Oronasal Infections with Dr. Jamie Kunkle: Rational Wellness Podcast 375

Podcast: Play in new window | Download | Embed

Subscribe: RSS

Dr. Jamie Kunkle discusses Oronasal Infections 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

---

---

Dr. Jamie Kunkle has a doctorate in Naturopathic Medicine and a masters in Acupuncture and Traditional Chinese Medicine. He has specialized in working with complex chronic disease patients including those with Lyme and other chronic infections and autoimmunity. He currently works at Gordon Medical in San Rafael, California. Their phone number is 415-767-6100 and the website is GordonMedical.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 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 having a discussion about oral nasal infections with Dr. Jamie Kunkel. Obviously, many people suffer with colds and flus and various respiratory infections that affect the oral nasal sinuses. But in the functional medicine world, we often treat patients with various gut problems, such as SIBO or Candida, and these can have an oral nasal component.  And not addressing this can be one of the reasons why our patients don’t achieve better health, why they don’t completely resolve. There can also be an oral nasal component. of other chronic diseases like Lyme disease, mold infections, which are also common conditions that those of us in the functional medicine world often treat.

I’ve asked Dr. Jamie Kunkel to join us to give some insights into how to analyze and treat oral nasal infections for nearly a decade. Dr. Kunkel has worked with complex chronic disease patients, including those with Lyme, chronic infections, autoimmunity, hormonal disturbances, chronic pain, chronic fatigue, and environmentally acquired illnesses.  Dr. Kunkel grew up in the East Coast, as I did, and had early first [00:02:00] hand experiences with tick borne infection, and he’s witnessed the various stages of this illness on individual systems, including several family members. Soon after medical school, a notable prolonged mold exposure in Seattle greatly affected himself and his wife.  And though his fatigue symptoms cleared over time, his wife developed an autoimmune condition and this event underlying the importance of early recognition of environmental illness and the diversity of individual responses that may manifest. In fact a close friend of mine, Dr. Howard Elkin integrative cardiologist, just passed away this week, and he had mold exposure at his house.  And that may have played a role in his demise. In addition to his doctorate in naturopathic medicine, [00:03:00] Dr. Kunkel holds a master’s in acupuncture and traditional Chinese medicine from Bastyr University. And he’s extensively studied traditional medical systems, including Chinese integrative hospitals to better understand how to treat patients and get to the root cause of illness.  So Dr. Kunkel, thank you so much for joining us.

Dr. Kunkle: Thank you, it’s a pleasure to be here.

Dr. Weitz: So, I have to admit that while I’ve treated quite a number of patients with various gut disorders and also with mold, Lyme’s never been something I’ve seen a lot of people for, but I never really focused that much on the oral, nasal components of these conditions.  So, can you tell us how how this plays a role and then I’d like to go into how to analyze it, test for it, and how to treat it. Sure.

Dr. Kunkle: Well, I mean, I think you could think of the model of the oronasal system similarly to the gut in some ways. It’s sort of a continuum anyway, right?  It’s a continual mucosal barrier in the system. If there’s immune activation in one area, you could see symptoms associated in the other area. This has been evidenced with like food sensitivity responses. For example, they always say, lower the dairy, for example. You might get some more nasal symptoms with dairy intake, and maybe that’s a local effect too, but sometimes it’s a delayed onset.  So there is a circuit through the gut that connects into the system. But just like the gut, this has a very, the sinuses in the nasal cavity and the oral cavity have a very unique microbiome. And some of that microbiome is similar to the gut, but a lot of it is very different. So, the food we eat, the air that we breathe, the toxins we take in or breathe in or whatever, all influence this particular system.

And as you can imagine the health of one’s teeth can be incredibly important too in this conversation. And we can kind of dive into that as well. But the difference between here and the gut is the gut does connect [00:05:00] with the brain in a lot of different complex ways and some of it is through the nervous system.  Some of it is through the immune system. Here you kind of have in the head region, you kind of have a very close proximity to the central nervous system. So if there’s something very inflammatory going on here, it’s kind of a skip and a hop to this particular system and some of the outlets of this system, some of the detox mechanisms of the head and the sinuses and the, just that whole cavity basically.

And I can go into more details on that too. So, so yeah, so you just have a unique sort of setup where chronic, anything because you probably all have at least experienced at some point in your life a common cold. Maybe you have a summer cold right now or you’ve had a sinus infection and just how you feel during those acute episodes.  I feel brain foggy. I feel kind of tired. I feel kind of blah. I certainly don’t want to work or, use my brain all that much. But those are, small moments. Maybe they just go away with the passage of time. So imagine sort of a chronic low grade level of that type of response and how It can start to influence a normal brain function and functions at that level.  So, yeah, that’s just a brief introduction and I’ll elaborate more as we go.

Dr. Weitz: So I understand that part of the way to understand your oral nasal cavity is to look at the microbiome of the mouth and the nose. Can you perhaps talk about that a little bit?

Dr. Kunkle: Sure, there’s different ways of doing this. I think traditionally, conventional medicine a lot of times has relied heavily on culturing certain things in the nasal passage or in the throat or whatever they’re swabbing and that kind of thing, but cultures, unfortunately, can have limitations.  They’re very effective when you’re trying to analyze a dominant acute pathogen, like I have strep throat or something like that has utility in an acute setting. But in a chronic setting, you may not get a full view of what the actual microbiome is in there. So cultures are useful. [00:07:00] Sometimes there’s a test that’s often used for mold and checking something called Marcon’s, which is a staph infection that’s associated with mold and exposure to water damage spaces.

But there are newer technologies that go beyond even PCR DNA analysis, but you can use basic PCR DNA analysis. And then there’s something called next generation sequencing, too, that will sequence all the DNA that is present in the specific sample. So why is this important? Well, one It’s important to know what’s in there in its entirety.

