventilate, you breathe out too much of this gas and we need an element of it, a balance of it in the body for oxygenation of your body tissue cells.

Dr. Weitz: So wait a minute, how does carbon dioxide help us?

Niraj: So C02 is one of the miracle models. We have nitric oxide as well, but CO2 is the byproduct of respiration. Oxygen plus glucose …

Dr. Weitz: Right.

Niraj: It’s internal combustion reaction by the way, just like a car engine. Oxygen burns fuel. You produce ATP energy that drives the function of life, but we also produce CO2 and water vapor.

Dr. Weitz: But we normally think oxygen good, CO2 bad, but that’s not exactly the case, right?

Niraj: We’ve also been conditioned into believing that CO2 is what’s going to kill us all because of global warming, right?

Dr. Weitz: Right.

Niraj: But here’s the thing, that’s very debatable. CO2 is plant food. By reducing CO2, we will get rid of plants and trees and we need those, right? So it’s all very convoluted bullocks. Clever bullocks, I call it. Anyway, so let’s get back to our human body though. We need CO2. It’s the Bohr effect. So your red blood cells binds oxygen and it transports it, but there’s a signal that tells your blood where to drop off oxygen in your cells. There’s a signal. That’s CO2. Otherwise, you wouldn’t be very efficient at breathing because you breathe in oxygen, oxygen will flood into all the cells and there’d be constant oxygenation needed, right? But when you just do a little sniff of air, like that, you’re fully saturated oxygen. We have an abundance of oxygen. But unless you have the right balance of CO2 in your bloodstream, the oxygen is bound to the red blood cells because it’s the affinity of oxygen to blood cells. That is what keeps it stuck. And the CO2 is what reduces the affinity of oxygen for blood cells and that is what allows the oxygen to flood into body tissue cells. So the CO2 is the gatekeeper. So if you hyperventilate, you get lightheaded actually. We could do it now if you want to get lightheaded.

Dr. Weitz: Yeah, sure.

Niraj: So for 20 seconds, we’re going to breathe like you are having a panic attack, like this, all right? So keep going, keep going, keep breathing. Good. Keep going, keep going, keep going, keep going, keep going. All right, 10 more seconds. 10, nine, eight, seven, six, five, four, three, two, one, stop. Okay, how’d you feel?

Dr. Weitz: I guess a little lightheaded.

Niraj: Yeah, so not great. You probably don’t feel great though, right? Nice.

Dr. Weitz: Right.

Niraj: Yeah. So now let’s do the opposite. So now I want to do is a normal breathing pattern, a healthy breathing pattern. So you’re going to breathe into your nose, out through your nose with a very relaxed inhale and exhale. So your inhale, silent, subtle, relaxed exhale, then you’re going to hold your breath for around four seconds after the exhale and then repeat, okay?

Dr. Weitz: Okay.

Niraj: So in silent, subtle into your diaphragm. Exhale relax. Hold, three, two, one. Inhale silent, subtle. Exhale relax. Hold, three, two, one. Inhale silent, subtle. Exhale relax. Hold, three, two, one. Inhale silent, subtle. Exhale relax. It hardly looks like you’re breathing. Hold, three, two, one. Now how does that feel in comparison?

Dr. Weitz: I feel more mellow and relaxed.

Niraj: There we go. So that’s how we should feel. We want to be feeling grounded, relaxed, clear. You’ll be more focused as well. You’ll be able to perform better and so on. Hyperventilation really affects performance. Really does because it cuts off blood supplies of the brain, oxygenation of the brain-

Dr. Weitz: Right. That’s what happens when we breathe too fast, when we breathe through our mouth, when we don’t hold our breath at all.

Niraj: That’s it. That’s it. That’s it. Some of my breath is all about improving your default state. It’s all about, “How do I bring my breathing into the perfect quality it can be?” because I know that your breath is a reflection of what’s going on the inside, your thoughts, your emotions, right? Your breath is the mirror of that. So you are on your default state, the time when you’re not doing any techniques to be the best it can be, right?

