Bioidentical Hormone Therapy with Dr. Maggie Ney: Rational Wellness Podcast 361

Dr. Maggie Ney discusses Bioidentical Hormone Therapy at the Functional Medicine Discussion Group meeting on April 25, 2024 with moderator Dr. Ben Weitz.  

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


Podcast Highlights


Dr. Maggie Ney is a licensed naturopathic doctor and a Menopause Society certified practitioner. She’s the director of the Women’s Clinic at the Akasha Center for Integrative Medicine in Santa Monica, California, where she has been supporting women through perimenopause and menopause since 2006. Dr. Ney is co-founder of HelloPeri, (TheHelloPeri.com) an online resource for women going through perimenopause, and she’s been featured on The Doctors show and Goop for expertise on women’s health and hormones.  Her website is DrMaggieNey.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


How To Manage Low and High Iron with Dr. Christy Sutton: Rational Wellness Podcast 360

Dr. Christy Sutton discusses How to Manage High and Low Iron with Dr. Ben Weitz.

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


Podcast Highlights

2:40  In part I of this interview with Dr. Christy Sutton, which was episode 347, we discussed the consequences of either high or low iron levels, the genes that increase the risk of high iron, and how to test for iron status.  Today we will focus on how to manage patients with either high or low iron.

3:09  Iron deficiency anemia.  There are quite a number of negative health consequences related to low iron or to anemia, including compromising brain function and development if it occurs during pregnancy or infancy.  In fact, lower iron during pregnancy is linked to ADHD, lower IQ, and autism risk.  Anemia technically means low red blood cells or low hemoglobin, of which iron deficiency is only the most common cause.  Iron deficient anemia can create fatigue. It can create cardiovascular problems because the heart’s having to work harder to get enough oxygen to your brain and the rest of your body because there are not enough red blood cells. It can lead to depression, which then gets treated with antidepressants.  If you have a patient with iron-deficient anemia, the first question to ask is why?  Do they have a malabsorption issue, a GI bleed, are they over-exercising, or are they simply not eating enough absorbable iron, which is the heme iron found in animal foods like red meat?  Do they have the celiac gene, which could cause malabsorption, or do they have some other digestive issue, such as SIBO or IBD or H. pylori or having had part of their digestive tract removed surgically, such as with gastric bypass surgery for weight loss of part of their intestines removed because they have severe Crohn’s disease?  Do they have low iron or low copper or low minerals or do they have heavy periods or uterine fibroids that are leading to blood loss or are they taking a bile sequestrant or a proton pump inhibitor like Prilosec? 

9:39  Pregnancy.  Women usually need extra iron during pregnancy, which doesn’t just create low iron, but low everything.  OBGYNs seem to be focused on the need for folate, but they often overlook the need for iron and many other nutrients. And just taking a modest supplement may not be enough for you. Ideally, doctors should test for nutrient status and then test again during the pregnancy to see if the supplementation is adequate, though this often doesn’t happen.  Dr. Sutton was told to take 30 mg of iron, but for her during pregnancy, she need to take 150-180 mg of iron per day for most of her pregnancy to keep her ferritin at a decent level.  Sometimes iron levels can go down fast into a dangerous zone and some women may need an iron infusion or a blood transfusion.  But while this may be necessary, this is not that great for your body, since such iron is unbound iron that is damaging because it will oxidize things and steal electrons.  The type of iron–ferrous peptonate–that Dr. Sutton likes is Hemo-Lyph from Nutri-West, which is very absorbable and doesn’t create as many GI issues.  This product also contains vitamin C, which increases iron absorption.  Dr. Sutton also believes that taking NAC with iron will increase iron absorption, though she does not find adding copper is helpful.  And to maximize iron absorption, do not take iron at the same time as calcium, alpha-lipoic acid, silymarin, vitamin E, or curcumin at the same time, and also don’t take your iron at the same time as drinking tea or coffee, since these can all interfere with iron.

23:25  High Iron.  At least 31% of people have at least one of the hemochromatosis genes that leads to them being more likely to store iron.  And there are also patients with hemolytic anemia or thalassemia who have red blood cells breaking apart and spilling iron and these patients have high iron but should not remove blood, because while they have high iron, they already have low red blood cells.  When clinicians start looking at complete iron panels and start looking for iron status, it is common to find that there are many more patients having problematic high iron levels from hemochromatosis.

27:24  Treating high iron.  If you have a patient with high iron and who does not have thalassemia or hemolytic anemia, then you want to remove blood by either donating blood or going to a hematologist and having a therapeutic phlebotomy.  The hematologist can remove as much or as little blood as is needed for that patient, but it can take a while to get to see a hematologist and it can cost more, depending upon insurance coverage.  If the ferritin is very high, such as over 1000 or 2000, then you may need to have blood removed several times to get it down, so going to a hematologist may be more effective, than a blood donation center that can only remove blood every six weeks unless your doctor signs a form.

35:30  Diet and Supplements. Curcumin.  Blood donation ideally should be used in tandem with changes in diet, nutritional supplements, and lifestyle.  Of course they should avoid taking supplements with iron and should also avoid high dosages of vitamin C, which increases iron absorption.  There are several nutritional supplements that can help to remove iron and they also have the benefit of being anti-inflammatory and helping to promote your health.  The most powerful supplement is curcumin, which lowers iron by binding to it and curcumin is not only anti-inflammatory but it is anti-cancer, brain protective, and heart protective. Dr. Sutton noted that many of her patients with hemochromatosis also have a lot of joint pain and curcumin helps with this by reducing inflammation.  Dr. Sutton usually uses a higher dosage of curcumin, such as 3 grams per day.  She likes a product from Epigenozyme called Inflam-Redux Turmero and she uses six pills a day of that taken with meals, spread through the day. 

41:25  Silymarin.  Silymarin from milk thistle also binds to iron and has been shown to reduce stored iron in the brain, the liver, and the spleen. In particular, silymarin is known to protect the liver health and it can also reduce benign prostatic hypertrophy and it can also increase sperm count.

44:32  Quercetin.  Quercetin does not bind to iron but it increases hepcidin, which lowers iron absorption.  And quercetin has lots of other antioxidant and health promoting properties, including lowering histamine, which helps with allergies and some gut problems. And since one of the negative consequences of high iron is high histamine and mast cell activation, then this can be helpful. And of course quercetin helps get zinc into cells for antiviral properties.




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 I am excited to be having a second interview with Dr. Christy Sutton on the importance of iron and iron overload. Part 1 was episode 347, and we focused mainly on the importance of iron, the problems with having too much iron as well as how to do the proper detail testing to be able to diagnose either low iron or high iron with an emphasis on the hemochromatosis or high iron. But we didn’t have time for treatment. So today we’re going to focus on how to treat patients with low or high iron.

                                Dr. Sutton is a doctor of chiropractic who’s an expert at genetics. Her first book was on genomics, Genetic Testing: Defining Your Path to a Personalized Health Plan. Dr. Sutton is also an expert at diagnosing and treating iron problems, especially high iron or hemochromatosis as well as anemia. Her new book is The Iron Curse: Is Your Doctor Letting High Iron Destroy Your Health?  Dr. Sutton finds that hemochromatosis or high iron is more common than most people think, and it’s often undiagnosed. High iron is also a topic that is really discussed in the functional medicine world and may be an underlying problem with patients suffering from liver, cardiovascular, or neurological problems. On the other hand, iron is an absolutely essential mineral is needed by nearly every organ in the body, nearly all the cells. In fact, I was just listening to a podcast by Dr. Peter Attia on my drive in here, and he mentioned that 2% of the human genome encodes for iron-related proteins, which is staggering amount, and that 6.5% of all enzymes in the human body are iron-dependent.  Dr. Sutton, thank you so much for joining us again today.

Dr. Sutton:          Thanks for having me.

Dr. Weitz:            Good. So as I mentioned, in part 1 we discussed the consequences of low or high iron. We talked about the genes that increase the risk of high iron and how to test for iron status. So today I’d like to focus on how do we manage patients with either high or low iron and perhaps maybe go through a few examples.

Dr. Sutton:          Okay.

Dr. Weitz:            Great. Why don’t we start with iron deficiency anemia? And we’ll spend most of the time on high iron. So iron deficient anemia is too little iron which can compromise brain health. Women often will have problems with not having enough iron during pregnancy, and this can lead to higher risk of developmental brain issues with children including ADHD, lower IQ, autism.

Dr. Sutton:          Yes, so there’s certainly a plethora of negative health consequences related to low iron, anemia. So technically, anemia doesn’t mean just low iron. It means you just don’t have enough healthy red blood cells or hemoglobin. There’s multiple different types of anemias. You could have adequate iron but still be anemic because you have low red blood cells or low hemoglobin. But if we’re just going to talk about iron deficient anemia, that is a common problem and it can look like fatigue. It can create cardiovascular issues because your heart’s having to work harder. Any anemia can make your heart have to work harder because now your heart has to pump faster basically to get enough oxygen to your brain and your arms and legs and your whole body because there’s not enough healthy red blood cells, not enough oxygen being carried. And so it can really just wreck your life, long-term health consequences and short-term.  And unfortunately, it’s I think being also misdiagnosed a lot. It could create a depression-type problem, and then maybe your doctor treats you with an antidepressant rather than… Just like low thyroid could create a depression-type problem and then you get mistreated. These are common issues that slight tangent of subject here, but in my opinion, psychiatric medicine could maybe have some room for improvement with ruling out other diagnostic issues rather than just using SSRIs or antidepressants, but that’s a tangent. But low iron is one of those things that can create a lot of neurological issues.

                                And if we want to focus on the treatment piece of that, then the hardest part of that piece is figuring out why you’re anemic. If you have iron-deficient anemia, why? And then ultimately you have to fix that and then increase, change your environment so that you fix the why on top of getting your iron levels back up. And so the why is the wild card.  And the most common reasons for low iron are blood loss, which is one reason that females tend to become anemic. So much more common than men. Although men can become anemic. If a man’s anemic, especially if they’re eating red meat, then you have to rule out do they have a malabsorption issue, a GI bleed, are they over-exercising? Even over-exercising in men doesn’t tend to create anemia type issues if they’re eating iron, but certainly vegan vegetarian diet will cause iron deficient anemia because the most absorbable iron is heme iron, which is only found in animal products. So this is why I could eat a pound of spinach and not get as much iron as I would and a couple bites of a steak because it has more iron in the steak and it’s more absorbable. That’s key.

                                So it’s not just the absorption. And you have to look at does somebody have… A big one now, it’s people that are taking PPIs, like proton pump inhibitors and they’re not absorbing iron or really other nutrients, period, because it’s all the acids being depleted in their stomach. That’s a big problem that causes low iron and low copper and other minerals and low protein and just malabsorption period. And then having any type of a GI bleed will cause low iron, whether it’s in your stomach. Do you have an H. pylori infection in your stomach that can cause it? Do you have a GI bleed anywhere in your digestive system, which is common? Do you have maybe a malabsorption issue from celiac disease that’s undiagnosed and untreated? That’s a common issue as well, which is one reason that I talk about the celiac gene and celiac disease in my book and talk about that. And then-

Dr. Weitz:            Even dysbiosis and SIBO will decrease absorption of nutrients?

Dr. Sutton:          Yeah, just I mean any digestive issue. Having part of your bowels removed or having the… It’s not as common now that people are losing weight other ways, but in the past when a lot of people were getting the bypass surgery to lose weight where they just kind of bypass the first part of your small intestine, that will cause low iron, low copper, low minerals because minerals are absorbed largely in the first foot of your small. So if you bypass that part, you’re going to have a lot of problems, which is one reason that they have so many issues.  And then certain medications like bile sequestering. Not a lot of people take those, but they will bind to iron. So there’s just a lot of factors. But probably the most common reason that I see low iron is because of heavy periods, malabsorption, fibroids. Women that just, they have uterine fibroids and they’re bleeding heavily. It’s just really hard to get enough iron to make up for this chronic blood loss that you’re experiencing.

Pregnancy is a great way to become low in iron because making a human being is very nutrient dependent, including iron and pretty much every other nutrient, which is why pregnancy doesn’t just create low iron but creates low everything. And then that low everything ultimately is a big part of the pregnancy complications and postpartum issues and even developmental problems in the baby.  Another side tangent. I wish that OBGYNs did a better job with the nutritional part of pregnant women. And I experienced that firsthand. I’ve seen that countless times in my own patient population. And they seem really focused on, are you getting enough folate? Which is important, but it’s like, “Well, there’s a lot of other nutrients that we need here too.” And me personally, when I was pregnant, I did become anemic and I went into pregnancy with, I think my ferritin was maybe in the 60s or 70s, which for me is a solid ferritin because I kind of have fought a low iron issue. So 60s or 70s is pretty good going into pregnancy. I knew it was going to go down. I didn’t know how fast.  So I took iron throughout my whole pregnancy, but around, I want to say week eight or week nine, I just did some labs on myself and I was like, “Oh, I’m getting lower. I need to take more iron.” And then a couple weeks later, the doctor did some labs on me and I was even lower, and they said, “Okay, you need to start taking 30 milligrams of iron now.” And I’m like, “I’m already taking 90 milligrams of iron.” So I think I ended up taking 150 or 180 milligrams of iron a day for most of my pregnancy, and my husband would have to just sit there and force me to swallow these pills because I was like… Because these iron pills smell so bad and I just couldn’t make myself do it. But his job was, I had this bag of vitamins I had to swallow every day. And it literally took another human being making me to do it because I was not otherwise going to do it. So anyways, but I’ve seen that time and time again with pregnant women.

Dr. Weitz:            One of the important things you just highlighted there is it’s often that a patient may be going into pregnancy, she might get tested once for iron and then just told to take iron as part of a prenatal, but rarely will they get tested again to see if it’s actually working or to what extent it’s working. So as we know in the functional medicine world, we’re big on testing. And the reason is because we need to see exactly what’s going on. We need to see the underlying cause. And then if we make an intervention, we need to see if it’s actually working, is it working too much, is it not working enough. And in order to try to save money, doctors tend not to retest.

Dr. Sutton:          Yeah. And unfortunately with iron in pregnancy, it can go down fast into a dangerous zone. And that’s where often women end up needing iron infusions, which an iron infusion is where they just inject iron into your blood, which is different than a blood transfusion. So a blood transfusion is where you get somebody else’s blood, there are red blood cells, hemoglobin. There’s iron in there, but you’re also getting the red blood cells and everything and the blood rather than just iron. And so a lot of pregnant women, they’ll need either an iron infusion or a blood transfusion depending on their situation. And there’s side effects to both of these, right?

                                So with a blood transfusion, you’re at risk for getting whatever. If somebody was taking a medicine or has a disease or toxic in something, then you just got their blood and now you have that in you. That’s obvious. We know about that. With the iron infusion, there’s side effects that are a little bit less known. People that have gotten iron infusions, some of them, they don’t feel a problem, but often they’ll have a bad reaction and they’ll feel really bad. And iron infusions always cause a lot of oxidative stress in the body because it’s unbound iron, it’s just free iron. And unbound iron is particularly damaging because iron is very reactive and it will go out and oxidize things and steal electrons. And it doesn’t do that if you absorb iron through your digestive system and then your digestive system binds that iron to a protein so that it’s protecting you from this potentially problematic iron that we need, but the body has figured out how to use it in a protective way.

                                And so the iron in the body without being bound to that protein is very reactive and creates a lot of rust oxidative stress in the body. So one thing that people need to do for the treatment part of this talk is if they are going to get an iron infusion, they really need to do a lot of antioxidants, vitamin C, glutathione, in my opinion, if you’re giving somebody a iron infusion, then give them some glutathione too or vitamin C later or before or whatever. Just vitamin E. All of these antioxidants have been shown to be protective from iron-induced damage. But circling back to other causes of low iron, we talked about-

Dr. Weitz:            So we’re talking about adding iron to somebody who’s low in iron. Is there a form of iron you like and then what other nutrients can be added or what can be done to increase their likelihood of absorbing the iron?

Dr. Sutton:          Yeah, that’s a good idea. So there’s lots of different types of iron. The one that I use in my practice the most is a ferrous peptonate form. The company that makes it is a company called Nutri-West. It’s called Hemo-Lyph. Why I like it is that it’s very absorbable and patients feel better. We’re using it. It doesn’t create as many GI issues. It doesn’t create the stomach pain and constipation like a lot of the other ones. And part of that is because of the form and because it’s highly absorbable.

Dr. Weitz:            What about the ferrous bisglycinate?

Dr. Sutton:          Hold on. I have to tell you the cons of the Hemo-Lyph first.

Dr. Weitz:            Oh, okay.

Dr. Sutton:          The cons of the Hemo-Lyph is that they do put folic acid in there, so you’ll want to take some methylfolate with it just to protect yourself from that folic acid.

Dr. Weitz:            Oh, okay.

Dr. Sutton:          But that’s kind of a side note. I don’t know why they do that. It’s weird, but you know. I have looked for and not found another one that I like more. And if I find one I like more, I’ll change to that. I don’t profit at all from that Nutri-West, like whatever. I think it’s a good company. It’s a family-owned company that makes good products, but I’m more than happy to change to another company if I find a better product. I just haven’t yet.  Now the ferrous bisglycinate, I’ve seen ferrous bisglycinate and used it in patients because sometimes people will want a non-animal source of iron. And the hemolyte does have some animal source in there, and that’s probably why so absorbable. So there is a ferrous bisglycinate product that I have used in some hardcore vegan vegetarians, and they do not do as well with it. So I have used it. It’s not my preferred. My preferred is the ferrous peptonate Hemo-Lyph. What I don’t like, which is most commonly found on the shelves and prescribed, is ferrous sulfate, which is not very absorbable. But okay, so-

Dr. Weitz:            That’s the one most often prescribed I think by AMDs.

Dr. Sutton:          Yeah, exactly. And so that’s the type. Okay, so then the second part of it, this question is, “Well, how do you take it?” Okay, the biggest problem people encounter when taking iron is it causes them either constipation or stomach pain. And then that is the number one reason that they don’t follow instructions for taking iron. So if you take iron with food, it is less likely to create that stomach pain. If you start getting constipated, then just lower to a lower dose. Sometimes people start getting constipated even with a really good iron source just because they’re getting too much of it, okay?  And if you’re going to take iron, then don’t take it around the same time as things that are going to bind to iron like calcium. Calcium binds to iron, this is one reason that young kids eat a lot of calcium tend to be anemic. But don’t take calcium around the same type of iron. Don’t take curcumin around the same time as iron. Any supplements that bind to in lower iron, alpha-lipoic acid, silymarin, don’t take those at the same time as the iron. Even vitamin E can do that to some extent because it can bind to the iron and render it less absorbable.

                                Don’t drink coffee or tea around the time that you’re consuming iron supplements or an iron rich meal because that will decrease iron absorption. If you’re taking a medication to lower acid or a bile sequester or something that’s going to lower iron absorption, try to take that medication away from your iron supplements, iron rich meal, that type of thing if possible. Or better yet, if you can fix the underlying problem, fix it. Why are you on a PPI for 20 years? Maybe that’s something that needs to be looked into.  So the when you take it and how you take it is very important. And then fixing the underlying problem, like are you a celiac patient that is going to chronically be low in nutrients if you don’t just get on a gluten-free diet or whatever? So that’s crucial. Was there anything that I left out there? Oh, some people get low in copper and that copper deficient anemia can cause iron deficient anemia too, which is becoming more well-known as people talk about it more. But in some cases people will need to take some copper with or in lieu of iron to help absorb iron better because if you’re low in copper, you’ll become low in iron.

Dr. Weitz:            Which is why I think you see some combination iron products designed to help improve red blood cell production. Include copper. Usually they throw in some vitamin C. Usually they throw in-

Dr. Sutton:          Yeah, I forgot to talk about vitamin C. But yeah, vitamin C will increase iron absorption. You’re totally right. That’s a great point. I have tried the products that have copper in them that Hemo-Lyph doesn’t have it in it, and they caused more problems in people. And then I tried it on myself and I had problems and I was like, “Forget about it.” But you have to find what works for you. And then taking vitamin C around the same time or eating vitamin C-rich foods, that’s a well-known way to increase iron. And then NAC can also do that, so N-acetylcysteine. If you take NAC around the same time as iron, then that can increase iron absorption as well.  And then just, I mean, I think really eating as much iron-rich food as possible. The best way to get your iron levels up is through your diet, you’re going to absorb that the best. And then it’s just a matter of if you’re a vegan or a vegetarian, are you willing and able to eat more iron in your diet that’s absorbable, which is probably going to mean veering away from that vegan vegetarian diet? And some people do that and other people are not willing to, and then you just try to walk the line. But it’s certainly can be a challenge for a lot of people, mostly women, mostly women in childbearing years because they’re menstruating. Postmenopausal women tend to not have as many issues with high low iron. And that’s where you see a lot of hemochromatosis women that say, “I have been low in iron. I can’t be high in iron.” I was like, “Well, yep, you’re not menstruating anymore. Sorry.”

Dr. Weitz:            So let’s go into high iron, which is I think fascinating topic. I had no idea there were as many people who have problems with high iron. And you mentioned in your book that at least 31% of people have at least one of these hemochromatosis genes, and that’s only referring to two of the genes, and there’s a third gene that’s usually not even mentioned. So we probably have more than 30% of the population as a propensity to absorb and store more iron.

Dr. Sutton:          Yes. Yeah. Have you started looking for high iron more or looking iron labs more?

Dr. Weitz:            Yeah. In fact, I just recently had a woman and her daughter and the mother is a vegan. She’s not a lifelong vegan, and her iron was sky-high, so were her hematocrit and hemoglobin. She was shocked and nobody even looked at that for her.

Dr. Sutton:          As a vegan, so does she have those genes?

Dr. Weitz:            We didn’t check the genes. I asked her to send me her 23andMe, and she was having a tough time getting the raw data because 23andMe is having all these problems with being hacked. Everybody’s getting hacked. So I don’t know, but her daughter also has a propensity for storing iron.

Dr. Sutton:          Yeah. Then statistically speaking, there’s a good chance. And you have to rule that out because the question is, why is this happening? And so yeah, that’s interesting. But yeah, as clinicians really start looking more, I think their eyes open to like, “Oh, this is a common problem that maybe hasn’t been on my radar and I haven’t really been looking at it properly.” And so as a clinician, it’s kind of like to me an easy fun thing because this is easy. And we get to catch something that could really damage your health and even your family’s health if you have that gene. And we get to catch it hopefully before it does. Or if it has already created issues like, “Well, we get to work on the steps to help support your health so that you get better” and you don’t have to actually find answers rather than just more diagnostic codes and more medications.

Dr. Weitz:            You [inaudible 00:26:02] complex the problem is this. I have an eighty-year-old woman who was having fatigue and her red blood cells and hematocrit were low. So the doctor right away said she needed iron, but he couldn’t put her on any iron because he had to send her to a hematologist. And that took months to get an appointment. And so I just put her on some iron and her iron came up, and then I realized her iron shot up really high. I looked back and I had her bring in her labs. For a while, she had a keratin level of 1,200 and nobody was seeing anything. So this is somebody who has a propensity to store iron. And now she’s had lower iron and nobody asked why. So we just did a stool test and she’s losing iron in her stool. So there’s an underlying problem. And this is, I think, the real message of functional medicine. Let’s search for the underlying cause and not just treat the symptom.

Dr. Sutton:          Yeah, totally. It would be interesting that ferritin could also be high from inflammation. That’s where you have to look at the full iron panel. I think we talked about that last time, but I’ve slept since then, so I will not go back to that. I’ll focus on the task.

Dr. Weitz:            Okay. Yeah, so let’s talk about… so we have a patient with high iron, and so the options of things to do involve therapeutic phlebotomy, changing the way they eat. And then you go through a bunch of supplements. And some of those supplements, you also have some great clinical pearls that I want to mention when we go through them.

Dr. Sutton:          Yeah. Do you want to start with the therapeutic phlebotomy or do you want start-

Dr. Weitz:            Sure.

Dr. Sutton:          Okay. So in the Iron Curse, I have the Iron Curse protocols, which is basically like five steps that you can learn about and use to help lower iron regardless of if it’s hereditary hemochromatosis or iron loading anemia, like a hemolytic anemia or a thalassemic anemia. If you have high iron and you want to lower it-

Dr. Weitz:            By the way, for anybody who doesn’t know what Dr. Sutton just said, that thalassemia or hemolytic anemia means you have some condition where your red blood cells are breaking apart and spilling iron.

Dr. Sutton:          Exactly. Exactly. And so those people can have low red blood cells, but be high in iron, and that’s called an iron loading anemia. So thank you for clarifying that.  So step one of the Iron Curse protocols is remove blood if you can. Not everybody can remove blood. So for example, if you have low red blood cells, low hemoglobin, you don’t want to remove blood because you’re anemic and you will only become more anemic if you remove blood.  By the way, I’m seeing this a lot. People are coming to me and they have low ferritin and their person they’re working with is telling them to go donate blood to help mobilize the iron, and then their health crashes afterwards. I don’t think it’s a good idea to be donating blood if you have a low ferritin. I think that’s counterintuitive. And there’s a reason that people’s health crashes after that because now you were already struggling and now you just made it worse. So as long as we’re talking about donating blood, I just felt like I needed to put that little pearl in there. There is a school of thought out there.

Dr. Weitz:            [inaudible 00:29:45]-

Dr. Sutton:          There is a school of thought out there that… And I’m having more people coming and asking me about this, and I’m like, “I have no idea why you would donate blood when you’re low in iron. That doesn’t make sense to me.” And the proof is in the pudding, tasting of the pudding, and you felt worse afterwards. So there you go. It wasn’t a good idea.  Okay. But donating blood for people with hemochromatosis or not even donating blood, just removing blood. So if you have hemochromatosis hereditary hemochromatosis-

Dr. Weitz:            What’s the difference between removing blood and donating blood?

Dr. Sutton:          Okay. So if you go to a hematologist and have a blood removal, it’s basically the same thing as if you go to the blood donation center and have a blood removal if you donate whole blood. The difference is the advantage to the hematologist is that they can remove as much as they want, they can remove more or less. The hematologists are also much more specific about testing the full iron panel and the CBC before removing blood. Whereas if you go to the blood donation center, they’re not looking at the full iron panel, they’re just making sure like, do you have enough red blood cells in hemoglobin? If you don’t, they won’t let you donate blood. So the hematologist is just looking at it more specifically for hemochromatosis patients, which is why it’s really a better option.  The downside is, as you mentioned, it’s hard sometimes to get into a hematologist, especially if it’s your first visit. It’s also much more expensive. If you don’t have a great healthcare plan or haven’t met your deductible, it’s going to cost a lot more. Whereas if you can donate blood, that’s free. But if you have some type of an STD or you’re taking a blood thinner or there’s some reason you cannot donate blood, then you can have blood removed to lower iron either by going to the hematologist and having them do it and then disposing of the blood, or getting a doctor to sign a form called a therapeutic blood phlebotomy form. And that allows the blood donation center to remove blood, and then they just dispose of it rather than give it to somebody else.  So it’s basically the same thing. It’s just if you go to the hematologist, it’s going to be more specific for hemochromatosis patients. Whereas the blood donation center, they’re not treating you, you’re a good Samaritan removing blood unless you go with that signed therapeutic phlebotomy and then they’ll remove the blood and throw it away. But you have to have a doctor sign that. They also-

Dr. Weitz:            What if you have a vampire doing it?

Dr. Sutton:          Yeah, I haven’t researched that. I’ll have to look up vampire on PubMed and hemochromatosis.

Dr. Weitz:            Sorry to throw you off.

Dr. Sutton:          But I bet it would work really well. But then you have the risk of an infection in your neck and you might have to take antibiotics because of the wound from the fangs.

Dr. Weitz:            Oh, yeah, there you go. Thanks.

Dr. Sutton:          So donating blood, removing blood, whatever, that’s going to quickly lower iron because there’s a lot of iron in your blood. And so when people first get diagnosed with hemochromatosis, whether it’s hereditary or non-hereditary, because diagnosis is so poor, they often are really sick. Their ferritin is over a 1,000, sometimes over 2,000 or 3,000. And then they go to the hematologist, which unfortunately it takes forever to get in. And usually, they’ll have blood removed if possible and they’ll try to remove blood as frequently as possible. So if you go to the hematologist, they can remove blood more frequently. Whereas if you go to the blood donation center as just a donator, you can only remove blood like every six weeks unless they sign a form. Your doctor signs a form that says you can go more often in a two-week interval or whatever.

                                But regardless of how you’re getting that blood removed, at some point in time, if your iron’s really, really high, you will be limited by getting the lower iron by not being able to remove more blood. Because at some point in time your iron’s still going to be high, but you’re going to become anemic because you just removed so many red blood cells and hemoglobin, but you still have so much iron stored in your body. And then you have to wait, well, this is without step 2, 3, 4, 5, you have to wait for your hemoglobin and red blood cells to come back up before you can remove blood again. And so because blood donation is like the primary tool used by hematology and they’re not using these supplements, they talk about don’t take vitamin C, don’t take iron, things like that, but they don’t really dig into using the supplements, which I think is a huge disadvantage to their patient population. And I hope that my book helps to change that.  So anyways, blood donation is a very useful way. I think it always needs to be used in tandem with diet, supplements, lifestyle. If you go to the hematologist, they’re probably just going to be using the blood donation. In some rare cases, they might use a pharmaceutical chelation, which they have a lot of side effects. And the research that I put in my book shows that the nutrients actually work better without the side effects and have positive health promoting side effects, health promoting benefits. So-

Dr. Weitz:            Let’s go through some of those nutrients.

Dr. Sutton:          Okay. So the nutrients are, the most common one that I use is curcumin because it’s anti-inflammatory. I’m a chiropractor like you. A lot of people, my hemochromatosis patients, have a lot of joint pain from high iron and other reasons too, but part of it is the inflammation from the iron. And so the nice thing about the curcumin is that it can lower iron, but it also decreases inflammation and can help with some joint pain related to that. And then the patient feels better. That gives them… Because some of these people-

Dr. Weitz:            Curcumin is an amazing supplement. If you look at the anti-cancer properties, the brain protective, heart protective, curcumin is an amazing supplement. So it’s definitely one of my favorites.

Dr. Sutton:          It is one of my favorites. As a low iron person, I wish somebody would invent a curcumin that lowered inflammation without lowering iron. But I don’t think that exists. Because I have Crohn’s and even I’ve had a gastroenterologist say, “Curcumin is great for that.” In fact, I remember the conversation vividly, it was years ago before I wrote the book, he was like, “Curcumin is great for inflammatory bowel disease. For some reason it lowers iron, but we don’t know why.” I’m like, “Well, actually we don’t know why it binds iron, but that’s okay. It’s still good information.” So yeah, curcumin is a great one.

Dr. Weitz:            And one of the clinical pearls, actually, I’m going to mention two clinical pearls that you just happen to mention that I’m not sure everybody’s aware of that is really interesting is turmeric can cause kidney damage, but curcumin does not. So the patients who come in and say, “Well, I’m taking turmeric,” I usually inform them that turmeric is very poorly absorbed and even curcumin is not absorbed so we have to use a specialized form of curcumin. But that’s interesting that turmeric can have some possible other side effects, especially if you’re trying to use it at a high therapeutic dosage. And number two, you mentioned that curcumin interacts with tamoxifen and can increase its efficacy in the treatment of breast cancer and can even prevent, tamoxifen, cancers from growing and reduce the toxicity of tamoxifen. And tamoxifen is an estrogen-blocking drug often used as part of a protocol for patients being treated for breast cancer. So extra benefit of curcumin.

Dr. Sutton:          Yes. Yeah, that’s great. I forgot about those little things. Good job.

Dr. Weitz:            And to reduce iron, we have to use a relatively high dosage of curcumin, correct?

Dr. Sutton:          Yeah. I mean, I feel like the most common dosage I see for that type of an equation is a 3 gram a day, which most the curcumin that I use is 500 milligrams per pill, which is a-

Dr. Weitz:            Which one?

Dr. Sutton:          I use… So it’s Epigenozyme, which full disclosure is my brand, but that’s Epigenozyme Inflam-Redux Turmero. And I use six pills a day of that for if it’s like an acute situation. Whether it’s acute pain. I really like to have an iron panel on anybody I’m putting curcumin on because I don’t want to cause them to be anemic. If they’re anemic, I’m probably not going to give them curcumin even if they’re in pain and it’s inflammatory pain because I don’t want to create a problem. Let’s figure out how to fix this without causing another problem. But for a high iron person, 3 grams a day, which is about six pills a day. Now one limiting factor is in some people it can cause some loose stools. And so sometimes you just have to dose up to your bowel tolerance. Spreading it out throughout the day helps and taking it with meals can help as well.

Dr. Weitz:            Do you take it after the meal, with the meal, before the meal?

Dr. Sutton:          I would say with, with the meal, because the meal is where the iron is, and so it’s going to have the biggest effect there. It’s also less likely to create gastric issues, if so.

Dr. Weitz:            Okay.

Dr. Sutton:          So taking it with a meal is a good idea. And then I just wanted to add, the reason that turmeric causes kidney issues in some people is because it’s high in oxalates, whereas the curcumin is not high in oxalates. When you’re doing something therapeutically, it’s really important to make sure that you are consistent and you’re able to measure what you’re doing to know if it is or is not working. And so while if a patient just wants to do turmeric, it’s like, “I don’t know how much turmeric you’re taking on a daily basis in your diet.” I’m not saying don’t eat turmeric. There’s a lot of good things about turmeric. I just don’t think if you’re going to be using curcumin therapeutically to turmeric as a good option, just for the same reasons you mentioned, so yeah.

Dr. Weitz:            And the next nutrient you mentioned in your book is silymarin from milk thistle.

Dr. Sutton:          Yeah, silymarin’s great too. So before I say anything about silymarin, I think it’s worth mentioning that there is some research that shows that silymarin, curcumin, some alpha-lipoic acid, some of these iron binders, they have been shown to decrease stored iron in the brain, the liver, the spleen. I think that’s really valuable information. I don’t really have this problem with my hemochromatosis patients, but I have seen on a lot of the Facebook groups, like people that say, “Oh, I have this joint pain and my iron levels are normal.” And it’s like, “Well, either you’re not fixing the underlying cause of the joint pain. It could be something else. It could be rheumatoid arthritis. I don’t know. You’re not my patient. I don’t know what’s going on with you.” But really adding that curcumin helps with a lot of unresolved joint pain in these hemochromatosis patients because I think it’s getting the iron out of the joint.

Dr. Weitz:            That’s fascinating. And we also know that amyloid plaque, one of the reasons why it’s laid down in the brain, which is related to Alzheimer’s disease, is to protect the brain, the neurons, against heavy metals. And too much iron can be a heavy metal that can damage the brain, so…

Dr. Sutton:          Mm-hmm. Yeah. Yeah. So that’s worth knowing. And then silymarin, it also binds to iron. Well, curcumin is very good for the liver. silymarin is particularly one of its better attributes if an herb can have an attribute, is that it’s really good for the liver. So silymarin is the extract from milk thistle. So because hemochromatosis is quite ruthless and unrelentless to the liver, it is very nice to have something that will both lower iron and protect your liver. It is in the ragweed family, so if you’re super allergic to ragweed, then it might not be your best option.

Dr. Weitz:            You also point out, another clinical pearl, that silymarin, this is for men, can increase the number of sperm, and we know sperm counts are going down. And it can reduce BPH, benign prostatic hypertrophy. I didn’t know that. So that’s another…

Dr. Sutton:          Yeah. Yeah, that’s good. I forgot a lot about these clinical pearls honestly. There’s a lot in this-

Dr. Weitz:            There’s a lot of them.

Dr. Sutton:          There is a lot in this book.

Dr. Weitz:            You threw in there and I was like, “Whoa!” 

Dr. Sutton:          I know. I need to go back and read it, but honestly I never want to read it. I’m so tired of looking at it, so thank you for helping me remember.  Okay. And then the next one is quercetin. I do use a lot of quercetin. Quercetin does not bind to iron, but rather it increases hepcidin, which lowers iron absorption. The problem with people that have hereditary hemochromatosis is that they do not have enough hepcidin. They’re naturally low in hepcidin. That’s what the genetic change does to their body. That enzyme that makes hepcidin, it just makes less hepcidin. So if you take quercetin, it can boost the hepcidin production and decrease iron absorption. And then quercetin just has a lot of other wonderful antioxidant health-promoting effects as well. Lowers histamines, so it can help with allergies. Quercetin-

Dr. Weitz:            You mentioned also in your book that one of the side effects of high iron can be mast cell activation and high histamine.

Dr. Sutton:          Right. Yeah. Yeah. So that’s a good one. And then of course with the pandemic, quercetin kind of got its heyday with it being a… It can help drive zinc into the cell.

Dr. Weitz:            Exactly.

Dr. Sutton:          And then there’s berberine. I don’t use as much berberine because we will talk about what berberine does. It also increases hepcidin. And there’s a lot of good research that shows berberine’s great for the liver and lowering cholesterol and the heart. However, I had one patient that she took berberine and her liver enzymes went high. And it kind of made me uncomfortable using the… I had to rethink berberine because if you have a hemochromatosis patient, their liver enzymes might already be high. Maybe you need to hold off on the berberine because if somebody has high liver enzymes already because hemochromatosis and you give them berberine, you might not know if their liver enzymes are going high because of the hemochromatosis or the berberine. So in my opinion, and this is a newer opinion, is if you have hemochromatosis and you want to lower iron, wait until your liver enzymes are in a normal range and you’re in a more managed range before you consider adding the berberine.

Dr. Weitz:            Just my clinical experience, whatever that’s worth, I use a lot of berberine. I love berberine, I use it for blood sugar lowering. It’s one of the few things that’s been able to reverse atherosclerotic plaque. Berberine is… I’ve not seen any patients who had an increase in the liver enzymes from taking berberine. Berberine is like a natural form of metformin.