So even if it comes up as like sort of a smaller amount, it doesn’t mean that it’s not living higher up in the nasal passages or something like that. So a culture may pick up the thing that has the biggest signal that grows the easiest, but it won’t pick up these little guys. Number two, biofilms. A lot of biofilm colonies can live in anywhere that’s water, basically.  So, you better bet they can live here. A lot of that strandy stuff that comes out of your nose when you’re ill is, is partially biofilm. So imagine just more complex, aspects of that. So you’re not going to always get a perfect culture of [00:08:00] a highly biofilmed, colony, especially in the higher sinuses.

So nuances to testing and the same thing can go for the oral cavity. Generally speaking, you can use the same type of technology or you can try to use DNA PCR. Sometimes I’ll do both too. It’s just to try to get a broad view of the microbiome and try to be as accurate as possible. And when you’re, when it comes to fungal elements well, one, a culture can take up to 30 days, so it’s slow.  You, so you’re going to get results much more quickly from these other technologies, but two you’re going to be more likely to pick it up too because a fungal elements are Much more difficult to diagnose through culture, but I’ve picked up a ton of them on these other technologies, so to speak.

Dr. Weitz: Can you give us some specifics especially for clinicians out here who would like some help in figuring out how to manage patients maybe mentioned for Mold for or Bacteria for Fungi for Candida, etc. What specific tests do you like to run?

Dr. Kunkle: Sure. Well, [00:09:00] I’d say that for the sinuses, first of all, or the nasal passages.  For a culture, I still use Microbiology DX. I think, I believe they’re out of Massachusetts. They’re a pretty good culture system. They’ll do a fungal culture too with an add on. And they’ll do a biofilm analysis for the Marcon staff and bacterial infections. And it is good to see if you can pick up some other creatures in there too, not just the Marcons like Klebsiella pneumoniae, for example, is a significant creature that comes up there.  And then MicroGenDX is a company that does the next generation sequencing and kind of classic PCR. They were originally designed for, identifying chronic urinary tract infections and cystitis, in, in males and females or STIs that are hidden or something like that. So, but they can do almost anywhere in the body pretty much.  So you could do a skin sample with them. You can do a sinus, nasal, throat, whatever. So I use them quite frequently too. Those are probably my top two in terms of those particular technologies. And there are others that are out there, but I, if it’s not broken, don’t fix it. I found that those work pretty well.[00:10:00]

Dr. Weitz: And how about for the mouth in terms of DNA testing?

Dr. Kunkle: Yeah, DNA Connexions has an okay one. I think there, you can do it with a floss sample generally speaking. So that, which sample…

Dr. Weitz:  Floss?

Dr. Kunkle: Yeah. Floss. Yeah. So if you want to go around a tooth that, that is infected or something like that, you could also take out and an infected tooth as well. There are several others for the mouth too, depending on what you’re looking for. I believe there’s one called like periopath, if I’m remembering correctly, that’s kind of more for gum disease, which I think is important, especially people have gum recession, gum bleeding, and it’s all very important for recognizing in connection to even cardiovascular risk factors and neurocognitive stuff.  There’s the bristle test, I believe that one is a good one too for just general microbiome, because what you’ll realize is that some of them are very much more pathogen based and trying to find what the bad guy is and kill them or whatever. But you also want to kind of look at what the good guys are.  So I believe the Bristle Health one that [00:11:00] seems to look at more of the broader microbiome. So it’s really nice to know if you have some good creatures in there too, because it may not be that you want to. kill all the time too. You may just want to, whatever, regulate the biofilms. There’s nasal probiotics and oral probiotics.  There’s other ways to go that aren’t just nuking the earth.

Dr. Weitz: By the way, you mentioned biofilms. For those who are not familiar with biofilms, explain a little bit what a biofilm is and what its importance is.

Dr. Kunkle: Oh yes. So biofilms are very important concept. They’re sort of the elephant in the room sometimes with any chronic infection, as in we’re not, we don’t have a perfect way to measure them to begin with.  But we know through extensive research that they exist. And even the CDC is recognizing that drug resistant biofilms are on the rise and they are very dangerous. And we don’t have a lot of good conventional drugs and tools to address them. So what is a biofilm? Think of it this way. It’s a small colony of bacteria or several other bacteria or sometimes fungus. It’s basically a little micro city that’s kind of surrounded by some kind of barrier. And there’s [00:12:00] different complexities of biofilms. People have classified them as like phase one, phase two. Phase one might be easier for your immune system to handle.  It might be easier for basic stuff like herbs or essential oils or even condiments, things we use in daily life to take care of. But phase two might be like more like a bunker system that just becomes like this big, thick, resistant concrete structure. And it can be multiple organisms living in this structure they can cohabitate.

So it is possible for say, like strep to cohabitate with candida or something like that. And theoretically, viruses can get stuck in there too, or they can, be a part of it. So you can have this elaborate colony that sits there. What’s the importance of that? The immune system is not great at regulating some of the more complex structures that develop.  And it, it seems like, yes, you can get infected with a complex biofilm. That’s evidence with like hospital resistant infections and stuff like that. But it is also possible if you are chronically ill and immune suppressed or immune dysregulated to, to be at higher [00:13:00] risk of developing more complex biofilm structures in your body too.

So if you see somebody with a chronic illness, who’s been on a lot of antibiotics especially, or a lot of antimicrobials over time, yet is still showing signs of infection or microbiome dysregulation, you have to almost assume those people probably have some level of microbiome. And once again, MicrobiologyDx does have at least a microbiome analysis.  And there used to be more. They’re, FriLabs, I don’t think is collecting samples anymore, but I suspect in the coming years you’re going to see more testing to, to find these. And you’re also going to see that they’re releasing more FDA approved drugs to treat them too. So, yeah.

Dr. Weitz: You mentioned next generation DNA sequencing.  Can you just explain what that is compared to PCR?