Dr. Weitz: What do we mean by default state?

Niraj: So this is when you’re not doing any techniques, when you’re at rest, right? Just normal, calm, relax, not working, not doing anything, just sitting. How would you breathe? If you’re heavy breathing, wheezing, stuffed sinuses, breathing into your chest, frantic, erratic, breathing, that’s a sign you’re stressed out. That’s a sign there’s a lot of stuff going on inside. Your mind’s probably very racing with thoughts. However, if your breath is calm, relax, you have an automatic pause, you hardly look like you’re breathing, then you are like Lao Tzu. Lao Tzu said, “The perfect human breathes like you don’t breathe at all.” He was a famous Chinese philosopher from ancient times. So we’re all about improving default state.

Dr. Weitz: So what are some of the benefits of this breathing in terms of health?

Niraj: So most diseases are caused by low body tissue ox oxygenation and oxidative stress. Oxidative stress is what makes us age. Oxidative stress is the stress that creates the wear and tear on our internal engines, the mitochondria.

Dr. Weitz: But I thought oxidative stress was too much oxygen.

Niraj: Oxygen stress, exactly. So the less you need to breathe, the longer you live. Does that make sense? So when your natural default breathing pattern is below 10 breaths per minute, you’re going to live much longer. If your default breathing pattern is 15 or more, which is above average, 20 breaths per a minute above average, then you’ll live shorter length of time. In yoga, you measure someone’s lifespan by how many breaths they take or need to take.

Dr. Weitz: It’s interesting, when I went to school as part of doing a physical exam, as a doctor, you learn about measuring people’s breathing. And yet in practice, we measure blood pressure, we measure all these other things, but rarely do we measure how rapidly people are breathing.

Niraj: Well, Buteyko really tried to drill home this message that all the doctors need to do is look at the breath, observe the breath, adjust the breath when symptoms start and then the disease goes before it’s too late. He got persecuted like mad. He got really into a lot of trouble for that.

Dr. Weitz: Right.

Niraj: He got kicked out basically, he got ostracized from the medical community. Why?

Dr. Weitz: Right.

Niraj: Because breath is free, it has no side effects and it’s not patentable.

Dr. Weitz: Right, exactly. So talk about the impact of breathwork on longevity.

Niraj: Yeah, so as I said, breathing rates, well, breathing volume is more accurate, the amount you need to breathe is linked to breathing rates. So I’ll give you a little an example from the mammal world because a lot of yoga practices were developed by studying mammals in nature. So the mammals that live a very long time like elephants, turtles, and whales, they breathe very slow, like one to two breaths a minute. Whales hold their breath for two hours at a time. They live 200 years plus. Now on the other end of spectrum, rats and mice, they breathe very fast, 150-300 breaths a minute. They don’t hold their breath. They’re very fast breathing rates. But there’s a very strange anomaly to this. The naked mole rat. The naked mole rat is a rodent, but it lives primarily underground and hypoxic environment. It holds its breath for 18 minutes a time and it lives 30 times longer than a normal rats. So humans have conscious control of our breath. We can choose to breathe like whales or like rats in the rat race. But I’m not saying you need to be like a naked mole rat and live underground. Also, yogis go and live also where oxygen’s low. They go to the tops of the Himalayas and they’re immortal like the one that taught Leonard Orr rebirthing, right?

So why do they do that? Why do they do that? Because oxygen is stress, right? You’ve seen what happens to an apple, right? It goes brown. What happens to your car? It rusts. So we are also rusting inside because of oxygen stress. We have a constant battle going on against oxygen stress. Helmut Sies is the pioneer of this kind of science. He says that it’s impossible to live without oxygen and it’s very difficult to live with it because of oxygen stress. So we have this toxic codependent relationship with oxygen. We have to make it our friend, right?

Dr. Weitz: And when we exercise, we’re forcing a lot of oxygen through. We’re creating a lot of oxidative stress, but that’s actually good for longevity.