Dr. Sutton:          Yeah. No, I love berberine. I’m not willing to take it off the table, but I feel like I needed to tell that story so that maybe berberine is not used at the very beginning. Maybe you wait until the liver enzymes are normal because then if it does cause them to go high… And I think this lady just had something else going on that was like-

Dr. Weitz:            Well, a lot of times patients are doing multiple things, you know?

Dr. Sutton:          Yeah, I mean she was pretty certain it was berberine and I couldn’t say otherwise. But there is some research that shows that berberine can increase liver enzymes, but then there’s other research that shows that it lowers it. So berberine is a great thing.

Dr. Weitz:            [inaudible 00:48:06]. Another clinical pearl in your book you mentioned berberine is useful for autoimmune patients because it suppresses pro-inflammatory responses to Th1 and Th17 and increases T-regulatory cells.

Dr. Sutton:          Oh, that’s great. Can you just read that chapter to me?

Dr. Weitz:            I always listen to my own podcast and my wife goes, “Why are you listening to yourself? “It’s because sometimes I find out stuff that we forgot to edit, and so it’s important.

Dr. Sutton:          Uh-huh. Yeah. It is good. I cannot listen to myself. And apparently I cannot read my own writing.  Okay. And then the next one is glutathione. Glutathione does not lower iron, however, it’s essential for everybody, particularly hemochromatosis patients because it protects the whole body, liver, brain, heart, spleen, pancreas, joints, everything from high iron and iron-induced damage. And it protects from ferroptosis, which is where high iron causes damage to the cells and then the cells die. So you know if you have high iron, you’re going to be low in glutathione. And then the best thing to do is to just supplement with extra glutathione. And I like the liposomal glutathione. That is liquid. So if you’re a pill person, the S-Acetyl L-Glutathione is a good option as well. What you don’t want to do is you don’t want to do N-acetylcysteine while your iron levels are high because that can increase iron absorption.

Dr. Weitz:            You mentioned a really high dosage of glutathione. I know the form of liposomal glutathione that I like, which is the Quicksilver one comes in 100 milligrams strength, and you mentioned taking 1,000 milligrams. So with that one it might be hard to get it up to that level.

Dr. Sutton:          10 pumps a day.

Dr. Weitz:            Oh, okay.

Dr. Sutton:          It’s not that hard.

Dr. Weitz:            Okay.

Dr. Sutton:          It might be expensive, but it’s not that hard.

Dr. Weitz:            Yeah.

Dr. Sutton:          Yeah. Yeah.

Dr. Weitz:            Good.

Dr. Sutton:          And in acute situations is where you need the higher dosage. As somebody gets into a more managed range, you can adjust and lower or remove as you desire. But if somebody has a high ferritin, their iron ranges are out of range, then that’s an acute situation and you are definitely protecting yourself from damage by taking extra glutathione.

Dr. Weitz:            That’s great. You mentioned CoQ10 and resveratrol as well.

Dr. Sutton:          Yeah, so CoQ10 does not lower iron. However, it’s analogous to glutathione and that it helps to protect from iron induced damage. People that have high iron tend to be low in CoQ10. And low CoQ10 not only make you feel bad, but it is really bad for your heart and your health. So that’s an important way to protect.

Dr. Weitz:            And there’s two forms of CoQ10 on the market, ubiquinone and the ubiquinol. Ubiquinol is much more expensive and is marketed as more highly absorbed. You mentioned that, another clinical pearl, is that the ubiquinol is actually better absorbed.

Dr. Sutton:          Yeah. In my opinion, and I think if you really ask some of these supplement companies and they’ll give you an honest answer, they’ll agree with me. Ubiquinol is a scam. It’s a scam. It’s a way to get people to pay more for the “activated form.” And the reason it’s a scam is because it’s, one, it’s not shelf stable. So they might put ubiquinol in that supplement, but it has converted to ubiquinone usually by the time you take it, okay? And if it is ubiquinol, then it will convert to ubiquinone in your digestive system because ubiquinol is not absorbed well in the digestive system. Ubiquinone, the cheaper stuff, is well absorbed. And once you absorb it, it will get converted into ubiquinol.

Dr. Weitz:            Cool. And you mentioned resveratrol. You mentioned in your book that it suppresses iron overload, induced heart fibrosis and improves cardiac function. I didn’t know that about resveratrol.

Dr. Sutton:          Yeah. Resveratrol for the heart and people with any heart issue. It’s also really good for the brain. But because if you have high iron, you’re more likely to have fibrotic heart, heart disease, heart failure, heart issues, resveratrol is very protective against that. It does not lower the iron, but it’s very protective against the iron-induced damage in the heart, which is valuable.

Dr. Weitz:            Cool. Great. Maybe you can give us one example of a patient that you were managing with higher iron and then we can wrap.

Dr. Sutton:          Okay. Well, yesterday I talked to a lady who I’ve had maybe four visits with her. She found me. She did, I think the Iron Curse workshop because I think she kind of knew she had some high iron issues that the doctors were not looking at. I don’t know how she found me or the workshop, but she took the workshop and she started using some of that information to make some changes. And what she did was really valuable is she got the genetic testing and the labs. She did the best she could. And then she made a couple appointments with me.

                                So she has one C282Y gene. The first appointment with her, she was still pretty high in ferritin. I might be on the numbers here, but I think her ferritin was in the 500s, but had come down from the 700s with the work that she had done, and she basically diagnosed herself. She wanted to talk to me for confirmation. Yes, she had a high iron saturation, like 55, and then she had a high ferritin, but nobody else cared. She figured out herself. And then she came to me and we just talked about it and she wanted my confirmation. I’m like, “Yeah, you do have a problem. You really do need a hematologist.” And she is in the process of trying to get one, but their finances are pretty rough right now for multiple reasons, and I don’t know if it’s going to happen.

                                So anyways, so what we did was she had kind of started a couple supplements, but you know what I’m talking about. People come in and they hear about something, and then they start it and then they hear about something else and they start it. And they’re just, by the time they come in, they have 30 different things and they have this bag, and it’s like, “Well, these are good in theory, but this isn’t what you need. If you just want to wing it, and a lot of these things, they’re kind of working against each other and the quality might not be there.” And so what we did was we just-

Dr. Weitz:            [inaudible 00:56:00] just combination products that have things that are good and things that aren’t.

Dr. Sutton:          Yeah, exactly. And so what we did was we tailored down her supplement list to more specifically her needs, which her biggest problem was not just the high iron, but she has an Alzheimer’s gene too and was dealing with a lot of brain fog. And so what we did, what she started taking was she started taking… I just saw her yesterday, so this is all fresh in my head, but I’m not looking at it so I might be wrong a little bit. She started taking a higher dose of curcumin. So I think she was taking two. We tried to put her on six, but she could only tolerate four. And then she couldn’t do the silymarin and she did not tolerate the resveratrol at all. It caused digestive issues, so we couldn’t do that. We put her on the quercetin and she got on a good DHA fish oil for her brain. She got on something called cognitive complete, which has a lot of vinpocetine and huperzine and ginkgo biloba. And that is really what fixed her brain fog, because that got more blood to her brain.

                                And then we did follow up labs, and she had come down to 150 on her ferritin using just the supplements. No, she donated blood once. She donated blood once and she took those supplements. And then she couldn’t donate blood again after that because her red blood cells were not in a range. That was really a good idea. And then she stayed on the supplements and on the lower iron diet as well. And the next time she did the labs, I think her ferritin was like 112, so it continued to come down. And we’re going to get another one. I just ordered more labs on her yesterday, so we’re going to get another one here soon. But-

Dr. Weitz:            Your goal for her ferritin, you want to see it where?

Dr. Sutton:          Well, she’s got one of those hemachromatosis genes and she’s postmenopausal. So ideally I’d like it to be probably below 60 so that she’s got a buffer to protect her from it going high. But 112 is exponentially better than 700.

Dr. Weitz:            Of course.

Dr. Sutton:          And it was going in the wrong direction. What we talked about yesterday, I guess this is why I wanted to tell this story now I’m realizing, is she was so appreciative because yesterday we talked about her granddaughter who is six years old and we were looking at her granddaughter’s genes in labs. Her granddaughter has a celiac gene, has a hemochromatosis gene, is having a lot of health problems. Her iron levels were actually normal, but she was low on vitamin D and low on B vitamins and had a high inflammatory CRP. So we talked about we really need to either get more labs to see if this girl’s a celiac, gluten-sensitive child or put her on a diet. She couldn’t afford the labs, and so they’re going to put her on the gluten-free diet. But here’s the reason that this is so important, is she was like, “I think God sent me to you because I needed to get better to take care of my granddaughter because her mother is an alcoholic that has a 40% chance of surviving the next year.”

Dr. Weitz:            Wow.

Dr. Sutton:          And now she feels good now. Her granddaughter hopefully will start feeling better soon, but she now feels good. She has energy, she’s clear-headed. She’s going to hopefully live a longer, healthier life and be able to take care of her granddaughter who desperately needs her. And so I guess that sometimes it’s not like that one person we’re helping, but the circle around them that is so meaningful.

Dr. Weitz:            Yeah, that’s great. That’s a great story.

Dr. Sutton:          Yeah. Yeah.

Dr. Weitz:            So tell listeners how they can find out about getting you books. You have some courses that are available.

Dr. Sutton:          Yeah. So the Iron Curse workshop is at ironcurse.com. And then if you go to christysutton.com, pretty much everything I have is there. And I have that Iron Curse workshop, which is me verbally going through everything as far as hemochromatosis, anemias, everything that’s in the book, and then just more kind of discussion.  And then I have other workshops. I have one on brain health, Alzheimer’s, Parkinson’s, cognitive decline. I have one on celiac, gut issues, one on age-related macular degeneration. I have one coming up on heart health. And then I have another one, oh, the MTHFR one, which is just methylation. And then I think I have another one, but I can’t remember. Anyways, they’re all at that website.

                                And then my books, I have my first book, the Genetic Testing: Defining Your Past to Personalized Health Plan, which is a decent book and a lot of people love it and my greatest critic, and I will call it decent. But if you’re looking into the hemochromatosis part, don’t go there. Go to The Iron Curse. The Iron Curse is, I would say, a really good resource for iron related issues. The first book has a lot of different genes. I wrote that a long time ago, and I think it’s an important piece of information. But if you’re interested in the iron piece, don’t go there. Go here to The Iron Curse book.

Dr. Weitz:            Awesome. Thank you, Christy.

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 appreciate it if you could go to Apple Podcasts or Spotify and give us a 5-star ratings and review.  If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. So many areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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. Please call my Santa Monica White Sports Chiropractic and nutrition office at 310-395-3111, and we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.



Controversies in SIBO with Dr. Allison Siebecker: Rational Wellness Podcast 359

Dr. Allison Siebecker discusses Controversies in SIBO Testing and Treatment 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

1:28  Testing for SIBO.  Dr. Siebecker still prefers the SIBO breath test that measures hydrogen and methane that has been around for years and she prefers the version where they do it for three hours.  She also likes the Gemelli Labs Trio-Smart test that measure hydrogen, methane, and also hydrogen sulfide gases, which is the newer SIBO breath test.  Dr. Siebecker has a hydrogen sulfide SIBO study group and the consensus in the group is that Trio-Smart under-reports methane.  On the other hand, the studies used to validate the Trio-Smart test were really good.  Using the older SIBO breath test, if there is a flat line for hydrogen, this is often used to indicate hydrogen sulfide SIBO. Dr. Josh Goldberg and Dr. Siebecker and others have found that if patient did both the older SIBO test and the Trio-Smart, there was not a good correlation between the flat line and a positive result for hydrogen sulfide.  On the other hand, Dr. Siebecker pointed out that when patients with a flat line get tested with treatments for hydrogen sulfide, they often improve and feel better.   

7:37  Three hour SIBO breath test.  While it is more common to do the SIBO breath test for two hours, Dr. Siebecker prefers that the test be done for a three hour period of time.  For one thing, while excess hydrogen production is known to occur only in the small intestine, the organisms that cause excess methane and hydrogen sulfide are known to overgrow in the large intestine as well as in the small intestine.  Therefore, doing the SIBO test for 180 minutes instead of only 120 minutes can help, with the assumption that after 120 minutes the lactulose is in the large intestine.

11:50  Fructose as the substrate.  The use of fructose and glucose as well as lactulose as the substrate for the SIBO breath test. While the SIBO breath test is most commonly done with lactulose, some doctors, such as Dr. Jason Hawrelak from Australia, often has patients perform the test with lactulose, glucose, and also fructose. In fact, Dr. Hawrelak has found that fructose is actually more accurate than lactulose for diagnosing SIBO.  If you have a patient who tests negative with lactulose, you might consider having them repeat the test with fructose.

17:57  The Food Marble.  The FoodMarble is a portable SIBO breath testing device that the patient can buy and use at home over and over as needed and this device it threatens to upend the SIBO testing industry.  It can help you to figure out your dietary triggers.  Once you buy one for about the cost of a breath test, it allows you to be able to retest regularly, which otherwise can cost a lot.  And the validation studies on its accuracy seem to be pretty good.


Dr. Allison Siebecker is a Naturopathic Doctor and Acupuncturist specializes in the treatment of Small Intestinal Bacterial Overgrowth and she teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO, siboinfo.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. Allison Siebecker, one of my favorite people, about controversies in testing and treatment for small intestinal bacterial overgrowth.   Dr. Allison Siebecker is the Queen of SIBO. She’s a naturopathic doctor and acupuncturist specializing in the treatment of small intestinal bacterial overgrowth. She teaches advanced gastroenterology at the National University of Natural Medicine. She has the most incredible resource of research articles and information about SIBO at her website, siboinfo.com. Dr. Siebecker has been participating in the SIBO SOS program, which is another incredible resource of courses and information about SIBO. Allison, thank you so much for joining us.

Dr. Siebecker:                    Thank you so much for having me.

Dr. Weitz:                           So let’s start off with testing for SIBO. So which SIBO tests do you currently recommend?

Dr. Siebecker:                    Right, because we have some new additions in here.

Dr. Weitz:                           Yes.

Dr. Siebecker:                    Well, I still like the standard test that most of us have been using, which is a test for hydrogen and methane and uses lactulose. I like it three hour, and I like it when it has… The most samples that it can come with typically on the market is 10, meaning 10 tubes or bags or collection items. So that’s the standard for a very long time, and I still really, really like that. But we do have some newbies. Gemelli Labs has Trio-Smart. That’s been out about three years now, I think, but it still feels new, right? For a lot of us.

Dr. Weitz:                           It’s only available in the United States I think at this point, right?

Dr. Siebecker:                    I think so. Yeah. That one tests for hydrogen sulfide. We were all really excited, waiting for that. I like that test too because it tests for hydrogen sulfide. Then I feel a little bit bad to share this just with the public but I will is that I have a hydrogen sulfide study group that we assembled a bunch of practitioners to basically study when the Trio-Smart came out and help each other with what we were all seeing. From that group, many of the doctors in there, they shared that and basically they saw when they would compare the test against the standard hydrogen methane test because they would run too often on one person that the methane sometimes was lower on the Trio-Smart than on the traditional test.  So some of the docs there, they just felt that it may be under-reported methane, the Trio-Smart. Now when the studies are done, studies were done to validate Trio-Smart against the standard machinery. The studies were great, so it doesn’t line up. This is more of like a clinical happenstance. Studies are great. So just passing that along. Because of that, it’s really hard to explain why I haven’t switched fully over to Trio-Smart, because I’m always very concerned about missing anybody with SIBO. I want to be sure that I find it when it’s really there. By SIBO, I mean the methane type of SIBO as well.

Dr. Weitz:                           How valid do you think the flat line is as a way to diagnose hydrogen sulfide?

Dr. Siebecker:                    Well, this is really interesting. So for years, that’s what we use. We still use it. I found it very effective in that when you treat people with treatments for hydrogen sulfide and they have a flat line, they respond. They get better. You can often see the next, the retest perform like you’ve seen, they’ve gotten better. Meaning it won’t be a flat line anymore. Also, one of the directors of one of the breath testing labs, for years, I had been gathering symptoms that my patients had that they told me they had when they had a flat line. I was able to come up with this little group of symptoms that to me indicated hydrogen sulfide. I shared that with anyone who wanted to know in all my lectures and things.  So the director of this lab started using that and he got back to me and said he found an excellent correlation with this and that people would really respond to treatment. So here’s this clinical data that seems good. But then my friend who’s does a lot of research, Dr. Josh Goldenberg, he and I and several others, he really led the effort, did a survey. In that survey, so this is low quality evidence, but here it is. We actually found that when people compared the flat line with the Trio-Smart. So do people with a flat line actually have hydrogen sulfide gas? There was a very poor relation. What is a flat line then if it’s not actually hydrogen sulfide? I don’t know. Is this definitive? No, because this is just a survey. It’s not good quality evidence.  But it made us think, “Huh, maybe the flatline isn’t what we always thought it was,” except I don’t care. Because when we treat it like it’s hydrogen sulfide, people get better. But that is an interesting thing that we don’t often see. I’m sure other people will have their own evidence, but someone with a flat line testing positive for hydrogen sulfide on our Trio-Smart. I don’t know why.

Dr. Weitz:                           Have you found that the Trio-Smart also has a relatively small number of positive hydrogen sulfides?

Dr. Siebecker:                    Yeah, I mean that makes sense. Hydrogen sulfide is going to be the least common type of SIBO, the least common gas. Never expected.

Dr. Weitz:                           I’ve heard 10 to 15%.

Dr. Siebecker:                    Yeah, I think so. Maybe less. I mean, it’d be interesting to hear what Dr. Pimentel says, who’s probably got the most experience at saying what the percent is, but that makes sense to me. Pretty low, right? So yes, but the thing is it can be this tricky thing. I think where we want to bring in for sure testing and make sure we’re not missing it is in cases that are challenging. If everything’s going great and you’re treating and there’s no issue, you don’t have to think about it.  But what if somebody still has symptoms and you don’t know why and their test looks negative or things like that or the treatments you’re giving for hydrogen or methane aren’t quite working? Geez, maybe they have some hydrogen sulfide there you don’t know about because clearly there can be hydrogen sulfide without there being a flat line. Then you would need to shift your treatments.

Dr. Weitz:                           Now explain why you feel it’s important to do three hours. Because if on average after 100 minutes or certainly 120 minutes, you’re now in the colon. How are we diagnosing a small bowel issue with a three-hour test?

Dr. Siebecker:                    Because we have these three types of SIBO, hydrogen, methane, and hydrogen sulfide. Methane even now is not really considered a type of SIBO, though I still consider it that way because that’s so long I’ve thought of it that way. So it’s intestinal methanogen overgrowth. Well, it’s only the hydrogen that is small intestine only. So both methane and hydrogen sulfide, those organisms overgrow in the large intestine as well. On our breath test interpretation, we use the whole three hours for the interpretation. So this is why it’s so important. I mean, I have example after example where we could miss somebody’s methane or hydrogen sulfide if we only had 90 minutes or two hours.

Dr. Weitz:                            So if you see a dramatic rise after 120 minutes, you would still consider that positive in either methane or hydrogen.

Dr. Siebecker:                    Not hydrogen, methane or hydrogen sulfide. That’s the thing. That’s the thing. It’s only hydrogen that we’re using the first two hours. But for methane and hydrogen sulfide, we need that third hour, because it’s not just yes or no because the level of the gas influences our treatment choices. Because amongst our different choices, we may choose a treatment that is better at reducing more gas more quickly. Also, it informs our prognosis because we know most people will need multiple rounds. We know on average how much each treatment lowers gas on average.  So we can calculate how many rounds might be needed by seeing how high the gas goes. So we need that information. The other thing is why wouldn’t you just get all the information that would help you if the person’s going through the test? So it really irritates me when manufacturers only offer two hours or less. It’s like you’re shorting us out here. I mean, the person is going through the effort. They did the prep diet, they’re doing this whole thing. What is one more hour? Let’s get all the information we need.

Dr. Weitz:                            Now, isn’t another argument though that the issue about SIBO is that if this bacterial overgrowth occurs in the small intestine and gas is produced, you’re going to have all these symptoms? But if that same gas is produced in the colon, you’re not necessarily going to get those same symptoms because the colon is this very extensible tube and it easily expands. There’s always bacteria producing gases in there, and that doesn’t typically create symptoms.

Dr. Siebecker:                    I don’t think that’s true. I don’t know. I haven’t read studies to prove this one way or the other.

Dr. Weitz:                           But isn’t fermentation very common in colon and isn’t that good, actually healthy?

Dr. Siebecker:                    Yes, at a certain amount. So I think it’s about the amount. It’s about how rapidly the gas is created and how much. Actually, this is the whole basis of the FODMAP diet is just that rapid and excessive gas creation in the larger intestine leads to a lot of symptoms. It is completely my understanding that you would not escape symptoms if there was a lot of gas in the large intestine.

Dr. Weitz:                           Okay. I thought the purpose of the low-FODMAP diet was not to feed the bacteria in the small.

Dr. Siebecker:                    Yeah, they did have SIBO or the small intestine in mind in some of their early papers but barely. Their main target was the large intestine actually, believe it or not. Also, inflammatory bowel disease. Now it’s changed since then. They’ve morphed, but that was the original intention. What I love about that diet is they’re like, “We don’t know what’s causing it. We’re not even going to try and think about it. We’re just trying to help symptoms.”

Dr. Weitz:                            Some doctors, for example, Dr. Hawrelak likes to use different substrates for the SIBO prep test. He told me that he regularly will have his patients do a test with lactulose, a test with glucose, and a test with fructose.

Dr. Siebecker:                    Yeah, I love this. So this is great. This all came out of a conversation he and I had at a conference when we were lecturing. Because long ago, he was a fan of glucose, and I was never a fan of glucose as a substrate because I knew it absorbed pretty quickly, pretty high up in the small intestine. So it couldn’t test the whole rest of the small or the large intestine. We were just talking about how important that is. So I said to him, I said, “Could you give me more information about the comparison between glucose and lactulose? Tell me what you think.” Well, he’s a researcher. So he’s fabulous. He went in his office and he did this in-office study over years. He didn’t publish it, but then as soon as it was ready, we came and I featured him giving out a class on this.  He’s been telling everybody. He came out with the most fascinating information. He found that, well, glucose was the worst at finding SIBO in somebody who had it. So he ran, like you said, each one of these substrate tests on the same person. Lactulose was second best. Fructose was the best and best of all was lactulose and fructose. He ran these on different days. So I brought up the statistics so I could tell you from a study. So glucose was 67% of a diagnostic rate, lactulose, 73%, and fructose, 85%. When we did the fructose and the lactulose together on separate days, it was 96.5%. So this just blew me away and has changed my mind about a lot of things. So what I’ve been doing is recommending to practitioners who are having trouble getting a lactulose test.

                                                There are companies where you can get the lactulose test, but not everybody knows that or wants to do it. So they can order fructose. This made me feel comfortable, recommending fructose as a substrate. It’s interesting, because in my early testing, I did test people with different substrates. This is like 14 years ago or whatever. I didn’t do as many as Dr. Hawrelak. He did 130. I have it written down here, 130. I didn’t do that many. So you need a lot to figure things out, but I often found that people were not positive on a fructose test who were positive on lactulose. So this really surprised me, and that’s the value of doing a bunch of these. Now I have something else to tell you. Dr. Nirala Jacobi, another one of our colleagues, she has a lab in Australia also.  She is now checking this out for herself, and she is running a lot of these lactulose and fructose. She’s only in preliminary data, so it is too early to speak. Please keep that in mind, but she isn’t finding fructose to be better than lactulose. She didn’t tell me if it was the same or worse, just not better at this point. She’ll come out her with her findings, but I still feel confident based on the data from Dr. Hawrelak. So I think it’s a wonderful thing to think about. Something else that he discussed is that he found people who would be negative on lactulose but positive on fructose. I mean, obviously, that’s the difference between that 73% and 85%. So it’s something to keep in mind if you really feel like somebody, you really suspect SIBO and you test them and they’re negative.  You could run a fructose just to see. That’s also the place where you might want to test with the trio if you weren’t to see if there was hydrogen sulfide, if something’s in your mind going, “But I really feel like they have it.” So I’m generally in favor of it. I haven’t switched over to it.

Dr. Weitz:                           Interesting. So one of the issues for some patients and some practitioners is that… I don’t know if this is across the whole country, but lactulose is considered a prescription drug. I know in California-

Dr. Siebecker:                    It’s so irritating. Oh, no, the whole country.

Dr. Weitz:                           The whole country, okay.

Dr. Siebecker:                    It’s a mistake that it’s on there. I’ve talked to so many people about this, but the problem is it would cost a lot of money to get it off the formulary. So it’s going to stay there and it’s a terrible mistake. It shouldn’t be. So then non-prescribing practitioners technically can’t order it, but there are labs you can order it from. Basically, I can just speak about labs because there’s no CE. So Genova offers it and that you can get that also through Rupa Labs, True Health Labs, direct labs.  So they’re the main way. The other thing is that a lot of times, a patient’s primary care, they can give them a prescription for lactulose as a laxative. It’s often used in veterinary medicine. So you could get it and then you could buy a no substrate or a glucose test kit and then substitute it. But here’s now the fructose as a potential option.

Dr. Weitz:                           Is it the same amount as lactulose?

Dr. Siebecker:                    No, it’s 25 grams. Let me just make positively sure that I got that right. I have a little note. Yeah, 25 grams for fructose, 10 grams for lactulose

Dr. Weitz:                           Mixed in eight ounces of water?

Dr. Siebecker:                    Mixed in eight ounces of water. It has to be diluted. Same with lactulose. Isn’t that fascinating?

Dr. Weitz:                           That is fascinating.

Dr. Siebecker:                    Did you have him on to speak about it?

Dr. Weitz:                           Yeah, we did speak about it.

Dr. Siebecker:                    Yeah, fascinating to me.

Dr. Weitz:                           He continues to use all three.

Dr. Siebecker:                    He says sometimes he uses just two, unless he’s changed. Last I heard he had dropped glucose, but he might. Who knows?  He might’ve brought it back because he’s like, “That’s out.”

Dr. Weitz:                           So what do you think about the new SIBO testing device, the FoodMarble?  Is this threatening to disrupt the whole SIBO testing industry?

Dr. Siebecker:                    Right. I forgot. This is the other newbie on the block here, so I have so many thoughts.

Dr. Weitz:                           For those listening, you might not be aware. There’s a home SIBO testing device. It’s known as the FoodMarble, and you can use it over and over again at home. You can test yourself in whatever way you want exactly. You just breathe into that. It measures hydrogen and methane. I think they’re working on a version that’s going to include hydrogen sulfide, and you could duplicate a SIBO breath test. You could do lactulose or fructose and then do it every 15 or 20 minutes, or you can just see how you react to different foods.

Dr. Siebecker:                    Exactly. Yeah. I think that the original intention was just to help you figure out your dietary triggers really. People love it for that. They just test after eating various types of meals and they see where their gas levels are. The gas report comes as a fermentation score, which goes as high as 10. They’ve now broken out the different hydrogen or methane, and they let you know. So it’s not parts per million like it is in a breath test. It’s just to give you a sense of what’s going on, but it works with an app and it’s very user-friendly. On the app, the challenge function is how you do a formal breath test and then you choose whatever substrate you’re going to use. Like you said, you could just buy glucose or fructose or if you can get a prescription for lactose.

                                                So I think it’s amazing because it’s inexpensive and I love that. So because they claim that this device is able to do accurately many, many, many breath tests, I think 40 or more. I think it’s more than that. So that’s for the price of one. It costs about the same as doing a breath test, and then you can run multiple, multiple tests. That’s just incredible because the budgetary concerns are sometimes the biggest impediment in the whole treatment process with SIBO. I mean the treatments can cost a lot too, but I’m a physician who likes to retest a lot. Otherwise, I just feel blinded. You can’t really judge my symptoms very well. What the heck is actually going on with the overgrowth levels? Because they don’t correlate perfectly.

                                                So this can solve the budgetary issues, the retesting issues. So that’s incredible. It’s also so user-friendly. Anyone who’s ever tried it or used it, they love it. I’ve tried it. I think it’s great. It’s so easy to use. Now the issue is what about the validity? This is what everybody wants to know. Just like Trio-Smart, they have done studies that are great and show excellent validation against our standard testing machinery. A colleague of mine, the one who I did that hydrogen sulfide study with, he said he likes the studies. He feels good about the studies. Everyone has to decide for themselves, but I like that a colleague who was a researcher felt good about the study. So that’s good. So that’s good. Now, what about in real life, right?

                                                So in practice, sometimes we see some odd things like an occasional really high level of gas that just blips up. That’s hard to make sense of. Is it correct? It has an opportunity to potentially be more sensitive and more accurate because it’s analyzing the breath instantly, instead of being shipped off for a week in transit and then being analyzed. Because of that, the FoodMarble has a trend I think to have slightly higher gas levels, probably because it’s being analyzed immediately, although there could be other reasons for that. But a number of us have done side-by-side testing. Whenever we do that, by the way, Dr. Pimentel has recommended giving five minutes apart when you’re breathing into two different devices.

                                                The technicians and the scientists at FoodMarble say even two minutes might be enough, just letting you know for anyone who wants to do this, because you need the gases to be able to equilibrate again. You don’t want to have them completely blown off from one test to the next. So anyway, when we’ve done comparison side-by-sides, people are finding different things. I find in the ones I’ve done only I think one or two of them lined up correctly perfectly. Then I’ve seen it all different ways where hydrogen or methane was higher or lower in my side-by-side tests. I haven’t really quite decided what that means and what I think about it. I can say that I have colleagues who don’t feel good about it because of that, because it’s not perfectly lining up.

                                                So they want to stick with what they’re used to. I have other colleagues that love it and they don’t care if it lines up or not. They feel like the advantages are so great, the studies where they’re validating it, that they’re just using it and they’re recalibrating their clinical sensibilities to the device, to the new data. For me, I’m used to just a lot of data, because as a SIBO specialist, I ran tests all day long every day. I need to see a lot more of their tests until I decide fully what I think of it, but I’m favorable towards the advantages that it has to offer. So what do you think, Ben? Have you tried it?

Dr. Weitz:                            I’ve got one now and I just started fooling around with it. I don’t know yet. I have a couple of patients that are going to be doing side-by-side and I’m curious.

Dr. Siebecker:                    Me too. The other thing that people should note is that to get the parts per million, practitioners can get that. You just have to ask them and sign up for the clinician’s dashboard, I think it’s called. So that’s a website you can go to that’s connected where you immediately see the results in parts per million. They have graphs and things like that, because otherwise, you’ll get the fermentation score. So that’s the one drawback for patients who are using it. If they do a formal SIBO test, they’re only going to see a fermentation score. Someone needs to be a practitioner to get that clinical dashboard and see the parts per million. That’s a limitation that I’m not fond of but they know that, and I’m sure they’re doing whatever they need to do legally. Who knows? Maybe it’ll change.

Dr. Weitz:                           Do you often order a stool test as well to look at the microbiome with your SIBO patients?

Dr. Siebecker:                    Well, I’m not in practice now, but when I was, I wasn’t running microbiome tests. It was like before that became a big hot thing. But I did run functional stool tests a lot, but not microbiome once. Tell me where you’re heading with this one. Have you been doing it? Are you correlating things?

Dr. Weitz:                           Yes, I do. I regularly do a stool test and I like to see what else is going on in their gut. It seems to me a lot of patients with SIBO also have other issues.

Dr. Siebecker:                    Well, that’s for sure. I mean, personally, I think when someone comes in and you suspect that they would have SIBO, you should run expanded screening blood work, the SIBO test, and a stool test. To me, that’s just the fundamentals. It would be sure great if you could also run a really good hormone test.

Dr. Weitz:                           Right, absolutely.

Dr. Siebecker:                    But for certainly stool and breath, because yeah, we have to see what’s happening in the large intestine as well.

Dr. Weitz:                           Yes, exactly. So I talked to several practitioners who feel that the bacteria that caused SIBO are migrating up from the colon. It’s my understanding that Dr. Pimentel originally felt that that was the case, but that current data doesn’t really indicate that that’s the case. What do you think about that?

Dr. Siebecker:                    Yes, that’s my understanding. Ben, I just have to say for anyone watching, I don’t know why my face looks so red. I see it on the screen, and Ben was saying he looks orange. We tried to adjust our light beforehand. I don’t know what’s happening. So sorry about that.

Dr. Weitz:                           It’s okay.

Dr. Siebecker:                    Because I just looked over and saw myself. I’m like, “Literally, I have a sunburn.” I don’t know what’s happening. Totally, that’s my understanding. I was never of that belief that it was a back migration. Even though so many articles and studies said it, that just didn’t make sense to me. Then as Pimentel’s research continued, he came to the same conclusion just as you said. At one of our SIBO symposiums, we used to have SIBO symposiums each year at NUNM where I teach. He said that. He said, “Now I think the majority is it’s there in the small intestine already at low levels and then it overgrows.” So I was thrilled because I felt validated. That is my understanding. It is possible some could come up, but I don’t think that’s the majority of what’s happening. So yeah, I think it’s just overgrowing. It’s already there.

Dr. Weitz:                            There seems to be some studies correlating some of the bacteria that appear in the mouth with the bacteria that end up that caused SIBO.

Dr. Siebecker:                    Yeah, that’s interesting. I’m so sorry. I forget the main researcher’s name. There’s one researcher that’s been working on that premise the whole time I’ve known about SIBO like 15 years or more, and now others have been following in his footsteps. So there’s some little group that is into that thinking. They like to separate oral-like bacteria SIBO from small intestine bacteria SIBO. I don’t think Dr. Pimentel is on that train. I don’t think he’s thinking that way. So that’s like an offshoot of a different thinking. Think it’s Dr. Bohm. We had him come speak at one of our conferences one time. So very, very interesting.

Dr. Weitz:                            Currently, what are the best ways to stimulate GI motility? Do you have any experience with Dr. Satish Rao’s vibrating device?

Dr. Siebecker:                    Oh yeah, that is the coolest thing. The vibrant capsule is just so amazing.

Dr. Weitz:                           Which I don’t think is on the market yet.

Dr. Siebecker:                    It is.

Dr. Weitz:                           It is on the market.

Dr. Siebecker:                    Yeah, it is on the market. I can’t remember exactly when, but it’s been out for a good while now. I haven’t used it, but I’ve talked to a couple colleagues who have. As with anything, some people have amazing results and other people it just didn’t do the job. For anyone who doesn’t quite know about this, this is a non-drug treatment for chronic constipation, really meant for the patient where typical treatments don’t work. Actually, laxatives don’t work. Various medicines don’t work. Prosecretory agents, Amitiza, they’re just not doing the job and you’re at your wits end. You could bring this in. Now, I think you could bring it in even before that. If somebody really has chronic constipation, how nice for them not to have to swallow anything.  So this little pill, it’s timed and it’s timed to just give this very gentle vibration when it would be hitting the large intestine. So anyway, in one patient for a colleague of mine, it was an absolute miracle game changer, insane constipation that nothing would do anything about. This gave her the urge and she goes naturally now normally. Another colleague, it just didn’t work for them. So I guess you have to find the person it’s going to be right for, but I think it’s so great we have this option. So that’s a wonderful thing for stimulating large intestine motility. Yeah.

Dr. Weitz:                           How long does it work for?

Dr. Siebecker:                    Oh, I think you take it five. There’s five capsules you take in a week.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    So it’s almost like a daily thing.

Dr. Weitz:                           I see. Okay.

Dr. Siebecker:                    Yeah. It’s not inexpensive either. I know they had an introductory price. Since it’s new, it hadn’t yet been covered by insurances. So I know that I think in both these cases they were paying out of pocket. So let’s hope it gets covered by insurance and the price becomes better, but in a certain situation, it’s going to be the right fit for some people.

Dr. Weitz:                           What would you say is the most effective drug for motility and nutritional product for motility?

Dr. Siebecker:                    I guess it depends on what kind of motility we’re talking about.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    If we’re talking about large intestine motility meant to create a bowel movement, in essence, a laxative, I have my favorites, my favorite supplement. It’s not a stimulant laxative. So it’s not actually creating movement. That would be magnesium oxide or magnesium citrate. I like osmotic laxatives for actually stimulating movement in the large intestine. Many people like the prosecretory agents, Trulance, Ametiza, Linzess. They’re tricky. So magnesium can be tricky too. You have to make sure you’re getting the right dose at the right time or it could be too strong, but some people, that’s a game changer for them. I’m not the hugest fan of stimulant laxatives that are natural, but many people do like them, senna, cascara, aloe, rhubarb, things like that.  But then we could move to the class of drugs that are prokinetics and they’re really aimed more at and natural agents, the upper GI. So more like the esophagus, the stomach, and the small intestine. So those are used more for achalasia, gastroparesis, and for the migrating motor complex in the small intestine. I mean it’s hard to say a favorite, but I would say probably the most effective would be prucalopride, which is still this Motegrity in the US. Amongst all the gastroenterologists I’ve spoken to, they say it’s the best they’ve ever used. Almost no side effects. I mean, people can have reactions, but no adverse concerning side effects.

Dr. Weitz:                           It certainly seems to be Pimentel’s favorite.

Dr. Siebecker:                    Yeah, many, many gastroenterologists I’ve spoken to. Yeah, because many of our prokinetics that were available had cardiac risks and extrapyramidal symptoms, all sorts of awful things. There’s so many practitioners that think prokinetics as a category is dangerous and that’s not so. There are safe options, but that’s really probably the best there. Naturally, the main things we have is Iberogast, which is like a combo herbal product. Actually, there’s like a dupe now for that because it can sometimes be hard to get.

Dr. Weitz:                           Yeah, very hard. Yeah.

Dr. Siebecker:                    That’s by Heron Botanicals, which is a company from fantastic herbalist and naturopathic doctor. They have a product called Gut Motivator, and it uses pretty much all the same ingredients, except I think there’s fennel instead of something else. I can’t remember.

Dr. Weitz:                           Oh, interesting. Gut motivator.