Dr. Kunkle: Yeah, my general understanding and, since I’m not a bench scientist, I’ll try to explain it the best I can, but my general understanding is it just actually takes the DNA structures and parcels them out and actually sequences them. So theoretically, there’s not just this set [00:14:00] database that is present there.  It will find, hidden pathogens that aren’t, commonly found or treated or stuff like this. So it just, it’s supposed to have a little more sensitivity and specificity. It’s slight, the limitation to PCR and all those DNA things in the past has really been not so much the technology as it is like the sample.  So like getting something in the sample To measure is the hardest thing for any of those technologies, and the same thing goes with culture. So if you have to it’s also important to be able to do like a higher sinus swab if appropriate, or the sample is kind of a more important piece. But yeah, that’s my understanding of NGS.  It’s just a slight up on PCR technology in terms of finding some of the hidden pathogens.

Dr. Weitz: What are some of the important preventative measures we can do to improve the health of the oral and nasal cavities?

Dr. Kunkle: Sure. Well, I think it starts with your immediate environment in a lot of ways, and I already mentioned that, The food that you eat can influence that cavity in a lot of ways too.  And it goes [00:15:00] without saying it can influence the oral cavity and the health of your teeth and everything. So eating healthy foods is very important for that reason, but food sensitivities, if one has them too, sometimes can also cause chronic inflammation in those regions. Same thing goes with allergens.  We can’t always avoid, pollens and other things like this, but I think it’s important that if you are in a allergy time of year and stuff, that you can maybe do some nasal rinses or some mitigation techniques and tools. And there is a time and a place for using either antihistamines or even your nasal steroids and stuff, if appropriate.  And it kind of comes down to how much do you have to mitigate inflammation and how much is that inflammation creating? Further or deeper disruptions or dysregulations in the local systems, whether it’s the nervous system or the cardiovascular or otherwise just as examples off the top of my head there.

So rinses are good. So avoidance, it’s usual. If there’s any environmental influences, try to avoid them. But if you can’t avoid them, Try to mitigate them. If you can lessen the load, air purifiers. I love air [00:16:00] purifiers. If people can do them, especially if they’re in moldy areas, because we can’t sterilize our environment of all molds too, honestly.  I mean, if you have mold in your home and the ERMI scores are high or whatever testing you’re doing, it looks pretty terrible. Yeah, certainly remediate that. I mean, that would be my number one thing, but if you’re just in a place that’s very humid and moldy or, there’s many places in the United States that are like that, honestly, that have high mold counts.

And I believe you can find that online too. If you’re in a high mold region, you want to use air purification appropriately, and you want to do your nasal rinses. What kind of nasal rinses? You could do classic nutty pot, as long as the water’s clean. Some people say you really should just use distilled water because there’s been some, contamination and stuff like that, or you can get a, sterile saline solution. I believe even Arm Hammer has a sterile mostly sterile saline solution, I should say. Navage is a newer technique. It’s like a vacuum and a pressure system. So it’ll really work stuff out of there. So, if you want to pressure wash your nasal passages, go for it.

[00:17:00] Nasonebulization is a very fine mist that gets to the highest sinuses. You can do it as a rinse, but you can also add in medications to it or other substances. So, that’s best done through compounding because it needs to be pretty clean when you’re putting meds in it. But if you can just get a sterile saline base, you can do high rinses there.  And then as far as the oral cavity goes, I mean, that’s all oral hygiene, but I really love the water picks and the irrigations. And if appropriate, you can use low levels of peroxide or ozone other things like this too. So it depends on what level you need to intervene there, but the oral health is equally important when it comes to the head.

Dr. Weitz: As far as the nasal cavity, I’ve heard of doctors recommending using glutathione and other substances. Are there specific substances, nutritional substances or otherwise that you find helpful for some of these nasal infections or nasal components of chronic infections, say mold or candida?

Dr. Kunkle: Oh yeah, I’ll tell you some [00:18:00] gentle agents first.  I mean, for one glutathione is harder to get, but it is a good agent on the last and it’s cousin, NAC or N acetyl cysteine or acetyl cysteine used to be able to use that as a mucolytic or a thing that thins the mucus. Glutathione is also a

Dr. Weitz: You can’t use NAC anymore, are you saying?

Dr. Kunkle: It’s just harder to get. It’s not impossible to get, it’s just, I don’t know, it’s harder to get, I don’t know why. But you might be able to find them. But the point is, if you can find either of those, then yes, use them. 

Dr. Weitz: And you can’t just buy like a liposomal glutathione and nebulize that. You’re saying you need to get it from a compounding pharmacy?

Dr. Kunkle: Yeah, ideally. I mean, that’s my official recommendation. I mean, people can do other things, but it’s just, since it gets into those higher spaces, any kind of nebulization you need to be a little bit cleaner with just basic sprays and rinses, you could probably get away with it safely because it’s not getting into those higher spaces, but the closer it gets to your brain, essentially the cleaner, you have to be with it.  So that’s, that was the whole, even the nutty [00:19:00] pot, risks. But anyway, so. Natural substances. So yes, if you can do glutathione or NAC, they’re also biofilm agents, they’re mucus thinners, and they can also cross into the blood brain barrier, and they can help with, detox. 

Dr. Weitz: Otherwise, do NAC or glutathione?

Dr. Kunkle: I just do NAC oral with most people, honestly, and then I’ll do glutathione nasal. So if I was going to do them, I’d do them that way, honestly. Right, okay. Because then you get better bang for your buck in the, because the oral works better. Just as well with NAC and it’s really easily accessible.  And then you can use silver in the nose, like, 23 parts per million at the lowest is fine. You can go higher, but it, that’s a good starting point. Silver is a good biofilm agent. It in fact addresses multiple types of infections. The dose is so low, it’s not toxic. It’s not going to really cause a toxicity reaction and it’s mostly water.  So it doesn’t burn really badly. And then Xylitol and Grapefruit Seed Extract, aka XLEAR, X L E A R, is pretty good for Low level biofilms and fungal elements and thinning mucus and, it’s xylitol. It has a [00:20:00] little bit of a sweet flavor. It’s not terribly offensive. It’s a sugar alcohol. It doesn’t absorb and you’re not getting a really large dose of it really.