Niraj: So any positive stress response for a brief period, intermittent stress is beneficial to the body. The body adapts and becomes stronger as a result. We need a little bit of controlled positive stress responses to fuel our life. Also, exercise has other benefits because there’s a wrong way to exercise too, we should talk about, but exercise has benefit because it moves the lymphatic system, which doesn’t have a pump. It clears the junk from the brain, right? You need to move. If you don’t move it, you lose it, right? That’s the whole classic expression.

Dr. Weitz: And when you exercise regularly, you have a lower heart rate, you have a lower breathing rate.

Niraj: Yeah, but there’s two types of exercise. Anaerobic, aerobic. Anaerobic, in my opinion, is the best, okay? Aerobic is good too, but anaerobic is the best. High-intensity interval training is anaerobic. Exercise where you’re holding your breath or slowing your breathing with each pose. My favorite anaerobic exercise, I call it the Hindu squat. Do you want me to show you how to do it?

Dr. Weitz: To do a squat?

Niraj: The Hindu squat.

Dr. Weitz: A Hindu squat.

Niraj: Do you want to see it?

Dr. Weitz: Yeah, I’ll watch.

Niraj: Okay. Do you want to do it?

Dr. Weitz: I don’t know if I can. I fractured my femur 10 weeks ago.

Niraj: Oh, no, then don’t do it. Yeah, this is the Hindu squat. It’s a different … This comes from the ancient martial arts system in India, which was originated around the time yoga was, right? It was normally only taught to the kings and the warriors and suppressed to everyday people because this is a secret of longevity and strength. So this is a very cool technique. So what you do is you put your hands out like a zombie pose. You breathe in. So a full yogic breath of air and then you descend into a squat like this. You go down and you breathe out through your nose as you go down. Breathing out, breathing out, breathing out, breathing out for 10 to 15 seconds to start with and you start increasing the time.

You go all the way down, all the way down, all the way down into a squat, right? Then you hold this pose for five seconds right down in the bottom of the squat and then you start to breathe in. So you hold your breath at this point and then you start to breathe in, breathe in, breathe in, breathe in, breathe in, breathe in on the way up, right? And you do that for around 10-15 seconds. So the idea is you add on a few seconds every time you are practicing and you see an improvement. I can do it … My time now is getting to a minute, 30 for the complete sequence, which is pretty insane, but it takes time. You have to gradually build up, but you can apply that to any technique, any body weight exercise, right?

Slowing the breathing down on the contraction and the relaxation, right? And what was I going to say? So what this creates is a state called intermittent hypoxia, right? And the Hindu squat I love is because it’s working with the psoas muscles, the biggest muscle group in the body. So if we can make these muscles as strong and efficiently [inaudible 00:31:53] as possible, it has a strong effect over the rest of the body, right? It is like the first muscles we really should adapt to make strong and we carry a lot of stress and tension there. So what’s going to happen when you do this, you’re going to increase CO2, nitric oxide dramatically.

Nitric oxide is the miracle molecule for the body. It’s antiviral, antimicrobial, antibacterial, vasodilator, bronchodilator, antioxidant, anti-inflammatory and so on. It’s the most potent one, nitric oxide. We get abundance of that and we get strengthening over the whole physiology where your breathing over time become more efficient. So do this five times in a row, right? Do it to 80% of your maximum effort because you don’t want to burn yourself out and then you’ll be put off doing it and start doing this and then watch what happens to your wellbeing as a result.

Dr. Weitz: It’s interesting, there’s a technique of exercise now where you put a mask on and you control your oxygen and you switch between higher oxygen state and in a lower oxygen state. So you learn this exercise with intermittent hypoxia and there’s data actually showing it decreases Alzheimer’s disease, improves brain function.

Niraj: There you go. You got it. So this is the philosophy of everything we do at SOMA Breath.

Dr. Weitz: Yeah, I know.

Niraj: Little bit of controlled stress goes a long way.

Dr. Weitz: Right. That’s it. Controlled stress. That’s it. For a short period of time as opposed to the long prolonged stress that people see in their everyday lives with work stress and everything else.