Dr. Siebecker:                    Gut motivator. It’s in glycerin base, which is nice because it’s easier to take straight from the dropper and it tastes a little sweeter. The only problem with it is that they’re still ramping up. They grow a lot of their own herbs and they’re so ramping up their supply of Iberis amara, the main ingredient that gives its name. So they’re only selling to practitioners at this time. So it’s not ready for the general public, but it will be eventually.

Dr. Weitz:                           Is that available through Fullscript?

Dr. Siebecker:                    No, not yet. I’ve asked them to carry it, but you have to get it from Heron Botanicals right now. So just so people know there’s another option. Some of my colleagues are reporting very good results with it, so I’m glad to hear that. But the other really nice prokinetic is for the upper GI’s ginger. So many studies on that. By the way, so many studies on Iberogast. I mean, it’s been around for a long time, amazing studies where head to head against Cisapride and metoclopramide, other prokinetics where it did just as good, if not even better. So amazing. But then ginger also has excellent prokinetic ability, and we have all of these companies now that put it in their formulas. I call them the ginger-containing prokinetic formulas. There’s six of them.

Dr. Weitz:                           Yeah, we use motility activator a lot.

Dr. Siebecker:                    Yeah, that’s a good one. There’s a lot of good ones. So those are some options. I mean, there’s probably other options, but that is generally good.

Dr. Weitz:                           So we know that patients with IBS, 60 to 70% have SIBO. Then the question is what about the other 30 or 40%? So how often do you think patients have SIFO or fungal overgrowth, and what’s the best way to diagnose that?

Dr. Siebecker:                    I think a good amount do. I can’t remember the statistics from Dr. Rao’s studies on this, but I think it was at least a third also have it, if not more. It depends on your patient population, but I think a lot of us see that a lot. When I was first practicing for SIBO, for years and years, I was looking for yeast and a majority of my patients did not have it at the same time as SIBO.

Dr. Weitz:                           How were you trying to look for it?

Dr. Siebecker:                    Okay, so I don’t think the testing options are great. The gold standard is going to be endoscopy, which is impractical.

Dr. Weitz:                            Right.

Dr. Siebecker:                    Yeah, but I was honestly running three tests because people were coming to me as a specialist. I was running the urine organic acid test. That can’t distinguish between small or large intestine, but it can show indicated and overgrowth by metabolites. Then I would run a functional stool test and look for actual overgrowth in the stool, and then I would run a blood test. The Candida Immune Complex and Antibody test, Quest and LabCorp have that. So I would run all three. Then with the blood test, it doesn’t really tell you whether there’s an overgrowth. It more so tells you if there’s a hypersensitivity. There could be an overgrowth, but it could also be that there’s a normal amount of yeast and their immune system has decided to react against it.  So you are telling different things from this, but I lost confidence in doing those tests. I never felt very sure about what was the best and right way. I can say that you recently had Dr. Morstein, I know. She likes to use the questionnaire from The Yeast Connection, the old Yeast Connection book by Dr. Crook, which I think you can see the questionnaire online. She likes to say that it has been shortened. That questionnaire has been shortened to five questions or seven questions, and she doesn’t think that’s adequate. So she likes just use the questionnaire. I always like to ask other practitioners what do they feel confident with in testing. I don’t think we have a perfect way to test.

Dr. Weitz:                            Well, I feel like with the stool test, since it usually does not come positive that when it is positive, I feel pretty confident that there is candida there if it comes up on the stool test.

Dr. Siebecker:                    I would agree.

Dr. Weitz:                            Organic acids seems to come up too often positive potentially. I’m a little skeptical. I haven’t used … I know Dr. Ilana Gurevich, she loves the candida antibodies test.

Dr. Siebecker:                    The blood one. Yeah.

Dr. Weitz:                            Yeah. I haven’t done that test though.

Dr. Siebecker:                    Yeah, I mean, I used to run them all. I can’t remember what happened, but I think I had somebody with a yeast overgrowth infection vaginally and the organic acid test, maybe it wouldn’t because maybe that’s only telling you the intestinal situation. I don’t know. Then the blood test didn’t come positive and I just thought, “Oh, this is hard.” Maybe it wouldn’t, but I don’t know. Just somewhere along the line, I lost confidence and I stopped doing them all. But I do think that to your point, what are the other things that can be IBS that aren’t SIBO?  A lot of times people have other things at the same time. Yeast is really common. I mean, I’m saying that without having a proper way to diagnose it, but it’s like because then you treat it and they get better. Then parasites also I think are very common. I mean, I’ve written differential diagnosis charts on this, and you just get tired of including things. It’s like 40-

Dr. Weitz:                           By the way, I just saw or listened to your podcast that you did with Nirala Jacobi.

Dr. Siebecker:                    Is it out? I didn’t even know.

Dr. Weitz:                           It’s out. I listened to it this morning and it was great podcast. Nirala Jacobi was really good too.

Dr. Siebecker:                    Oh, good. I really enjoyed that.

Dr. Weitz:                           You guys went through all of these different possibilities, and you made a really profound statement, which was that you find that practitioners often find what they look for.

Dr. Siebecker:                    That’s exactly right. It’s like, “Well, what are we testing for? And then what do we know?”

Dr. Weitz:                            I’m a mold expert. I’m looking for mold and I’m finding mold.

Dr. Siebecker:                    That’s right, because it’s what we choose to test for. But then, of course, what if our tests don’t turn anything up? Well, then we got to look over in the area we don’t normally look, but I mean, what are you supposed to do? Also, you can’t test for everything. People can choose their own path where they want to put their attention first. If that works out, great, and if it doesn’t, then we have to look other places.

Dr. Weitz:                            A similar question, which is it’s known that so many patients who get treated with rifaximin or herbal antimicrobials don’t get completely better after one round. Why do they need multiple rounds? Is it because we haven’t effectively reduced the microbes, we haven’t killed enough of them, or is it that they grow back? Is it because there’s biofilms and we can’t get to them? Is it because there’s layers of problems like you’re mentioning other things? So maybe they have SIBO and they have dysbiosis, and we have to correct both of those. Why do we think it takes repeated rounds?

Dr. Siebecker:                    I mean, all of that can be true. So yes, yes, yes. But I think predominantly, what my experience has been is it’s just that it’s different when we have an overgrowth versus an acute infection that we’re used to thinking of where there’s a prescribed acute infection and we know 10 or 14 days of an antibiotic is going to take care of it. Because here in SIBO, we have these levels of which the overgrowth can be and we can see the gas can be 150 or something. In another person, it’s 20. So it seems to correlate the amount of rounds with the overgrowth amount. The gas is a representation of how many bacteria are grown. So I think it just takes time. Basically, it’s thinking of a chronic infection, even though it’s not technically an infection. We treat until we get effects.

                                                We just have to keep going and going at it. So then the question is why can’t we just use one treatment and then just treat for however long it takes until it goes down? For some people, that does work, but unfortunately, what I found happens so often was the treatment would peter out. Its effect would peter out and it would stop working. You’d know because they would have had some improvement and then their symptoms would come back while they’re even taking it. So it’s like it just couldn’t do anymore. It did all it could do. So then you just stop. At that point, I would retest, but you have to switch. You use something else. Thank gosh, we have a lot of tools in our toolbox.

                                                So then that’s the next round. If a patient is sensitive enough to pay attention to these things, some people are, some people aren’t. I think great. If they’re still getting effects, you can keep them on something until it’s not working anymore. But not everyone is paying attention like that or wants to. So that’s why we need, I think, the multiple rounds. Now, what about the biofilms, anti-biofilms? I think that that’s another thing to think about for sure. My experience was that I used a lot of anti-biofilm products for a long time treating SIBO, and then I wouldn’t use them in other people. So I had a good comparison and I was only using the enzyme-based anti-biofilms and the EDTA type of products. I could detect no difference at all in anything at all.

                                                Really, my intention in using them was to try to prevent as much relapse. That’s what I was hoping for, and that was a bust. But I can tell you that Dr. Ruscio did an in-office study on that and presented this at one of our SIBO symposiums. He found that statistically on paper when using the anti-biofilms, it reduced hydrogen gas a little, but he could not detect that clinically at all. There was no clinical representation of that. It was a statistical on paper thing. So just continuing down with this story, I was just very disappointed in anti-biofilms. But then I spoke to Dr. Paul Anderson, this was years and years ago, and he’s an anti-biofilm expert.

                                                He had treated a lot of conditions with very serious infections, and he had done a lot of research and found that bismuth thiol products were very good anti-biofilms and he thought the best. Now, he has an over-the-counter option, but at that time, he just had a prescription formula. So I used that in some of my patients and I found it made a difference. Where it made the difference was in relapse. I didn’t necessarily see as much of a difference in not needing multiple rounds. I think theoretically, it could make a difference. I just didn’t observe that at the time. So I like to recommend if you’re going to use anti-biofilm in SIBO that you use the bismuth thiol. I just couldn’t see any effect for three years of using the other products.  Maybe other people have different experience, but it was a dud for me. So I would say it is definitely worth an option and maybe it could reduce. I know when you’ve had Pimentel on your show in the past, he’s talked about, and even just recently I was doing a Q&A with him, finding that some of the overgrown microbes live in a biofilm along the lining. I know you’ve asked him and I’ve asked him, “Well, then what about anti-biofilms?” I think he’s waiting until he would present research whether it would be truly effective or not.

Dr. Weitz:                            I know particularly the methanogens seem to live in this mucus layer, which is a biofilm that it’s got to be hard to get to those. We know that treating methane seems to be more difficult than hydrogen.

Dr. Siebecker:                    What has your experience been with anti-biofilms?

Dr. Weitz:                            Sometimes I think we get a benefit and other times we don’t. So I haven’t done any systematic analysis of it, but I get the impression that we get some benefit from it.

Dr. Siebecker:                    That’s good. Do you use all the different types or just the bismuth ones?

Dr. Weitz:                            Yeah, no, I use the enzymes. I often start with the enzymes and then use the bismuth ones depending upon exactly what’s going on. I’m a little nervous about using bismuth for long because it is heavy metal.

Dr. Siebecker:                    Yeah, that’s right. We talked about that before. The good news with the bismuth thiol is… Well, this is in the context of treating hydrogen sulfide SIBO is bismuth helps with that, but the bismuth thiol are a much lower dose than what has been studied bismuth for hydrogen sulfide. So I like that we can use a much lower dose with those bismuth thiol ones.

Dr. Weitz:                            Speaking of treating hydrogen sulfide, in fact, any new treatments for especially herbal nutritional for treating SIBO? The traditional antimicrobials that are used are berberine, oregano, allicin. Any new guys on the block that seem to be hitting the radar?

Dr. Siebecker:                    Well, I’d say that bismuth. I mean, that’s not really that new, but it’s worth really mentioning. Other than that, well, Atrantil, we’ve been using that for years. That’s a combo product for methane. I did a bunch of before and afters. That’s not really new, but just mentioning it, right?

Dr. Weitz:                            Correct.

Dr. Siebecker:                    I haven’t really been using anything new, but Dr. Hawrelak has reported using perilla and tincture of oregano, which we already were using oregano, but he actually was reporting that he found that that worked on methane. I had used oregano for methane. I thought it was going to give me a result, and then in the end, it didn’t pan out. So I just wonder, “Huh? Could the tincture be the difference?” Because I really never did see much of an effect from oregano for methane, but perilla is a new one for me. I haven’t used it. So he’s using that one too, but he’s using that only when the standard things aren’t doing the job.

Dr. Weitz:                            Then some of the products have oregano and they also have thyme. The thyme oil seems to be… I find sometimes very beneficial.

Dr. Siebecker:                    Yeah, I mean, that’s a potent.

Dr. Weitz:                            It’s potent. Yeah.

Dr. Siebecker:                    The one problem with that is like what’s in the CandiBactin AR, but the one problem with that is if you’re using CandiBactin AR and BR, that’s great. You’re using berberine and oregano, which is our classic thing that we always use for hydrogen, but there’s nothing in there for methane. So always remember you have to add something in for methane, which would be the allicin-

Dr. Weitz:                            Like allicin.

Dr. Siebecker:                    … or the atrantil. Yeah.

Dr. Weitz:                            Right, absolutely.

Dr. Siebecker:                    If you have hydrogen sulfide, you add in bismuth. We also found high-dose oregano works good for hydrogen sulfide, but you’d probably want that separate then.

Dr. Weitz:                            Right. There are so many patients in this country right now taking GLP-I agonists like Ozempic for weight loss. We know that the way this works is by slowing GI motility. So when all these patients are done, when they’re now suffering with POS, that’s what I call post-Ozempic syndrome. Now their weight is ballooning up because they never changed their diet. Are we going to have a tsunami of patients with SIBO? By the way, I asked Dr. Pimentel about testing patients with Ozempic, and he said, “It’s just a nightmare. Their microbiome is so messed up.”

Dr. Siebecker:                    He said the same thing the other day when I was interviewing him also, I asked him the same question. I wanted to know what he thought. What is he seeing? Yeah, he said, it’s really hard to test it because nothing leaves the stomach. Dr. Morstein had said she is testing… Because she’s a diabetes expert, and she had said she’s testing patients the morning of the day they were going to do their next dose. So it’s like it’s been a week since they’ve taken their dose and on that morning, and she says it’s going fine. I asked Dr. Pimentel about that, because when you look at the studies, it takes weeks before the medicine becomes steady state or leaves the body.

Dr. Weitz:                            So Mona is giving him a SIBO test?

Dr. Siebecker:                    Yes.

Dr. Weitz:                            Okay.

Dr. Siebecker:                    Yeah, yeah, a SIBO test. Yeah. So my concern is, is that enough time? She said, “That’s working for her,” but Pimentel said, “Well, no, the reason you give the dose on seven days before it gets too low, you don’t want people bottoming out.” So he has a very hard time getting accurate results testing anyone on Ozempic. To your point, yeah, there’s a real concern that people could develop SIBO. Of course, we have no data on us at this time, but it’s a real concern. The thing that it seems to do is slow the stomach. Does it also slow the small intestine?  I think so. But the stomach itself, the migrating motor complex, one of the forms or I guess one of the types of migrating motor complex starts in the stomach and continues through the small intestine. That is, from what I’ve read, the more powerful migrating motor complex. That’s our protective wave. That’s our number one body’s protection against SIBO is the migrating motor complex in the small intestine. So I believe it will turn that off. So it’s a real concern. It’s a real concern.

Dr. Weitz:                            Does the motility come back to normal typically with patients once they stop Ozempic?

Dr. Siebecker:                    I don’t know. I don’t know that. I don’t know if anyone’s looked at that. I bet you there’s people that could report about that just in their sensibilities, but I would think it would. Because when you hear about people’s hunger comes back after they get off.

Dr. Weitz:                            That’s why we tend to gain weight again.

Dr. Siebecker:                    On the other hand, you have to weigh it out against what someone’s facing. I would never want anyone to have SIBO, good lord, but diabetes can be fatal. So it depends on how much it’s needed. I guess also how it’s affecting that person. I know there’s people doing things with compounds where they’re going much lower and still getting good effects on blood sugar and things like that, but these are early days, but it’s a real concern. One thing I want to share that I heard from one doctor who said about the people gaining weight afterwards is that what they’ll do is they’ll just give people a much, much lower dose and help them to hold their weight for… If I’m not mistaken, I think she said one or two years.  It might’ve been two, because that’s how the body sets its set point. So if you could hold that, your goal weight or whatever for one or two years. I’m sorry, I don’t remember exactly. This was an expert on this, a doctor, and then they’ll take people off, but they’ll put them way low. That was a fascinating thing to hear about, just to try to work against that problem.

Dr. Weitz:                            One more question on the treatment, a lot of functional practitioners, some of them will also incorporate an immunoglobulin product as part of their SIBO protocol. Some do it specifically because I tend to use it when I see that the secretory IgA is low on the stool test, but some will use it all the time automatically, something like SBI Protect or MegaMucosa. These are also known to bind with the endotoxins and potentially might help with the eradication.

Dr. Siebecker:                    I think it’s a great idea. I love serum bovine immunoglobulins, or for people who are vegetarian, they can do colostrum that has high IgG. I love it. I spent some time really looking into all the studies and just as you said, excellent for LPS. It has straight antibacterial properties. It can prevent food poisoning. I had an experience where I was traveling in Mexico, my husband and a group. We took it the whole time and we didn’t get food poisoning when the other people in our party did.

Dr. Weitz:                            Oh, interesting, because that question comes up a lot is I’m going to Mexico or wherever I’m going and I want to try to avoid getting food poisoning again. Dr. Pimentel’s answer is just to take antibiotics.

Dr. Siebecker:                    Take a half a pill of Rifaximin is what he recommends. I’m not sure that what I did is enough for everybody. What other colleagues will say is take one Allimed pill or two Allimed pills.

Dr. Weitz:                            Yeah. I’ve had patients take one Biocidin.

Dr. Siebecker:                    Yeah, yeah, yeah, things like that. But this worked for me and I was so grateful. It does a lot of amazing things. I mean, it can help with lipids, the IgG. I mean, it’s just so important, anti-inflammatory. It’s expensive is the problem, but I think if someone can afford it, it’s a great thing to have on board for so many reasons. Not just SIBO.

Dr. Weitz:                            What about the use of probiotics for SIBO? A number of practitioners use probiotics. We both know one prominent practitioner who says that’s the first line treatment. Everybody should get three probiotics, Lacto bifido, Saccharomyces boulardii, and a spore based. Some practitioners feel spore based is good because it won’t add to the bacteria in a small intestine. They’re concerned that even giving antimicrobial herbs or antibiotics, we might damage the microbiome. So why don’t we try to beef up the microbiome at the same time? And then we have Dr. Hawrelak who found specific strains like Lactobacillus reuteri, DSM 17938 that reduces methanogens.

Dr. Siebecker:                    Yeah. Okay. So here’s the deal. It’s all good. Then of course, we didn’t mention this. I think still Dr. Pimentel is not a fan of probiotics.

Dr. Weitz:                            Not at all, but part of the reason he’s against probiotics is because of all these meta-analyses that lump in all these different studies on probiotics, and they’re all using different probiotics. They don’t even report on which particular strains. You certainly wouldn’t throw in all antibiotics and say, “Antibiotics are effective for SIBO.” You test a specific one, and here we’re throwing in all these probiotics as if it doesn’t matter which strains and how much of each. Then we go, “Oh, probiotics work.” So he has a problem with that.

Dr. Siebecker:                    I would agree. That is a strange thing, isn’t it?

Dr. Weitz:                            It is.

Dr. Siebecker:                    Okay. So we’re fortunate in that we have a whole bunch of studies on probiotics and SIBO. I mean, right now, I haven’t counted recently, but there should be about 35, maybe even more than 35 studies, which is a surprise to a lot of people that there’s that many. There’s been reviews of these. The most recent one was I think 2017. So this gets quoted a lot, and it’s really astounding what it showed. It showed like a 53%, even with some products, actual eradication rate of SIBO. So this gets everyone excited. Oh, my God. Can I use probiotics for my main treatment of SIBO? The issue with these studies is a lot of them, and let me just preface, here’s the problem, is that clinically, it’s pretty rare for any of us to see those types of results. That’s frustrating.  We want to see these results. Even if you go out and you get the exact same product that was used in a study that had a fantastic decontamination rate, we don’t get those same results. It’s really frustrating. So one thing is that a lot of these studies were small. A lot of them were done on certain conditions with certain age groups. Just as an example, pediatric short bowel syndrome. That may not translate to an adult with IBS SIBO, who doesn’t have an altered anatomy. So maybe that’s what some of the differences, but one way or the other… There haven’t been any duplication studies on any of these.

                                                Maybe that’s why we’re having a clinical difference, but the evidence in the studies is excellent. Certainly, it shows that probiotics can lower gas levels, can lower symptoms, and may even be able to eradicate SIBO. What probiotics? In these studies, just as you said, for the general IBS studies, they use every different type, all different kinds of lactobacillus, all different kinds of bifidus, all different kinds of spore bacterias, and Saccharomyces boulardii. Here’s the thing, all of those different types showed benefits. As you mentioned, Lactobacillus reuteri, everyone says it different. That was amazing for methane. I think it’s like 55% at eliminating methane, but that same strain has been studied to help diarrhea.  So we think of methane with constipation. That same one was also studied, showing reduction of SIBO when you’re on a PPI. So really, really interesting. Bacillus clausii, the spore has excellent studies for hydrogen. Then there’s a lot of studies on combinations where they use yeast and lactobacillus and bifidus or spore and everything. But what are we supposed to do when we try it and then it doesn’t work? So basically, the study also for IBS, they’re pretty good too. I think it’s fine. A good idea to try probiotics, first line, I guess you have to decide where you are in the patient in the journey, because first line, I think that’s a great idea for someone who’s having digestive trouble.  But if they’re suffering with really bad symptoms for really long time, you may not want to do that first. A lot of the studies show that it takes three months to get these results. Well, if someone’s in real acute distress, we may not want to wait that long. So it probably depends on the circumstance. For some people, I think it would be a great first line. I think it’s a great thing to throw in and try at any point. I personally like to try probiotics before I’ve gotten somebody all the way better and they’re all perfect.

                                                I know that what most of our training is the four Rs, and you do the probiotics when you’re done at the end. I did that in the beginning when treating SIBO and I had a lot of problems because of all these multiple rounds that I needed to do, it could sometimes relapse and it would take me a while to get someone all squared away. It might take me a year and then I give them probiotics. It’s like I rock the boat and they would oftentimes have a bad reaction. I don’t want to rock the boat when it’s all good. So I like to start them on probiotics during treatment, or at least before I’m all finished with everything. People have a different ideas about that, but I just think if you do it, then if somebody has a reaction or something’s not right, you have time to fiddle.

                                                You’re in the middle of using antimicrobials. So then which ones? I don’t know. So many different ones seem to have worked in these studies. That’s probably why Dr. Ruscio likes to give those three all three together just in case cover all your bases. The problem also that I didn’t mention is that many people have a bad reaction to probiotics. So that’s where it is probably a good idea to make sure you’re trying the different ones. It might not have a bad reaction to yeast or to spore if they had Lactobacillus.  A lot of people have histamine intolerance and then there’s all people talk about, “Oh, well, there’s some probiotics that are safe for people with low histamine producing,” but then even they can still react. Dr. Hawrelak generally recommends bifidus for people who are sensitive to histamine, but probably that’s going to be very individual. I mean, we know how an individual it is with histamine sensitivities. So that’s an issue too, is that a lot of people can’t handle them, but then they may be able to handle them as they move along in their treatment. So that gets us going on the topic. So tell me what you think.

Dr. Weitz:                            So I was trained with the four R protocol from going all those seminars with Dr. Bland for all those years. I really do miss those. I used to listen to his functional medicine update. We used to get these little cassette tapes and then they were CD of DVDs we would put in the car. Anyway, so I started off doing a four R and then I decided to start adding in probiotics as part of the protocol because I wanted to make sure I didn’t damage a microbiome. That wasn’t really working.  So I went back to the four R program, and it’s a two-phase thing, which is we do the eradication first. Then when we feel like we’ve got the symptoms under control, we start microbiome restoration, rebuilding the gut, rebuilding the gut wall, and use those products. I usually start with the spore-based probiotic. That seems to be the safest. Then gradually expand to other prebiotics, probiotics, and at the same time, we’re slowly expanding the foods that they can eat as well.

Dr. Siebecker:                    That sounds great. So that’s gone well. You haven’t had too many reactions with that.

Dr. Weitz:                           Yeah, that seems to work pretty well, especially when the patients comply.

Dr. Siebecker:                    I mean, my problem is that I saw extremely sensitive patient population, and even the spore ones were… I mean, I used to make a joke about a very popular spore-based combination probiotic, and I said, “It should just be relabeled die off because my patients would react so intensely to it.” But that’s just the sensitive group. So it’s good to hear that your patients are tolerating that well.

Dr. Weitz:                           I know Pimentel had a negative report about lactobacillus.

Dr. Siebecker:                    Well, yeah, they found in one of their studies when they were really assessing what was overgrown in the microbiome, and then they figured out this new assessment for an imbalance or dysbiosis in the small intestine microbiome where they identified disruptors, basically certain bacteria that if they would get too overgrown, they would disrupt the entire ecosystem. They classified lactobacillus one of them. It was just this one little sentence in one of these studies, and we all noticed it. We all started asking about it, and that’s all they can say. They haven’t said anything else.  So all these years following this research as it comes out, I don’t get too excited about one thing or another. I just wait until more information comes out. I mean, look, we’ve been using lactobacillus in our patients forever with good results, unless they have a reaction and then we don’t use it. I’m not worried. We’ll just see what the research shows in the future. Maybe there’ll be some very specific things, but otherwise, I’m not going to worry about it.

Dr. Weitz:                           I was reviewing some of Pimentel’s recent papers, and one of them was the one where he looked at the methanogens and hydrogen sulfide producing bacteria. There’s this interesting information, I wonder if we have anything to do with it, which is that there’s certain bacteria that produce the hydrogen to feed the methanogens. So we have Ruminococcus, Christensenella, and then we have these Enterobacteriaceae that feed the hydrogen sulfide bacteria. It seems like something important, but is there anything we can do with that?

Dr. Siebecker:                    Yeah, this is key. These are the syntrophys. So this is basically what is creating the hydrogen for methanogens or hydrogen sulfide. They call them the syntrophys. What’s really amazing about this is that I and they, everyone just assumed it was the overgrown standard hydrogen bacteria, E. coli and Klebsiella. So we thought, “Okay, we’re aiming at that.” So basically, this is a new target for our treatment, and I haven’t actually spent time going through PubMed looking at various articles on what kills those things, what MIP levels. I haven’t done it yet because what we have works. So we’ve been using it for so long of all the before and after tests.

                                                We already know it works, but what I think is going to happen is, well, I know they’re doing research on it, Pimentel and Rezaie and all that. I think they might have something at this DDW, which is the big gastroenterology conference that happens every year in the spring. So 2024, I think they might have, we’ll see, some treatments to reveal aimed at those. If it’s not this year, it’ll probably be next year. I’m so glad you brought it up. I think that this is going to be the wave of the future. We probably get more specific at targeting when we’re treating methane and hydrogen sulfide, what treats, what aims at those syntrophys. Then they had a paper that came out in December and I don’t have all these organisms memorized, but they had this sequence now where it’s like this leads to this leads to this. It was like a further piece.

Dr. Weitz:                            Really?

Dr. Siebecker:                    Yeah. So sorry I didn’t bring it up in front of me or I could read it to you. For anyone who’s interested, I do a quarterly newsletter. You could just sign up at SiboInfo and I put all the research and I put comments. So I put a big thing all about it, because it was really fascinating. I have yet chance to speak to Dr. Pimentel to ask him to publicly to explain this, because that seems like another target actually. They’re just learning more and more of the specifics of what is overgrown. The whole point is this is going to refine our treatments.

Dr. Weitz:                            Right. Yeah. I’ll make sure to review that next time before I talk to Pimentel. I think they dropped the statin for methanogen.

Dr. Siebecker:                    He’s still working on it.

Dr. Weitz:                            Oh, he’s still working on it. Okay.

Dr. Siebecker:                    Yeah, he hasn’t fully dropped it. It was a disappointment, but so for anyone who doesn’t know, he was working on enterocoded, not exactly like a statin that wouldn’t absorb into the blood. So that you wouldn’t get all those other effects. Statins, it works like Atrantil. It inhibits methane production. It actually disrupts an enzyme in the methanogen, so they can’t make methane. So this was another way to treat, but it just didn’t give them the results they wanted, but they are still working on it.

Dr. Weitz:                            I wonder if any natural practitioners are using red yeast rice for the same purpose.

Dr. Siebecker:                    Oh, yeah. We asked Dr. Rezai about that, and then he said that in a few patients it does work and then in others it doesn’t.

Dr. Weitz:                            Oh, interesting.

Dr. Siebecker:                    Yeah, exactly. That’s all the first thing we think about. Could we just use red yeast rice for this, like an alternate? Atrantil does the same thing.

Dr. Weitz:                           Okay.

Dr. Siebecker:                    Yeah.

Dr. Weitz:                           Interesting.

Dr. Siebecker:                    Actually, I find Atrantil to be very hit or miss, probably just like red yeast rice. It’s in some people it hits like a miracle.

Dr. Weitz:                           Are you using a recommended dosage or are you using a higher dosage?

Dr. Siebecker:                    Using four to six a day.

Dr. Weitz:                           Oh, I think the recommendation is two a day.

Dr. Siebecker:                    Oh, yeah. So yeah, two is what we use for maintenance. Once you get your effect, then anywhere from one to three as your maintenance, because you still need to keep inhibiting that enzyme. Keep inhibiting the methane production.

Dr. Weitz:                            So you’re doing two or three twice a day.

Dr. Siebecker:                    Yeah, that’s right, for standard treatment round for a month. But here’s the thing, I’ve seen before and afters where that just works like a normal herbal antibiotic lowering methane in the same way you would expect, but there’s also these miracle cases that sometimes happen. The real miracle cases that I see are probably going to either be with Rifaximin or Atrantil and then they don’t work like that for the majority, but you get these miracle cases. You always remember them. But what will happen is for some people within just a few days, usually within four to five days, the Atrantil just has removed all constipation just completely. I mean, people in their 70s constipated for they’re entire lives gone in four days.

Dr. Weitz:                            Wow.

Dr. Siebecker:                    But then I find that the miracle, if it’s going to be a miracle like that, it’s usually pretty quick. My frequent educational cohort, Shivan Sarna, she interviewed Ken Brown. She interviews him a lot. He’s the creator of that. He said that he’s seen miracles happen months on. I haven’t. Usually, when you’re doing it for me, when I see him doing it over months, you’re just getting those incremental reductions in gas like you would anything else. I don’t consider that a miracle.

Dr. Weitz:                            Yeah. I haven’t seen any miracles.

Dr. Siebecker:                    Complete and fast. So maybe red yeast rice is the same. It’s like either it works or it doesn’t. That one particular approach I find is a bit more hit or miss.

Dr. Weitz:                            Right. If it lowers your cholesterol at the same time, probably not a bad idea.

Dr. Siebecker:                    You can get other benefits.

Dr. Weitz:                            Have you used any peptides? Some people use BPC 157 supposedly to help heal the gut lining, to help heal leaky gut.

Dr. Siebecker:                    I haven’t used it in patients, but when I found out about it years ago, I was enthralled and I brought in a whole bunch of people to interview for various summits and educational events, Dr. Bar and others speaking.

Dr. Weitz:                           I know he was using it a lot.

Dr. Siebecker:                    He was, speaking very favorably about it. I mean, when you read about it, it seems like a perfect match. Again, it’s expensive, right? I’ve heard some people say it was wonderful for them and not much for others. So I don’t have a ton of experience with it. I was very interested. Did you try it a whole bunch?

Dr. Weitz:                           No, not a whole bunch because of the expense. If I already have patients on four or five different products and then you throw in a product that’s $150 to $300 for a month’s supply-

Dr. Siebecker:                    It’s a lot.

Dr. Weitz:                           It’s a lot.

Dr. Siebecker:                    Yeah. I haven’t heard enough feedback to make me think that’s worth it full bore for most people.

Dr. Weitz:                           When I’ve used it, I found around four capsules a day was about the right dosage, but that means you’re going to go through a bottle in two weeks, so that’s 300 bucks a month.

Dr. Siebecker:                    I mean, I tried it on myself. I always try everything almost, and it was meh, but that’s one person.

Dr. Weitz:                           Yeah, I know. I use it for healing for musculoskeletal injuries as well. I wouldn’t say I’ve seen a lot of miracles, but there seems to be some benefit.

Dr. Siebecker:                    Yeah, and I guess I’ve heard some cases that responded really well.

Dr. Weitz:                           Right. All right. This has been awesome, Allison.

Dr. Siebecker:                    We talked about a lot of different things.

Dr. Weitz:                           We did. Thank you for being so generous with your time.

Dr. Siebecker:                    Oh, it’s been such a pleasure.

Dr. Weitz:                           Tell the viewers about some of your courses and how they can sign up for them.

Dr. Siebecker:                    Oh, yeah. I have a bunch of trainings. If anyone’s interested in learning more about SIBO, I have a full length SIBO training, very comprehensive, 22 hours, got mini trainings on SIBO and testing. I’m doing a testing masterclass here soon. You can find all of this on my website, siboinfo.com that has a lot of information. Of course, signing up for my newsletter. I always send my quarterly newsletter has all the studies. If there’s ever any treatment updates, like in the January one, there was different antibiotics that people are using. I put that in there. So anyway, I’d love for anyone to join me for a training.

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

Dr. Siebecker:                    Thank you so much, Ben.



Dr. Weitz:                            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. So many areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, autoimmune diseases, cardio metabolic conditions, or for an executive health screen.  To help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way, please call my Santa Monica Weitz Sports Chiropractic and Nutrition Office at 310-395-3111. We’ll set you up for a new consultation for functional medicine, and I look forward to speaking to everybody next week.



Bioidentical Hormone Replacement Therapy with Christopher Shade: Rational Wellness Podcast 358

Dr. Christopher Shade discusses Bioidentical Hormone Replacement Therapy 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

*Use the discount code weitz15 for 15% off Quicksilver products.

2:02  Quicksilver Scientific offers topical estrogens and progesterone over the counter because the FDA allows topical cosmetics to include hormones below a certain concentration, including an estadiol, estriol, biest, progesterone, DHEA, and a product called DHEA Plus female replacement serum that includes DHEA, pregnenolone, DIM and chrysin to hold back estrogen formation and increase estrogen breakdown, and then some adaptogens, including ginseng, maca, and dong quai.

3:51  Most transdermal cream formulations of hormones are not well absorbed, which is why some Functional Medicine doctors have been using saliva testing to measure hormones. But this may not be because serum or urine are not good at detecting these hormones, but that they simply don’t get absorbed through the skin. When you look at these hormone creams under a microscope, you see big chunks of the hormone that’s never been dissolved, while if you examine the Quicksilver topical hormones, they are dissolved into the oil phase in the center of the emulsion droplets. And then when you put those on, they go all the way through and you can pick them up in the serum. But Dr. Shade pointed out that when you measure estrogen in serum with women using topical hormones, you see levels go up and then down and then up and down as their bodies pull the estrogen into various compartments in the body.  He has found that urine is therefore the best way to measure hormones, such as through a DUTCH test, since you can pick up the fluctuations in hormone levels that occur over the course of the day.

7:50  DHEA.  If you look at androgens in women, like DHEA and testosterone, then these are picked up really well in serum. Quicksilver offers a DHEA product for women with 100 mg of DHEA, which is usually considered a high level for a woman to take, but Chris points out that since they use a nanoparticle delivery system, you’re bypassing the liver and you get way less incidence of the hair growth, hair loss, or acne that women sometimes get from high levels of androgens.  Interestingly, while DHEA converts into testosterone in women, in men it doesn’t convert into testosterone.



Dr. Christopher Shade is the founder and CEO of Quicksilver Scientific, which has revolutionized the nutritional supplement industry with their innovative nanoparticles and liposomal delivery system, their heavy metal testing, and their detoxification protocols that have become the standard for many for reducing heavy metals and mycotoxins.  The website for Quicksilver Scientific is QuicksilverScientific.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, I’m excited to have another interview with Dr. Chris Shade, and today we’re going to be speaking about hormones and hormone receptors. It’s really interesting to think about hormones, and we often don’t think about hormone receptors. We know that there’s lots of potential benefits of taking hormones if they’re needed.  However, if those hormones can’t attach to hormone receptors and those hormone receptors aren’t functioning optimally, then those hormones can’t do the things that they’re supposed to be doing. We’re not going to get the full benefit out of them. Dr. Chris Shade is the founder and CEO of Quicksilver Scientific, which has revolutionized the nutritional supplement industry with their innovative nanoparticles and liposomal delivery system.  Their heavy metal testing and their detoxification protocols have become the standard for many in the functional medicine world for reducing heavy metals, mycotoxins, and environmental toxins. Quicksilver has now added a slate of hormone products as well, as their nutraceutical line of products has become broader and broader. Chris, thank you so much for joining me again.

Dr. Shade:           I’m happy to be here, Ben.

Dr. Weitz:            This is great. I think this is our fifth interview, and I love our discussions because you’re such a deep thinker, and I love diving deep into physiology and science. I was actually surprised to see what that Quicksilver was offering a topical estrogen product, because I assumed that it would require a prescription. So tell me about that.

Dr. Shade:           So does everybody. Lo and behold, I started seeing some estrogen creams and progesterone creams out there. We could go into a Vitamin Cottage and get it. And so I asked my FDA lawyer like, “What’s going on with all this?” And turns out, topical cosmetic laws allow hormones up to a certain concentration. We make a really good nanoserum. And at those concentrations, this stuff works. It goes in and you get circulation.  And it’s able to go in and do bioidentical hormone replacement for you. So we did a estradiol, estriol, biest, and progesterone, and then we have for all the androgens, we have something called DHEA Plus female replacement serum, and that’s DHEA, pregnenolone, with DIM and chrysin to hold back estrogen formation and increase estrogen breakdown, and then some adaptogens, ginseng, maca, and dong quai. And so that together you totally have women covered.

Dr. Weitz:            It’s fascinating. So the dosage, if it’s below a certain amount of estrogen, that it’s allowed?

Dr. Shade:           Yeah, yeah. Some of these creams that have… I think everything’s below 2%. And there’s some creams out there have like four or 8%, and so those have gone past those laws, but all of ours are in the legal range for hormones in topicals.

Dr. Weitz:            Now, one of the interesting things is it’s common in the functional medicine world to feel that serum testing doesn’t really pick up transdermal estrogen. So it’s become common to use saliva testing with the idea that saliva testing is better at picking up transdermal hormones. But I spoke to Mark Newman of DUTCH Testing and he did some research. His research shows that the compounded transdermal estrogen products are just not well absorbed.  And the fact that people are not picking them up on serum is not because serum is not a good way to test for it, because they’re not really getting absorbed. So it’s interesting that I’ve heard you talk about these creams and how these products, it’s an issue with getting them absorbed. He found that the FDA approved patch had more consistent results upon testing. But maybe it’s just a case that these typical transdermal creams, compounded creams are just not well absorbed.