It’s just a couple sprays in your nose a couple times a day. Those are great. Starting agents generally. And as I said, you can also get creative and put other herbals in nasal rinses. I think the rinses are usually the best thing to do there. And I’ve used even like Biocidin, for example, as a company that has been used with Lyme and other chronic infections and stuff like that.  And sometimes you can use their liposomal formulation. So I agree the liposomal formulations, if you’re using herbals tend to be better tolerated in rinses and they tend to also absorb, better or. Stick better sometimes too. So yeah, those are all, fairly, really easy simple, but often quite effective starting agents for people.  And if you can gain some traction there, you can decide later. 

Dr. Weitz: Anything specific for mold?

Dr. Kunkle: Yeah, so for mold, the grapefruit sea extract and X clear and silver can work a little bit because they’re pretty broad spectrum, I’d say. But yeah, the grapefruit sea extract is probably one of the stronger herbal antifungals to kind of [00:21:00] begin with.  You can get creative with gentle drugs like Nystatin and stuff like that too, I think if you’re going to like, start kind of at a lower level, depending on how the person is before you have to use really heavy stuff. And then you can inhale essential oils too. So a lot of people like doing that with either a diffuser or steam inhalation.  I like the steam sometimes if they’re really dry people generally, just to get some moisture up in there. But yeah, essential oils are incredibly helpful if you don’t have chemical sensitivities or other contraindications. And you want to make sure you’re using organic food grade ones. And oregano is a really good one.  Thyme is a really good one. There, there are several, but those are very antifungal too. And they get into those higher spaces and they also do have a little bit of absorption through the nasal passages.

Dr. Weitz: You mentioned Biocidin and I was at a conference and they were presenting a bunch of products they have for the oral cavity.

Dr. Kunkle: Yeah, they do. They have a whole line for the dental, so the teeth and the gums, and I have no financial [00:22:00] relationship with them, by the way, but I do like them. So they have a toothpaste, they have a mouth rinse they have a throat spray, which I really do love too for people that have any kind of chronic pharyngitis or throats.

It can be even good if you’re like a big talker. Like you, you lecture a lot or you do this kind of thing too much. It can actually help your voice too. It kind of reduces inflammation there. It’s pretty cool. And then you can put their they have a liposomal and a regular biocide and the liposomal you can put in the nasal rinses, as I mentioned, pretty effectively, which is pretty cool.  And then the regular one is good for the gut. Or if you’re trying to get, like, if you do have candida or thrush or other things in the oral cavity, you can use it locally just as well. So their products are gentle. It’s like. small amounts of a lot of herbs. So none of them are really too toxic, which is great.  And they also aren’t really hard on your microbiome. So you can use them to augment in a killing phase without like causing too much collateral damage, usually.

Dr. Weitz: Yeah. They also have a oral mic probiotic as well.

Dr. Kunkle: That’s right. They do. I’ve used that [00:23:00] one before too. It has xylitol in it as well. So it kind of, has, it has a decent flavor, but it also helps as a synergist with, controlling and regulating biofilms.  And yeah they have some good products. They have a whole bunch of other stuff too. You can definitely check out.

Dr. Weitz: How does the health of the oral nasal system influence our sleep?

Dr. Kunkle: Well, the obvious answer is sleep apnea or obstructive forces like snoring and different things like this. And if anybody’s known somebody that snores, they could If they’ve slept next to them or seen them or otherwise you can see how that’s not really the best quality of sleep for most of these people.  Sometimes they will stop breathing, which is actual sleep apnea, which can lower your oxygenation, which is really problematic. Or they could just be drying out their mouth in their oral cavity. ’cause if you get dry mouth, you know you’re not. And that saliva is lower. You’re leaving yourself open and vulnerable to more gum recession or more infection activities there.

So you need to kind of have your immune system and your [00:24:00] mouth working too. So, there’s a lot of different things that can happen here between people that have chronic inflammation in the sinuses are more likely to develop obstructions in the nasal cavity and affect and influence the sleep. And then people with structural issues or sometimes central nervous system issues too but all of it still ends up influencing this cavity because at the most you’re just not breathing normally you’re not oxygenating normally, and you’re probably causing a lot of dryness and irritation mostly.

Dr. Weitz: What about the relationship between the inner ear and the vestibular system, and balance, and vertigo, and things like that, and the oral nasal infections? We’re always looking for new ways to try to treat patients with some of these symptoms like vertigo, and even tinnitus.

Dr. Kunkle: Totally. Yeah.  And sometimes they are related. So it is important to understand that where that might be coming from. And so the inner ear, the station tube these are connected [00:25:00] systems with the oropharyngeal cavity. So their drainage is dependent on the health of the rest of that system too.  Or if there’s an issue in one area, it can You know, go over to the other area too. So this has been evidence with allergies and other chronic sinus issues and things. People can be more likely to develop vestibular issues of, vertigo, dizziness sometimes tinnitus as well. And so, clearing out those systems is important and that there can, in my experience too, I’ve seen a lot of viral elements contributing to those things as well.  So it seems like. Stuff like Epstein Barr virus, for example, and other viruses can influence the inner ear and the sinuses, for example. So, determining sort of what the relative infectious landscape is there is important. And if you can get the sinuses draining and clearing in one form, in one treatment form or another sometimes those things will improve.

But also, if you’re just reducing overall neural inflammation it tends neurologic component of it. And so just by [00:26:00] simply treating this cavity, you’re often helping once again, that, that particular interface. And, tinnitus, for example, is a complex manifestation that doesn’t always have a very straightforward answer, but if you can influence it through these means you’re doing a service to the individual.