Niraj: So controlled stress, self-directed neurogenesis, because we can go into the more reprogramming techniques, the mindset stuff. So controlled stress, self-directed neurogenesis or neurosomatic programming is what I call it and the third one is control bliss or pleasure. Because once you know how to use feelings and how to control your emotions, you can map those emotions and feelings to what you want to call in more of. And this can turn into a very powerful productivity, efficiency, manifesting’s cool, but in terms of science, not some woo-woo shit.

Dr. Weitz: Control your emotions, that’s not an easy thing to do.

Niraj: You could turn on bliss. Imagine being able to make yourself feel orgasmic on command. How cool would that be?

Dr. Weitz: Yeah, I remember the Woody Allen movie where they had the Orgasmatron.

Niraj: Oh, yeah, there we go. Everything you needed to know about sex but you’re afraid to ask or something like that, I think. Is it [inaudible 00:34:49]?

Dr. Weitz: Yeah, something like that. Yeah.

Niraj: Amazing. Cool.

Dr. Weitz: So let’s see. What else haven’t we covered about breathwork? Let’s see. What are some of the experiences you’ve had with people being able to turn around their health with the proper breathwork?

Niraj: Oh, yeah. So a lot. We’ve had amazing studies. So we’ve had people who’ve been almost in a wheelchair, spending time in wheelchairs because they’ve lost their mobility with crazy fibromyalgia and colitis like symptoms I had. We had this one lady who just did my signature technique, is this breath meditation called Limitless and she used this neurosomatic programming method with the breathwork modality, controlled stress. And she, within a few months, went from taking 40 pills a day to zero and now she’s become one of our instructors and she’s spreading the mission. So that’s just one story. We have tons of stories.

We had a guy who had a very rare form of muscular dystrophy who did our technique. He just did our 21-day course and he wasn’t able to pick up his grandkid, right? He couldn’t throw a ball over his head and he was able to do all that and he went back to get his x-rays done because the doctors are freaking out about what’s going on. And they said, “Your muscles have stopped wasting away.”

Dr. Weitz: Wow.

Niraj: “So keep doing what you’re doing.” So I’ve got loads of stories like that. We have athletes who have significantly improved their game, professional stars who are using our techniques now and so on.

Dr. Weitz: That’s great. So I think that’s pretty much all the questions I had. Any other topics that you wanted to bring up?

Niraj: I think what would be interesting is to talk about the mind programming stuff.

Dr. Weitz: Mind programming, okay.

Niraj: How you use the breath to change your awareness of consciousness.

Dr. Weitz: Cool.

Niraj: So everything we do as human beings is a result of a feeling, either going towards feeling more of what we want or going away from what we don’t want, right? So moving towards pleasure and away from pain, right?

Dr. Weitz: Okay.

Niraj: So if I asked you, “What do you want to feel more of?” is there anything you could say?

Dr. Weitz: I don’t think anybody would not want to have more pleasure and less pain, right?

Niraj: Yeah. So if I was to ask you, “What is your highest excitement? What is your …” You don’t have to share that because that might be X-rated, but just if you were to think about that, you’ll get a feeling somewhere in your body, right? Okay, and if we can reverse engineer feelings where they come from and actually be more successful getting more of them, if you understand this process. So feelings have meanings and thoughts become things. Okay, so what comes before … Let’s say you want a result. There’s a result. You have this movie playing in your mind’s eye. It might be X-rated, it might be something else where you are feeling a lot of pleasure, you’re living and breathing something that you want to call in more of, right? Okay, and it’s a result. Maybe it’s a business aspiration you’ve got, a goal. It’s going to give you loads of pleasure. What result will give you that feeling? So if you could see that as a movie, what comes before a successful result? You have to do something, right? You have to take action.

Dr. Weitz: Right.

Niraj: So most people work on the area of action to get results. This is your outer world. So you’ll get a coach who’ll teach you more techniques, more strategies, more tools.

Dr. Weitz: Right.

Niraj: But quite often, your results get to a plateau or they diminish because there’s more to it than just learning the new technique or strategy because what comes before an action, a quality action? What do you think?