Dr. Shade:           Yeah. I mean, that’s really what it is. When you look at what a cream is, in fact, the best way to do it, and I have some pictures of this, is to look in the microscope. I have this little swanky microscope here for blood analysis. And you put a cream on there and you see all these chunks in there. You see the bubbles of the emulsion, and then you see these big crude chunks of all this hormone that’s never been dissolved in there. And that’s why they’re big on micronized because the smaller they grind it up, little bits of hormone dissolve into the cream off the edges of these little chunks.  But most of it is staying on the skin is these chunks. Now, what does go in gets into lymphatic circulation and shows up in the saliva and you can get a number there. Now, if you put ours, you put it under the microscope, it’s just totally transparent because the light microscope can’t pick up the emulsion and there’s no particles of hormone left. They’ve all been dissolved into the oil phase in the center of the emulsion droplets. And then when you put those on, they go all the way through and you can pick them up in the serum.

                                It’s just a little funny in the serum. When we do the uptake studies with women, it’ll go up, it’ll go down, it’ll go up, it’ll go down. If you want a real good one, you use me or a guy and you see estradiol go up and flatten out and then eventually come down. But women are pulling it into all these compartments. So what we found is the best thing for looking at is like a DUTCH or RINE is the predecessor to DUTCH, and you get that 24 hour and it’s like bringing together, integrating that whole 24 hour period and you see all the hormones in there.  Most importantly, people’s symptoms go away. And when we get to talking about hormone levels versus receptor levels, you see why we do use analytical tools, but we’re not relying on them totally like, well, you have to be at this level and that makes you okay, because every person is different where they feel good and what their dosages are to make them feel good. And so actually getting them to the right dosage isn’t all that hard. You want to measure them before.  And then when they’re feeling good, get an idea for what those levels are. But levels aren’t gospel, again, as we talk more about the integration of the hormone level and the receptor level.

Dr. Weitz:            On the other hand, it’d be nice to do a test to see how well a woman’s level go up when they use your product.

Dr. Shade:           If you’re looking at the androgen side, like the DHEA and the testosterone, just do serum. Boom. I mean, the DHEA just rockets up there. It goes super physiologic. But that’s fine with DHEA. DHEA has never really shown to have a bad upper side unless people start getting some acne. It’s amazing when you do this nanoparticle delivery, you’re bypassing the liver and there’s way less incidence.  The women who are hyper prone to acne might have it, but most women don’t have any hair growth, hair loss, or acne because you’re not putting this bolus of DHEA through the gut and into the liver and making all of these androgenic metabolites. And then if you’re doing a pharmacokinetic study and you’re watching the DHEA come up in the blood, you’ll watch the testosterone in lockstep with it come up. So you’ll be super physiologic in DHEA and testosterone will be up at the high end of the reference range.

Dr. Weitz:            That’s in women, right?

Dr. Shade:           In women, in women, yeah, because men don’t turn DHEA into testosterone. It’s like the forbidden fruit for us. I don’t know why that is, but it doesn’t happen. In fact, when you take ours, if you’re not supplementing testosterone by say injection, then your DHEA will go up and your testosterone will actually go down a little bit and then come back up because there’s so much signaling of the DHEA at the endogen receptors that you actually down regulate your testosterone production.  Now, if you’re doing injections, then DHEA will just ride up and you’ll have a real high DHEA level. But then back to the women, you’re going to figure out, do you want a half dose, full dose and just figure out where they feel best. If you get them a little too high, they get a little bit aggressive, and you just bring that down. So again, you’re working with their symptom load. So that you can watch serum. When you’re working with progesterone and estradiol, you can see it in serum, you can work serum, but it’s a little bit better in urine.

Dr. Weitz:            You brought up your DHEA product, and I was surprised to see the dosage that you have in the DHEA. Because the interesting thing about the Quicksilver products is one criticism sometimes people will make is, oh, the dosage is so low. And the answer is, well, because of the delivery system, it’s better absorbed, and that dosage will be effective. So I was surprised. Normally, when I recommend DHEA for women, we’re typically talking about 10 milligrams, and you have 100 milligrams in your product.

Dr. Shade:           And why do we do 10 milligrams? Because people get symptomatic above that. 25 and they’re getting acne, they’re getting hair growth, but it’s not really driving their testosterone up. Maybe they go from 10 to 25, like ooh, and their DHEA is running at 200. But really you want it smoking, DHEA real high. DHEA is a major metabolic thing. It’s fantastic for the brain. It’s great for libido. And so having that up in the 600 level and the testosterone in a 60 to 100, depending upon what your dosage is, people just do freaking great. They feel fantastic.

Dr. Weitz:            So the benefits of DHEA, in your opinion, the main benefits are what?

Dr. Shade:           Cardiometabolic, really strong there. So all these women that are doing weight loss and stuff, the cardiometabolic aspect is really good. Brain, it’s super good. It’s a good mitochondrial benefit. And it’s real strong on the androgen receptors alone and the testosterone that it makes. In fact, DHEA is interesting. It’ll get androgen and estrogen receptors.

Dr. Weitz:            It’s interesting. It seems like 10, 15, 20 years ago, DHEA was being touted as one of the main longevity products. And the first study that reversed epigenetic aging, the Fahy study, that included DHEA. But lately people have forgotten about it and nobody’s really sure if it really does much. I’m wondering maybe if we’re not using enough dosage.

Dr. Shade:           Not doing enough. Those low dosages just don’t move the needle. I mean, my friend Lauren Bramley is this great hormone doctor, and she talks about the personality of hormones. And she talks about DHEA dominant people. I’m a DHEA dominant people. I would run four to 500 when I was younger, just all the time, just smoking high. And those people are hyper intelligent, and they go and they do stuff. They’re action oriented. They’re funny. They’re handsome. Wait, am I just talking about myself?  They tend to be intelligent, witty, and fun and inventive people. And that’s not 100 to 200. That’s 400, 500. You’re not going to get people running at those levels with these little doses. I mean, because you see people who have really low DHEA and it’s like 40, 50, 60, and I cry when I see that. You give your 10 milligram pill and maybe they’re at 150, but they’re not going to run where we are. And that’s really I think where the game changers are. And I would like to do an epigenetic study, get the true diagnostic stuff out again, and just have women on our whole hormone system.  I mean, don’t even leave it at just DHEA. All of it at once. I swear that’ll go backward or slow the rate of aging because you get into menopause, those hormones drop off. Your age just accelerates.

Dr. Weitz:            To go back to estrogen, in terms of estradiol, estriol, some of the data seems to indicate that most of the action really comes with estradiol.

Dr. Shade:           Well, I would say no. Totally it depends what action you’re looking for.

Dr. Weitz:            Well, I know it’s common to be combined estradiol with estriol.

Dr. Shade:           With the biest, and I’ll tell you why.

Dr. Weitz:            With the biest, right?

Dr. Shade:           I think it was just never conveyed correctly how this all works, because it’s like, oh yeah, for brain, for cardiovascular, for bone, estradiol is what moves the needle. Estriol doesn’t really do anything. But for UTIs, for vaginal atrophy, pelvic floor strength, estriol does the same as estradiol. Now, why is all this? There’s two estrogen receptors, estrogen receptor alpha and estrogen receptor beta. Estrogen receptor alpha has estradiol is really strong on and estradiol does nothing on.  And that’s the one that rules brain, cardiovascular, and bone growth, and a couple of other things. It’s also the one with the breast tissue that is more proliferative or more prone to being proliferative. So it’s the one we worry about if we have gene SNPs that predispose us to breast cancer, we have a family history. If we all have these markers of it, then we’re worried about estrogen receptor alpha and estradiol’s effect with it. Now, the other one is estrogen receptor beta. Estrogen receptor beta is all through the urinary tract, the vaginal tract, the whole lower 48.

                                And it responds really well to estriol and estradiol. The first time I was introduced to it, this woman, Mary Cohen, who treats all these breast cancer cases, was like, oh, you’ve got to have estriol alone and not compounded so we can really lay on it. And all these women who are breast cancer survivors, I can lay on that and they’ll get all the benefits because it’s that incontinence, UTIs, and vaginal atrophy is vaginal dryness, it’s thinning of the vaginal walls, it’s thinning of the tissue and the vulva, and it’s just the aging of that whole area.  And they can lay on estriol. And estriol has no effect on estrogen receptor alpha. And in fact, estrogen receptor beta has some counter effects to alpha in being anti-proliferative. So the two actually balance each other out. And in the body, you make estriol in your liver from estradiol and you pee it out, and that’s how it’s hitting all those receptors. And so estriol has a great application in the whole pelvic floor dynamic. And in our system, we advise applying it vulval. And the women are like, oh my God.

                                It’s like reversing the age, reversing vaginological age. The tissues change vastly. And that’s all the tissues down there change and they just go back in age, and all the women who are doing it just freaking love it. Now, you still need estradiol or you get… Perimenopausal, we have you start estriol, and then start bringing in estradiol as you go menopausal. Because when you go to hot flashes, you need the estradiol. And again, long-term, bone, cardio, brain, you need estradiol.  But you can just get the estradiol up high enough where you’re not flashing. If you’re in serum, you want to get north of 30, in the 40 to 50 range. I know a lot of people like to keep it up with pellets and stuff 80 and 100, but I’d like to just keep that right where you need it to be and really lean on the estriol. So there’s definitely a place for both of them.

Dr. Weitz:            I know that rhubarb extract that Metagenics came out with a number of years ago that hits the beta receptor seems to have some effectiveness against hot flashes.

Dr. Shade:           Okay. That’ll be interesting. I’ll look that up.

Dr. Weitz:            That’s their Estrovera product.

Dr. Shade:           Okay, I’ll check that out. Now, look at other things that work on the hormone system. You look at the really bad things like plasticizers. All the endocrine disrupting chemicals that cause cancer, they affect estrogen receptor alpha. Then we’re worried about anything that’s a phytoestrogen. We think, oh my God, oh my God, we’re going to get cancer. But most of those things, the soy extracts, ginseng activates or… Well, ginseng increases activity of estrogen receptor beta, and all these others that are phytoestrogens act on estrogen receptor beta.  So we have to look at this. We have to throw away our fear. We got to throw away all this stuff from the Women’s Health Initiative, which was absolutely designed and interpreted wrong. What they thought was estrogen leads to an increase in all-cause mortality, it actually led to a decrease in all-cause mortality. And any person who had cancer who had estrogen before had a higher survival rate and had lower cancer rates overall. And so we got to get away from all that fear.  We still got to respect it with respect to breast tissue and uterine tissue. We got to get away from the fear and know the beta versus alpha story.

Dr. Weitz:            And you still got to avoid synthetic progestins.

Dr. Shade:           Oh, yeah, yeah.

Dr. Weitz:            And oral estrogen.

Dr. Shade:           The whole antithesis to the estradiol effect of proliferation, well, part of it is from estrogen receptor beta, but a big wad of that is from progesterone, which is antiproliferative. And so you can’t use synthetic progestins because they don’t do that at all. Now, let’s first define something, synthetic hormones versus bioidentical hormones. Absolutely bullshit statement. All bioidentical hormones are synthetic.  This whole yam derived, like you go and you get four billion yams and you’re somehow about to get some estradiol out there. There’s no god-damn estradiol in a yam. All right? This stuff called [inaudible 00:20:36] it’s a precursor to making hormones. And so all hormones start with maybe a naturally derived precursor, and then they’re synthetically created into either a bioidentical or a non-bioidentical. And so this is where we trip ourselves up with length.

Dr. Weitz:            So instead of saying synthetic versus bioidentical, we’re talking bioidentical versus non-bioidentical.

Dr. Shade:           Bingo!

Dr. Weitz:            Like conjugated equine estrogen.

Dr. Shade:           Oh, yeah, yeah. I mean, that’s one of the big ones. I mean, Premarin had some bioidentical estradiol in there, and then they had all of these equinones or something, equines. They’re horse equilines. I forget the name, but they’re horse hormones. And you don’t even have enzymes to break them down. They’re finding these horse hormones in women years after taking Premarin.  I mean, Premarin did some good things, but there was a good Stanford study where all the cognitive effects of estradiol only from bioidentical, not from Premarin. And then you get into even worse things like the diethylstilbestrol, which is a non-identical estrogen, the non-bioidentical progesterones. And why would they make those? Because you can’t patent the compounds of the hormones because they’re already naturally occurring.  So they make non-natural hormones that affect the receptors and sometimes affect the receptors more powerfully than the native hormones, but they don’t affect all the different things that the native hormones do because the native hormones will trigger this, but they’ll also bring in help from these other pathways that make it a whole balanced thing. And that was what happened with the non-bioidenticals. They nail this, but they don’t hit any of these other targets and you get this imbalanced thing that was more likely to lead you towards cancer.

Dr. Weitz:            Now, my friend Dr. Felice Gersh, she usually argues against estriol because she says number one, estriol is basically the hormone of pregnancy. It’s not something naturally occurring in decently high levels throughout a woman’s life. And number two, the real bang for the buck is with estradiol, not with estriol.

Dr. Shade:           I don’t know why she says that. I know Felice is the only one with this story out there. And then you see our story and it’s like, I mean, yeah, I could just load you with estrogen and I’ll hit all the receptors, but is that really what we want to do? And when you look at how it works, estradiol goes to the liver, turns to estriol. You pee it out. All the receptors along the urinary tract are beta receptors, and it goes in there and hits them. And then what? Think you’re off in the cave. You’re growing up in the wild, that pee’s splashing into the vaginal tissues.

                                And it’s like maybe you shouldn’t wipe so much. Maybe you’re getting some of that in there because that’s estrogen receptor beta in there too. And so there’s an obvious use of estriol because it works on beta, because it has some of these antiproliferative effects. You don’t have tons of circulating, but you have a lot going out through the urine. So I think that’s the way that it was designed in nature, and I just don’t think she’s right there. And then there’s this question about competition at the receptors.  But if you have a high affinity for a receptor like the alpha, then diol is going to get in there and out-compete triol in a second. Triol’s never going to get in there and get in the way of the diol when it’s a competition for a receptor there.

Dr. Weitz:            You were talking about environmental estrogens, and I always wonder if let’s say you’re working with a guy and he has high levels of estrogen, or maybe he’s got low levels of free testosterone. You’re trying to see if maybe environmental estrogens are playing a role. Which form of estrogen would you measure? Or is it possible to measure? The options are to measure estrone, estradiol, or estriol.

Dr. Shade:           It seems to be all diol for the guys. That’s the driver.

Dr. Weitz:            Now, what about for the environmental estrogens? Which one would those be picked up as? Or can they be measured at all?

Dr. Shade:           Oh, they won’t be picked up as estradiol. They just fit in the estradiol receptors. If you know, you’re looking for these five chemicals and you have a test for them, problem is we don’t have a lot of tests for all these things. It’s the academic places where they look at all 203 or however many chemical.

Dr. Weitz:            We usually do a urine test for environmental toxins.

Dr. Shade:           And that’s going to get some of them, but it’s not going to get all of them.

Dr. Weitz:            Right. Yeah.

Dr. Shade:           One thing to do, look at testosterone, look at estrogen. You’re looking at ratios between them with a test estrogen ratio of hopefully like 20 to 30. When you’re down at 10 to one, and that’s with the units as they’re reported, if you’re like at 10 to one, then you’re high estrogen and you’re going to be a little heavy on the mammary glands. And then 20 to 30, you should be very lean. But if you aren’t and you’re showing this estrogenicity, then that’s likely coming from some environmental estrogen.  And then as we talked about before, I think the thing that we’re missing totally… I have all these friends, these guys in their 60s, maybe early 70s, and I look at them and they’re really sarcopenic. They’re losing a lot of muscle mass. Skin’s hanging down. They’re slow. Definitely have no libido left. Some may. And I’m like, you need testosterone, buddy. There’s just no if, ands or buts about it. And they’re like, my testosterone level’s high. It’s 600, 700. When I was young and just running off my own testosterone, I was only 500, but I had low estrogen.

                                I had almost no binding globulin, and I had a lot of DHEA, and I was plenty androgenic. So those levels are high enough to do that. But here is what androgenicity is or estrogenicity is, it is the level of the hormone multiplied by the density of the receptors for the hormone. The hormone doesn’t go right in and do things. Like in a woman, it doesn’t turn the libido switch. It hits the androgen receptor. The androgen receptor then goes into the nucleus and codes for all the genes to be turned up that are responsive to the androgen receptor.

                                And then there’s these downstream things that happen. So you look at a woman and you’re going to dose her up with testosterone, try to restore her libido. Does that happen the day after you get the testosterone? No. That’s like seven to 10 days later. There’s this lag there. So the receptors are what are causing a cascade of things to make that happen. Now, you have a testosterone of 600, 700, and you’re young and you have… I’m just going to make up an arbitrary one to 10 scale.  I’ve got a eight of receptor density. So the testosterone could go in there, activate that, go to another one, activate that, go to another one, activate that. There’s a lot of targets to hit. But now you’re 65 years old and your receptor density is down to a three, and then the testosterone is just floating around looking for something to do. And it’s not activating anything and therefore you’re non-androgenic. And finally, it hits one. That’s the thing that we’re missing.  So there’s two things bringing down receptor activity. One is the absolute density, which is known to go down with time, and the other one is poisoning of the receptors by endocrine disrupting compounds.

Dr. Weitz:            Is there such a thing as receptor sensitivity? Can a receptor work better or worse?

Dr. Shade:           Yeah. We don’t have that one totally dialed in, and that might be like there’s some chemical stuck to the receptor and it doesn’t work as well. But then there’s when the chemical goes all the way inside and blocks the hormones from getting in there. So there’s a receptor, but it’s blocked and it won’t work. And we don’t know really if there’s a receptor, it’s working at 50% versus 100%. I imagine there is. But what we do know is you have less receptors.

Dr. Weitz:            Is there any way to measure…

Dr. Shade:           When you take all the testosterone out of the body, the density of the receptors goes down. Nobody has that test now. I mean, there’s ways to…

Dr. Weitz:            There’s no way to measure it?

Dr. Shade:           It’s just in academic labs right now. So we know those go down with time. And then we know they also get poisoned by other chemicals. So you can go in and detoxify them. Back to detox again. Any subject we bring in, we can go back to detox. And so you do PushCatch Liver Detox. Maybe add a little more DIMs and glutathione and roll them on that for a while and you’re going to move these plastics and pesticides and herbicides or atrazine, get those things out. But then what if you all clean but you’re only left with a couple of receptors?  You’re at like a two or three? How do you get those up? And turns out, adaptogens. There’s great data on adaptogens increasing density of the hormone receptors. Now, I always like to say, let’s bring ourselves back. I’m an emperor, emperor so back in China 2,000 years ago, and I’m getting old and they want to keep me virile and keep me up at heart and keep my muscle mass on and have me be an emperor of the world. And they don’t have injectable testosterone cypionate.

                                And so what do they do? So you’re eating testicle and tiger penis and deer penis. You’re eating, because those all have testosterone in them. And then you’re eating the deer antler tips, which have growth hormone or IGF-I at least in them, which are growth hormone stimulator. So you’re bringing up hormones that way, and then they’re giving you shit tons of the best ginseng. And those ginsenosides have the same steroid backbone as the hormones. So they work in with the receptors in some way.  And astragalus, ashwagandha with [inaudible 00:31:27] I forget the name of the plant, but all those, it’s beautiful. They all have a steroid hormone backbone and they go in and they massage those receptors and make them work better apparently. That one, we don’t know quite how that works, but they definitely get more density, more replication of the receptors, and then you get more hormone activity.

Dr. Weitz:            I saw some webinar you did, and you were talking about some of the heavy metals, and you mentioned how nickel was one of the heavy metals sets. Seems to be a big player in some of this estrogenic stuff and that kind of interest.

Dr. Shade:           At low levels they’re blocking receptor activity, and at high levels they’re activating receptor activity. So yeah, nickel is a metalloestrogen. Cadmium is a metalloestrogen. It screws the receptors bad, because we know cadmium is probably the biggest cancer causer in testicles and ovarian. It’s probably mostly ovarian, but it could be cervical cancer as well.

Dr. Weitz:            I think nickel is part of steel, right? And here we are avoiding bisphenol A, so we’re using steel water bottles and we may be getting nickel toxicity.

Dr. Shade:           Yeah, yeah. I remember a couple of years ago, I had my girlfriend, I was like… Polydipsia. She was drinking water all day. These people in Colorado are water junkies. And I’m like, screw that stainless, man. This is no good if you’re just after it all the time.

Dr. Weitz:            Does the nickel come out of stainless steel?

Dr. Shade:           And she’s been on glass for three years.

Dr. Weitz:            Does nickel come out of stainless steel?

Dr. Shade:           A little bit of it does.

Dr. Weitz:            Yeah.

Dr. Shade:           Not a ton, but a little’s coming out. The more you put acids in there, the more of it comes out.

Dr. Weitz:            A bummer is every time I try to use one of these glass water bottles and I take it to the gym, I end up breaking it.

Dr. Shade:           Oh yeah, I know. They got ones that are covered in rubber and stuff.

Dr. Weitz:            I know. They still break easy.

Dr. Shade:           Maybe at the gym you bring your steel. Just glass for the rest of your day.

Dr. Weitz:            So we have no way to tell if we were having fewer hormone receptors.

Dr. Shade:           Nor if they’re poisoned.

Dr. Weitz:            Right.

Dr. Shade:           Except by saying your levels are high and you got jack. So let’s bring those up and let’s jam your levels up too. Some of these guys, I would put their test levels up to 1,200 to 1,400 and just saturate them with high quality adaptogens.

Dr. Weitz:            What are your favorite adaptogens for that purpose?

Dr. Shade:           I think ginseng is probably my fave, but then I always love blending all these other things in with them.

Dr. Weitz:            I think maca is a pretty powerful one.

Dr. Shade:           Yeah, maca is a great one. We don’t understand those compounds as well, but they have great cultural use. You’ve got scientific use, so you’ve got cultural use, and so you could do both. We put the maca in that DHEA. But for the guys, ginseng, astragalus, He Shou Wu, ashwagandha, those are my favorite. But for male regeneration, ginseng is at the top. In Chinese medicine, if you’re young, they’d give you astragalus and they’d say that would build your wei chi or nai chi wei, the outside energy.  Make you more resistant to disease, make you stronger on the outside, because you’re strong on the inside, young. When you get old, you get weak on the inside and the outside, so they give you ginseng to bring you up from the inside and then they’ll give you astragalus for the shield on the outside.

Dr. Weitz:            So when it comes to female hormones, the progesterone you have available is also a topical?

Dr. Shade:           Yeah, it’s a topical.

Dr. Weitz:            So it’s pretty common to use oral progesterone in functional medicine world, because it seems like the oral is more effective than the topical.

Dr. Shade:           Well, it’s more effective than the topicals that are the creams with the micronized stuff in there.

Dr. Weitz:            I see.

Dr. Shade:           We’re able to get everything done that we need with these topicals. And so you look at an oral, oral base dose, there’s 100 milligrams. People will have maybe 200 milligrams, 9% absorption. So you’re only getting nine milligrams from 100 milligram.

Dr. Weitz:            Oh, interesting.

Dr. Shade:           From the topicals, we’re using mostly 12 to 16 milligrams a day. And we’re getting similar results even probably better when it comes to sleep. And similar when it comes to mood and anxiety, these are the things that progesterone does. It works on the GABA receptors, makes you calm, makes you happy, not irritable. It makes you sleep really well.  So we’re able to get that added 12 to 16. Occasionally, you need 20 milligrams. It works well. The only thing we’re not able to measure is endometrial thickness, and that was the measure that was made around the oral to prove that 100 milligrams is where you get endometrial thickness control, the thinning of the endometrial.

Dr. Weitz:            Right.

Dr. Shade:           Because that’s the thing, estrogen…

Dr. Weitz:            Unopposed estrogen.

Dr. Shade:           And progesterone’s clearing it back off for you. We haven’t been able to do those measurements yet. We’re seeing if somebody can do the ultrasound work on that.

Dr. Weitz:            Okay, that’s interesting. So one of your webinars I was watching, you were talking about sirtuins. I guess there’s a big controversy now about sirtuins with David Sinclair.

Dr. Shade:           …guy because he’s freaking taking away our use of NMN.

Dr. Weitz:            Yes, I know.

Dr. Shade:           Which part of the controversy?

Dr. Weitz:            Well, I guess there’s a controversy about the resveratrol.

Dr. Shade:           All right, so here’s how that all works. If you’re a sirtuin, you’ve got two openings here. For a ligand to come in. This is something that’s going to bond in to the protein and activate it. And on this side you’ve got the quintessential one, the one for NAD, NAD+, and that activates it. Then there’s another receptor that certain compounds called sirtuin-activating compounds can come in and bring it up to even higher level to super activate it. But if you don’t have any…  So if you go in with just resveratrol and you don’t have high NAD levels and you try to run it with a high resveratrol level, you’ll actually succeed in doing this by drawing NAD from other pools in the cell over to the sirtuin. Now, that can pull NAD away from PARPs that are doing gene repair, can pull it away from CD8s that are doing other types of cellular repair, and it can pull it away, most importantly, from the electron transport chain where it’s taking electrons from the citric acid cycle and bringing them over to the electron transport chain.

                                So even though sirtuin activation is supposed to give you heightened mitochondrial function and mitochondrial density, if you don’t have the NAD to support the resveratrol going in there, it’ll actually cause mitochondrial dysfunction. In fact, I had a guy in here I was interviewing yesterday that was saying, I could never reproduce what he was talking about back in grad school. And I told him this thing about NADs. He’s like, that’s why. I did a sirtuin activation study on a couple of people that were younger.  And we didn’t measure their NAD levels, but I was able to get great activation of sirtuins with a combination of resveratrol, pterostilbene, and maybe curcumin and quercetin. So we definitely did it. But that’s what I tell people, you got to watch out. When you’re low NAD and low ATP like in a weak person and you try to drive it with resveratrol, you’re going to drive them over the cliff. You bring up NAD levels first, you get that strength, and then you put in the resveratrol, and then you get the benefits.  And that’s why in those early studies it was like half of the cohort is doing great, half of the cohort is getting screwed up. They just cut all those things and stopped them.

Dr. Weitz:            What do you think about…

Dr. Shade:           And that’s when Sinclair was trying to make a drug out of resveratrol. Now he’s trying to make a drug out of NMN, and his company is the one who drove the FDA to try to take NMN away from the supplement companies. And that was a pretty shitty move.

Dr. Weitz:            But it seems like it’s still available?

Dr. Shade:           Yeah, it’s still available, but Facebook and Amazon won’t let us sell it. One of our payment processors, Shopify, won’t let us sell it. It’s like, guys, this is not a law yet. This is what they said they wanted to do and it’s all under review and you’re just acting as the enforcement arm for the FDA.

Dr. Weitz:            It’s like the same thing with NHC, right?

Dr. Shade:           Yeah, no, it was the same thing and it got all shunned by all the retailers and Facebook will stop you for having it. They’ll stop you advertising. But then NHC was given an exception. So we think that’s what’s going to happen with NMN. It hasn’t happened yet. There’s a lot of us throwing money into a common fund to sue those bastards.

Dr. Weitz:            Interesting. What do you think about NR versus NMN?

Dr. Shade:           They’re both really good. They’re a little bit different. They’re very similar. NR becomes NMN, which becomes NAD. Then when you’re trying to traffic the stuff cell to cell to move around your stores of NAD potential, you’re trafficking NR and NMN. They’re both good.  We’ve been working with NMN, worked through the intellectual property stuff around ChromaDex. ChromaDex had a “patent.” I’m doing big air quotes on the patent because it was a pile of freaking garbage. And finally, Elysium took him to task and went to court and the judge just shut it down and said, “This is a garbage patent.”

Dr. Weitz:            Oh, really? Why was it a garbage patent?

Dr. Shade:           It was garbage because, one, you’re trying to patent a natural molecule, which you can’t do. It should have been rejected just because of that. And then to get it in there, they started saying, well, the claim is NR in Ringer saline for injection, in this saline for injection, in coconut butter for doing a suppository, in a tablet for this, in a thing with this. And actually the junior patent attorney wrote this because juniors always write these things when they come out of university. He just came out of university.  And I know this all. My patent attorney is one of my best friends, and he wrote one of my first patents as a junior guy. And now he’s super experienced and he’s like, look at what they did. And instead of NR with this or with this or with this or with this, they put and. So really to violate the patent, you would’ve had to compound the NR with anything else that made it into eyedrops or suppositories or tablets or capsules or IV all together before you violated it. So it was just freaking garbage.   And in the supplement world, everybody’s afraid of a patent. They never have their patent attorneys read them and see whether there’s anything substantial there. So ChromaDex got away with having a monopoly on NR for years, and they sold it for a bajillion tons. And now Chinese synthetic labs will sell it to you for pretty cheap.

Dr. Weitz:            Oh, interesting.

Dr. Shade:           But NR, I’d be doing NR, but NR is less stable, and so it’s harder to work with in liposomal formulations. We’re going to get around that soon. If anybody’s selling you liposomal NR, it’s probably mostly broken down.

Dr. Weitz:            There’s so many companies out there claiming their products are liposomal.

Dr. Shade:           Oh my god, liposomes have exploded. Some is just absolute lie. It’s just like stuffing lecithin and some stuff in a capsule.

Dr. Weitz:            Well, that’s what a lot of it is, right?

Dr. Shade:           Oh yeah, it’s just freaking bullshit. Then, oh yeah, your stomach makes the liposomes. I have a million dollars worth of equipment over there that makes a liposome. So you’re telling me the stomach does the same thing they do? Eh-eh. And then others are just low grade. They’re getting cheap lecithin. They blend it up. You’ve got this milkshake looking stuff.

Dr. Weitz:            One of the issues has to do with taste. My wife has taken all this liquid stuff that comes in these little packets and it tastes good. She doesn’t like the taste of your products.

Dr. Shade:           They’re probably using symbiotic or something where it’s low grade with a bunch of syrups and flavorings. One of them had almond butter in it, so it absolutely could not have been a liposome. It was just some schmutzy blend up thing. And that’s where we get some is shit for our taste, because we taste like the compounds that are in it. I started in autism and Lyme and these guys are allergic to everything, so you couldn’t put all these synthetic flavors in.  Now I’m starting to juice them up a little bit and make them taste a little bit better. But if you want to buy elite supplements to get super good effect, just take it in there. Let that flavor get in there. It’s like the Vipak, the post digestive taste effect. I think that’s the right term for an Ayurveda, but taste is big in Chinese medicine and Ayurveda. It affects you, and it signals the body what you’re going to do. [Crosstalk 00:46:18]

Dr. Weitz:            Like the bitter herbs are so powerful because they’re affecting those taste receptors. Birth control. Most people don’t realize how potentially damaging birth control is. Maybe you can talk about how that affects hormone.

Dr. Shade:           I’m not great on the subject. I mean, I know how very damaging it is. It’s screwing up receptor density. It’s screwing up signaling, and it takes years and years to wean yourself or repair from the effects of the…

Dr. Weitz:            Right, to get your normal hormone levels to come back.

Dr. Shade:           To get all your hormones back. All this signaling has turned off all of your normal stuff. It was funny, my son was asking me yesterday about… Because he’s like 17 and he’s this wicked bodybuilder. And he said, “Oh, I had this great December. I grew all these pounds.” And I said, “You’re not taking steroids, are you?” He goes, “Well, I’ve been sneaking your testosterone, dad.” He was just kidding, because he was even scared of that. It’s one thing to be taking steroids and get deca dick and freaking lose everything, but he thought like…

Dr. Weitz:            Deca dick.

Dr. Shade:           Deca dick. It’s something called deca-durabolin. It makes you all anabolic in your ooh. But he thought if you go on test, you can never go off it. I’m like, no, you can go on and off. Just when you’re on it, your testicles going to atrophy and they’re going to come back down, but you could turn it all back on. And sometimes it’s easy to turn that stuff back on. Like test you could turn that back on. It doesn’t take long. But there’s something about the birth control that turns it off for a much longer period of time.  And this isn’t my area of expertise. I usually let Carol Peterson talk about that. So I don’t know exactly why that is, but it shuts it down for a long period of time. And you almost have to bring on bioidentical hormones first to reset the signaling and the way the cells respond, and then you got to nurture the rest of the system back up. I mean, some girls go off of it and everything’s fine. Other girls don’t.

Dr. Weitz:            It’s interesting that so many of these environmental endocrine disrupting substances all seem to be estrogenic versus androgenic.

Dr. Shade:           Yeah, versus androgenic.

Dr. Weitz:            Why do you think that is?

Dr. Shade:           I’d love to have a really savvy, oh, that’s because of this. I don’t have a savvy answer for that. I don’t know. Maybe we’re not even looking at it. The early endocrine disrupting stuff, it was making teenage boys fat and have gynecomastia. And so they would call them obesogens and they said, “Well, this must be all estrogenic.” And they did have estrogen receptor activity. But you know what? We missed all that.  Then later these papers are coming out, endocrine disrupting chemicals and cardiovascular disease. What they do is they inactivate the sirtuins, so they block sirtuin activity. And that is cardiometabolic wellness. So they’re turning on estrogen reception while they’re blocking sirtuin activities. So they have this dual sexual dimorphism problem and a cardiometabolic poisoning problem.

Dr. Weitz:            Interesting. That’s another thing we can’t measure, right, sirtuins?

Dr. Shade:           Well, I mean, you can’t go out to Labcorp and do it. We did one where we had to… It’s one of these research things. We had to isolate the peripheral white blood cells, put them on dry ice and send them to a lab that could do the assay for nuclear and cytosolic sirtuin activation. So you get total sirtuin levels and activated sirtuin levels.  We are doing this with a capsule-based liposome, like a real capsule-based, where it turns into nanoparticles in the GI. And it took about two hours. They activated it and it lasted about 24 hours. And so I’d like to repeat that with our AMPK charge and some of the NAD platinum, and I’m sure we’ll get similar results. So once you hit it, it does seem to stay activated for a while.

Dr. Weitz:            So the best way to get rid of these estrogenic substances, like these heavy metals like cadmium and nickel, are with your PushCatch system?

Dr. Shade:           Yeah, yeah. You should really upgrade to the advanced PushCatch because then you got liver sauce, kidney care, phosphatidylcholine is really good for helping with this process, and glutathione in there. A lot of these things are conjugated to glutathione, and then you have the binders.   So that’s general organic endocrine disruptors. You might throw a little bit more DIM in if you want. That could help. But then if you’ve got metals, then you got to go to the pro version, Qube 2.0, and that’ll bring in the IMD Metal Binder and EDTA. And that’s a nine week, much more intensive protocol.

Dr. Weitz:            Isn’t the IMD in Ultra Binder anyway?

Dr. Shade:           Yeah, but it’s not in there real high. You got like a half a scoop in a teaspoon. When I’m titrating up in a metal detox protocol, I’ll have you get up to three scoops twice a day on top of the Ultra Binder.

Dr. Weitz:            Oh, okay. Interesting. I think those are the main things that I had to talk about. Anything else you want to mention?

Dr. Shade:           I’ll just mentioned that for all the practitioners, we have an online learning management system to understand the hormones and our hormone system. And you just have to become a Quicksilver Scientific practitioner, which means you just go get an account with us online. It doesn’t matter if you’re buying from Fullscript or some distributor. You need an account with us to get all the education. We have 30 to 40 different webinars in there.  We have a free learning management system around detoxification. And then you pay a little bit like 200 bucks for the one on hormones and it also comes with a sample box of all our different hormones. So getting in, getting educated. A lot of people want to get into treating hormones. Everybody’s afraid of it. You don’t need to be afraid. You just have to be educated.

Dr. Weitz:            Yeah, it is a little scary if your license doesn’t include prescribing.

Dr. Shade:           Yeah, yeah, exactly. And so here you learn all the ins and outs of it.

Dr. Weitz:            That’s great.

Dr. Shade:           If you’re just certified, those are licensed only products unless you do the learning. If you go through that course and finish it, then we graduate you to a licensed practitioner and then you can buy those.

Dr. Weitz:            So practitioners can go to quicksilverscientific.com.

Dr. Shade:           Yep, that’s it, and go apply for an account.

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

Dr. Shade:           Thank you, Ben.



Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star rating and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation.  Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.



Integrative Approach to Cancer with Dr. Nalini Chilkov: Rational Wellness Podcast 357

Dr. Nalini Chilkov discusses An Integrative Approach to Cancer at the Functional Medicine Discussion Group meeting on March 28, 2024 with moderator Dr. Ben Weitz.  

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


Podcast Highlights

4:08  The relationship between cancer and obesity and glycemic control is huge.  Patients who are obese, have hyperglycemia, and hyperinsulinemia have a 40% increased chance of being diagnosed with cancer and have a 40% increased chance of a cancer recurrence.  Both insulin and insulin-like growth factor that are actually proliferative signals.  And tumor cells have more glucose, more insulin-like growth factor receptors, and more insulin receptors than normal cells.

7:34  The United States is a sugar nation and diabetes and obesity continue to rise here.  Obesity accounts for 14% of cancer diagnoses in men and 20% in women, and its higher in women due to the estrogenic effect of fat.  Some cancers are more directly linked with these signally pathways, including GI cancers like colon, gastric, gall bladder, and pancreatic cancer, liver cancer, endocrine cancers, Hodgkin’s Lymphoma, Multiple Myeloma, and renal cancer. There are biomarkers that we can measure to evaluate the cancer terrain in the tumor microenvironment. By identifying these signally patterns, including glycemic control, inflammation, and obesity and making changes to their diet and lifestyle, we can help patients to have better outcomes and have less chance of recurrence. 