And I’ve seen different things work too, like structural arrangements between well, I used to do acupuncture and some of these points around the ear, for example, but I’ve also in the past done craniosacral and other things to kind of help the mechanical drainage system in the nasal passages and the sinuses.  And I’ve seen that also help with. the dizziness, vertigo, and inner ear issues. And, some of the deeper communication lines, as I mentioned, in the brain are also involved in this whenever there’s localized inflammation.

Dr. Weitz: Yeah, similar experience I’ve had as a chiropractor doing manipulation to the upper cervical spine.

Dr. Kunkle: Yeah, that’s right. Yeah. The C1, basically the whole cranioscervical junction does have influence on this, the oxyploid, basically C1, C2. So [00:27:00] if there’s stuff going on there, it’s good to look at. If you’re a person that’s really hypermobile though, I’d be really cautious doing traditional forceful adjustments, but there are forms of chiropractic technique like NUCCA, for example, that are much gentler that could be used to still augment the C1. But if the C1 is unstable or sort of shifting in one direction or another, like as we see in CCI, some of our patients have something called cranioservical instability.  It’ll actually affect Some of the outflow and the drainage from the head, which is, pretty crazy, including the glymphatics and even venous outflow and can affect pressure dynamics and changes. So you can have a coexisting issue there. That’s probably worse by the inflammation happening in the oral pharyngeal.  But, pushing it further. So, I mean, that’s a complex thing, but it’s not as uncommon as we originally had thought in chronic illness, cause we’re talking about, we see some of the most, chronically ill patients. Sick people in the world here those things get, will get missed quite a bit.  So don’t neglect the structural elements is just the plug I want to put in.

Dr. Weitz: Can you explain what the glymphatic system is?

Dr. Kunkle: Ah, [00:28:00] yes. The glymphatic system is a relatively new concept, although it seems strange that we didn’t recognize it earlier. What it comes down to is the brain has its own lymphatic drainage, which is important for the immune system function, your lymphatics serve the immune system and kind of clearing and even activating immune system responses.  The nodes are sort of the central points where the immune system cells will live. So the glymphatic is the brain lymphatic system. It doesn’t have traditional vessels, lymphatic vessels and things that we would normally think of, which is why it has largely eluded anatomy people over the years.

But it does serve as a primary detox and waste disposal system, kind of like a a sewer system, so to speak for our brain and our CSF. And you better bet we have a lot of we accumulate up there, especially, we live in a toxic world and we also can get misfolded, proteins and various elements in our brain that could actually be really harmful.

It could be precursors to Alzheimer’s and stuff later. They’re [00:29:00] finding associations with ALS and Parkinson’s even in later life. So, the glymphatic system becomes more sluggish the older we get. Generally, and it can be influenced, once I said, by structural elements and trauma responses, but you better bet it’s also influenced by, local factors, including the health of the sinuses and the oral cavity too, so you do want to think about that system.

It actually drains the best while we’re sleeping. So that’s another thing that is kind of weird. But when you get into proper deep sleep they’re working on devices, I think of like 40 Hertz or so to like induce lymphatic drainage, like artificially. It’s kind of cool. But you know, the importance of good sleep once again, and the importance of addressing your obstructive apnea issues or whatever else can all aid in, in healthy brain function and normal brain energy.

Dr. Weitz: So when you say 40 Hertz, you’re talking about some kind of light?

Dr. Kunkle: Yeah yeah,

Dr. Weitz: that would be applied on top of the skull or I believe so. 

Dr. Kunkle: I think it’s like a head device of sorts.

Dr. Weitz:  Yeah.

Dr. Kunkle: Yeah. It’s [00:30:00] really interesting. I know those light therapies are pretty, Amazing different photodynamic therapies. I’m still learning about all that stuff, honestly, but it’s something to keep an eye out for.  They’re not as hokey as they sound on the surface. 

Dr. Weitz: There’s a lot of different things. There’s red light, there’s blue light, there’s a lavender there’s one device that just circles your head like this. It’s hard to see how that could really get much penetration. And then there’s various helmets, What about addressing the oral nasal cavity when working with a patient with dementia or Alzheimer’s?

Dr. Kunkle: Oh, yeah. I think that’s incredibly important for some of those reasons mentioned. First of all, I mean, it’s really best to treat those things as early as possible with Alzheimer’s dementia. They oftentimes in conventional systems just call it early cognitive decline and they don’t do anything until it becomes a bigger problem.

Right. But if you recognize quote unquote early cognitive decline, that’s kind First of all, you wanted to start it yesterday, but let’s just say that’s a better place to start intervening to [00:31:00] make a real functional change here. And so I’ll go my, go through my usual process of assessing all those things through the testing appropriately taking a thorough history, assuring that they if they’ve been exposed to mold or something like that’s really important because one thing to note about mold and Alzheimer’s dementia seem to have a close connection.

There’s, there’s been some case studies on that, I think is Bredesen and those guys were doing studies on that and they were looking at different parameters, but Lyme Borrelia, and all of its friends, the tick borne world, and then mold and all of that stuff. And when they were able to like remediate or even use harm reduction techniques to mitigate.

The mold in the environment, they were seeing improvements in that cognitive function, even so it was pretty significant. So you want to kind of, deal with the environment like anything else. And then you want to treat those sinuses appropriately, preferably in this case, probably with a naso neb device.

And if there’s something you can do to optimize lymphatic function, and there are a lot of herbs that do that too. There’s the sleep stuff and some of the emerging therapies. You might have a really good foundation for trying [00:32:00] to turn their brain around. It may. At the very least, you want to try to slow or halt those types of responses or prolong, any kind of digression.  You don’t want to just sit and wait like the conventional system does.