Dr. Weitz: Well, I guess your thoughts about what you’re trying to accomplish.

Niraj: Yeah, well, decisions. So your decisions, your quality of your decision will determine the quality of your action. So now we’re going to the inner world, right? We’re going into this inner world. So on the inside, there’s a whole load of chemistry going on and neurology and nerves and synapses firing that produces ultimately thoughts of different qualities and then decisions. So the quality of how you think is based upon what?

Dr. Weitz: I guess your prior experience, right?

Niraj: Previous … That’s partly, but it’s actually, if you think about this, think about … Have you ever been really hungover before?

Dr. Weitz: Sure.

Niraj: How did that affect your decision-making abilities?

Dr. Weitz: Definitely blunted them.

Niraj: Yeah, exactly. All the stupidest shits I’ve ever done was under the influence of alcohol, right? So we are messing with the nervous system when we drink loads of alcohol and hangovers carries on. So how you feel actually is what determines everything, the feeling. So if you don’t feel high vibe, you’re not going to be at your best every single day. You’re going to make bad decisions sometimes, right? The worst decisions most people make are when they’re pissed off, in rage or angry, right? Yeah?

Dr. Weitz: Sure.

Niraj: So how you feel is so important and this is now the realms of your neurochemistry, your nerves, hormones, transmitters, right? So the breath is the bridge between the body and the mind because the breath is what you can consciously control. You can control your breath consciously as well as let it run on autopilot. So this gives us conscious control of the autonomic nervous system. So we can change our state instantly with our breath. That’s the power of the breath.

Dr. Weitz: Right.

Niraj: It’s the code. It’s the remote control for the inner world, the autonomic nervous system and states. So with breathwork techniques, we can raise our vibe, and in this heightened state, we can reprogram your consciousness. But with heightened more powerful breathing techniques like holotropic, rebirthing and what we call kevala, which is the original centric breath way, we can invoke a higher frequency of thoughts where we go into beyond ordinary levels of thinking. We go into collective consciousness and non-local, universal consciousness where we suddenly start to get aha moments, inspirations. Inspire means to breathe in, by the way, right? That’s where the word inspire comes from.

But you go into inspired realms of thought and you start to get divine downloads and it also is called the metaprogramming state. This gives you ability to see all of your patterns, experiences, conditions with a new perception. As a powerful therapeutic tool, I can take someone through a breath journey to revisit moments where blocks to success came from, blocks to taking action, because ultimately, procrastination is a block to take an action and action is the keyword in law of attraction. You’ve got to do something to attract what you want, right? So the difference between lucky and successful people are the level of action they take.

So there will be a story associated with blocks that have happened at some point, usually in the first seven years of life. With breathing techniques, we can take somebody back into that time and we can make them aware of this and retell the story in a new way under this heightened vibrational state, which then reformats the hardware and the operating system, the mind. And with that, you clear the blocks and people start to get more successful.

Dr. Weitz: Amazing.

Niraj: That’s neurosomatic programming.

Dr. Weitz: Neuro somatic programming.

Niraj: That’s it.

Dr. Weitz: So people claim the same sorts of benefits from meditation. What exactly is the difference between meditation and breathing and breathwork?

Niraj: The easiest way to meditate is to observe your breath, just close your eyes, [inaudible 00:44:12] breath in and out.

Dr. Weitz: So it’s actually part of the same process.

Niraj: Well, yeah, it’s a technique, right? But meditation, its purpose, is to train you to have single focus attention, right? With absolute conviction of concentration, you will steal the mind to a single point and there’s many things you can do with that skill. You can learn and master new skills by being able to channel and go deep on one thing and disregard the noise. It trains you to have ultra focus. But also with that advanced meditation techniques, we can, as I said, have self-awareness. We can reprogram. We can also actually program, I call it self-directed neurogenesis. We can program ourselves to grow certain cells in certain areas of body to invoke healing or direct stem cells to the brain to create neurogenesis on command to match the things we want to call into our life. Do you understand? Brain change according to will. That’s the real what the Tibetan tantrics were trying to do, to change the brain according to will, to create superpowers, superhuman powers, but also to release all the karmic imprint that they had, so they can finally break free from this cycle of birth and rebirth.