Dr. Nalini Chilkov is the founder of the American Institute of Integrative Oncology Research and Education and the creator of the The OutSmart ® Cancer System.  It is her mission to change the face of cancer care so that every patient has a plan for their health and not just a plan for their disease at every phase of the cancer journey. She is committed to training front line clinicians worldwide to become skilled and confident in serving the health needs of patients whose lives have been touched by cancer by utilizing her OutSmart Cancer® System. She is the author of the best seller, 32 Ways to Outsmart Cancer_How to Create A Body Where Cancer Cannot Thrive and is recognized as an authority and pioneer in the fields of Integrative Cancer Care, Cancer Prevention and Immune Enhancement. Dr. Chilkov has lectured worldwide and at the Schools of Medicine at UCLA and UC Irvine and is a frequent expert resource to the media.  Her websites are Nalinichilkov.com and the American Institute of Integrative Oncology.

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.

                        I want to introduce our speaker, Dr. Nalini Chilkov. She’s the founder of the American Institute of Integrative Oncology Research and Education, and she’s a creator of the OutSmart Cancer System. It’s her mission to change the phase of cancer care so that every patient has a plan for their health and not just a plan for their disease at every phase of the cancer journey. She’s committed to training frontline clinicians worldwide to be skilled and confident in serving the health needs of patients whose lives have been touched by cancer by utilizing her OutSmart Cancer System. She’s the author of the bestseller, 32 Ways to OutSmart Cancer: How To Create A Body Where Cancer Cannot Thrive. And she’s recognized as an authority and pioneer in the field of integrative cancer care, cancer prevention, and immune enhancement. Dr. Chilkov has lectured worldwide and it’s a frequent expert resource to the media. Thank you, Dr. Chilkov.

Dr. Chilkov:        So, we’re going to be an intimate group, so I’m going to ask you to move to the center. I’m going to ask you to come so I can just look at one place and we can have eye contact and since it is a small group, we can be more interactive. So, while I’m lecturing you have a question, just raise your hand and I’ll be happy to answer it. Otherwise, I’ll also leave time at the end. So, we’re going to talk about cancer, and insulin, and obesity. And I particularly like to give this lecture to primary care clinicians because we have such an epidemic of metabolic syndrome, and obesity, and diabetes in our country. And this really causes a large group of patients to be at high risk. So, we’re going to talk about that and then some of the interventions that I use and some of the assessments that I use. And I think it’s really important in a primary care practice to be aware of this.

                        This is part of a online training that I have for primary care and frontline clinicians. So, if you get really inspired tonight, you can reach out. We’re happy to talk to you about my course. It’s self-paced. And then I also have a mentorship group for those people who want to have you review your cases and help you through them. And it’s a pretty engaged group. It’s a wonderful community that we have once a month online together. And also you can have a big discount by attending this. So, if you’d like that, you can just email us. I’ll give you my email address if you want to get the PDF of this lecture or you want more information about the course with the discount. And also, do you give people a PDF of the lecture?

Dr. Weitz:          What’s that?

Dr. Chilkov:       Do you give them a PDF copy?

Dr. Weitz:          I can.

Dr. Chilkov:       Yeah, so you can have the lecture slides. And I have this little handout that’s really nice to give to patients so that they can understand how to eat if they’re diagnosed with cancer. And so, it’s just like a checklist. It’s a one-page handout. If you’d like to have that for your practice, then you can have that, too.

Dr. Weitz:          All right, yeah, please give me your PDF, I’ll put it in my list.

Dr. Chilkov:       Well, I have one so we can send it to you.

Dr. Weitz:          Okay.

Dr. Chilkov:       We can just send it to you.

Dr. Weitz:          Okay, sounds food.

Dr. Chilkov:        All right. So, if you memorize this slide, you got the lecture. Okay. So, the relationship to cancer, obesity and glycemic control is huge. Patients who are obese, patients who have hyperglycemia and hyperinsulinemia have a 40% increased chance of being diagnosed with cancer and they have a 40% increased chance of having a recurrence. So, it’s a teaching moment for people. And people come into our practices at every stage of their cancer journey. So, wherever they come in, it’s a teaching moment as far as I’m concerned. So, if you look at these relationships, of course lifestyle is a contributor to all of these. But when you have insulin resistance and hyperinsulinemia, you have this driving force that has growth factors. And so, it’s insulin and insulin-like growth factor that are actually proliferative signals. And tumor cells have more glucose, more insulin-like growth factor receptors than an insulin receptors than normal cells. So, that’s why cancer is exquisitely sensitive to changes in blood sugar and insulin.

Dr. Weitz:          There’s one thing missing from the slide. Where’s Ozembic?

Dr. Chilkov:        That’s a whole other discussion, isn’t it? But it is interesting. It is interesting because when people have more normal body composition, less percentage body fat, more glycemic control, more normal insulin, more normal blood sugar, they don’t have the signaling going on. So, that population, that obese and diabetic population, is not only decreasing their risk of cardiovascular disease, which has been in the news, but they are also decreasing their risk of cancer that is driven by these pathways. Not all cancers. And some cancers are more explicitly sensitive to glucose. I have some slides on that for you. But at any rate, so you can measure fasting insulin and insulin-like growth factor one when you do labs on people. And then of course we know that people who are diabetic and obese also have more inflammation. And we also know that there’s a hormonal component, which I’m going to show you that as well.  So, this is essentially what we’re going to talk about. And it’s pretty daunting the amount of people in the world that are impacted by this. And so, that’s why I think it’s really important for primary care and frontline clinicians to be aware of this. And what’s true is that one in two adults with diabetes is diagnosed. So, these people are running around with higher risk, many comorbidities. And so, I think it’s really important for primary care clinicians to be aware of this. And these are just some statistics that are so really depressing. I want to read them to you. But if you look at the darker colors on this, the dark countries, that’s where the highest rates of diabetes are. So, welcome to America. All right.

                        So, this is the curve of the acceleration of diabetes in this country. United States is a sugar nation really. We teach kids to have a sweet tooth, really young. And so, it’s really a problem. So, what we’re going to talk about is first obesity being a major risk for cancer. And of course that goes along with diabetes. But not always. Not always. So, obesity is related to 14% of all cancer diagnoses in women in and… 14% in men and 20% in women. It’s higher in women because of the estrogenic effect of fat. So, that’s pretty daunting. And also, I just want to point out this book. Although it was published a long time ago, I recommend it because it has this really clear explanation of the physiology that we’re talking about. So, if you just want a really good reference to read in more in detail these signaling pathways, it’s just really well-written basically.  And so, if you look at, these are the cancers that are most linked to obesity. But you can see it’s a pretty wide range of cancers. It’s not just one category. So, you’ll see that there are GI cancers there. You’ll see that there are endocrine cancers there, liver cancer, and you can see Hodgkin’s lymphoma and renal cancers. So, it’s a wide range of cancers. So, obesity by virtue of changing the hormonal milieu, changing the inflammatory milieu, this is part of driving cancer. And one of the things we talk about in an integrative approach is oncologists are fascinating by the tumor, but they’re not fascinated by the biosystem that’s hosting cancer. And that’s what we need to be interested in. And so, we want to be interested in what we call the tumor microenvironment or the cancer terrain, which is the signaling environment that will either be proliferative or supportive of carcinogenesis, and proliferation, and progression of metastasis.

                        So, there are biomarkers that we can measure to evaluate that cancer terrain in that tumor microenvironment. And thereby, put a treatment plan together for the health side of the cancer equation. And that’s really what I teach. So, my mission, if you will, is not to train integrative or naturopathic oncologists, but it’s to train people like yourselves, how to monitor patients at every stage of the cancer journey and put together health plans, and identify these signaling patterns in their biosystem so that they also have better outcomes from their treatments, they have less chance of recurrence. And then we can restore their health and give them a biosystem that is not going to be supportive or hospitable to cancer development or recurrence. So, that’s the framework. And so, thinking about glycemic control, and inflammation, and obesity, and body composition is within that framework. Yes.

Speaker 3:         Is there a certain BMI, like is it BMI number 25 that presents this increased risk [inaudible 00:10:56]?

Dr. Chilkov:        So, the question is what about BMI? So, there’s no hard and fast statistics on that. I really think more about body composition. We know BMI is a waffley way too. But you could say 25. You could 25 is where there’s too much body fat. And then you get into because there’s more body fat and less muscle mass, then we get into all kinds of other metabolic issues. And think of the age demographic as well. So, the age demographic for cancer patients historically has been people over 50. Now we’re having an epidemic of younger people under 50 being diagnosed.

                        And in the press right now in the medical community go, “We don’t know why that’s happening.” But that’s a pretty lame comment because of course it’s environment, it’s body composition, it’s the endocrine disruptors in our environment, it’s stress, it’s sleep cycle, it’s all the things we know cause health or the lack thereof, make you vulnerable to multiple types of chronic illnesses. And cancer is a chronic illness. Cancer is not an urgent care. Cancer is not a short-term crisis. It’s a long term metabolic problem. It is a chronic illness and it has to be framed as such.

                        And if you look at it through that lens, you’ll address the whole biosystem and all the signaling, and the way that you are trained to practice already. If you keep looking through that lens, understanding what to pay attention to. So, these are some of the things we want to pay attention to. So, these are the cancers that are most associated with obesity. And so, you can see that they’re also diverse. It’s not kind of one category of cancers. But it is very interesting. Also, I think gastric cancer should really be on this list because gastric cancer is becoming more common, especially in younger people. And it is a cancer where error in fatty acid metabolism is part of what drives the cancer. And so, for example, sometimes we use statins off label for these types of cancers. And so, this in our country where obesity is such a problem is an issue. And should therefore be aware that you might want to be screening people more for cancer if they’re obese or have glycemic control issues.

                        So, I have a lot of slides. This is a longer lecture typically, so I’m not going to read all the slides to you. But if you want to get a copy of them and read the details, I think our time is better spent in dialogue than in me reading slides to you. So, obesity is a risk factor. And there’s other things that go along with that. If you have surgery and you’re obese, you have more complications, you have poor wound healing, et cetera. So, you’re at risk for secondary malignancies when you’re obese. There’s a higher mortality rate in obese patients. So, I want to give you the big concept so you can think it through with your patients.

                        So, here again, we have just what is the physiology that drives this? So, of course we all know that if you’re sedentary, you eat too much, you get obese. But of course we also know that’s not the only reason. It’s not just calories in calories out. So, want to identify metabolic issues in our patients. But if we are able to lower fasting insulin and lower insulin-like growth factor, we do get more control of cancer. And you can do that pharmacologically, but you can do it with lifestyle as well. And so, for example, if you lower your animal protein, you can lower your insulin-like growth factor.

                        So, it’s this tricky thing now since Gabrielle Lyon published her book, if you read her book on muscle medicine, the need to have adequate protein, which as we age to maintain muscle mass and to maintain metabolic health. And also because of the age demographic of cancer patients, we have a population of people who are potentially sarcopenic. And the physiology of cancer itself drives sarcopenia. Sarcopenia, the loss of muscle mass actually starts when you have a solid tumor. And you can’t see it, you can’t measure it, but it’s actually happening. So, it’s very important since obesity and glycemic control are related to muscle health and muscle mass to realize that all cancer patients are at risk for sarcopenia. And that be thinking about that right from the beginning because the oncologist is not. So, we want to be the team members, the collaborative team members that have this health model for the patient.

Dr. Weitz:          But this is a big dilemma. We want to give the patients more protein. It’s a great way to control glycemic balance, insulin.

Dr. Chilkov:        So, the best way is to exercise and increase your muscle mass. And of course you have to have the signal to the muscle, so you have to have enough leucine. So, I find that a lot of my cancer patients are exhausted and overwhelmed typically. And so, they’re not that interested in cooking or eating sometimes, especially if they’re in the middle of treatment. So, I use free-form amino acid powders, particularly branched-chain amino acid powders to give enough leucine to signal the muscle. That’s what I do. And so, you’re able to get adequate amino acids into people who aren’t interested in food or might not want to eat a lot of animal protein.

Dr. Weitz:          I often hear from vegans arguing a particular amino acid is going to increase your cancer risk. And pick different ones, methionine, glutamine, leucine.

Dr. Chilkov:        All right, well, that’s a little bit of a tangent, but I’ll [inaudible 00:17:24]-

Dr. Weitz:          Okay, sorry.

Dr. Chilkov:        … For a minute because we got to get through this lecture. So, cancer cells are smart. They co-opt our normal physiology for their own survival. And so, they do that in a variety of metabolic ways. But not all cancer cells do all these adaptions. So, there is a fear of glutamine in the misinformed community. And glutamine is the most ubiquitous amino acid in the body. It’s stored in the muscle. And if a cancer cell wants glutamine, it doesn’t have to go anywhere to get it. It’s all around. And so, if we want to give glutamine in order to heal someone’s gut because it’s been eroded by chemotherapy, it’s not going to change whether or not the cancer cell has access to glutamine. So, you still have to think of the whole biosystem.

Dr. Weitz:          You have Thomas Seifried recommending glutamine blocking drugs as part of this protocol.

Dr. Chilkov:        So, there are subset of tumor cells that shift into glutaminolysis. But you can’t block glutamine. It’s like junk science. So, that’s my opinion. So, now that’s on tape. So, the other thing is methionine definitely has a role in proliferation. But again, it’s not every cancer, it’s not every tumor cell line. And going on a low-methionine diet is very risky thing to do. And I am not a proponent of it. And for patients who are at the end of the line, they’ve become treatment resistant and they’re desperate to try something. There’s a subset of patients who respond to low-methionine diets, but those patients become extremely sarcopenic. Extremely sarcopenic. And so, we have a colleague who is in LA here who’s a big proponent of low-methionine diets. And I think if a patient wants to try it, they have to cycle on and off of it because otherwise they just become ill. There’s too many things that are methionine dependent, including your mood. So, these patients become extremely depressed and then they can’t be compliant with an already difficult protocol.

Dr. Weitz:          Thank you. One more quick question. Is there lab test-

Dr. Chilkov:        You can’t keep taking off [inaudible 00:19:53], okay?

Dr. Weitz:          Is there a number for IGF-1 labs that you like to see?

Dr. Chilkov:        I like it to be below a 100.

Dr. Weitz:          Below a 100?

Dr. Chilkov:        Yeah. So, that’s hard. So, that’s hard. Nasa Winters, who some of you are interested in cancer may know she’s a colleague of mine. 125 is reasonable. That’s doable. Completely [inaudible 00:20:11].

Dr. Weitz:          Valter Longo says below 175

Dr. Chilkov:        No, no. Valter Longo doesn’t know anything about health. He is a lab rat. He’s a lab rat. He is theoretical. He’s completely theoretical. I was just on a stage with David Sinclair and he’s the same way. If you guys know who David Sinclair is, it’s a longevity. So, he’s a brilliant guy, he’s like reductionist. And so, we have to be whole systems thinkers. That’s what causes [inaudible 00:20:38], is to understand the whole system. So, it’s great to have people that go deep into research. But Valter Longo and David Sinclair don’t know anything about health. Nothing. Nothing. They know about their pathway. I’ve met him, I’ve talked to them. All right, let’s not get lost. I’m barely through my slides.

Dr. Weitz:          Sorry.

Dr. Chilkov:        All right. So, Ben and I have known each other a long time. So, control yourself. So, anyway, these are the things that we can intervene, help people metabolically, put them on anti-inflammatory diets, teach them how to sleep, teach them how to exercise, teach them how to have a good body composition. So, all the things we already do already become more crucial in cancer patients. All right. So, I have tons of references in here for you. So, these things occur together, obesity and cancer. And diabetes and cancer also occur together. So, in bold are the more glucose and insulin sensitive cancers. And so, people always ask me also about a ketogenic diet. And I am not a fan of [inaudible 00:21:57]. There is actually not a lot of research to support ketogenic diets except in brain cancer and pancreatic cancer, which are the more glucose and insulin sensitive cancers. But a ketogenic diet is not a healthy diet. It is a therapeutic diet. And some patients cannot be on if you have a severe osteoporosis, if you have kidney disease, you cannot be on a ketogenic diet. And it’s a hard diet to maintain.

                        And one of the things I’m very sensitive to is that cancer patients don’t have a normal life, they feel socially isolated, and I want them to be able to even their friends and their family. And so, I don’t want them to become more isolated. And so, I only prescribe ketogenic diets in pancreatic and brain cancers. And otherwise where the research is, where the research is solid, and thank you Walter Longo, is in fasting mimicking diets and in intermittent fasting. That’s where the research is solid, really solid.

Dr. Weitz:          What was the first diet you said, the?

Dr. Chilkov:        Ketogenic.

Dr. Weitz:          No.

Dr. Chilkov:        Fasting mimicking diet. That’s lingo that comes out of Walter Longo and his studies. But his fasting mimicking diet is an intermittent fasting diet and a low carb, low glycemic diet. And he’s marketed it and made a product, which I won’t name on tape, but I don’t like it. And because it’s not healthy foods. See these guys that do all this research, they don’t know what healthy food is. And so, you can’t just go on the ride with them. All right. So, glycemic control and body composition change the growth signal for cancer. That’s the big thing. And they change mortality, they change risk recurrence, they change occurrence of cancer. So, getting control of this is hugely, hugely important.

                        So, there’s also so many more. I mentioned so many surgical complications. So, my goal for hemoglobin A1C, which is probably consistent with the [inaudible 00:24:14] is between 4.8 and 5.2. That’s where I want people to be. And it’s totally doable. You just have to teach people how to do it. Realize cancer patients have high cortisol, they’re really stressed. That can push up their blood sugar and impair their glycemic control. So, realize that’s a contributor in this patient population. A lot of cancer patients have disrupted sleep cycles, which will impair their glycemic control. So, you have to do a very thorough analysis of root cause in etiology to make sure that you’re addressing where the impairment is coming from.

                        The other thing that happens to these patients is they become at risk for secondary cancers. Although I don’t see that a lot in my own practice. The research is there. So, here’s the other infographic that helps you see the big picture, the big picture of this physiology that we’re talking about. So, of course we have patients that are more genetically susceptible to developing insulin resistance and for glycemic control. We have patients that are more susceptible both from environmental signaling and genetics also to developing body composition with more fat. All of these patients have more inflammation. You get signaling from adiponectin and also from leptin that changes the signal to the tumor cell and that changes an environment to make it more hospitable to the development of progression of cancer. So, I actually measure adiponectin in leptin in all my patients, and you can do that.

                        And then when you have more inflammation, you get this sort of cytokine environment. The cancer cell itself will secrete inflammatory cytokines. And then the larger biosystem, if it’s more inflammatory, you get inflammatory both from the cell and from the biosystem itself. And so, this is a highly proliferative environment. And so, controlling inflammation, which we know how to do is really important. The oncologist does nothing on this note. And the oncologist is not interested in insulin or glucose either. And in some chemotherapy infusions prednisone is used to inhibit inflammatory reactions to the drugs. Mostly in platinum chemotherapies this is done. So, this impairs the patient’s ability to sleep, number one, but it also shoots their blood sugar up. So, I ask my patients to ask their oncologist to cut that prednisone in half, and I’ve never had anybody object to that. So, one of the things that I feel we should do is be resources to our patients to understand that they can ask for individualized care.

                        And so, if you know a patient already has glycemic issues, you want to remove the prednisone from their IV. And in fact, they also put antihistamines in the IVs. And so, sometimes that’s sufficient. So, if you think prednisone is a really bad idea for your patient, you can have that conversation with the oncologist. So, I think that’s part of our job, is to help the patient be an educated patient. Help them understand how to ask for care that’s more appropriate to them so that they don’t just get cookbook standard of care cocktails. All right. So, the other thing that happens, of course you have a change in liver physiology and gluconeogenesis. But then you also as you know, will have increased risk of fatty liver disease with all of this as well. So, thank you Peter and Tia do all that for us. So, that’s a factor in this patient population, too. So, we have to be mindful of their liver health in the face of metabolic issues.

                        And so, then what happens in addition to that is you have more body fat, you have more estrogen going on, and then you get changes in sex hormone binding globulin due to that. And so, this whole hormonal milieu and this signaling which becomes proliferative. We know that steroid hormones are proliferative hormones. So, we get this whole tipping of the whole metabolic milieu. And this becomes an environment that is able to host cancer development carcinogenesis, but also increases proliferation and metastasis because you get this going on where a vascular endothelial growth factor, VEGF, increases as does plasminogen activator inhibitor. And this increases coagulation. So, the tumor microenvironment is a microenvironment of thrombus risk. It is a microenvironment of hypercoagulation that’s a fact of cancer.

                        So, two things go on as soon as you have a solid tumor. You start to have sarcopenia signaling as a risk and you start to have hypercoagulation as a risk. So, you want to be mindful of that because 40% of all cancer patients have a thrombotic event. They will either have a thrombus or an embolism. And so, there’s no reason for cancer patients to suffer those if we can prevent it. So, I monitor fibrinogen and D-dimer in my patients. And you will see those go up. Those are markers of hypercoagulation in the cancer setting. Those are reliable markers of hypercoagulation. And oncologists are loathe to anti-coagulate their patients because the drugs are so strong. But we can do it with curcumin, and boswellia, and high doses of omega-3 fatty acids. You don’t want to anti-coagulate your patient, but we can inhibit platelet aggregation. It’s a little harder to inhibit fibrin clots. But that’s what cancer patients get.

                        So, if you see that a patient has high fibrinogen and high D-dimer, then you want to give them something like lumbrokinase or natokinase, which are able to act on the fibrin formation. So, the things we think of as anti-coagulants are the typical things are just inhibiting platelet aggregation. But the risk is fibrin clots and cancer patients need to be aware of that. We can so decrease patient’s risk. And if I see a patient with really high risk of thrombus formation. Like I had a patient come into my office and she had a port in her arm for chemo and she had a chain of lip clots below the port. Now I see the patient more often than the oncologist does. I was doing acupuncture weekly.

                        And so, I called the patient on my cell phone in front of the patient in my office while they were on my table and I said, “We need to anti-coagulate this patient. I’m going to send them over as soon as I’m done here.” And I wanted the patient to hear it, hear me say that to the oncologist. And so, we were able to identify that risk. The patient doesn’t know that shouldn’t be happening. And so, we tend to see our patients more often, more personally and observe them better so we can keep them safer. And what else do you tell a patient who’s got a risk of thrombus? You make them make sure they’re not too sedentary. You make sure they’re hydrated. You make sure they’re on an anti-inflammatory diet. And so, we can really keep people much safer. So, the first slide I showed you, the more general slide about obesity and cancer, et cetera. And then this slide, if you want to go back and really wrap your mind around all the factors that are contributing factors, these two slides really have everything that’s important to pay attention to.

                        And so, we know, again, I mentioned that there’s more insulin receptors on tumor cells and that’s why it’s really important to get control of insulin and blood glucose. Okay. So, there are other factors that drive obesity. We know that menopausal women tend to have different relationship to percentage of body fat. So, that’s the patient population that we’re typically working with in this age group. If you have a younger patient, it might actually be someone who had ovarian or endometrial cancer who had a hysterectomy. So, then she becomes in this group as well. As we always do, we always understand the patient’s lifestyle, which the oncologist doesn’t even ask about. And so, you want to be paying attention to that. So, you can see here that as I was talking about this estrogenic effect of obesity and we get changes in sex hormone binding globulin change in the ratio of free and bound hormone.

                        And so, we get changes in signaling and we get increased aromatase. And aromatase is an enzyme in the tissue that converts androgens to estrogens. So, you get more estrogen signaling. Which is why women who have estrogen-driven breast cancers are more at risk if they’re obese or have glycemic issues. It’s a high-risk population. Super high-risk population. A lot of them are in our offices because they want us to help them with their menopause. So, we got their ear. And so, we want to attend to this. And then because lifestyle runs in families, so do all these risk factors, it’s not just genetics. So, we have an opportunity to affect more people in one family if we do our patient teaching in that way.

                        All right. So, I want to hit the highlights so that we can just have a conversation. I think I made this point. But this is really interesting. Oh no, this isn’t the slide I want to talk about. But anyway, you can see that diabetes and glycemic issues are really a driver of breast cancer. But also say estrogen-driven cancers include other cancers. So, lung cancer can have estrogen receptors. Pancreatic cancer can have estrogen receptors. Colorectal cancer, brain cancer, prostate cancer. There’s a lot of cancers we don’t think of as hormonal cancers that have estrogen receptors on them. And so, you can request the pathologist to check.

                        All right. So, here’s what I wanted to talk about was the role of intermittent fasting and carbohydrate restriction. We know that this is a way to get glycemic control. But there’s all these studies on cancer patients and intermittent fasting. And so, I just want to say, there are historically what I call old naturopathic ideas about water fasting in cancer. That’s not what I’m talking about because that is too high risk for sarcopenia in this population. It’s just too high risk. And so, I don’t water fast people over 50 because they need their muscle mass. So, if you have a young patient who’s in good shape, they can tolerate some loss of muscle mass, they’ll get it back. But an older patient’s not going to get it back.

Dr. Weitz:          What about water fasting just before and just after chemo?

Dr. Chilkov:        I don’t want to put my patient at risk for sarcopenia, period. So, the question was what about water fasting before chemotherapy? The better question is what about fasting before chemotherapy? So, we know that there’s good studies that show if you stress tumor cells by making glucose unavailable to them, the cancer cells already stressed when the chemo is administered so you get a higher kill rate. So, it is well documented. However, I’m very careful. So, I look at the patient. If the patient is already underweight and undermuscled, I don’t do that. So, what I have that patient do is maybe drink bone broth or do a protein shake that has no fruit in it at all, and just get or just do branched chain amino acids, something to protect their muscles while we’re stressing the tumor cell does not get this impact. This stress comes from withholding glucose to the tumor cell.

                        So, if you can accomplish that and preserve muscle, that’s your goal. That’s my approach. Okay. That’s my approach. So, if I have a more robust patient, I’ll have them just do protein shakes or bone broth for 48 hours if they’re pretty robust. Some people will do it 24 hours. If somebody can only do it 13 hours, the data shows 13 hours enough to get a switch in the metabolism and have an impact. So, it depends how robust and also how psychologically motivated, and if somebody has experience with fasting and all of that. And they must be well hydrated. When you’re having an infusion of chemotherapy or anything else, you have to be well hydrated. You want to keep diluting what is coming into your system. And so, actually have people drink bone broth during their infusion. So, they’re getting fluids, electrolytes, and some protein. And that keeps them from getting into trouble with their kidneys also. Really, really protects the kidneys and the gut as well. Yes.

Speaker 4:         Do you recommend intermittent fasting for someone’s in remission?

Dr. Chilkov:        Yes. I actually think intermittent fasting as a lifestyle is really great, actually for everyone.

Speaker 4:         But how long?

Dr. Chilkov:        I think I have a study here. Let me see if it’s here. So, here’s the impact of carbohydrate restriction. And I do have sliding here somewhere on the study. So, there’s this balance between enough protein and lowering carbs. And what happens to people is they do need some dietary guidance. I have a nutritionist that works in my practice because when people just take their carbs out, they lose weight. And so, this patient population cannot lose weight. They need to maintain their weight unless they’re over fat, then we want them to lose fat but not muscle. So, if you take the calories out from carbs, you have to replace that with healthy fats with protein so that you maintain your weight. So, there’s some patient teaching that has to go on with that.

                        And I often will put a therapeutic shake into the protocol because again, these patients are not really that interested in food or in cooking for a lot of their treatment cycle. Afterwards, they may be. But during, they’re not, and they really need to be protected. So, they feel well also while they’re going through treatment and that they do well while they’re going through treatment, they have enough nutrients to repair the damage that the chemo causes. So, I do have a study in here, it’s coming up. 13 hours is out of it. 13 hours is out of it. Let me find that slide.

Speaker 4:         Like they do that every day?

Dr. Chilkov:        Yes. It doesn’t take much to fast for 13 hours. You eat breakfast a little later or dinner a little earlier. It’s not hard to do. It’s not to do at all. And if they wanted to have something in that window, they could have branched-chain amino acids during that time. It doesn’t disrupt this physiologic switch we’re trying to accomplish. So, it’s not hard to do. So, I actually recommend it to everyone who has cancer history, cancer risk, or is going through treatment. And then it becomes a lifestyle. So, I’m trying to teach people how to eat for their life, not for their key. And so, I think it’s really important that patients who are going through surgeries really need to keep their protein together and their gut together.

                        Just giving probiotics around any surgery decreases surgical complications in all patients, not just abdominal surgeries. Why? Because of its impact on inflammation and immunity. So, it’s really important and on mood as well, on neurotransmitters. So, at any rate, this is a classic ketogenic diet. And so, I don’t want to spend a lot of time talking about it. If you want to learn about ketogenic diets, I actually gave a really long lecture on one of the supplement companies that I can’t name during the recorded lecture, but I’ll tell you afterwards. There’s a long lecture on this online. Anyway, I don’t recommend it unless pancreatic with brain cancer. Or you could do a ketogenic diet for a couple of days before chemo. But you’re not going to get into full ketosis if you want to do for a couple of days. You only get a therapeutic mileage out of a ketogenic diet if you sustain ketosis.

                        It’s hard to do. You don’t feel well, people get diarrhea. It’s not an easy thing to do when you already don’t feel well. You already don’t feel well. So, I am very, very sensitive to what’s worth doing. What’s worth asking a cancer patient and a family to do cancer doesn’t affect just the patient, it affects their whole family. And so, it has to be sustainable over time. If it’s too hard, it’s not going to work. But anybody can do intermittent fasting and low-carb diet. Anybody can do that, teach them how to do it. It’s not hard to do. So, here is this study. This is a really cool study. It was done with a 13-hour window and it was done with thousands of breast cancer patients. It was a European study. And they found that it changed IGF-1 levels and that it was better than just calorie restriction itself. It was just better to do intermittent fasting.

                        And there’s a lot of different ways to do intermittent fasting. You can do low calories two days a week or like that. But that’s too complicated for people. Which days is it? What are they going to eat? Just fast. Just don’t eat 13 hours of every 24. It’s really easy for people to put that in their lives. So, I have some statistics here, let me find them. So, this was a cohort of 2,400 plus women in early stage breast cancer. And it was a wide age range, which I liked and it was a seven-year follow up. So, I liked this study. 21% lower risk of dying from breast cancer by doing 13 hours of fasting out of every 24. That’s pretty good solid motivation I think to integrate this. And then there were some more statistics, change rates of recurrence changes mortality, as well as recurrence. So, I like that study a lot.

                        So, now let’s just talk about interventions. So, those are the big physiologic functional ideas and we can talk about them more if you want. But let’s look at interventions. So, what time is it? [inaudible 00:44:31]. We’ve got time. Okay, so omega-3 fatty acids are very important in the tumor microenvironment for a variety of reasons. And so, not only for inflammation but also reduces tumor cell adhesion, which is another reason to really optimize omega-3s. I measure them. There’s LabCorp and West has the omega check test, which are sufficient. There’s more sophisticated tests. But those are sufficient to see if the dose of omegas that you’re giving your patient is optimized for them. And so, I tend to dose high on these. I give most of my patients get a minimum of four grams a day of omega-3 fatty acids. If you have a particularly inflamed person or a person with more brain inflammation, I like to use the pro-resolving mediators, the SPMs. Those really are powerful. And especially if someone’s feeling depressed, that also really helps them.

                        Remember that the blood-brain barrier is compromised in all cancer patients due to the high level of matrix metalloproteinases. And so, the SPMs are really great for the brain. Of course the EPA is also. But even better is the phosphatidylcholine-bound omega-3 fatty acids. Those get into the brain preferentially. And so, there’s a couple supplement companies that make phosphatidylcholine-bound, omega-3s. And anybody for example, who has an APOE4 allele, they must have those phosphatidylcholine-bound omega-3s because they have an error in transport of omega-3 fatty acids into the brain, which is why they’re at risk for dementia.

Speaker 5:         What does [inaudible 00:46:26] like for the SPMs? Do you do those in addition?

Dr. Chilkov:        Yeah, I’ll do them concurrently. Yeah, it’s too expensive to do just the SPMs by themselves. So, I’ll give four grams of the EPA, DHA. And then I’ll give two cats twice a day of the SPMs on top of that. And sometimes that’s just phenomenal what that can do for patients. It’s expensive, but it’s therapeutically very powerful. And then as I mentioned, I do a therapeutic shake. So, I wanted to show you what I put in that shake. And one of the things that I like to add, especially if people are having trouble getting enough calories and feel fatigued, you can put medium-shake triglycerides in there. And I really like to put carnitine into either the capsules or powder. A lot of the companies have stopped making powdered carnitine recently. And it makes the shake taste very sulfury. So, people don’t like it. But about two grams of extra L-carnitine, not Acetyl-L-carnitine, L-carnitine for the muscle and the mitochondria.

                        So, when you give that extra carnitine, you address some of the mitochondrial fatigue that cancer patients have, but you also address muscle physiology because you get better energy delivery and fatty acid metabolism in the muscle. And remember that the biokines that are secreted by the muscle also have an impact on immunity. And so, this whole idea of paying more attention to muscle-centric medicine I think is really important. I don’t know, when I went to school nobody ever talked about it. So, I think it’s really important. I think it’s a good contribution.

                        And then you want to make sure people are getting some soluble fiber. Patients think of fiber as insoluble fiber. And so, to teach them where soluble fiber comes from or give them powders to take so that their microbiome has some sustenance. That’s how I put that together. And also you can add more fatty acids to the shake, and add calories and more fatty acids that way. I find these dense shakes, if you put a half of an organic lemon with the rind into the blender, it just brightens up and lightens up the taste of the shake. That was the idea for Mark Kleinman. You can put half an avocado in the shake to give more calories. A lot of these patients are having trouble getting calories, because they don’t have any appetite, or they’re nauseous, or they don’t feel like cooking.

                        So, some people, especially after they have their chemo infusions, a lot of them don’t feel like eating for three to five days. They can live on two or three shakes a day and some branch chain amino acids, and bone broth until they feel like eating. As long as you put some greens powder or some greens into the shake and they’re getting some phytochemicals along with all of this. I also put in some of the Chinese mushrooms into the shakes. The only contraindication to using Chinese mushrooms in these patients is if they’re on PDL-1 and PD-1 blockers, the immunotherapies. Because these are therapies which take the breaks up the immune system. And so, we don’t want to be ramping up their immune system while the drug is doing that. We can cause a forest fire of inflammation where we only want an ember. And so, you want to be careful with Chinese mushrooms, and astragalus, and echinacea, these phytochemicals that push on the immune system. You have to be careful. In the same way, you have to be careful with autoimmune patients in that same way.

                        So, that’s just my shake recipe. Berberine is really great for this patient population because as you all know, berberine is very important. What is that? Oh, somebody opened the door. Okay. So, as you know, berberine is a good agent to use for glycemic control. But look at this slide. Berberine interacts with over 20 different pathways that infect cancer physiology. So, you want to look for multi-taskers. Phytochemicals are phleomorphic. They can bind to multiple receptors and influence multiple pathways. You guys are going to get the slides. So, anyway, berberine is in the news because glycemic control. But I simply want to point out that it’s really powerful in multiple pathways in cancer physiology. It is also like many phytochemicals, very important in changing the microbiome as well and changing how we utilize phytochemicals.

                        So, we’re running out of time. So, let me just go through these. Curcuminoids also have a big impact on glycemic control. They’re not usually thought of in that context. But I want to point out that they do have an impact on glycemic control. This slide also shows you that curcumin also actually affects the pancreatic beta cells. It affects adiponectin, triglycerides, and leptin, and liver fibrosis. So, I think that we tend to get a little siloed in our thinking about some of these phytochemicals. And I have to say, botanical medicine is my first love because of the fabulous multitasking and ability for molecules from nature to bind to multiple receptors and interact with multiple pathways. And so, curcumin is widely used in cancer as you all know. But you can see here there are certain cancers, it’s more powerful. And I use this in almost all of my patients.

                        There’s a subset of patients who get some enteritis from curcumin. So, if you have one of those, use boswellian instead or together. Resveratrol also exerts glycemic control. We don’t think of it that way, but it does. It also has an impact on fatty acids. And resveratrol interacts with multiple pathways that affect tumor cell metabolism. Green tea, you’re all familiar with that in terms of its impact on obesity and body composition. But it also of course has multiple signaling pathways for glycemic control as well. And ganoderma, which is reishi mushroom, also has a big impact on blood sugar. And it’s also one of the only Chinese mushrooms that has a lot of anti-inflammatory effect that you can use it in an autoimmune patient. You don’t have to be so worried about that. So, I really like it because it has this glycemic control, tumor control. Also, it has a big impact on mood. And in the Taoist culture it was used for meditation. And so, that’s why it’s so famous. Affects gastric emptying also.

                        So, let me just summarize because we have 20 minutes. We can have some discussion and you can look back at these slides. So, obesity is linked to cancer and diabetes. Chronic hyperglycemia, hyperinsulinemia and elevations in IDF-I facilitate tumor genesis and worsen outcome. Patients with diabetes really and hyperglycemia hyperinsulinemia need our patient teaching, and need to learn how to get it right. And because there’s this 40% increased risk of occurrence and recurrence in this patient population, there are obese or diabetic or both, the risk is really high and for the complications of traumas formation as well, and complications of surgeries and treatments. And so, we got their attention. We’re the ones that have their attention on this. So, I think it’s really important.

                        So, these are the things that we talked about today that I chose to include as interventions. So, you think about curcumin, resveratrol, green tea, berberine, ganoderma, the omega-3 fatty acids, put the SPM’s in there. And think about carbohydrate restricted diets, low glycemic diets, intermittent fasting and ketogenic diets where appropriate. You can also include the idea of fasting before chemotherapy adjusted to the patient, what’s appropriate for that patient. And that’s how you get a hold of my assistant. And I have a bunch of references in here for you. And then here’s this handout if you want it. And here’s this discount. If you’re interested in my course, if you just want to talk to me about the course, we have a payment plan. And it’s my legacy project is to pass on this out to our cancer system that I created to all of you. Thank you. We can take as many questions as you [inaudible 00:56:05].

Dr. Weitz:          What do you think about apricot seeds that make the blood?

Dr. Chilkov:        So, there’s a lot of cancer therapies that have been done for a long time. And I think what we need to do is be mindful of where the science is. So, there’s a lot of things that have been used in naturopathic oncology that don’t really have good science behind them. I think amygdala does, but it’s so toxic. And I think we have better choices. We understand cancer cell metabolism better. We don’t have to give people cyanide, which is what that is. There’s a better ways to manage cancer.