Dr. Weitz: Absolutely not. And we have the Bredesen model, which now has demonstrated. In several studies, there are smaller studies, but that cognitive impairment can be reversed. The, he’s published, for those who are not familiar, Dr.  Dale Bredesen has published three or four books on the end of Alzheimer’s. And he’s been he’s got a program that he teaches to doctors and practitioners, and how to treat. take patients with cognitive impairment. And one of the things he mentions is there’s something called what is it?  There’s subjective cognitive impairment before you actually really have the signs of cognitive impairment. And if you can catch patients at that stage, That’s probably your best chance of intervening once [00:33:00] they’re in what’s called mild cognitive impairment, they’re actually severely impaired, unfortunately.

Dr. Kunkle: So listen to your patient, or the spouse of the patient, or whoever, like, spent a lot of time with that patient. If they’re telling you, like, yeah their cognitive function is changing and shifting just cause it doesn’t work. Check out on one of the, the conventional testing platforms or something, listen to them.  That’s the first step.

Dr. Weitz: Right. And there, there are some more sensitive tasks for these early signs than the MoCA score, which is probably more appropriate for somebody who has at least subject, at least mild cognitive impairment. But we’re CNS Vital Signs that can pick up some of these early patients.  Right on. That’s awesome. So what about the relationship between oral nasal cavity and the eyes and visual system?

Dr. Kunkle: Oh, yeah. Well, yeah, that’s always an interesting one. If you’ve ever had a allergies, it’s in a lot of sinus congestion. It’s not [00:34:00] just that your eyes get red. Sometimes they might actually get like pressure or they make it like gooey.  The consistency of the lacrimal secretions are basically the tears can change and stuff too. And so because there is drainage points around your eyes here too, that connect with the sinuses and other areas it’s like you’re crying, your nasal stuff moves too. Obviously this can be influenced, but if it’s really severe, there’s also a possible local influence in the, And the optic nerves are, it’s not that it actually kills your eyes or anything like that, but it can affect visual processing sometimes in some cases.

And the visual system is very much involved in the vestibular system too. There’s a lot of connection points there. Our body really relies a lot on visual cues for balance and even proprioception, place in the world, our sense of where we are in space and everything And so if anything starts getting influenced there it is possible when it’s more severe, especially if it’s, I see this mostly with mold because you can also do the Shoemaker VCS visual [00:35:00] contrast model.  And you’ll also see that there’s shifts. 

Dr. Weitz: Oh, so that’s the explanation for why that test might be positive? 

Dr. Kunkle: Well, partially, I’d say partially.  It may be because what I’m trying to say is if there’s local colonization, there can still be mycotoxin or toxin formation in that area. Okay. It is possible that one of the mechanisms is a local mechanism and, don’t entirely quote me on what Shoemaker thinks on that, but I’d say it could still be influenced.  In other words, you can shift and change those manifestations through the local treatments. That’s what I do know sometimes. So you have to, Dr. Ben Weitz, Orfanos, Annatto E, LDL, HDL, Lp a, Bernie, Boston Heart, Do we, do we treat those things with antifungals or not? And there’s been so much controversy there.

That’s kind of why I brought that up is that a lot of people don’t think we should be doing that entirely [00:36:00] because it could be creating more resistances or it may not be necessary. And then another world says, well, if they’re there and we find evidence of them and the patient’s symptomatic and they’re chronic, then why aren’t you treating them?

Right. And and. I don’t hardline anything in the world, but what I’ve seen is if you do treat them, sometimes those things can improve. And so you don’t have to always treat them with drugs. I agree. There’s a lot of drug resistances that have been coming up, especially with the azole. Anything with the azole at the end of it would be the ones that I’d be most concerned about overusing, but, herbs are great.  They don’t tend to create as many resistances. Yeah,

Dr. Weitz: And if you do treat them with drugs, are you suggesting local treatment or systemic? 

Dr. Kunkle: Local I think is better for mitigating some of those influences. You could still create resistances theoretically, but you can do a longer local treatment with less toxicity.  And then you can do recolonization with whatever else afterwards. And you always pair it with a biofilm agent, say EDTA or something like that. So you can do Idraconazole, EDTA or if you’re worried about resistances, [00:37:00] another thing is you can use Nystatin or Amphotericin. Amphotericin locally doesn’t absorb just like Nystatin.  They’re sort of superficially related, but they’re very much topical therapies. So you can use these bigger drugs if you have to, just locally. And you have to compound them, of course, because there’s no, conventional system there, but it’s probably better that way anyway, because it’s much cleaner mix.  There’s not a lot of extra junk in there, and you don’t really want that in these cases.

Dr. Weitz: Is there any relationship between this pressure in the eyes and glaucoma and these other eye pressure diseases?

Dr. Kunkle: Yeah, I mean, it’s possible that they have a contributing force or influence. It’s interesting to think about because Intracranial pressure in general seems to have an association here.  And then also in some cases like low intracranial pressure or CSF or spinal leaks too. Some of those can happen through the sinuses and the nasal passages too. And I’ve seen this in my like hypermobile EDS patients before is that they don’t always have to have a trauma. Certainly if they have a trauma, they’re more likely to [00:38:00] develop it.  But their meninges, the outer parts of their brain and that sort of barrier system and possibly even. Some of the vulnerable points at the apex of the sinuses, like the olfactory nerve sheaths and sort of, that’s your smelling nerve where they enter into the brain at the apex can all be vulnerable for leaks too.

But anyway, to answer your question, originally issues in this area, chronic inflammation can influence pressure in the brain at large whether it’s, through that cervical area, those outflow issues that I mentioned before, or whether it’s, a process locally or whether it’s microglial activation of the immune system in the brain and neural inflammatory response. So, in other words, I’ve had a lot of people with quote unquote pressure issues in their eyes that maybe aren’t even always defined as classic glaucoma, but they are seemingly related to What’s going on in this particular region and they often will come down.  And so it’s very hard sometimes to diagnose all that stuff because you don’t want to subject people to spinal taps and other things, but the glaucoma test is much easier. So if you do that, [00:39:00] I would do that routinely every year. But certainly if you haven’t had it for a while and you’re diagnosed with these things and you’re having any visual disturbances, you do want to roll out if there is actual pressure changes there because they are theoretically possible.