Dr. Weitz: Interesting. I always thought the concept of meditation was more about not to have any conscious activity, to have no focus.

Niraj: There’s many, many types of meditation, but ultimately, you’re focusing on something other than the conscious mind. You’re trying to focus on something beyond the conscious mind, the voice in your head, because the verbal part of the brain is what creates tension in the body.

Dr. Weitz: Right.

Niraj: All the words going on in your mind …

Dr. Weitz: Right.

Niraj: … creates tension, which creates resistance, which stops blood flows to your muscle, tissues, joints. So when you can’t quiet that voice in the head through bringing your awareness of something other than that voice in the head like your breath or a sound or a fricking candle, what happens is you steal the mind and you go into a very relaxed state of meditation where you suddenly get blood flow to areas of the body that haven’t had blood flow for years. You might even get an erection. That’d be a great side effect.

Dr. Weitz: Yeah, I know people who do these intense meditation retreats and very reaching a higher state of consciousness from doing it intensely for longer periods of time.

Niraj: Amazing.

Dr. Weitz: Yeah, I heard you say that breathwork gives you a similar effect that you can get from doing psilocybin.

Niraj: Yeah. Certain breathwork techniques and LSD and DMT.

Dr. Weitz: How is-

Niraj: We do these in our retreats. We do very advanced breathwork techniques that get people into very psychedelic experiences.

Dr. Weitz: Interesting.

Niraj: And you can even do the combination of the two, like a lower dose of psilocybin or LSD and you can have very powerful psychedelic journeys.

Dr. Weitz: Oh, interesting.

Niraj: Yeah. We work with some centers that do this clinically with doctors, certified doctors.

Dr. Weitz: Right. It’s being used for patients with resistant depression and certain other conditions that haven’t able to be conquered.

Niraj: But it’s all this, what I just described to you, neurosomatic programming is the real method of doing it. So we get you into a state where you can see yourself with a new lens and change that perception, change the story.

Dr. Weitz: That’s great. Okay, so how can listeners find out more about your SOMA Breathwork techniques?

Niraj: Yeah, so the best thing to do, go to my Instagram, nirajnaikofficial. DM me the word breath on there, direct message breath and you’ll get through the jiggery pokery a link to my masterclass. You can sign up. And then when my book comes out and … You get loads of free stuff, if you sign up for free with your email and then you can follow me as well. I have this thing where I say, “A Reel a day keeps the doctor away,” on my Instagram. Every technique you’re going to learn is going to help get push the doctor away a little bit, right? So go and check that out. And my book’s coming out soon. It’s called Breath Works. So there’s a whole complete like bible of breathing exercises in the evidence and science and supports everything I’ve been talking about today.

Dr. Weitz: And I’m assuming that’s going to be available, Amazon, Barnes & Noble, everywhere.

Niraj: Yeah.

Dr. Weitz: And then what’s your website that people should go to?

Niraj: Yeah, the website is somabreath.com. We have various courses. We also train instructors. So if you want to build a career doing this stuff, what a lot of people do is they do our stuff, they fall in love with it and they want to build a career and they’re going to share it. So we train instructors and we also work with people already certified in other modalities to add what we do as a modality to what they do and we get crazy amazing results.

Dr. Weitz: And I practice functional medicine as part of my chiropractic practice and I can see where breathwork is a great addition to helping patients with all these chronic health conditions.

Niraj: I want to tap into more chiropractors, so if you know them, let’s get this stuff to them because this is the very powerful stuff.

Dr. Weitz: Yeah. Everybody’s coming in with pain and they’re stressed out and-

Niraj: Exactly.

Dr. Weitz: Yeah, there’s a great modality. Okay. Thank you so much for bringing this to us.

Niraj: Cheers, my friend. Thanks for the interview. It’s been a lot of fun.

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.

February 6, 2024/by drweitz

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