Speaker 6:         I have few questions.

Dr. Chilkov:        I don’t use it. So, I don’t use it.

Speaker 6:         Do you recommend that these will all be in the form of extra supplementation with supplements? Or can you get this for the diet? I always worry about [inaudible 00:56:50] supplement.

Dr. Chilkov:        So, great question. In order to change signaling in tumor cells, you have to give a pharmacologic dose. You cannot give a nutritional dose. So, you have to think high-dosing. And so, I’ll give two or three grams of berberine a day. I’ll give four to six grams of omega fatty acids a day. I’ll give three to five grams of resveratrol a day. You cannot change a cancer cell’s behavior or change the signaling in the cancer environment with a nutritional dose. Great question. Great question.

Speaker 6:         How do you feel about, I guess the senolytics are there too, but like senolytic or NAD, NR, NMN.

Dr. Chilkov:        So, all those things, yeah, all those things are important. I focused on the things that impact glycemic control. There are certainly multiple things that influence other pathways and cancer cell metabolism. But in that context, you think about mitochondrial function. If you widen your thinking out to mitochondrial function, you start to think about other things like nicotinamide, ribonucleoside, or NNN. Or you start to think about all the B vitamins that drive the cancer. You want to think about optimizing mitochondrial function in these patients, which is where [inaudible 00:58:13] contribution comes in. But he’s too narrow. And [inaudible 00:58:16] ideas have not been really supported by research. So, you have to realize that.

Dr. Weitz:          Now isn’t there a risk of increasing cancer with NR or NNN?

Dr. Chilkov:        So, theoretically there is. So, I’m conservative. I’m a very middle path clinician. Very middle path. So, the things I’ve told you that I give in high doses I think are super safe. But there are things that are questionable. So, I think you can use the senolytics, which curcumin’s in that category, resveratrol’s in that category. Those things are in that. I like Ficetan quite a lot. I think there’s a lot there. I like to stick with things that have human studies over time when we are thinking about cancer patients. As a clinician, I do not experiment on my patients. I’ll experiment on myself, but not on my patients. And so, I think we have to be careful.

                        And baby boomers like me are becoming hysterical about aging. So, I’ll be 71 this year. And so, we have to be careful to not go off the deep end and create Frankenhumans or whatever. We have to be careful because anytime you leverage only one pathway, you’re going to get into trouble. And so, I do think it’s not clear. I think as we age, we need to enhance our NAD pathways. And so, be conservative on that. An aging person needs more efficient mitochondria. But maybe we don’t go into these big therapeutic pharmacologic type doses of these other things I’ve mentioned that I know are safe in those doses. So, I think it’s too new. We don’t know the answer to that.

Speaker 7:         What about IV nutrients? Some practitioners even use IV [inaudible 01:00:19].

Dr. Chilkov:        So, you have to realize I also recommend them, but let’s have context. So, IV therapies are temporary, unlike when we prescribe something more that a patient takes every day. So, the day you get your IV, it has an impact for a few hours and then you pee it all out. So, you have to remember that. So, what are you trying to accomplish when you give an IV? So when you give high dose IV vitamin C, it becomes a pro-oxidant. In low doses it’s an antioxidant. But when you give it in high dose IV 50 to 75 grams per push, then it becomes a pro-oxidant and causes the production of hydrogen peroxide in the blood, which kills cancer cells and spares healthy cells. Not all patients tolerate that. Some people get hyperglycemic when you do that. So, you have to find out.

                        Also, you have to make sure high dose IV vitamin C is safe. You have to measure an enzyme G6 PD to make sure that they will not have red blood cell lysis when you give them high dose IV vitamin C. There are clinicians who are specialized in treating cancer patients with these IV therapies. And there are some good people here in LA and around the country that do that. But just because somebody does IVs in their office doesn’t mean they should be treating cancer patients with IVs.

                        You can give IV resveratrol, IV lipoic acid, IV curcumin. There’s a lot of to IV NAD, there’s IV phosphatidyls pulling. But you need a highly trained person to administer these therapies because… and also I insist that if we’re going to treat cancer patients with these aggressive IV therapies, there better be a nurse in a crash cart in that office. And the team there better be trained to deal with an emergency. And there’s all these clinics where that’s not so, and they’re not safe. And these are vulnerable, fragile patients. These are not healthy patients going for a little upper on their IV. And so, these are fragile, fragile patients and they have to be in a safe medical setting. Yes.

Speaker 8:         Have you heard of C15 or what is it?

Dr. Chilkov:        Those fatty acids? Yeah. I don’t think there’s enough information there to do anything. Yes.

Speaker 9:         Do you have any comments on beta-glucuronidase activity [inaudible 01:02:56]?

Dr. Chilkov:        I didn’t understand you.

Speaker 9:         Do you have any comment on beta-glucuronidase activity, the stool test at risk for the breast cancer?

Dr. Chilkov:        I’m not understanding.

Dr. Weitz:          Oh, some stool test report on beta-glucuronidase.

Dr. Chilkov:        Oh, [inaudible 01:03:11]. Yes. Yes, absolutely. So, if you have an estrogen-driven cancer, I have a whole lecture on the estrovalome, which is the way that the microbiome influences estrogen metabolism. And so, beta-glucuronidase is involved in conjugation and decontagation of estrogens in the gut. And so, if you have high levels of beta-glucuronidase, you have higher levels of decontagation of estrogen. What does that mean? So, estrogen in the bloodstream goes through the liver it gets conjugated, and excreted through the bile into the stool. If there’s too much beta-glucuronidase in the gut, that gets decontagated, which means that estrogen goes back into the general circulation and you get a double whammy hit of your own estrogen. So, patients who have that have a certain type of estrogen dominance essentially. So, you need to fix that. Yeah, you need to fix that. A whole lecture just on that subject.

Speaker 10:       What do you think about melatonin? Some practitioners now are using 200, 300 milligrams a day.

Dr. Chilkov:        So, melatonin can be used to alter tumor cell metabolism at multiple effects. And again, I’m a conservative clinician. So, all the original studies were done by a group in Italy that studied 20 milligrams of melatonin at bedtime as a dose in breast cancer patients. However, we think of melatonin in this very narrow way, but it has a lot of impacts on multiple pathways and metabolic pathways in the cell and in particular has an influence on cancer cells. And there is a rationale to give high doses of melatonin to patients. I’ve never gone myself over 180 milligrams. That’s plenty melatonin, I think.

                        And so, it’s interesting because I think melatonin is misunderstood. Melatonin is not a sedative. Melatonin is a dark signal to the brain. And so, it tells you it’s nighttime. It tells you to get ready for sleep. So, when you get into these pharmacologic doses, it’s not about that. It’s about changing metabolic pathways and cells, and some of which drive proliferation. And it’s pretty safe. I’ve never really seen anybody get into trouble with it. Patients, I think of this placebo effect where they think they’re sleepy because they’re taking melatonin until they explain to them it’s not a sedative. And they can wake up refreshed after they take a high dose of melatonin.

                        But I always start slow. I never go way up there. I’ll start somebody on 20 or 40 milligrams, and then up to 80. And I’ll go upstairs, get people up to see how they do. There are some people who just don’t rate it very well. The primary adverse effect is wild dreams. And so, that’s as bad as it gets. But for some people, that’s not normal. So, you can modulate it down then. But it is quite effective. But I tend not to go straight to those therapies. There are patients who do quite well, do anything extreme. But there are subsets of patients who become treatment resistant in the standard of care oncology setting, in which case we need to really think about what can we do that’s a big lever for them to really change their course of progression.

                        But realize most of the naturopathic therapies don’t kill cancer cells. Most of our therapies are metabolic therapies. You have to really realize that there are times when you need something that’s really toxic, that’s going to kill cancer cells because in some patients, you really need to reduce tumor burden quickly. And there’s nothing in natural medicine that does that. So, that’s why I call my approach integrative because I always ask the question, what’s the right tool for the job? Or what are the right combinations of tools for the job? And some people really, really, really need toxic chemotherapy to reduce their tumor burden for a period of time. And so, the enemy is not chemotherapy. The enemy is cancer. So, you have to have a way of thinking about how you’re going to give this person a good long life and quality of life. And sometimes chemotherapy is part of that solution for a finite period of time. And where people get into trouble is over-treated with chemotherapy. But it has a place.

Speaker 11:       I know you said you don’t experiment on your patients. Do you have any thoughts on peptides minus and alpha that have been showing in research that we do?

Dr. Chilkov:        I think we could say, what about off-label use of drugs? We could say that, too. So, I do think that there are some things that are quite safe to do. And if we’re in the realm of safety, why not? Why not if there’s a good rationale? But I still think you have to look at your patient. What are the metabolic pathways in their tumor cell line? What are their comorbidities? What will they tolerate? What can they afford? So, I look at all of that. I think there’s a lot of things we can do with off-label use of drugs like statins interrupt metabolic pathways significantly in numerous cancers. They’re cheap, they’re safe, and things like that. There’s metformins widely used in the cancer setting. So, I think that that’s a whole other lecture also.

                        But I think if it’s something safe, I think it’s safe to try. Metformin tries statin, try something like a well thought-through peptide. I don’t think there’s any reason not to. Everything I do is individualized. You have to just look at the patient. And I’m very mindful of how much I ask them to do and ask them to spend. And so, if someone really has limited financial resources, then I really want to make sure that what I’m giving them are the big levers that I do know are going to make a difference. It’s quite different when you have a stage four patient that’s become treatment resistant and then you have to think about all other kinds of things.

Speaker 11:       Any thoughts on giving it to younger patients and possibly proliferating cancer?

Dr. Chilkov:        Giving one to [inaudible 01:09:59].

Speaker 11:       Different peptides, because I think there’s a lot of [inaudible 01:10:01].

Dr. Chilkov:        I think we don’t know enough about peptides. I think, look what’s happening with [inaudible 01:10:06]. I mean, it’s the Wild West as far as I’m concerned. It’s dangerous. What we’re doing is dangerous. And so, here we’re in LA welcome to the Hollywood. So, everybody wants to be thin and rich. And so, we always at least be thin. Maybe not rich if you buy your [inaudible 01:10:27]. But I think I am just careful. These are really fragile, vulnerable patients. But it’s tricky because you also have the family to deal with. And so, you might have a patient that wants to engage in the kind of therapies that we include and their family’s freaked out about it or as a willing to spend the money on it.

                        And it’s tricky because I do feel that patients values and wishes for themselves should be respected. And sometimes the family just can’t deal with it. Or the family’s so terrified that the patient’s going to die, that they want to do everything the oncologist says, even though the oncologist stuff isn’t working anymore. It’s complicated. It’s very kind that people have different feelings about death, and mortality, and suffering. And I always say, if you want to work with cancer patients, you have to have a level of complexity. I think it keeps it interesting. Yes.

Speaker 12:       I just want to make sure I didn’t… I know I misheard something earlier about when you were talking about the diet, about the animal protein. You were like some decreased animal protein. But then [inaudible 01:11:38].

Dr. Chilkov:        So, I restrict red meat because there’s a lot of studies showing that red meat is very carcinogenic. And so, I restrict that. And it’s largely because of the iron in red meat. Cancer cells sequester iron and use it for their own metabolism. And so, there’s a whole line of cancer cell physiology, which is involved with ferroptosis and leverages iron as a way to-

Speaker 12:       I heard the protein and then you immediately-

Dr. Chilkov:        Yeah. Yeah. So, cancer patients need protein to maintain muscle mass or restore muscle mass that they’ve lost. So, if they have a high IGF-1, then you have to try and figure out what protein is going to build their muscle and not increase their idea of blood.

Speaker 12:       What was the name of the BCAA powder?

Dr. Chilkov:        There are many companies that make branch chain amino acid powders. Many, many companies. I just pick high quality companies where it doesn’t taste terrible. Basically, I taste everything before… different companies make better tasting things. So, it’s eight o’clock. Are we supposed to stop any-

Dr. Weitz:          Yeah, I guess theoretically [inaudible 01:12:57].

Dr. Chilkov:        Until we get kicked out. Should we get kicked out?

Dr. Weitz:          Thank you everybody.

Dr. Chilkov:        Thank you everyone. Oh, I have something for you. Wait a minute.



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 appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.



Constipation with Dr. Ilana: Rational Wellness Podcast 356

Dr. Ilana Gurevich discusses Constipation with Dr. Ben Weitz.

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


Podcast Highlights

2:16  “We are living in a constipated world”, according to Dr. Gurevich.  More than 35% of the US population has reported using laxatives and it’s over a $500 million a year industry. 

2:44  Dr. Gurevich finds treating constipated patients much more challenging than patients with diarrhea.  There are a number of patients with lifelong constipation issues and they can be very challenging patients to figure out the root cause and to resolve.

3:57  Red Flags. We need to be alert for when a patients with constipation has signs that might indicate that they need medical intervention. One red flag is when you have frank red blood in the stool, which looks like coffee grinds. This indicates either an upper GI or a lower GI bleed.  It could indicate hemorrhoids or it could be colorectal cancer or inflammatory bowel disease.  If you have severe pain in the GI tract or rectum or you have a spiking fever, those are both red flags. Also, if you have recent onset of fatigue and anemia, then that is a red flag that you might have GI bleeding.  Now constipation can also be caused by many conditions, including diabetes, Parkinson’s, MS, and other neuropathies.  There are also non-neurogenic conditions that can cause constipation, including hypothyroidism, pregnancy, and a history of binging disorders.

8:55  Idiopathic and Functional Constipation.  Functional constipation is the stuff that Functional Medicine practitioners often treat, like SIBO, low fiber, slow transit, outlet constipation, dyssynergic defecation, and pelvic floor dyssynergia. Dr. Gurevich has a patient who’s in his 80s but who bikes a hundred miles per week and sits on a bicycle seat for hours per week and it causes nerve damage, which is a pelvic floor dysfunction.  Switching to a recumbent bike is one good idea and seeing a good pelvic floor therapist can also really help.  Dr. Gurevich also points out that when you avoid going to the bathroom when you have an urge to defecate, this can increase constipation due to nervous system feedback.

14:42  Drugs.  There are a lot of drugs that can cause constipation, including anticholinergics, antihistamines, iron, opiates, some blood pressure meds, some calcium channel blockers, and NSAIDs.

15:34  Functional Constipation. These include normal transit, slow transit, and rectal evacuation disorders.  Functional constipation is when our Functional Medicine strategies like fiber and bulking agents and herbal laxatives can be helpful.


Dr. Ilana Gurevich is a board-certified naturopathic physician and acupuncturist and is currently co-owner of two large integrative medical clinics, one in northwest Portland and one in northeast Portland.  She runs a very busy private practice specializing in treating inflammatory bowel disease as well as IBS/SIBO and functional GI disorders.   Dr. Gurevich is also one of the co-hosts of a successful podcast, Turd Nerds, along with Drs. Rebecca Sand and Ami Kapadia. Her website is OpenWellnessPDX.

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, I’m very excited about talking about one of my favorite topics, which is constipation, and I’ve often been accused of that. We’re going to be speaking with Dr. Ilana Gurevich, and she’s one of our favorite gut health experts. Constipation occurs in up to 20% of the US population, making it the most common gastrointestinal complaint. The symptoms of constipation include the following: fewer than three bowel movements per a week, hard or dry stools often described as Type 1 on the Bristol Stool Chart if you know what that is. Straining or pain when passing stools. A feeling that not all the stool has passed. A feeling that the rectum is blocked or having to try to help yourself to pass a stool. Dr. Gurevich is a board-certified naturopathic physician and acupuncturist, and she’s the owner of Open Wellness in Portland, Oregon. She specializes in treating gastrointestinal disorders, including inflammatory bowel disease, IBS, SIBO, and other functional gastrointestinal disorders. She’s also one of the cohosts of a successful podcast, Turd Nerds, along with Dr. Rebecca Sand and Ami Kapadia. Dr. Gurevich, thank you so much for joining us.

Dr. Gurevich:                     This is actually one of my favorite topics, too, and as an aside, this is the most downloaded episode that we have on the podcast is-

Dr. Weitz:                            Oh, okay.

Dr. Gurevich:                     …the constipation. We are living in a constipated world, and the last time I did a data search on it, more than 35% of the US population has reported using laxatives. It’s over a $500 million industry.

Dr. Weitz:                            Really? 35% use laxatives. Wow.

Dr. Gurevich:                     Yes. Last time I looked, and that’s lots of people not reporting.

Dr. Weitz:                            Right.

Dr. Gurevich:                     Yeah.

Dr. Weitz:                            So in your practice, how often do you see constipation?

Dr. Gurevich:                     I have to say, when I get a diarrhea patient, I’m like, oh. It’s like relaxing. Diarrhea patients are generally, not always, but generally pretty easy to treat and get to the underlying cause. Constipation, it’s just a lot more nuance, and I mean, there’s a lot of underlying causes for diarrhea, but constipation can first and foremost go back to childhood. There are people walking around with lifelong constipation issues, you know what I mean? It’s difficult. You got to do a lot of history and a lot of tracking down to try to resolve it for real.

Dr. Weitz:                            Right. So it seems like there’s actually different forms of constipation because when you think about the fact that you have somebody, maybe who hasn’t pooed it for two or three, four days, and then somebody else who’s maybe having three or four or five bowel movements a day but has a lot of trouble getting it out and other people who it’s just a lot of strain and it seems like they almost should be described as something different.

Dr. Gurevich:                     Okay, so let’s start with when is constipation, not just constipation? The first thing that I always want to talk about is what we call the red flags. When is something going so wrong that you’re not looking for a laxative you’re looking for medical intervention? That’s the easiest place to start. One, either frank red blood, a significant amount or what we call melena, or coffee grinds. It looks like you have a coffee grind consistency to your stool. That right there is telling you you’re bleeding either an upper GI bleed or a lower GI bleed.

Dr. Weitz:                          Wait a minute, coffee grind consistency in the stool?

Dr. Gurevich:                     It looks like your stool has coffee grinds in there.

Dr. Weitz:                          So now how do you know that? Did you look at their stool or they report that?

Dr. Gurevich:                     No, they report. They report.

Dr. Weitz:                          Okay, okay.

Dr. Gurevich:                     Look, you’re trying to figure out what’s going on. We take a peek at your poop… Please. This is my public service announcement. Please look at your poop. It gives you a lot of information. A lot of information. So if it looks like you’ve got coffee grinds in there or like coffee grind particles, that’s super important because that means that probably you’re bleeding higher up, right? That’s an esophageal bleed, a stomach bleed. If you’re having frank red blood, that’s a little bit more nuanced. If you’re having frank red blood, that generally comes off on the toilet tissue, especially after a hard or more impacted bowel movement. I’m not worried about that. That’s most likely a hemorrhoid. If it keeps going, then you want to get it checked out, but that’s a hemorrhoid. You might have some rectal itching that I’m not worried about, but if you’re having a toilet bowl full of blood, then that’s another big sign. That could be a colorectal cancer, that can be an inflammatory bowel disease. That’s a red flag.

Dr. Weitz:                          Yeah. Those are the two main things you’d be concerned about, right?

Dr. Gurevich:                     Yeah, for sure. If you’re having a new onset of rectal pains, I had a patient come to me five or six years ago, and she was an ulcerative colitis patient. She also happened to be in my community, and she was an ulcerative colitis patient, and so she was like, the bleeding I have you see, the pain I have you see? But she was describing this… The way she described her pain, it like somebody was drilling into her rectum and she was in my community, so she was really into alternative health.  So she waited, waited, waited.  By the time she went into the gastro, she had stage four colorectal cancer, and she was in her forties.  She was in her sixties. She was very young. So that kind of rectal pain, that’s a red flag. That is not normal. Constipation does not cause that type of pain. If you are having a fever that doesn’t make sense, you’re spiking fevers left and you have constipation, that’s a red flag. And then the other thing is unexplained recent onset fatigue that’s consistent with anemia, and then you check your blood and you’re anemic, that means you’re bleeding somewhere from the GI. All of these are not the constipation we’re going to be talking about today. Those are all red flags go, you need some medical help. So that’s red flags. However, outside of red flags, constipation can be caused by a lot of things. So one thing that can cause constipation is neurogenic disorders. So Parkinson’s, diabetes mellitus, MS, any neuropathies. And in fact, there is recent data that shows that Parkinson’s, the first sign of Parkinson’s, which usually onsets in your forties is constipation, and that is-

Dr. Weitz:                          And that constipation occurs up to 20 years earlier than-

Dr. Gurevich:                     Isn’t that frightening?

Dr. Weitz:                          …patients are diagnosed. So then the question is, imagine if we could intervene at that point and could that even help?

Dr. Gurevich:                     I mean, and the problem with that-

Dr. Weitz:                          By way is that the Bristol Stool Chart on your-

Dr. Gurevich:                     Dude, I’ve got one skill, one skill to only helping people poop. That’s all I got.

Dr. Weitz:                          You’ve got to be a GI expert to be drinking out of a cup with the Bristol Stool Chart.

Dr. Gurevich:                     I clearly need some hobby. So yeah, that’s the scary thing about Parkinson’s, that a lot of these neurological disorders onset with constipation, which then you have to worry about the mental slippery slope of, okay, now I’m a middle-aged mainly woman or a middle-aged human being, and I have onset constipation. How do I not sit up in the middle of the night convinced I have Parkinson’s? Right? Okay. So those would be neurogenic disorders that onset constipation. There’s also non-neurogenic also systemic disorders, hypothyroidism, pregnancy, and then unfortunately there is a big correlation with a history of binging disorders, even either currently or in your past. So eating disorder history also can onset constipation. So that I would say is neuropathic systemic causes. Then we’ve got the idiopathic causes, which they don’t really know what to do with, but we also treat them really differently and it’s important to know. So we think about functional constipation, and then we think about idiopathic constipation. Functional constipation is the stuff that we, me and you do a really good job treating-

Dr. Weitz:                          Like SIBO and motility problems.

Dr. Gurevich:                     Low fiber, slow transit. So then we have the idiopathic, so either slow transit constipation, outlet constipation, or dyssynergic defecation, and then pelvic floor dyssynergia. So when you’re taking a history, let me give you a great patient history on this. I had a man come in to see me. He was in his eighties. This guy was a powerhouse. I think he would be… I think still he’s 82 he will bike a hundred miles a week.

Dr. Weitz:                          Wow.

Dr. Gurevich:                     Okay. So that’s important because he’s also sitting on his bottom on a bicycle for hours every week. This guy came in and he was on laxatives. They didn’t really do anything. That’s a keynote. He had tried all of the drugs. They didn’t actually improve his symptoms, and it almost seemed like his thing wasn’t like when the stool would come out because he was on so many laxatives, it would be diarrhea. It was like a Bristol Six, a Bristol Seven, and he had to spend four or five hours every morning stooling. And I’m listening to him, and he’s also talking about his rectal pain. He had been worked up at Mayo. He had gone to a pelvic floor therapist. He had taken all of the fiber and all of the all of the and it didn’t matter because what he had was not a functional constipation. It was a pelvic floor dysfunction, and this is why it’s, I think, really important to have-

Dr. Weitz:                          So he was damaging the nerves by being on that bicycle seat.

Dr. Gurevich:                     Unfortunately, I’m still treating him and he’s actually doing a lot better. That’s like he can’t. He’s like, “Why would I be alive? I want a stoma if I can’t bicycle,” which I get.

Dr. Weitz:                          Could he get a different kind of seat?

Dr. Gurevich:                     We are now negotiating a recumbent. That’s what we’re negotiating. Yeah. Because yes that’s a solution. A solution is not a seat that puts pressure on the rectum. The other thing is I sent him to a really, really good pelvic floor rectal specialized pelvic floor physical therapist. And the story that I always tell with physical therapists is when I was pregnant, I have an 11-year-old. When I was pregnant, I was reading this book about French babies don’t throw food or some kind of Europe book. And 11, 12 years ago in the book, they said in France, after childbirth, every woman goes to a pelvic floor physical therapist that’s just stuck in the medical system. And 12 years ago, I was like, pelvic floor physical therapy I’ve never heard of such a thing. At least now for me, there’s an incredible pelvic floor physical therapist, every third window. Do you guys have a bunch there too?

Dr. Weitz:                            I wouldn’t say it’s that common around here and then there’s a diversity of what ends up becoming the therapy too. Some of them just have them do some of the same exercises, and I’m not sure that’s always all that effective.

Dr. Gurevich:                     That was his problem. He had gone to somebody who claimed they were rectal specialized. They told him to do the same things. They didn’t really do any internal work. They didn’t teach him about engaging his muscles and so when he came in to see me, he was like, been there, done that. It didn’t work.

Dr. Weitz:                          Right. I did the Kegels it didn’t work.

Dr. Gurevich:                     It didn’t work. And so then I sent him to who I personally think is the best person in Portland, and of course, she doesn’t see patients, but now she runs a clinic and she teaches her staff, and it made such a difference. They did a bunch of internal work, so they were able to release the rectal muscles. They talked to him about the bike seat, and then we changed his stool, his stooling regimen because he was basically having diarrhea but couldn’t engage his muscles. Because everybody was thinking that he had a functional constipation, but he didn’t. He had a dyssynergic constipation. So it’s really important to differentiate that.

Dr. Weitz:                          By the way, when I was listening to one of your podcasts about constipation, I learned something, which I didn’t know, which was that not going to the bathroom when you feel like you need to increases your risk of constipation.

Dr. Gurevich:                     Yes, yes. Thank you. Yes.

Dr. Weitz:                          And as a busy clinician, how many times am I have back-to-back consultations and I can’t go to the bathroom and I put it off?

Dr. Gurevich:                     And then, so let me just explain that mechanism, because that also is crazy. So you have everybody but me and you both have an internal rectal sphincter and an external rectal sphincter, right? The internal rectal sphincter is what’s going to control the entire bowel above it. The external rectal sphincter controls communication to the internal. So oftentimes the internal sphincter will be like, is this a good time? Let me just put out a little gas. Let’s see. Let me put out a little stool. And the rectal, the external rectal sphincter would be like, oh, I’m doing a podcast interview. It’s not a good time. We can’t do this right now and so it will shut it down. If you continue to do that, your nervous system learns that it’s not a good time and it will talk to the entire brain all the way down to slow down the peristalsis. So if you do not listen to your bowels when you have an urge, it will shut down the entire system and you will make yourself be more constipated.

Dr. Weitz:                          Wow.

Dr. Gurevich:                     It’s very important. And then you think, like I said, a lot of constipation starts in childhood, so kids are learning that it’s not a good time to have bowel movements and so now-

Dr. Weitz:                          During class or they’re… Yeah.

Dr. Gurevich:                     Or they’re trying to keep control. Their parents are going through a wicked divorce. This is something they can control, and now they’re setting themselves up for the entire life of being constipated.

Dr. Weitz:                          Wow.

Dr. Gurevich:                     Isn’t that crazy? It’s like a-

Dr. Weitz:                          So it’s a neurological thing, right?

Dr. Gurevich:                     Yes. And then there is some retraining that has to happen. Oh, the other thing that causes constipation is a whole hell of a lot of drugs. A lot of drugs cause constipation. The anticholinergics like the antihistamines, everybody’s all about MCAS. All of the MCAS drugs cause constipation. Iron, we all know that the rock hard iron. Opiates, some blood pressure meds, some calcium channel blockers, all of those are going to be-

Dr. Weitz:                          And NSAIDs.

Dr. Gurevich:                     All of them are going to be associated with constipation. So then you have to, as you’re taking your patient history, you’re kind of working backwards. Could this be it? Have we ruled out these things? Have we ruled out this thing? And then we go into the category of what I call or what’s called functional constipation, normal transit, slow transit, or rectal evacuation disorders. All of those would be constipation. And these are the things that I feel like this is where our therapies shine. The dyssynergic constipation, really the best solution for that is pelvic floor. Honestly, that’s kind of the only solution for that. With the constipation, the functional constipation disorders, this is when we can use fiber and bulking agents and laxatives. That’s really where our treatments work.

Dr. Weitz:                            Yeah. I think another interesting thing is that I’ve always tended to think that if the patients have constipation, that’s a motility problem because it’s not moving or the muscles aren’t working properly and then if they have diarrhea, then it’s not a motility problem. But actually, if the muscles don’t work, they’ll get just rampant diarrhea because it’ll go right through and when they have constipation it’s because the muscles are holding on tighter.

Dr. Gurevich:                     Yep. So my answer is it could definitely be a motility issue, and it could also not be a motility issue. The bowels are, it’s like this orchestra. It’s a crazy orchestra and everybody has to do their part for it’s a work, and it’s real damn easy to shut down somebody’s part.

Dr. Weitz:                            Right.

Dr. Gurevich:                     So that being said, there are some pretty good, we have options, and part of the options is how do you go one at a time? First of all, how do you work up the case? How do you work up the case?

Dr. Weitz:                            Yeah. Are you trying to get to the root cause? Are you going to jump in and try to treat the symptom? Are you going to wait until you correct the root cause? If there is a root cause that you can discern?

Dr. Gurevich:                     And then not only that but also how do you have them moving their bowels? How do you give them some symptomatic relief while you’re trying to get to the underlying cause?

Dr. Weitz:                            Right. And then how do you deal with the fact that they’re already using all of this stuff before they saw you?

Dr. Gurevich:                     Right, right, right, right. And the other thing that we know unfortunately is I feel like both me and you always come back from the microbiome like that’s-

Dr. Weitz:                            Of course.

Dr. Gurevich:                     Yeah. And a lot of the laxatives that they’re using we know are killing the microbiome, just completely decreasing diversity, changing the species that are in there and so that’s also very challenging. They’re taking laxatives because it’s so uncomfortable not to poop, and that laxative is making the problem worse, but you can’t get it with a laxative because you have to work in a microbiome. And by the way, treating constipation is never fast. I mean, it takes years. It could take years and honestly, that’s where I get a little bit lazy. And some of the drugs that we have are, they’re really, really good while we’re dealing with the underlying cause to get things moving, so at least we can keep working at it. And I have some interesting protocols, some that I’m trying that are new, some that I’ve been trying for a while. But for me, if somebody comes in once a week, maybe bowel movements, I’m going to start them on something to get them to poop right away. I’m either going to start them on some kind of bulking fiber, which works. I mean, if it’s a functional constipation patient-

Dr. Weitz:                            And as long as they don’t have SIBO.

Dr. Gurevich:                     As long as they can tolerate it, the bulking agents are like Rebecca Sand always says, “I think psyllium and water can put me out of business.” So I’m going to start them on a bulking agent, or I’m going to start-

Dr. Weitz:                            Now if you suspect they have SIBO are you using PHGG?

Dr. Gurevich:                     So what I’m going to do is I’m going to test. If they have any of that middle… So whenever I start taking a history with a patient, I’m always listening and I’m like, does this sound like a small bowel presentation? Does it sound like a large bowel presentation or does it sound like an upper GI? Upper GI would be reflux, esophagitis. Small bowel would be a lot of bloating. Some periumbilical pain, large bowel, they don’t have any bloating, but they have dysfunction in their evacuation, either diarrhea or constipation. If it’s sounding small bowel, I’m always going to start there. I’m going to work my way from the top going down.

                                                And so if it sounds like it’s bloating, SIBO, distension, I’m going to work them up right away. I’m a big fan of testing. I’ve been in practice too long to believe that it sounds like… So I’m going to give you… Going to save us any time or money. So if it’s SIBO, great, we’re going to start there. And sometimes treating SIBO is enough, and sometimes there’s other small bowel disorders that are not bacterial, like a fungal disorder or… So in my opinion, I do see chronic fungal overgrowth in the smaller large intestine causing constipation in the chronic. In the acute, it generally causes diarrhea.

Dr. Weitz:                            How do you diagnose the fungal overgrowth? Because stool tests seem to underreport it.

Dr. Gurevich:                     Yeah, I think well, remember with stool tests, you’re only looking at what’s happening in the stool. So that’s a great question. Candida is at least findable-ish through Quest, Labcorp. Some of the functional lab tests there is Candida, IgA, IgM, IgG, and Candida Immune Complex. And those, I think, so one panel is the IgM, IgG, and IgA, and then the other one is the Candida immune complex. Those, I mean, there’s data going back to 1952 [inaudible 00:21:26]-

Dr. Weitz:                            What about that compared to organic acids test?

Dr. Gurevich:                     So that’s the thing that I’m just starting to believe exists. So I’m a terrible person to ask because I’m just right now being like, oh, I think there might be some use in this organic acid thing.

Dr. Weitz:                            Wait a minute, you’re just figuring that out. Come on.

Dr. Gurevich:                     It just doesn’t have as robust a data set behind it.

Dr. Weitz:                            Right. Of course. Yes. Right. Yeah.

Dr. Gurevich:                     And so I’m hard-pressed telling a patient who’s dropping money on me to then drop money on my favorite stool test because I think there is good data on a lot of the markers on the stool panel to then drop another 400 bucks. But I think it exists. I think it’s valid. I think it does help. And so that’s the line that I’m walking now. I’ll always do the blood, the Candida, IgA, IgM, IgG, and the immune complex. I’ll always do that, but that is sensitive only for Candida. And we both know there’s a whole lot of other funguses out there besides Candida.

Dr. Weitz:                            Right. And then anytime I see fungus, I’m always want to suspect the possibility there could be mold as well.

Dr. Gurevich:                     Which also I’m just finally starting to admit exists. But yeah, and that I see causing chronic constipation.

Dr. Weitz:                            Another whole layer.

Dr. Gurevich:                     Yeah. Another whole layer, and that like it’s really-

Dr. Weitz:                            I really think that we have to think in terms of layers.

Dr. Gurevich:                     I could not agree more. Yep. Okay. So if it’s SIBO, if it’s SIFO, I’ll try to work that up. If there isn’t a lot of small bowel stuff, then that brings me back to the large bowel and the large bowel, really, I’m looking at some kind of stool testing. And I personally am a big fan of provocation, which I think not everybody agrees with me about, but so provocation basically-

Dr. Weitz:                            Yeah, you’ve mentioned that before. Yeah.

Dr. Gurevich:                     I’d like to give people high-dose enzymes for 10 days before they take the stool test because I’m trying… Because I know biofilms and I know things hide underneath there. So I’m a big fan if I’m going to drop that much money if I’m going to convince them to drop that much money on a test, I kind of want to see what’s hiding underneath that [inaudible 00:23:38]-

Dr. Weitz:                            Now, have you ever run that by the stool testing folks to see if they think it could affect it?

Dr. Gurevich:                     That’s a good question. No, I haven’t. That’s a great question because I have a pretty good relationship with my stool company-

Dr. Weitz:                            Okay. I’m going to email Tom Fabian after this.

Dr. Gurevich:                     Yeah, I mean, that’s a company that I use too. I have a pretty good relationship. I’ve never asked them.

Dr. Weitz:                            Yeah, I know when it comes to the mold testing, a lot of doctors like to do a glutathione provocation thing, and they specifically recommend not doing that.

Dr. Gurevich:                     What do you do? Do you provoke the OAT test? Do you have them to stop their supplements for the OAT test? What do you do for that?

Dr. Weitz:                            I usually don’t provoke.

Dr. Gurevich:                     Okay. Do you find anything?

Dr. Weitz:                            Yeah.

Dr. Gurevich:                     Yeah. Okay.

Dr. Weitz:                            Yeah, quite a bit. Yeah, but I don’t know. I’m not so sure how effective the various biofilm-busting agents are either. I’ve gone back and forth on that. The enzymes are great. I’m not sure the enzymes are doing anything. I got to go to the next level. And then I don’t know. Do I really want to put everybody on Bismuth and then where do you go?

Dr. Gurevich:                     Yeah. So I mean, I will say that I have played around with all of them. I’ve played around with the enzyme class. I’ve played around with the OTC with Bismuth, and then I’ve played around with the prescription. I feel like the one I can hang my hat on the most is the prescription. And so I don’t really-

Dr. Weitz:                            That’s the Paul Anderson one.

Dr. Gurevich:                     That’s the Paul Anderson one. Yeah. Unless they’re not local and they don’t have access to a compounding pharmacy. I am generally, I’m using the pharmaceutical one. And is it a hundred percent reliable? No, nothing… I mean, it’s medicine, nothing is.

Dr. Weitz:                            Right.

Dr. Gurevich:                     Do I get improvement? I mean, I think 65. 65%, 70%. I can get some kind-

Dr. Weitz:                            Oh, that’s a pretty high percentage.

Dr. Gurevich:                     Yeah. That’s not bad.

Dr. Weitz:                            How long are you comfortable using a heavy metal like Bismuth for?

Dr. Gurevich:                     So Bismuth goes back like in Chinese medicine I was once lecturing at a conference and I was like, you know who used Bismuth? Ayurvedic medicine in Chinese medicine and they’re the oldest medicine in history. And then Eric Yarnell, who’s a pretty incredible naturopath and herbalist was like-

Dr. Weitz:                            I’ve heard of him-

Dr. Gurevich:                     …actually, the Egyptian medical system is the oldest system in medicine. They have books going back. And I was like, of course, Eric Yarnell knows that, but probably it’s used for a long time both in Chinese medicine and in Ayurvedic medicine. Is there a toxicity to it? Yes, absolutely. But you have to use it for a long time and from what I understand-

Dr. Weitz:                            And a long time is how long?

Dr. Gurevich:                     Nine months to a year. From what I understand, based on Dr. Anderson’s work is the thing about that compound, the bis-Thiol compound when you match the Bismuth with the Alpha-lipoic acid is it makes this bigger molecule so it even less so go systemic, even if they’re having intestinal permeability. So it’s safer.

Dr. Weitz:                            Yeah, I’ve heard him… I have talked to him before and he said that.

Dr. Gurevich:                     Yeah, so I’m just banking on that. However, I am a really, really big fan of breaks and I like to pulse, and so I’ll give it for three months. Okay, let’s take a break. Is it doing anything? What’s going on? Let’s take a break from everything. Where are you really without the $8,000 of support? Okay, we’re not anywhere. Let’s go back or oh my God, we’re done. Go be free, eat fermented food. We’re good. So that’s where I am with that.