Dr. Weitz: Interesting because I know working with some glaucoma patients over the years, it’s a very tough condition to treat. We’re always looking for new strategies. So this might be something to look at.

Dr. Kunkle: Yeah, it’s worth, it’s worth exploring. I mean, nothing’s off the table. Every case is different. So it’s like whatever your individual situation is, if it’s not being resolved, there may actually be another factor to it that you just didn’t see before.  That’s usually the case. That’s great. 

Dr. Weitz: So this has been a fascinating discussion. I think I’ve those are the questions that I came up with. Are there any other things that you wanted to talk about? 

Dr. Kunkle: Oh yeah, good question.  Yeah, I mean, I think just when you’re treating these things too like I said, it’s important to kind of go through all those different steps, like figure out what you’re dealing with microbiome wise, assess the environment around you appropriately and mitigate whatever you got to do harm reduction techniques or purification rinses and different things like this. But also it’s important to think about other things. If the interface is the brain, like I said, one of the interfaces is the brain. What other things can you do to support the brain while you’re going through this type of work?  And I think. I could, just say a few comments on that, but

Dr. Weitz: that’d be great. 

Dr. Kunkle: Some of the common things to think about would just be your usual like turmeric, curcumin, boswellia type setups, the herbs that are really anti inflammatory for the brain generally, but and other bioflavonoids are really good, like say luteolin, quercetin, things like this.  But also you can think from the hormonal perspective, this is something I just wanted to plug in sometimes is that when people are, chronically ill or chronically inflamed. You have to look at the adrenal access in a lot of these people too, and see what their cortisol systems are doing. Cause that’s like kind of your, one of your primary natural regulators of not just circadian rhythm and stuff, but [00:41:00] also inflammatory responses.  And so you do want to see what’s going on in that area. 

Dr. Weitz: And that’s why I like the salivary cortisol test with Okay.

Dr. Kunkle: Yeah, I usually use the salivary test. I’ll still do an AM cortisol with whatever conventional blood lab sometimes and check it at 830 or something like that. And then I’ll run like pregnenolone, DHEA and some of the other things.  That’s kind of what I wanted to bring to too is pregnenolone, DHEA and progesterone even are all what are called neurosteroids. And so when the adrenals become stressed over time, and let’s just say you’re a menopausal woman or an andropausal male or like an older male or something a lot of those natural.

Hormones become depleted and dysregulated, and they actually serve a natural purpose to reduce or augment inflammatory responses in the brain. And they can also help you sleep and help, serotonin, GABA, and all kinds of other things. And so I really do look closely at the big three really, which is like your adrenals, your thyroid and your sex hormone systems and how they interface with the brain in these cases.  And [00:42:00] especially if you’ve had a traumatic brain injury on top of all of it, there’s a good chance those systems can be even more likely to dysregulate with the HPA, the hypothalamic pituitary access. 

Dr. Weitz: And a lot of patients don’t even realize that they had a brain trauma. Maybe they just hit their head and they thought everything’s fine.

Dr. Kunkle: I think it’s important to put a plug in for TBI traumatic brain injury in general for this discussion because it doesn’t have to be I got knocked out or kicked in the face by a horse or something crazy or a car accident. Some people, especially when they’re already ill, I’ve seen what seem like small inconsequential hits.  The big responses. And you can also see the same thing as in the sports world. You might see a guy get hit in the head 20 times and not have any perceivable problems at that moment. Maybe later he will. But then you have one guy that was kind of hit and then, he has really severe concussion signs or something like that.  And so it’s just like any trauma, I guess they say that with any child. 

Dr. Weitz: We even see patients with whiplash injuries because you can actually get this diffuse shearing of [00:43:00] neurons in between parts of the brain.

Dr. Kunkle: Yeah, totally. So, I mean, I think it’s important also if there was a mechanical motion movement, or it’s Vector C1, or the cranial bones, or anything those trauma responses can influence the drainage of the system, and, the lymphatics once again, and like I said, the HPA.  Yeah, I just would say put a plug in for, in these cases, you’re always treating the whole person the best way you can, and That was just an extra little thing I wanted to make mention of, but you’re always looking for those little pieces of what, where’s the system also dysregulated and how does it relate to this inflammatory response?

How does it relate to the health of the mucosal tissue? Like women, when they get menopausal, their estrogen goes down and that actually affects their secretory IGA. Some ENTs are starting to use nasal estrogen even. Really? Yeah. Which is interesting. So I’ve dabbled with it a little bit, but you see low IGA in their body and their gut and their gut.

nasal passages. It’s like, it’s going to be hard for them to clear infections. So you can also use these systems naturally to manipulate the mucosal tissue. So kind of cool stuff.

Dr. Weitz: I [00:44:00] want to ask you a question. You mentioned pregnenolone and progesterone. Now I run hormones in men and I often see progesterone low.  And I often wonder, does it ever make sense to give a man some progesterone?

Dr. Kunkle: You certainly can. I think a lot of people do it mostly for the traumatic brain injury stuff, or the acute neuroinflammatory, so they’ll put them on it for like a short duration usually. That being said, less is more in some cases with men.  You can do maybe lower doses for augmentation. Progesterone is definitely like the strongest of the neurosteroids. So if you’re not getting anywhere with pregnenolone you can give men progesterone. I would just be careful going from zero to 200. Like I’ve seen, like I had a patient that went to like 200 right away and that’s a lot for a male because men don’t produce that much.  Right. And he started having kind of more like, neuropsych responses. They weren’t severe and like crazy or anything, but [00:45:00] he certainly felt a little different and I was like, okay, too much too fast. So if you are going to titrate people, you have to kind of go slowly that way, but it isn’t unsafe technically.