Dr. Weitz:                            And then sometimes you get patients who say, “That’s it. I’m never eating those foods ever again.” And you have to convince them. No, it’s really important. No, I’m fine. I’m fine. I feel good.

Dr. Gurevich:                     Yeah. I am always like before the 1940s, there was not a single civilization in the whole world in the history of the whole world that did not utilize fermentation as their main system of preservation. Not in the whole world and then in the 1940s, we did two things at the same time, discovered antibiotics and discovered refrigeration. That is the beginning of our chronic health issues.

Dr. Weitz:                            Great. So now you’ve got this patient with constipation and you’ve decided it’s in the category of uncertain, right? It’s not an obvious SIBO, it’s none of the worrying signs of colon cancer or some of the other things. Where do you go next with that?

Dr. Gurevich:                     So if it’s the small bowel stuff looks pretty clean, I’m going to do a large bowel stool assay. That’s what I’m going to do. I’m going to look at what is going on with the microbiome. Are there any chronic infections that I can correct? Sometimes if you know chronic parasites will cause constipation, they just cause a pretty stark shocking difference of the microbiome. So depending on what comes up on the stool test, I will continue to move forward from there. If there’s something in the microbiome that looks funny, any of my big biofilm disrupt or any of my big biofilm pathogens, I’ll treat that. And then if that doesn’t work, then I’m like, I don’t understand what’s happening. So then I’m back to like, okay, is there a traumatic thing here? Could this be some mental emotional constipation? Is there a pelvic? Maybe it doesn’t present like a dyssynergic constipation, but I should probably get you assessed with a pelvic floor therapist.

                                                Maybe what we need to do is, maybe what this is this is a hyper sympathetic overload. You literally have never given yourself enough time to poop, right? Or your stooling posture is atrocious. You’re in there on your phone, you’re Instagramming, and it’s all making you anxious, and then you’re in the story. You know what I mean? You’re never going to poop that way. Sometimes that’s the problem. It’s so nice when that’s the problem and so we do all of that hygiene stuff. We make sure their hydration is in check. We make sure their diet is in check. I personally will push, I want probably somewhere between 35 to 40 grams of fiber a day. You know I got-

Dr. Weitz:                            That’s really hard to get.

Dr. Gurevich:                     I know. I mean, you can do it with supplements and it doesn’t taste good.

Dr. Weitz:                            I don’t think you can do it without supplements to get to 40 grams.

Dr. Gurevich:                     Not in today’s diet, but I want to rule all of that stuff out. You know what I mean? I want to make sure that the low-hanging fruit is taken care of. And if I’m still stalled out, then, so the new thing that I’m playing with, my favorite, favorite conference on the whole planet is called the Gastro Association of Naturopathic Physicians.

Dr. Weitz:                            The what? The what?

Dr. Gurevich:                     The Gastroenterology Association of Naturopathic Physicians, the GastroANP, which I’m clearly very biased because I’m a board-certified naturopathic gastroenterologist. I’m clearly biased, but we put on a yearly conference every year. This year it’s in Seattle, I think last weekend of October. And it’s really, really cool because you get a bunch of people presenting data, but a bunch of people presenting straight-up nature cure. It’s really herbal. It’s great. But there was a lecture last year, Dr. Janel, Dr. Kathleen Janel. She calls herself GI Janel, and she presents it on a protocol that I had never been exposed to before her using MSM or a high-dose sulfur. And this is really interesting. You haven’t heard this either, huh?

Dr. Weitz:                            No.

Dr. Gurevich:                     Okay. So we listened to her talk while we were… Four of us were driving back to Portland, and we had it going on the car radio and somebody would say something, everybody is in the car, would be like… You’re hanging on the edge of her seat because it was such a mind-blowing protocol. But this is what I’ve been putting in. This is my newest discovery. Discovery. Kathleen Janel told me how to do it I didn’t discover it.

                                                So the theory is because of antibiotic use, because of pesticides, preservatives, all of that, what happens, and I’m hoping I’m not butchering this, it’s not my theory, it’s her theory. So hopefully I’m not butchering it, but what happens is you have sulfur-fixing bacteria within your microbiome normally like it’s a healthy thing, but because we’re exposed to all of these antibiotics and pesticides and preservatives, those antibiotic and all of those, by the way, are just antibiotics. They’re just antibiotics that you put on plants or antibiotics that you put in food to prevent other bacterial growth. All of that kills off the sulfur-fixing bacteria and that’s really important because the sulfur-fixing… Sulfur is the third most abundant mineral in your whole body.

Dr. Weitz:                            So does fixing sulfur lead to hydrogen sulfide?

Dr. Gurevich:                     No. But when you kill… Thank you that you’re exactly going the right direction. When you kill off all of that sulfur fixing the bacteria, sulfur is so important that the body actually then up regulates the sulfur-producing bacteria and that’s what leads to hydrogen sulfide. Absolutely. Absolutely. And so what Dr. Janel was talking about is doing this very, very slow titration. Very slow titration up using MSM. The MSM is mono… I don’t know what it stands for, but it’s sulfur the SSL. So doing this very, very slow titration, up to sulfur, building up on the sulfur. And then it’s like, it’s almost like when you have that much sulfur localized, it pickles the hydrogen… Sorry, the sulfur-producing bacteria, and you can reverse the microbiome to get that sulfur-fixing bacteria back.

                                                However, and this is a big, however, the other thing that sulfur does is it’s like the main thing that fuels our detox pathways. And so I have definitely seen, if you go too fast and I’m just supercharging your detox pathways and it’s not very clean in there, you are going to feel bad. Fatigue, brain fog, nausea, you’re just going to… I’m just pushing your detox, but your body’s not ready to detox. You’re bloated and constipated and so this is the new thing I’m playing with very, very slow titrations, like a pinch.

Dr. Weitz:                            You ever look at food sensitivities?

Dr. Gurevich:                     I don’t.

Dr. Weitz:                            Okay.

Dr. Gurevich:                     I feel like I’m like, my practice is all GI. I’m usually their sixth stop not their first stop and so-

Dr. Weitz:                            They’ve already done food sensitivity testing and-

Dr. Gurevich:                     Everybody in my practice has intestinal permeability. They’re seeing me. So it’s just a really expensive way of telling me what they’re eating.

Dr. Weitz:                            Right. In other words, what you’re saying is if they have leaky gut, then most likely all the foods they’ve been eating recently or a lot of them are going to show positive on a food sensitivity test.

Dr. Gurevich:                     Exactly. That’s exactly what I’m saying. Yes. So why am I going to make them drop more money on that and then I’m going to give them anxiety?

Dr. Weitz:                            What about trying to analyze motility and doing some sort of test for intestinal motility?

Dr. Gurevich:                     So if I can get it covered, absolutely I think it’s worth it. If I can’t get it covered, then I think I just have to make the assumption and put in some of those prokinetics and see if it gets us anywhere. Sometimes it does, sometimes it doesn’t but the testing for gastroparesis is notoriously 75% unresponsive so-

Dr. Weitz:                            So are you talking about anorectal manometry or are you talking-

Dr. Gurevich:                     No, I’ll definitely send for… If you’re looking at is the small bowel, is the stomach dumping? Right? There are tests that you can look at to see how fast the stomach is dumping out. Those are 75% on-

Dr. Weitz:                            Is that where you swallow one of those capsules?

Dr. Gurevich:                     I think they give you something radiographic and then they’ll take x-rays of you to see how quickly you’re descending or they can give you a smart pill. And a smart pill will go through there and it’ll look at the pH and it’ll look at the motility and all that.

Dr. Weitz:                            Somebody was telling me they saw some sort of presentation with Dr. Satish Rao and that there’s some sort of a capsule that stimulates motility. It’s like a treatment.

Dr. Gurevich:                     Oh, yeah, yeah, yeah. It’s the new one. I’ve tried it. I tried it-

Dr. Weitz:                            Oh, you tried it?

Dr. Gurevich:                     Yeah. I only have five patients. I don’t have a big… All of them it was like a whomp whomp. What is it called? It’s like a vibration it basically you swallow it and you swallow it at bedtime and it literally vibrates in the intestine. And so it should you to cause you to upregulate your peristalsis. Every single and I’m only trying and these are my most chronic of my chronic mainly with those people, I’m mainly… What they report is, oh yeah, I could totally feel it vibrating. It didn’t make me poop anymore, but I could feel it vibrating. They call a bunch of them actually, I have multiple patients who refer to it as my little [inaudible 00:36:51]-

Dr. Weitz:                            Are you part of a study or how-

Dr. Gurevich:                     No, no, I have the most chronic patients. And I’m like, let’s try this new intervention.

Dr. Weitz:                            Is it on the market?

Dr. Gurevich:                     Yeah. Yeah. I can email you what it’s called. Yes, it’s definitely on the market. I’ll email you what it’s called.

Dr. Weitz:                            Thank you.

Dr. Gurevich:                     They don’t even I think it’s not a drug. Do they [inaudible 00:37:11]-

Dr. Weitz:                            Right. Right. It’s a medical device I would think, right?

Dr. Gurevich:                     It’s a medical device. Yeah, yeah.

Dr. Weitz:                            Yeah.

Dr. Gurevich:                     So I haven’t seen anything. There’s a new one that it’s like something you put on your ear. What’s that one for? No, maybe that’s the nausea one. They’re coming up with some really interesting new things. We’ll see how they pan out.

Dr. Weitz:                            Interesting. I know we’ve been looking for a non-invasive test for motility for years, and there’s really not one. I remember at one time Pimentel was working on something to do with acoustics and sound, and I don’t think it ever panned out.

Dr. Gurevich:                     It’s hard. This population is hard. Really it’s like… That’s when I have a diarrhea I mean, I’m saying diarrhea I’m like, oh, I got this. Usually not always but you know-

Dr. Weitz:                            So in terms of interventions for some of the idiopathic patients, you were talking about fiber and then you were talking about laxatives. What kinds of laxatives do you tend to go to first?

Dr. Gurevich:                     I mean, I’m a naturopath, so I like either magnesium or I like my herbs. Some of the herbs-

Dr. Weitz:                            And you use mag citrate?

Dr. Gurevich:                     I either use mag citrate, if they’re unresponsive then I’ll go on to mag oxide. It really depends and some people you know interestingly-

Dr. Weitz:                            You feel like mag oxide is stronger than citrate?

Dr. Gurevich:                     I do, but it’s oftentimes too strong.

Dr. Weitz:                            And when you do citrate, what’s a typical dose switch for you?

Dr. Gurevich:                     So what I generally say is it can take up to three days to go from the mouth to the toilet. So for the first three days, try 150. Okay, we’re nowhere go to 300. Okay, we’re nowhere. Go to 450, find your dose, titrate up. Everybody is different. So that’s what I’ll do for mag citrate. That’s also what I’ll do for mag oxide and you know what else is really interesting is I will say that I don’t think every… I think for the magnesiums you should try to use capsules or powders because the technology to keep a tablet together is definitely affecting the way that tablet degranulates in your system. And so I don’t actually… I’ve seen 800 milligrams of tablet mag citrate do nothing but 150 of capsule mag citrate and they’re like having diarrhea. So I do think what you’re taking matters and then we’ve got great herbs, we’ve got some really, really good herbs.

                                                Triphala is great. Cooked Dahuang so in Chinese medicine, Dahuang is rhubarb. Sorry. So you can have the raw rhubarb, which is really purgative, and then you can have the cooked rhubarb and so cooked rhubarb is going to be a little bit more gentle. There’s also this great study that I stumbled upon that it actually changed how I do some things where they use this Chinese herbal formula, Bu Zhong Yi Chi Tang, which is so B-U Z-H-O-N-G Y-I C-H-I, Tang T-A-N-G. And it was a 2300-person study out of China where they used a slight modification of this classical Chinese herbal formula. And the herbal formula is actually, interestingly enough, it almost lifts your organs. That’s the energetics of it.

                                                But there’s this great study that showed that it greatly improved functional constipation. So Bu Zhong Yi Chi Tang is now in my rotation. If I can do it as a powder, I’ll do it as a powder kind of tastes like spicy dirt. So yeah, I’ll definitely work on the herbal aspect of things. I like to avoid the stent of the cascaras because that’s going to cause more harm in the long run. But if I can’t, we’ll visit those a little bit and then I think my favorite Dr. Sand, when she was my resident, she sold me on prucalopride or Resolor or Motegrity, and that one is still… That one the data on it says the worst, the constipation, the better it works and so that’s still my favorite drug if I can get it to work [inaudible 00:41:19]-

Dr. Weitz:                            Prucalopride that’s your favorite drug?

Dr. Gurevich:                     Favorite. Favorite. Yep. And I put it in the category of naturopathic drugs because generally-

Dr. Weitz:                            Why is that a naturopathic drug?

Dr. Gurevich:                     That’s a great question because it does not have a lot of side effects. It has been shown in one study in particular, I think it was a mouse study, that it actually re-heals the nerves that innervate the large bowel. And so if you’re dealing with neurological stuff, and I have been able to put patients on prucalopride for three to five years and then be able to take them off and they can have spontaneous bowel movements on their own. And the worse your constipation, the better it works. The worst, most intractable constipation, those people end up getting spontaneous bowel movements, which might be like-

Dr. Weitz:                            Is that usually get that covered by insurance and if not, how much does it cost?

Dr. Gurevich:                     So in the US, I don’t know if you’ve heard our system’s kind of broken. Have you heard? So US, it’s still only brand. It was released in 2019. So it won’t be generic until 2026 or ’27. But out of Canada, you can get it for sometimes under a hundred bucks.

Dr. Weitz:                            Okay.

Dr. Gurevich:                     Yeah. So that’s kind of what I’m doing-

Dr. Weitz:                            Apparently, they’re starting to negotiate for lower drug prices, but-

Dr. Gurevich:                     Yeah, by saying you should buy your drugs in Canada.

Dr. Weitz:                            So where do you go to next is in terms of-

Dr. Gurevich:                     So God, if I am stalling out there, then I’m probably going to refer to one of my colleagues to work up Lyme because Lyme has a huge GI component and I’m just not skilled there. I’m going to probably have one of my chronic toxicities and then mold, that’s where I’m going to go next. Yeah.

Dr. Weitz:                            Yeah. I’ve definitely found constipation to be an effective mold.

Dr. Gurevich:                     Yeah. So that’s probably if I stall out, then they’re going to get referred there. And then-

Dr. Weitz:                            So when you work them up for SIBO, which SIBO breath test? So you using the Trio-Smart, are you using the two-breath test?

Dr. Gurevich:                     So we have a machine in the clinic if they’re constipated or mixed, I feel pretty comfortable using my machine. If it’s unclear, it might be a hydrogen sulfide picture I’ll send out for Trio-Smart. I don’t know. I’ve never seen a hydrogen sulfide come back positive. Have you?

Dr. Weitz:                            I have, yes.

Dr. Gurevich:                     A lot or a few?

Dr. Weitz:                            A few.

Dr. Gurevich:                     Yeah. I’ve never seen one. So it makes me, with my diarrhea patients, I’m kind of like, is it worth the extra [inaudible 00:43:59]-

Dr. Weitz:                            Do you still use a flat line as a way to diagnose hydrogen sulfide on a two-breath test?

Dr. Gurevich:                     I mean, if they have a flat line in their diarrhea, then I’m going to say we maybe should try Bismuth. Let’s see what happens. Yeah. And at those higher-

Dr. Weitz:                            So it sounds like you don’t have much confidence that that’s necessarily hydrogen SIBO, but you think it might be hydrogen sulfide SIBO?

Dr. Gurevich:                     Yeah. I feel like I wish I was so excited about Trio-Smart, I was so excited and I still run them. I probably still run a handful of every week. I just was… I have yet to see. How long has that test been out? Two years?

Dr. Weitz:                            I think so. That sounds right.

Dr. Gurevich:                     I’ve yet to see a positive hydrogen sulfide.

Dr. Weitz:                            Do you find when you use the Trio-Smart that it underreports methane?

Dr. Gurevich:                     No, actually I was finding that at first. I do feel like they’ve corrected that formulation.

Dr. Weitz:                            Okay.

Dr. Gurevich:                     Yeah. I am seeing a lot more methane positives on my SIBO test probably within the last year. So from March of last year, I feel like something changed in their settings.

Dr. Weitz:                            Now, what do you think about the concept of using a stool test to partially diagnose IMO?

Dr. Gurevich:                     Pimentel always teaches that the small intestine, your small intestine has more to do with the small intestine of a mouse than it has to do with your own large intestine. So you are seeing, okay, you have a stool test and you are seeing the Desulfovibrio or the, sorry, the [inaudible 00:45:34]-

Dr. Weitz:                            Methanobrevibacter smithii-

Dr. Gurevich:                     Methanobrevibacter. Yeah, yeah, yeah. I don’t know if it’s enough. I don’t know if it would change my treatment enough, but I don’t know if it’s enough for me to make it… I don’t feel comfortable calling it IMO. How about that? I think that if there’s a very clear designation of this is how we designate it, it’s seeing over 10 within the first 90 minutes, I’m more likely to just use that designation because that’s the designation that’s been set for us.

Dr. Weitz:                            Have you experimented with the new portable breath test?

Dr. Gurevich:                     Oh, I have some patients who do it.

Dr. Weitz:                            Yeah, I just got one, and one of my patients was using it and got me one. I just started fooling around with it. It’s kind of cool.

Dr. Gurevich:                     And is it?

Dr. Weitz:                            Yeah.

Dr. Gurevich:                     What are you learning?

Dr. Weitz:                            Well, I mean you can do breath tests all day. You can do it after you eat certain foods, you can… It’s kind of cool.

Dr. Gurevich:                     It’s like another wearable, it’s like a device.

Dr. Weitz:                            Well, it’s a device you blow into it but right now I’m testing it on a few patients who are doing the Trio-Smart and using this side by side so I can get a sense of how accurate we think it is.

Dr. Gurevich:                     I can’t wait to hear that. That’s my question. Yeah, that I can’t wait to hear the result of.

Dr. Weitz:                            But it’s kind of a cool concept and for 250 bucks, which is less than the cost of one SIBO breath test, you can use it over and over.

Dr. Gurevich:                     Yeah, totally. Totally.

Dr. Weitz:                            You can see how certain foods react.

Dr. Gurevich:                     Yeah, I can see the appeal of it. I can totally see the appeal of it.

Dr. Weitz:                            Yeah.

Dr. Gurevich:                     Yeah.

Dr. Weitz:                            All right, so what else haven’t we talked about? What about probiotics for constipation?

Dr. Gurevich:                     Okay. So I definitely prefer fermented food over probiotics, generally speaking, and I think that probiotic-

Dr. Weitz:                            Why is that?

Dr. Gurevich:                     Mainly, I think of probiotics like air conditioning when you’re taking it it’s really helpful if you stop taking-

Dr. Weitz:                            What?

Dr. Gurevich:                     Yeah. Yeah.

Dr. Weitz:                            Probiotics like air conditioning.

Dr. Gurevich:                     Yeah. Yeah. When the air conditioner is running, you’re nice and cool, but when you turn it off, you’re hot again. You know what I mean? When you’re taking probiotics, it’s really doing something, but when you turn it off, it’s gone. Right? So I think-

Dr. Weitz:                            Oh, come on. It’s got to do more than that.

Dr. Gurevich:                     I’m more likely to land on fermented food and the other thing is I played around, I feel like when probiotic research was first starting and we were studying all these multi-strain probiotics, I was seeing a lot more efficacy when it was robust. And now everybody’s trying to get into the game and patent one single bacterial species. And I’ll look at the studies and I’ll say, “Oh, I have a patient that presents with just like this group that had really good response to this strain. So let me give you this one strain.” And I’m just not seeing it play out like it does in the literature. So when I go-

Dr. Weitz:                            But there seems to be more and more of those types of studies and-

Dr. Gurevich:                     Like the single strain?

Dr. Weitz:                            Yeah, exactly.

Dr. Gurevich:                     There’s so many. So many. And yet I’m-

Dr. Weitz:                            And sometimes having amazing effects for specific conditions and-

Dr. Gurevich:                     I just don’t. I’m a clinician. I tried to publish some of my ozone data. I had a researcher be my resident for a year and she was like, “Ilana, dude, there’s nothing to publish here. There’s too many protocols at the same time. You’re not doing…” Research wants to study one thing. I’m like, okay, who’s the patient in front of me? Let me do that. So I just didn’t see it play out. And so it kind of turned me cold a little bit. And then I go back to the beginning of time, fermentation was the way we preserve food. So do I think there’s a role for probiotics in constipation? Yeah, I do and I’ve definitely seen it help, but I feel like I’m much more likely to teach them how to eat so that we can change the microbiome in the long run.

Dr. Weitz:                            Yeah. I worry about fermented foods because how do you know which bacteria are growing and how do you know they have anything to do with the bacteria you really want to encourage in your microbiome? And then you maybe look at some of the commercial products like yogurts and stuff, and they have these strains that are not the strains that we’re really concerned about.

Dr. Gurevich:                     See, I actually go about it the exact opposite way. I’m like, you know what the problem is to think that we know anything about the GI microbiome. You know what I mean? We don’t know anything. We only admitted that it was important in the last seven years, maybe 10 years we only admitted it was important.

Dr. Weitz:                            Come on. Akkermansia is the key to everything.

Dr. Gurevich:                     Well, only if you’re talking to the Akkermansia people, but if you talk to the MegaSpore people, then Bacillus is the key to everything. You know what I mean? It depends on who you’re talking to and so that’s honest where I’m like, lacto-fermented this was how preserved food and we were a whole lot healthier. So that’s where I… I don’t know if I’m right, the thing I always say is, you put a hundred of us in a room, you get 80 good treatment plans and 70 of us are correct. I don’t know.

Dr. Weitz:                            Right. All right, good. I think we pretty much covered what we wanted to cover. Any other final thoughts you have… What?

Dr. Gurevich:                     If one person poops better we have won.

Dr. Weitz:                            That’ll make this country better.

Dr. Gurevich:                     That’s right. One at a time.

Dr. Weitz:                            Okay. So how can listeners, viewers find out about you, get in touch with you, find out about your programs?

Dr. Gurevich:                     Okay, so I’m about to launch my new business, which is killing me very quickly. The clinic I’m hoping is openwellnesspdx.com. We’re hoping to launch it April 15th. And then if you like how I sound, me, Dr. Sand and Dr. Kapadia talk about poop all day long on the Turd Nerds podcast. So that’s really… I mean, that’s us doing this every other week basically.

Dr. Weitz:                            Right. By the way, I don’t know if you noticed, but there’s several pet waste removal companies that use the same name.

Dr. Gurevich:                     We found one. We only found one, and then we found another podcast called the Nerd Turd, but I think it’s a plumbing podcast. So we’re the Turd Nerds.

Dr. Weitz:                            Great. Thank you, Ilana.

Dr. Gurevich:                     Thank you so much for having me. I’ll see you later.



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 appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we’ll set you up for a new consultation for functional medicine and I look forward to speaking to everybody next week.



Osteoporosis with Dr. Lani Simpson: Rational Wellness Podcast 355

Dr. Lani Simpson discusses How to Test for and Manage Osteoporosis 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

5:01  Osteoporosis.  We are seeing more osteoporosis among younger people today due to the fact that so many people in the US are eating an unhealthy diet and are leading a sedentary lifestyle.  The bone density scan is a good way to diagnose osteoporosis but people rarely get one early enough. Ideally it would be a good idea to get a bone density on women who are at risk before menopause.  That might help them to decide whether or not to go on hormones.  Any patient who is at risk for osteoporosis, such as that they are small and thin or smoke or drink alcohol, should have their bone density measured. 

8:16  Trabecular bone score.  Dr. Simpson explains that with the bone density scan, we should also have the trabecular bone score test done, if the lab offers it, which can give us a sense of how resilient the bones are, which can better help to determine fracture risk, which is really what we should be focused on.  Dr. Simpson has osteoporosis, but she has a good trabecular bone score, which is why she has not had a fracture yet.

11:42  Bone density test.  A DEXA (dual-energy X-ray absorptiometry) scan reports on the hip and the spine and sometimes also the forearm.  It measures our bone density as compared to an average 30 year old, which is the T score.  Peak bone mass typically occurs at around age 30.  It would be ideal to be eating a healthy diet and doing weight training during our teenage years as we are increasing our bone mass.  One bone density test does not tell us whether we are actively losing bone mass.  We need to compare tests to see if there is a trend.



Dr. Lani Simpson is a Doctor of Chiropractic who has established herself as an expert at bone health and women’s health over the last 35 years. She is a Certified Clinical Densitometrist, which means she is an expert at reading bone density tests, and she was the first alternative doctor to be awarded this certification.  She produced Down to the Bone, a CEU course for practitioners and she has been presenting the Heat is on, Menopause and PMS seminars for chiropractors, acupuncturists, and other practitioners for the last 35 years as well. She is the cofounder of the East Bay Menopause and PMS center and of the East Bay Osteoporosis Diagnostic Center. Her website is LaniSimpson.com.  Dr. Simpson will be teaching an advanced course on Osteoporosis starting on April 20, 2024: Ultimate Osteoporosis Course.

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

                                                Hello, Rational Wellness podcasters. Our topic for today is osteoporosis; how to diagnose it and how to manage it with Dr. Lani Simpson. Osteoporosis literally means porous bones and it refers to a condition in which the bones become fragile and the risk of fractures increased. According to the National Osteoporosis Foundation, one out of two women and one out of four men over the age of 50 will break a bone due to osteoporosis.  What’s actually worse, and that’s actually, I think, an older statistic, so it’s probably worse now. The most common sites of fracture are the hip, the spine, and the wrist. If you have osteoporosis and you break your hip, there’s up to a 40% chance that you’ll die within the next year. When you look at a bone density scan, if there’s a T score of minus 2.5 or worse, this is generally defined as osteoporosis, and a T score of one to minus 2.4 is termed osteopenia, which is a loss of bone, though not as severe as osteoporosis.  As I understand it, the way we should understand osteoporosis is that throughout our lives, we have a balance of both cells that build new bone, osteoblasts, and cells that clear out old junky bone, osteoclasts. When we’re younger, there’s a tendency for the osteoblasts to dominate over the osteoclasts and when we get older, there’s a tendency for the osteoclasts to dominate over the osteoblasts.

                                                Dr. Lani Simpson is a doctor of chiropractic who has established herself as an expert in bone health and women’s health over the last 35 years. She’s a certified clinical densitometrist, which means she’s an expert at reading bone density tests and she was the first alternative doctor, meaning non-MD to be awarded this certification. She produced the Down to the BONE course for practitioners and she’s been presenting The Heat is On: Menopause & PMS seminars for chiropractors, acupuncturists, and other practitioners for the last 35 years. She’s the co-founder of the East Bay Menopause and PMS Center and of the East Bay Osteoporosis Diagnostic Center. Most importantly for us, Dr. Simpson is the most knowledgeable doctor I know about bone health and osteoporosis.  Dr. Simpson, thank you so much for joining us.

Dr. Simpson:                      Thank you for having me. I always enjoy talking about bones with you.

Dr. Weitz:                           Let’s pick some bones. Let’s start right in with, how do we test and diagnose our bone health and when should such testing occur?

Dr. Simpson:                      A lot of times what happens in the alternative world is, someone will come into a doctor’s office with a bone density test. What they have is the report. In the 90s, the first bone density machine came on board. In fact, I had one in 1990, I don’t know, 1994, 1995. You didn’t hear as much about osteoporosis until then.  Prior to that, there was a way to test bone density, but it wasn’t good. But at that time also, there wasn’t any way to treat it. The nursing homes were full of people who had broken hips, mostly women. But one fourth of all hip fractures also occur in men. Men, by the way, don’t come back from that as well as women do. But when we hear that statistic that you said about 40% don’t make it after they get a hip fracture. That’s probably much older people. If we really looked at what the age range is, if somebody’s 60 or 70, in pretty good health fractures their hip, they’ll probably do okay. But those that aren’t, they’re doing the horrible diets. They’re not eating well. You and I know about that. We talk about it.

Dr. Weitz:                           That’s the typical American.

Dr. Simpson:                      Yeah. So we are seeing more osteoporosis and I really, really am concerned for the 30-somethings. My kid is 32, no, 33. I’m concerned about that generation. They’ve been the kids that were on computers, not exercising, not getting impact. My kid rides a bike, but that’s not impact. The food, a lot of young people don’t cook anymore. This is true across the board, but with each generation, we see certain things that are just plain bone depleting habits and they’re not good.  So obviously, preventing osteoporosis is one thing, but it’s quite another once you’ve been diagnosed. Can you reverse it? Frankly, I just have to say to everybody, if somebody says, “You can reverse osteoporosis. Just take my supplements,” run the other way. Who are we talking about? Some people have very advanced osteoporosis, but when people hear osteoporosis, they think, “Oh, it’s osteoporosis. They’ll treat it however.” An alternative doctor might go, “Here. Here’s the supplement.” Or, the knee jerk for medical doctors, “Here’s Fosamax.” Is it even the right medication? Is it the right sequence to give somebody Fosamax before, say, an anabolic that actually builds bone.  So we really have to understand, who are we talking about. My bones aren’t your bones. To lump everybody together makes no sense. Then I’ll have a couple other pet peeves. You asked when should somebody get a bone density. You look at someone like me. I’m thin. That’s just who I am. I weigh 115 pounds wet. I’m five foot five. So thin people are at more risk. Now mind you, I’ve been an athlete all my life, so that’s been helpful to me. But you want to get a bone density on women who are at risk before menopause.  Who’s at risk? Women. People who have a background of smoking, alcohol, doing that now. There’s so many things that impact the health of our bones. It’s mind spinning. People who are too flexible can have EDS, Ehlers-Danlos syndrome. A lot of the people that we watch, go to Cirque du Soleil or whatever, they’re doing great things, but there’s a condition there that they have.

Dr. Weitz:                           Wait a minute. Being more flexible means you’re at higher risk for fractures?

Dr. Simpson:                      No, no. Thank you for asking that.

Dr. Weitz:                           They’re less at risk?

Dr. Simpson:                      No, no. If they have a condition where they’re hypermobile, they can take their thumb and put it on their, can you do that? Can you take your thumb and put it on your-

Dr. Weitz:                          Oh, of course not. No.

Dr. Simpson:                      Exactly. They can do that.

Dr. Weitz:                          No, I know that.

Dr. Simpson:                      You put their arm up and it’s like, you know.

Dr. Weitz:                          Absolutely, yeah. People with that condition, it also leads to a lot of gut problems.

Dr. Simpson:                      Yes. That’s exactly right. Makes you wonder how much is which. I’ve had Marfans folks, patients over the years. It’s interesting. There’s a lot of ways to think about how I assess bone. But in Marfans, these are really tall people and they have a long femur neck. They’re more at risk because they have a longer femur neck, because it’s more of a lever. I always look at how long, because in Caucasians, sometimes we have a longer femur neck. Whereas you look at Asians, though they get it, too, but it’s more compact. Also, shorter people have less distance to fall.  It’s lots of ways I think about things that make sense about what’s the fracture risk? Honestly, Ben, that’s what we should be talking about. What is a person’s fracture risk? The bone density’s not everything. You and I were talking before we went on about a test called the trabecular bone score. That gives us a sense, you’ve got bone density. You want to have dense bones, like a piece of oak wood versus pine. Oak is really strong wood. It’s dense. Pine, not so much.  But also, you want whatever you have in terms of bone to also be resilient. I’ve had people who have osteoporosis, I have osteoporosis. But my trabecular bone score is good, which is why I haven’t fractured yet. I’m going to be 75 next month. I haven’t fractured and I’d like to say to you, “It’s because I’ve done everything perfectly.” No. I think I lucked out genetically because I did a lot of bad things. So genetically, I think I came into this world with pretty good bone quality genetics. We can test that kind of stuff now.

                                                But also, I get a sense about that. When someone says to me, “I’ve been an athlete all my life. I have never broken a bone, but I just got this diagnosis of osteoporosis.” If they’ve broken a major bone, that for me, is time to do serious workup. If they’ve broken their humorous or their femur or their wrist. Then also, I want to know what happened. Okay, you fell over. I had this one woman who was on a tennis court and she fell backward on both hands, so she equaled that weight. 52 years olds, shattered both wrists. That’s not normal.    Well, it turned out that yes, she had osteoporosis, but she was also going through menopause, so that probably tipped things over a bit because number one cause of osteoporosis is estrogen loss. That is primary osteoporosis, which is why it drives me nuts that women, especially who are at risk, are not given a bone density prior to menopause. Because by the time they’re 60, they come to me and now they have full-blown osteoporosis with fractures.  I know I kind of went off in a couple of directions there. Maybe you can bring me back.

Dr. Weitz:                            Okay. Let’s get back. Let’s put a little detail on the picture. Let’s go into a little bit about the DEXA scan and then also maybe explain a little more exactly what a trabecular bone score is. A DEXA scan reports on the hip and the spine, and sometimes the forearm as well. It’s giving a rating of the density of the bone in the T scores compared to a younger person with the Z score as compared to somebody equivalent age.

Dr. Simpson:                      Yeah. We’re measured up against, the database is average 30 year old. We actually want to do that. Some people say, “I don’t want to be measured up against them. I want to be measured up to my own age.” No, you don’t. You want to be close to a 30-year-old, average 30-year-old. The further you move away from that age group. By the time we’re 30, peak bone mass, the bulk of it is done by the time we’re 18. So 80% of our peak bone mass that we were destined to potentially lay down, and hopefully we did nutrition well and exercised during those years, is laid down at that time. By the time we’re 30, we don’t have all that help of the extra hormones. We just don’t.  So that would be the time, if people understood that, to increase their weight training. We know weight training works, in terms of stabilizing bone and in terms of sarcopenia, resisting that as we’re aging because the people who have the worst osteoporosis as they age are people who have muscle wasting and osteoporosis. But the one thing I want to say is that one bone density test, and this is really critical, does not mean active loss is occurring.  You can have osteoporosis diagnosis, but maybe that happened, and I like to use this word so people think about it, historically. We know eating disorders, for instance, a lot of things like that. But also, maybe there was a period of time you decided to be a vegan. When people do an extreme diet, and vegan is one of them, some of them have the worst bones I have seen. I’m not saying they can’t be vegan and have good bones. But I am saying when I hear the word vegan, it’s a risk factor. Big one for me.  So any kind of big change that’s going to eliminate food, those are, and frankly, a lot of people had eating disorders going to these diets. The intermittent diet. Okay, you can do some of it.

Dr. Weitz:                            It’s interesting. Vegans tend to perk up when they hear about somebody with a fracture and right away say, “That’s because you eat meat. That’s why you have a fracture.”

Dr. Simpson:                      And it’s nonsense, absolute, utter nonsense. I don’t eat meat. I don’t eat anything with four legs. I do eat chicken. I eat turkey. I eat fish. I wish I could do dairy, but I can’t for other reasons.  The protein thing is so critical. You could take all the calcium and vitamin D and vitamin K and all that kind of stuff. If you don’t have enough protein, and I see that over, and over, and over again in my patients. Most of them are women. I got men, too. But protein is critical. You can’t build bone if you don’t have good protein.

Dr. Weitz:                            But of course, the vegan argument is all that animal protein is acidic and it’ll leech calcium out of your bones to balance out your pH.

Dr. Simpson:                      But here’s the interesting thing about that. There’s always a kernel of truth. Yes, if somebody is on a strict paleo diet and they’re just slugging down a lot of meat, yes, it’s acidic. I’m talking about a little more of a balanced approach and not missing the forest for the trees. I talk about this a lot. We also saw, for many years, and it’s still going on, doctors recommending 10,000 a day of vitamin D. Have they tested the vitamin D? Have they tested the serum calcium? Have they tested the parathyroid? You can’t do that. That’s a hormone and for some people, especially those who have primary hyperparathyroidism. That is not a good thing. Also, some people are sensitive to high levels of vitamin D.  My second book is on, a lot of it is around vitamin D. Some people, even if they’re 40 nanograms per milliliter or 50. I’d say 50 nanograms per milliliter. My sweet spot’s about 45. I don’t care how much vitamin D you take. I want to see the blood level. You have to respect it this way. You have to test.

Dr. Weitz:                          We test all the time.

Dr. Simpson:                      Yeah.

Dr. Weitz:                           We’re in Southern California and I’m amazed at how many patients in Southern California who regularly go out in the sun still have low vitamin D.

Dr. Simpson:                      Yeah. Australia’s the same thing. We were talking about that the other day. People are told to stay out of the sun from 10:00 to 4:00. You can’t make vitamin D unless the sun’s pretty much directly overhead. If the sun is at an angle from time of day or season, you don’t make vitamin D. Then you’ve got people slathering on sunscreen. Here’s the thing. I support that to some degree.  The reason I wrote my second book is because I’ve had 25 rounds of skin cancer. Three months after that book came out, the vitamin D book, sun book, rather, with a lot about vitamin D, I found my first melanoma. It was literally, it was like freckle that had darkened. I’d had so many skin cancers because why. Because I abused the sun. I had so many sunburns as a kid, horrific sunburns. You’ve got some doctors out there say, “Oh, no. You don’t get it from,” of course, you do. If you abuse anything, that’s not good.  However, I don’t always put, my face. I don’t need any more sun on my face, but I will expose my skin for five minutes here, five minutes there, but I take vitamin D. Vitamin D is very important, as you know. It increases absorption of calcium, magnesium, phosphorus, and it does so many other things in the body. But the problem was, is that absurd study that came out, and I’m sure you’re probably aware of it, a couple of years ago, that was not about vitamin D, but they went in and looked at some vitamin D stuff. They said, “Oh, vitamin D doesn’t do anything for osteoporosis, doesn’t reduce fractures.” Then they said, “By the way, don’t test.”