It’s not really, it’s just an intermediary really for men. They don’t use it for the same reasons as women do, but it’s an intermediate step in the process of creating other hormones. It’s before cortisol even. So if your body is actually producing a lot of cortisol, cause it’s chronically stressed or inflamed, your progesterone is going to be down anyway, but.  Given whether you give pregnenolone or progesterone, you’re kind of feeding that system from the upper part of the steroid pathway.

Dr. Weitz: So if you’re going to use pregnenolone for a guy maybe who might have had a history of traumatic brain injury, what kind of dosage would you use in that situation?

Dr. Kunkle: For traumatic brain injury, it’s like usually 100 to 300 milligrams.  Okay. Yeah. For men. And then you can technically go higher, but that’s a usual range and you shouldn’t have to use much more than that, depending on the severity. My average patient [00:46:00] uses 100, honestly. So you shouldn’t really need more than that. But Sometimes you do if it’s really severe and they’re really, I treat a lot of complex neurologic folks and it’s like a question of like, how much can I give them that they can tolerate?  Cause most of my patients are really sensitive. But also, how much they need to meet the demand, whatever the state is.

Dr. Weitz: I recall interviewing one doctor who mentioned that for a patient who just had a traumatic brain injury to apply glutathione topically to the back of the neck.

Dr. Kunkle: Interesting. There are some really good topical glutathiones out there, theoretically. There’s one called Glutaryl that just came out. Once again, no financial relationship here. I think it’s from Oro Wellness and it’s supposed to have a more stabilized form of glutathione topically. And it kind of feels a little bit like putting aloe on your skin.  It has a little bit of a sticky feel, but it’s supposed to get into the brain a little more efficiently and a little more intact because the concern is that most glutathione that you take, it’s broken down into cysteine pretty quickly. And some people, a lot of, some [00:47:00] of my patients have, you Cysteine or CBS issues, basically sulfur issues in processing, and sometimes they’re not able to tolerate it as well.  So theoretically these topicals could be really cool. And yeah, I would try putting it on the back of the neck and see if it works. Otherwise, generally speaking with topicals, I’ll just use a thin skinned area, like the inner arm or something like that. And it’s, supposed to get there anyway, but it’d be worth trying.  Yeah. 

Dr. Weitz: Very cool. Cool. So maybe some final thoughts and then let people know how they can get a hold of you. 

Dr. Kunkle: Sure.  Yeah, so final thoughts. Don’t neglect your sinuses. You may have subtle, your sinuses or your oral health, by the way. And if you don’t like your regular dentist, go find a holistic dentist, like a biologic or something like that, because they tend to be a little bit more likely to listen to you.  And a lot of us have a lot of dental trauma, so don’t let that, Stand your way of getting the help that you need. Same thing with ENTs. Sometimes they don’t help you as much as you’d like them to. Or they wanna just do surgery on you, which might be necessary. That’s, but don’t get scared away of by other doctor.

Dr. Weitz: God do certain ENTs in the area, everybody [00:48:00] I send them, they automatically recommend surgery. 

Dr. Kunkle: automatic surgery. It’s just a routine day of surgery. 

Dr. Weitz: I know you have this slight bleeding, we need to do this. You can operate. Sinus surgery.

Dr. Kunkle: Don’t get scared away by some of that stuff.  Some of us normalize our symptoms, whether whatever form they may come in, like, Oh, my gums are just bleeding. They just do that. Or, I wake up really congested every day and like, Oh, whatever, I just blow it out or a netty myself. Don’t let those things go on forever, like, seek some help, because there are solutions to it, and it might not be as quick of a solution because I’m not saying go out and just take Flonase or Esteroid or whatever, because that’s not really, that’s just suppressing it, it’s not really addressing it, but if you’re able to really understand it and address it, it can make a really big difference for your quality of life.

I promise you, you will sleep better, you will have less brain fog, and you will sleep good. And you’ll just feel like, Oh, I can breathe. And that’s great. And I can, I can eat a little more freely too. I’m not as worried, so if you actually [00:49:00] address the issues in the mouth and the flora and all of those things, even if you have to be on a restrictive diet for a period of time, if you get through that and treat all those things, you can come out the other end and be a little more free in terms of what you’re able to eat and deal with, as long as you have a good you know, cleaning regimen.

So, yeah. So even though it seems like, Things are really difficult and overwhelming. There’s a light at the end of it. It just may take some time. And, that could be like one to two years in some cases, on the top end, but that’s a small portion of our lives really for the wellness and the potential freedom that comes at the other end of it.

So don’t give up hope there and take your head. Health, seriously, in whatever form it may come in. Anyway, this was a pleasure. You can find me at GordonMedical. com. I’m at Gordon Medical Associates office of Dr. Eric Gordon and all our friends. We just merged with Pacific Frontier, which was another Lyme and chronic illness focused clinic.

So we have a lot of wonderful practitioners. Feel free to find us. Most of us understand these dynamics that I’ve spoken about today, but look forward to talking to some of you. in the future. [00:50:00]

Dr. Weitz: What would be the website and or phone number?

Dr. Kunkle: Oh yeah, GordonMedical. com. You can just do it all one word GordonMedical.com. And the phone number’s on there. I didn’t memorize it, but Use the website. YouTube and other areas. So if you look at Jamie Kumkel, ND, Gordon Medical you’ll find a lot of other talks that I’ve done. So if you’re interested in anything else I’ve talked a lot about nervous system stuff over the, over the years here too.  So, Please find me. Excellent. 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 very much appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review.  As you may know, I continue to accept a limited number of new patients per month for functional medicine. If you would like help overcoming a gut or other chronic health condition and want to prevent chronic problems and want to promote longevity, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310 395 3111.  And we can set you up for a consultation for functional medicine. And I will talk to everybody next week.