                                                I was so upset about that because it’s wrong. I don’t care. Sometimes studies come out, they can be large. This was an epidemiological large retrospective study. What does that mean? People don’t know how to read studies. It meant nothing because all you have to do is understand basic physiology that, what does vitamin D do? It increases calcium, magnesium, phosphorus, all of which we need for our bone. So of course, it helps bone be strong. Studies, I can tell by hearing about it if it makes any sense to me physiologically.  Since we’re on calcium, let me just say this. I’d like to get rid of these stupid ideas that are out there. When you hear a generalized statement that is supposed to be for everybody like, “Get all your calcium from food,” I could scream. Who do they get this on? Who are those people? They’re average Americans who are eating pizza, who are obese. They’re not me, for God sakes. I’m not going to eat as much, I don’t eat as much food as a lot of people. It is harder for me to get the calories I need in, and certainly calcium, and I don’t eat dairy.  And then plus, let me just throw in the vegan thing again. Vegans, who eat a lot of greens, a lot of oxalates. We see more kidney stones now because you’ve got to have calcium, actually, to make sure the oxalates are going to go out in the stool rather than go into the kidneys.  I got off track there. Okay. Here’s the-

Dr. Weitz:                            Let’s point out a couple of important things about getting-

Dr. Simpson:                      Wait, wait, wait. Let me just finish that one thought, Ben.

Dr. Weitz:                            Okay.

Dr. Simpson:                      So the main thing is, really be careful about generalized statements because it doesn’t apply to everyone. When I’m dealing with osteoporosis, most of those people are taking maybe 600 a day of calcium citrate malate in divided doses and some are taking as much as 4,000. Why? Because they had part of their colon removed or whatever, I mean or their intestines removed. Now we have more and more people who are getting gastric bypass. Their bones are in bad shape. I just get my soapbox going here.

Dr. Weitz:                            Yeah. No. Any sort of gastrointestinal condition, the majority of them are going to decrease the ability to absorb nutrients. Even a simple condition like small intestinal bacterial overgrowth means you’ve got too many bacteria lining your small intestine where the bulk of absorption of nutrients takes place.

Dr. Simpson:                      Yup. Exactly. Digestion’s key.

Dr. Weitz:                            Let’s go over some of the important things about a DEXA scan and why some places, some DEXA scan centers get it wrong in terms of the things that need to be done. For example, the positioning of the patient.

Dr. Simpson:                      Well, another pet peeve that I had hoped, over the years, I’d have some influence on, but I haven’t. I’m still going to work on that as I’m moving into retirement because it’s just outrageous. It’s not required that anyone be trained who writes the report or signs their name to the report of the bone density and the technicians don’t have to be trained, so we see errors. People send me their bone densities. I find errors almost on every one of them, one way or another, but I’m really picky. Those errors, say for instance, let’s say you had a perfect bone density test. They did it right. Then the following year, the person was sloppy and they didn’t rotate your hip properly. That can be a 7% gain or loss. If it’s a loss, that’s going to trigger a medical doctor to give you a medication.

Dr. Weitz:                            So let’s describe the positioning. A patient’s on their back. Do they have something under their knees?

Dr. Simpson:                      That’s the best way, but are they doing that? No. In my book, by the way-

Dr. Weitz:                            That would flatten the spine.

Dr. Simpson:                      It would be better to have the knees up so that it’s down. But now, let’s say the first time you had a bone density, your legs were straight. Then you’re getting smarter and you decide you’re going to go in and say, “You know what? Make my back flat.” You don’t want to do that.

Dr. Weitz:                            Because it’s got to compare to another scan.

Dr. Simpson:                      Right. Now in my clinic-

Dr. Weitz:                            You’re supposed to be rotated in 15 degrees, right?

Dr. Simpson:                      That’s right. They put you in a little thing. So the GE Lunar equipment typically, they have both legs out at the same time and pretty much all logic’s doing the same thing. It’s faster. Is it the best way? No. When you have the back flat, as you know, you’re not going to have any overlapping. It’s just going to be better to analyze.

Dr. Weitz:                            And if the patient’s had scoliosis, that’s going to affect the results.

Dr. Simpson:                      If the patient has scoliosis, I had a case in the other day. Woman had 45 degree scoliosis. This center, and it was, it was Mayo or one of the big places, did the bone density of her spine every year and she had a lot of rotation. When you have rotation, let’s say … I can’t really say this part. Okay. When they’re doing a bone density, it’s straight through, P to A. When there’s scoliosis with rotation, now what do you get? You get some of the transfer processes and so forth, you’re going to get a false reading. It’s going to show a better bone density than it is.  Now, if you have two vertebrae that don’t have rotation, or very, very little, you can’t use one vertebrae in the spine for diagnosis. You can use two. You can use three and better four so that we can look at all four. The spine is typically going to be lower than the femur. That’s the discordance. People have arthritis, it’s going to falsely elevate the density. So I always, by the way, and this is me, I always order the four because it gives me additional data to look at. There’s only one diagnostic place in the mid-forearm. It’s the mid-forearm. That’s compact bone.  So the spine is mostly trabecular bone. What’s good about what we call the ultra distal radius is that it’s mostly trabecular bone, so it gives me another area to get a sense about trabecular bone and I like that. The more, like I say, I have these data points, the better.

Dr. Weitz:                            If the patients have osteoarthritis-

Dr. Simpson:                      That’s going to falsely elevate. I had a case where the person had spondylolisthesis, a forward slippage of L4 onto L5. Well, L4 was all messed up. See, if they were trained, they were delete L4 and then only include L1 through three.  So in the bone course that you and I have talked about that I’m starting on April 20, I’m going into detail about how to look at bone density because all doctors who are entertaining helping people with their bones should get the full bone density, not just the report. You want the images. So you either want to get the CD or ask the center to print out the images from the computer. You don’t want them to go into a file and make a copy of it because it’s going to look like blobs. If you get my book, y’all, it’s still good, look in the back. They look like sharp little X-rays. I can glean a lot from that information.

Dr. Weitz:                            If the patient gets a conventional X-ray, not a bone densitometer, and that shows bone loss, what does that mean?

Dr. Simpson:                      First of all, it doesn’t show bone loss. What it does, it shows density. Remembering for everybody, a single bone density doesn’t mean there’s active loss. We’re after that question to answer, but on an X-ray, if an X-ray says osteopenia, it’s actually osteoporosis. Because the word osteopenia means low bone density. That’s all that it means.  But in order to see that on an X-ray, you have to have about 40%, note how I’m saying this, less bone density in that spine for that to be real. That would mean that it would be, from a T score perspective, about a negative 3.5 or negative four. Each standard deviation’s 12%. If I have a negative four, it’s 48%. A lot of times, yes, that is visible on an X-ray. They can see it and they can see it in an MRI.  But what the report will say, it won’t say osteoporosis. It’ll say osteopenia because that’s how they do it in radiology. But don’t expect a radiologist actually to still write a good report. I’m just saying.

Dr. Weitz:                            I’ve seen where they write “slight bone demineralization.”

Dr. Simpson:                      That’s a good term, too. When they’re seeing that, that person has osteoporosis. It’s low bone density. We have to think about it. Mostly what we’re looking at, especially in the spine, you’re losing that nice lattice infrastructure. So you can imagine if you lose that, how are you going to build that back up. You going to take some supplement to start growing these? You have to think this through and understand bone.  But I also say that we can build bone quality at any time and I have seen people like you, Ben, who can increase bone density with the right program. It happens. It’s just not as common. Let’s say I did bone turnover markers on you or someone. Not you, because you really work out and all that. But I do bone turnover markers and I can see that bone turnover is high. That should not be happening. That means bone loss is occurring.  Here’s the interesting thing. My top two bone turnover markers are the C-telopeptide. That’s CTX, the P1NP, which is the pro-collagen type one. So the CTX is a peptide. It gives us information about osteoclastic activity.

Dr. Weitz:                            So these are [inaudible 00:31:34] that can tell us about whether or not the person is losing-

Dr. Simpson:                      Actively. Actively losing. It could be stable. Let’s say that CTX comes in at 700. Okay, now that’s giving me a hint, notice the words I’m using, everyone, a hint that bone loss is occurring. But I ordered two bone turnover markers at least, and now the P1NP, which is a marker of osteoblastic activity, is high. You would think that would be good. It’s not.  So in this case, let’s say the CTX was 750, P1NP was 120. They are turning over bone and losing. I want to see the P1NP around 30. I want to see the CTX around 200 or 250. Then I think they’re pretty stable. But if those are high, they are losing. The P1NP should only be high in one case and that’s if somebody’s on an anabolic medication.  Now, the other thing I’m doing because, again, I’m doing this course that’s coming up is, I’m reviewing all the data on people like you who work out a lot and bone turnover markers because you may be the exception. But that said, even people who work out and do all the right things, because people say this to me, they come in to me, they have a bone density, they’ve got osteoporosis. They just fractured something. They were walking across their lawn and fell on their hip and fractured it. “I can’t have osteoporosis. I’ve been doing blah, blah, blah, blah.” No, you can.  So a lot of different things, a lot of prongs in this wheel of bone that have to be illuminated, but it’s very individual, which is why I don’t think this is ever really going to be handled that way. But you and I both know, when you evaluate somebody, it’s an individual.

Dr. Weitz:                            So let’s go over some of the other tests. Osteocalcin and then Genova offers an uncarboxylated osteocalcin.

Dr. Simpson:                      Now, the under carboxylated is kind of a no. Where this all comes from is, Kate, I think her last name starts with an R, a vitamin K book. I’ve interviewed her myself many times. She’s super smart. I don’t think it’s really holding up, but here’s what we do know from physiological perspective.  Vitamin K2 does stimulate osteocalcin. Osteocalcin stimulates osteoblasts. To what degree? Is it going to help? I’ve never seen any evidence that, that alone as a treatment that, that would work. I wish I could.

Dr. Weitz:                            Now, could that be because very few people are taking the proper form and the proper amount of vitamin K?

Dr. Simpson:                      Okay. We’ve got K2, we’ve got MK4 and MK7. The proper would be the MK4.

Dr. Weitz:                            Correct.

Dr. Simpson:                      If we were really looking at it.

Dr. Weitz:                            And the proper dosage-

Dr. Simpson:                      Well, wait a minute.

Dr. Weitz:                            … 45 milligrams, which-

Dr. Simpson:                      And that’s a hell of a lot, so you better hope that, that’s right. That was first on the scene, Japanese studies. It was actually used as a treatment for osteoporosis.

Dr. Weitz:                            Correct.

Dr. Simpson:                      I’m just saying, it’s weak as a treatment program. It didn’t pan out. So what about MK7? MK7 comes along in lower doses, milligrams. You only take maybe 120 micrograms versus the 45 milligrams because as Dr. R, again, do you know her name? I can’t remember her name.

Dr. Weitz:                            Who are you thinking about?

Dr. Simpson:                      The woman who wrote the vitamin K book. Kate. Anyway. That’s where it really got launched, the MK7. That we find, of course, in foods. We find MK4 in foods, but it’s going to be more animal sources. MK4 is in animal sources like dairy, and meats, and so forth. By the way, our large intestines, if they’re healthy, actually make some MK4. So MK7 comes from fermented foods. The reason that took off and that book was written, and why she thought vitamin MK7 was better, it has a longer tail so it lasts longer in the blood. MK4, you would have to take throughout the day so that it would be available throughout the day.

                                                I’m looking into this again, Ben, because I want it to be true, but I’m pretty critical now. It was interesting because a couple of weeks ago, my doctor’s group, there was a woman who, I can’t think of her name right now, she’s a researcher on nutrition. I thought, “Oh, great. Here we go again.” Because the typical people, the doctors in my group are phenomenal. I see them save lives every day. They bring the most complex cases I get to learn from. Nutrition? It’s ridiculous. In fact, one person came a few months ago to give a little nutrition thing. You can eat peanut butter and white bread and you’ll still get enough protein. I’m screaming. But I learned a long time ago, they don’t know nutrition and I don’t bother with that part because I get to learn all the other stuff from them in terms of diagnosis and so forth. But the foundation of every treatment program should include obvious digestion, nutrition, all that stuff.  But anyway, this woman came on and I was kind of blown away. She was a real critical thinking researcher on nutrition. I asked her about the vitamin K. I said, “I’m just not seeing that much in terms of real, solid evidence.” But here’s the thing. Do I think people should get vitamin K? Yes. I don’t even do MK4. I think it’s fine if you do it. I don’t think necessarily it’s hurting. I don’t know how much good it’s really doing.

Dr. Weitz:                            Weren’t there more studies on MK4 than there were on MK7?

Dr. Simpson:                      Early on, yeah. Yeah. That’s true. I’m in the process of looking at all that again with a little more critical eye, once again.

Dr. Weitz:                            If you look at the different organs in the body, for the most part, vitamin K is stored as MK4 in most of the organs. The liver is the exception, where it tends to store it as MK7. But you ingest K1 and the body converts it and stores it as MK4.

Dr. Simpson:                      Well, not all of it. It’s a smaller percentage than you would think, but yes, it does do that. Like I said, I’m in the process of going through those studies again. I’ve been at this for 35 years or so and my ability to look at things changes as I learn more and I develop a wider lens with how I’m looking at things. So I don’t know. I just have to look at it again because I’m not so sure.

Dr. Weitz:                            Okay.

Dr. Simpson:                      I do have one little tip.

Dr. Weitz:                            Yeah.

Dr. Simpson:                      She also did a study on blueberries, which was really fascinating, where they did the equivalent maybe to 3/4 of a cup of blueberries. I can’t remember how they used it, was it powder, blah, blah, blah. Then a larger amount of blueberries, and then really high blueberry content. These are with animal studies. They found in the study, which was really surprising to her, that the middle amount actually was supporting the bone turnover markers in a better way than the high or the low. Whether or not that turns out to be really true with further studies, we know the polyphenols and all that kind of stuff and how powerful they are.  People get really wound up and then they’ll do five cups of blueberries and miss the point. Or they’ll do prunes. I never bought into the whole prune thing, but to this level, I do. Which is, if people want to eat four or five prunes a day for bone health, fine. I don’t recommend 10 or 12 prunes, which was in those studies. But I do believe that the polyphenols and the boron that is in prunes is helpful.

Dr. Weitz:                            Trabecular bone score. What is that exactly looking at? Is that measuring the trabecular bone versus the cancellous bone?

Dr. Simpson:                      It’s measuring, yeah. That’s the same thing, trabecular and cancellous is the same.

Dr. Weitz:                            Oh, okay.

Dr. Simpson:                      You’ve got trabecular and compact.

Dr. Weitz:                            Compact, okay.

Dr. Simpson:                      The trabecular bone score, first of all, the bone density’s volumetric, centimeters squared in terms of how they view that. Then the trabecular bone score is looking at structure. Structure is the resilience. That’s what we’re looking at is that resilience. I have a video that’s on YouTube, that I interviewed Dr. Didier Hans. You can just look me up, bone quality. He really explains it. It’s an hour when we’re talking about it, but understanding how important that bone quality is to our bone health.  That’s why we can have some people with a negative five, meaning 65% of their bone density’s gone and they’re not fracturing. Is that true for most people? No. We always have these extremes people like to point to, but I’m telling you, I’ve seen it and it blows my mind. It just tells you that bone quality’s really important.

                                                When you get a trabecular bone score, it is separate software that the company or the imaging center has to have purchased for about $10,000. So because no doctors know about it, or don’t know what to think about it, no one’s asking for it, so they’re not putting it in because they’re not going to be able to recoup their money. You have to have a bone density test of the spine and then they apply the trabecular bone score. They push a button to run the trabecular bone score test. Then you get a nice little printout and the higher, the better. One point four something is really, really good. Let’s say I have somebody with normal bone density, but that trabecular bone score comes in as a 1.080. That’s not good and that person often will come to me because they’ve already had a fracture that didn’t make sense.  So it’s really important, this bone quality. Of course, again, there’s genetics involved there. But also, what else would affect bone quality? All the things you and I know and do with patients; nutrition, gastrointestinal health.

Dr. Weitz:                            Sleep, exercise, on and on.

Dr. Simpson:                      I have people-

Dr. Weitz:                            Smoking, drinking.

Dr. Simpson:                      Over exercising. We’ve had people with what we call now, and there’s an article on my website called Anorexia Athletica. There are people out there that exercise, I know this one woman, she runs a marathon a month. Very, very thin. I’m trying to get to her a little bit because I’m around her some. I’ve given her my book and so forth. I’m sure she’s going to be in deep doo-doo when she gets to menopause. She’s right there now and if she doesn’t do something, she’s going to start fracturing. She already has had stress fractures. Are stress fractures a clue? They certainly can be. A wrist fracture can be the first heads up, there may be something wrong with these bones.

Dr. Weitz:                            In general, running marathons, triathlons is increasing your risk of having risk of osteoporosis or fracture.

Dr. Simpson:                      Keith McCormick is a good example of that. He’s a chiropractor. He’s written a book on osteoporosis. Super smart guy. When I met him, I wrote about him in my first book. He had, had 14 fractures.

Dr. Weitz:                            Wow.

Dr. Simpson:                      He’s the 100 marathon guy.

Dr. Weitz:                            Oh, wow.

Dr. Simpson:                      He ended up doing Forteo, which is an anabolic and saving his life, I believe. He still was out there doing that kind of stuff. That’s my opinion. Again, the hundred marathon thing, it’s got to be so tough on the body. So one day I said to him after he got better and stopped fracturing thanks to Forteo, I said, “So Keith, what are you doing now for exercise?” He said, “I just did the Tough Mudder.” I said, “You did what?” You know what the Tough Mudder is?

Dr. Weitz:                            Yeah, I think so.

Dr. Simpson:                      It’s that really intense, it’s a really intense athletic event. Throwing yourself over here and over there. You’re wafting through the mud. I said, “What did you do that for?” He said, “I wanted to see if I broke a bone.” We all think differently about things. That’s his thing.

Dr. Weitz:                            That’s better than, I ran into some patients who have osteoporosis, who’ve had fracture, and now they won’t do anything where they could ever fall or have to balance or anything. That’s not the right approach, either, because you need to work on your balance. You need to put yourself in situation where you can be safe, where you work on improving your ability to balance, and load, and things like that.

Dr. Simpson:                      I always say, it’s so true, walk in the world with awareness. But what’s happening in the example you just gave, they’re so fearful. I have a background of mindfulness practice, sitting for three months in silence in India and so forth. I’m out there doing pickle ball and doing my sports and stuff like that. I fell a few weeks ago, but I think the fear is worse than the fracture. The other thing I say to people, fractures are part of life. They just are. They can happen. We want to avoid them. Obviously, most fractures occur because people fall, pure and simple.

Dr. Weitz:                            So exercise for bone health. It looks like, from the studies I’ve been reading about, that the most effective exercises are involving heavy weight training exercises, things where you load the bones, like doing squats, dead lifts. It looks like there’s some special benefit to doing, if you can do it in a safe way, some high impact ballistic exercises. I’m sure you’re familiar with the LIFTMOR trial from Australia.

Dr. Simpson:                      Yeah, Belinda Beck. Belinda Beck, yeah.

Dr. Weitz:                            They have people jump onto a pull up bar and then drop down.

Dr. Simpson:                      Here’s the thing. When they first came out, I went up against them because they were showing people with rounded backs doing, just this really bad, I’m a former yoga teacher, so I’m very big on the mechanics of the body. But even something like OsteoStrong, which I did a whole video on that, I’m very against that program and it’s ridiculous and dangerous for a lot of people. You say, “Oh, you can’t fracture.” Of course, you can. If you sit there and strain and you have severe osteoporosis, and you know this, if you increase your intrathecal pressure, you can then, you think different about Schmorl’s nodes as we get older, you can end up with a Schmorl’s node, which is what? A fracture, partial.

Dr. Weitz:                            Right, but I think the reason why they feel that it’s safe is, you don’t sit there and suddenly get a big load on you. It’s based on how much you’re pushing or pulling.

Dr. Simpson:                      You’re straining.

Dr. Weitz:                            So you don’t start out with the heaviest load.

Dr. Simpson:                      No, but it’s B.S., period. Their claims are wrong. He got his PhD in Cayman Islands. I could go on about this guy. You don’t want to support him in any way. I did an hour long, he’s with, you know Anthony Robbins. I did an hour long video on him. It’s over on YouTube. I have 65,000 views on that, making no money on it, but I just got so tired of these people. They make these claims, “Oh, you just have to do it 10 minutes, 20 minutes, once or twice a week.” It doesn’t happen. They claim 14% increase in six months. It does not happen.

Dr. Weitz:                            Well, they’re claiming that you have to load your body weight, you have to put a load of more than your body weight. I forgot if it’s two or four times your body weight to really cause new bone formation.

Dr. Simpson:                      They have 150 studies. Have you watched that video I did of them?

Dr. Weitz:                            No, I haven’t.

Dr. Simpson:                      I was warned. The Canadian group-

Dr. Weitz:                            I have interviewed John [inaudible 00:51:11] before, though.

Dr. Simpson:                      Yeah. John? Yeah, I know John. I said to John, I said, “Bring me over five cases,” early on because of course, he would like me to support him. He shows them to me. He doesn’t even know how to look at bone densities. I said, “First of all, John, this one you’re showing me, you’re comparing the right femur to the left. Then this one,” I said, “Oh, this person’s 80 years old. They have osteoarthritis, John.” None of them were correct.

Dr. Weitz:                            Okay.

Dr. Simpson:                      I was warned not to put that up because they would come after me. No one, none of their attorneys, do you think they would if I was wrong? Yeah. And then there’s another one that Laura, I can’t think of her last name, out of Canada, who’s one of the top exercise experts in the world. She put up one about them, as well, because we’re all tired of hearing about them.

Dr. Weitz:                            What about vibration platforms?

Dr. Simpson:                      The original big hoo-ha came from Clinton Rubin. Back in the day when I was involved, people gave me stuff. I’ve got the Jufit. I’ve got the Marodyne. Because they wanted me to sell things. I sell nothing. I never have, but I would support something if I thought it worked. So what do I think?  When you stand on a Jufit or you stand on the Marodyne, and all this stuff about NASA, this is where people have to start putting their thinking caps on. NASA did the studies. On what machine? And did they continue to use it? The answer to that’s no, it didn’t work. It was done on the one and only machine was the Jufit. The Jufit, I have to say, which goes for around $6,000 or $7,000 is a very solid piece of machinery. It feels like a hum when you stand on it.  Who would I maybe recommend this to? I would recommend it to people who can’t exercise because it has a .05 vertical displacement. The idea is that by doing that hundreds of times in a short period of time, your body’s going to think you’re jogging. I would do it with people who have had lower limb fractures, people who just can’t exercise. That’s who I’d go for. Forearms, they can lean on it. They have to be able to afford it.  But I would not recommend it for you. I would not recommend it for me. I can exercise. Now, what about the more intense-

Dr. Weitz:                            I’ve been using one for the last several months.

Dr. Simpson:                      Yeah. You may have another reason to do that and that could make sense. But the Power Plate, which is more intense, and I’ve used one of those, and I have to say absolutely, my balance is crazy good after that. But it’s so violent and I’m concerned with retinal detachment, which definitely has been, that’s a big concern. Also, a lot of these vibration machines don’t have vertical displacement. They have horizontal. Horizontal, in the world, we don’t have horizontal vibration. So I’m concerned about the health of the joints with that kind of thing. So you have to be really careful if you’re getting into that stuff. Do we really all need now to buy vibration equipment?

Dr. Weitz:                            Best diet for preventing fracture, increasing bone density.

Dr. Simpson:                      A balanced one. In my book, I talk about it, although I’d up the protein now. But yeah, it’s about having that balance. Really, when I say to people, “Here’s the diet you should do. Dump the junk. Do you not know what the junk is?” If they’re at that level and they’re still drinking a six-pack of Coke a day, I don’t know how far you’re going to get with them. But people know what junk food is. We had a vegan restaurant, not a restaurant, but a store around the corner from us and it was just a bunch of junk food.  You want to eat three good meals a day. I always eat a really, really good breakfast every day. I have protein. I’ve got eggs. I might have a piece of turkey bacon with that or two. I might add some hemp seed. Actually, I like to do a tablespoon of hemp hearts and a tablespoon of pumpkin seeds in the morning. Right there, I’ve added about eight grams of protein. And I do avocado because I want to have the fat. I do all that. I just can’t eat as much as you, Ben.

Dr. Weitz:                            I do have a big breakfast. I think this morning I had a container of egg whites with chopped up kale, onions, mushrooms. I had avocado and I think chicken sausage in there.

Dr. Simpson:                      Oh, that’s my favorite. I like to put together mushrooms, kale, and onion. It’s kind of my go-to.

Dr. Weitz:                            What about including soy? There’s isoflavones in soy. Some studies have shown some benefit with those.

Dr. Simpson:                      You mean like genistein?

Dr. Weitz:                            Dietine and then there’s one called ipriflavone that some people are selling.

Dr. Simpson:                      Ipriflavone is, it’s not from soy. It’s actually just chemically made.

Dr. Weitz:                            Okay.

Dr. Simpson:                      The question is, and I talked about all this in my book. Would I take it? No, I don’t think there’s enough evidence. I think there’s evidence for eating a really good, solid diet. You have to get enough calcium, got to get enough vitamin D, magnesium, B12.

Dr. Weitz:                            Is [inaudible 00:57:49] a good idea?

Dr. Simpson:                      What’s that?

Dr. Weitz:                            Dairy?

Dr. Simpson:                      If I could, dairy, it is true that dairy’s inflammatory, but then you hear people say if you eat dairy, you’re going to lose bone. That is just so asinine. I’m sorry. It just is. I cringe when I hear this kind of ridiculous global statement. Then you’ve got people, every few months you hear the same kind of thing go out there, or get all your calcium from food, like that’s going to work for everybody. You’ve got to be really careful about buying into these things.

Dr. Weitz:                            Let’s go into nutritional supplements now. You talked a little bit about calcium and you said maybe on the average 500 to 800 milligrams a day.

Dr. Simpson:                      Depending. Again, it’s very individual. I always want to look at their metabolic panel, get a sense, especially if they had three or four of those, because then you can really look at the total protein and the calcium over time. But I like to see, again, it’s about blood level for me. I like to see it around 9.3. 9.5 would be really nice.  But when you’re on the low end of normal, it’s not good. When you’re on the high end of normal, it’s not good. I talk about, when I’m teaching lab techs, to note when you’re looking at high end and low end normals. B12’s another one. We used to think-

Dr. Weitz:                            Let me stop you on the calcium. Serum calcium is probably not a great measure of the body’s need for calcium, though. Isn’t that right?

Dr. Simpson:                      Say that again.

Dr. Weitz:                            Serum calcium, in my estimation, I don’t think is a particularly good marker for the amount of calcium the body really needs. I don’t think it indicates tissue levels.

Dr. Simpson:                      It’s the best we’ve got. It gives us an idea. That goes along with, by the way, if I’m evaluating somebody, I’m going to be doing a 24-hour urine. The interesting thing about a 24-hour urine, high end of normal, low end of normal matters also. When you do a 24-hour urine for calcium, let’s say it’s low or on the low end of normal, they’re not getting enough calcium, at least on that day. I’m going to do another. I always redo tests. I’m going to do another one, but there’s also a whole way. I can’t explain it in this thing, but you’ve got to do it right and I’ll test it again.  This is a really important point. When somebody comes to me and, I’m not taking new patients now, but when my older patients come back and I’ll still work with them, I never change anything. You want to do lab work first. I think a lot of doctors of any persuasion immediately want to start messing with stuff, when they don’t even know what they’re dealing with. Are they actively losing? What do the CTX say?  Because then, if you have that groundwork done, then you’ll be able to see if whatever you do is helping. If it’s a woman, her CTX is 600, 700. She’s year two of menopause. You might help her a little bit with nutrition, but boy, put low dose estrogen in there and get it up to 50 in the blood, it’s going to bring that down to about 250. I’m not a big fan, by the way, of gels and all that kind of stuff. That’s a whole other topic. But all these things matter.

Dr. Weitz:                            What do you think about AlgaeCal?

Dr. Simpson:                      Oh, God. That’s another company. Don’t support them. They make claims, “You’re going to gain blah, blah, blah in six months.” Of course, you’re going to gain because you’re going to be doing strontium and strontium does what?

Dr. Weitz:                            Improves absorption of calcium.

Dr. Simpson:                      No, it replaces calcium in the bone. Now, because of where it is in the periodic table, is going to show a higher bone density that’s not real.

Dr. Weitz:                            You don’t think there’s any benefit to strontium citrate?

Dr. Simpson:                      No studies on that one. Strontium ranelate’s where the studies are.  Now, is it worth doing if somebody cannot do anabolic medications, they have very serious osteoporosis? I would consider it. I just know the anabolics do a much better job. But to have these people out there willy-nilly just taking strontium, again, when a doctor has not actually evaluated this person fully, is just not right.  I don’t really like the AlgaeCal company. I’m careful with companies that I recommend or I’ll work with. The other thing, too, is what is AlgaeCal? They call it plant calcium. It’s calcium carbonate.

Dr. Weitz:                            I heard-

Dr. Simpson:                      Oral calcium is calcium carbonate.

Dr. Weitz:                            You sure of that?

Dr. Simpson:                      Yeah.

Dr. Weitz:                            Okay.

Dr. Simpson:                      But e-mail me if I’m wrong.

Dr. Weitz:                            I tried to check that and I couldn’t find any data from the company’s website.

Dr. Simpson:                      Where does the plant get it from? It absorbs the nutrient. It absorbs it from what? The soil. Because a lot of times people say, “Calcium carbonate, it’s rocks.” Of course, it’s rocks, but that doesn’t mean it’s also bad, by the way. There are some people now that I would give calcium carbonate. If they really do have an acid problem, calcium carbonate may be the way to go until I get other things going, but overall, citrate’s the way to go. Kidneys love citrate. I mean kidneys … Yeah, go ahead.

Dr. Weitz:                            Magnesium?

Dr. Simpson:                      Glycinate.

Dr. Weitz:                            Should we be two to one calcium magnesium?

Dr. Simpson:                      No. It depends. Some people can do that much. Others can’t. It depends on their digestion. It depends on their sensitivity to magnesium. It’s a bit of a balancing act and understanding their stools and all that kind of stuff.

Dr. Weitz:                            We do an RBC magnesium and try to make sure it’s above 5.5.

Dr. Simpson:                      I stopped doing that because I didn’t see that much difference with it, but I know. A lot of docs still order that.

Dr. Weitz:                            Okay. And your target level for optimal vitamin D?

Dr. Simpson:                      45 nanograms per milliliter. That can change if somebody’s on medications and so forth, with especially the PTH analogs. Yeah, that’s a good number.

Dr. Weitz:                            It seems a little low to me. I’ve seen data showing that 60 is a good target to decrease breast cancer risk.

Dr. Simpson:                      I thought so, but no. There’s too many risks when you do it. When you have too much vitamin D, what is it going to do? What’s going to happen to parathyroid? I’m asking you.

Dr. Weitz:                            Oh. It’s going to grab the vitamin D and bring it into the bone. If you have enough vitamin K, it’ll make sure-

Dr. Simpson:                      No.

Dr. Weitz:                            … soft tissues.

Dr. Simpson:                      No. It’s going to decrease your PTH, parathyroid hormone. The kidneys and the parathyroid glands and vitamin D all work together. That’s in my second book because we need the parathyroid gland to, if it’s too suppressed, you’re not going to get what we need from it, which is that the osteoclasts clean up old bone, right? In the body, the parathyroid hormone, that’s what it does.  Interestingly, the parathyroid analogs, the Forteo, teriparatide and abaloparatide, the Tymlos work differently. They build bone, but they also increase osteoclastic activity, especially Forteo. It’s interesting. There’s a lot of complexity with all of this. But the point is, if you look at people in Hawaii who are out all day not wearing sunscreen, their level’s about 30. So what you’re doing is a big, fat experiment right now, bringing people up to 60. Nobody did that. Nobody had 60. Who has 60 in just normal, normal life? I think that’s too high.

Dr. Weitz:                           People who are out in the sun all day.

Dr. Simpson:                      And you run the risk of losing bone when you get too high, for certain individuals.

Dr. Weitz:                           Yeah, I’m not sure if that level’s 60, though.

Dr. Simpson:                      I wrote the book. You can think what you want, but I’m saying I think it’s better to be a little more cautious. It is a hormone.

Dr. Weitz:                           45. What about boron?

Dr. Simpson:                      And then I need to stop.

Dr. Weitz:                           Okay.

Dr. Simpson:                      This is another good one. I’m glad you brought this up because boron, I don’t even know the name of the guy. He was recommending high doses of boron that was going to do this. This is what I’m talking about. We see this kind of stuff. Do you know who I’m talking about?

Dr. Weitz:                            I interviewed Laura Pizzorno and she has an article-

Dr. Simpson:                      Right, the AlgaeCal. And she has an article and who cares. Is boron, no, really. Is boron helpful to bone? Is protein helpful to bone? Yeah, but to do high levels, there is no evidence over time that’s safe or a good idea. When you start doing that, it’s really interesting because alternative doctors love to do high doses. Let’s do 10,000 vitamin D. Now let’s do 20 milligrams of this or that. But that’s kind of extreme.

Dr. Weitz:                           So what do you consider high? What do you consider a safe level?

Dr. Simpson:                      I think if somebody’s eating a good diet, eating apples, things like that, and maybe prunes, and they’re getting enough, I’ve reeled it in. I have to tell you, Ben, I’ve reeled it in over the years because I don’t know. I’ve just seen too many things now and I would rather be in a real safe zone because we really don’t know long term. Or the blueberry example I gave you. Somebody ate two cups of blueberries a day. Is that going to be beneficial or is it really just one cup?

Dr. Weitz:                           Let me ask you just one more quick question. Fluoride. Is that good or bad for bone?

Dr. Simpson:                      Well, fluoride is bad, but is it bad in small amounts because it’s in soil. It’s in everything, and especially now. They use the waste product fluoride. They’re watering everything with that water. I don’t think they’re filtering the water.

Dr. Weitz:                           Of course not.

Dr. Simpson:                      The question is, is there a way to really test? It’s interesting. I look at bone density, bone quality. I don’t know that I would associate high fluoride drinking water with that. My bones are good. I drink a lot of water. I don’t know. But back in the ’80s, that was one of the main treatments they were going after because when they gave people fluoride and they looked at X-rays, the X-rays were really dense, so they were really excited because it did increase density. But what happened over time was that these people on the fluoride started fracturing. These nice dense looking bones started fracturing because the quality was terrible.  The thing is, I guess as I’ve gotten older, I worry less with the more I know. I just try to keep myself on a good, even keel and do the best I can and get through this life. I’m careful about articles I read and things that people say because people just say stuff. They do. They just say shit. I’m sorry. They just do, Ben. They say stuff all the time. I used to be one of those people, but now I’m a little more, I don’t know. Maybe a little older and wiser, I’m not sure.

Dr. Weitz:                            Okay. You are definitely wiser. So tell everybody about where they can find out about your books and tell us about this upcoming course that you have.

Dr. Simpson:                      On April 20, I’m starting a course, may be the only time I do it live. It’s 20 hours plus. I take people through the basics of what you need to know in terms of reading bone density tests. Honestly, this is also for people who may want a different career or add to their, they may want to get into really helping people. So how I frame my work, and I have for years is, I’m an educator. I don’t take insurance and I charge good money to see me. Right now, the only thing people can really get online is the bone density second opinions.   But it’s needed and I really feel, I’ve always felt, actually, that chiropractors should have their hands in this. But what I keep learning is that they just don’t want to. I’ve been teaching for years. People, they didn’t really want a mentor. That’s what I’m creating with this. I’ve even got some doctors from Peru that have joined the course, which is great.  It starts on April 20 and it’ll start on a Saturday for four hours. I’ve got it in four hour blocks.

Dr. Weitz:                           And how do they find out about it?

Dr. Simpson:                      Go to my website. It says bone course right at the top.

Dr. Weitz:                           And website address is what?

Dr. Simpson:                      Lani, L-A-N-I, Simpson, S-I-M-P-S-O-N .com.

Dr. Weitz:                           Great.

Dr. Simpson:                      And they can find out about my books there and they’re sold other places. They’re in libraries.

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

Dr. Simpson:                      You’re welcome, Ben. Very nice working with you and I’m really glad that you’re learning about it and helping people the way you do because it’s so important.

Dr. Weitz:                           Thank you.



Thank you for making it all the way through this episode of the Rational Wellness podcast. For those of you who enjoy listening to the Rational Wellness podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we’ll set you up for a new consultation for functional medicine. I look forward to speaking to everybody next week.



Breaking the Code of Chronic Disease with Dr. Andy Barlow: Rational Wellness Podcast 354

Dr. Andy Barlow discusses How to Break the Code of Chronic Disease with Dr. Ben Weitz.

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


Podcast Highlights

2:18  The difference between traditional medicine and functional medicine is that traditional medicine tends to focus on the symptoms whereas functional medicine tends to focus on the root causes.  When you go to see your traditional medicine doctor for your seven minute office visit they focus on your symptoms and will often prescribe a different drug to treat each symptom.  With a Functional Medicine approach we attempt to identify and address the root causes of dysfunction and disease.  Let’s say you have a patient suffering with depression, using a Functional Medicine perspective, we might investigate gut health by doing a stool test because of the gut-brain connection. In fact, Dr. Barlow’s first book is  Highway to Health: The Roadmap to Overcoming Depression, Anxiety, Insomnia, and Chronic Pain through the Gut-Brain Connection.  The goal is to restore order to get the body back in a state of homeostasis, to optimize the recovery and the health status of this human being that’s sitting in front of us. 

5:45  Molecular mimicry.  If you go to your conventional medicine doctor with Hashimoto’s thyroiditis, you will get a prescription for thyroid hormone, which is very helpful. But Hashimoto’s is an autoimmune disease in which your immune system is attacking your thyroid. And if you don’t figure out some of the root causes of the autoimmune condition, then your immune system will continue to attack your thyroid gland.  Some these causes may include gluten sensitivity via a mechanism known as molecular mimicry.  The immune system creates antibodies to gluten and then because gluten is similar enough to thyroid hormone, these antibodies then attack your thyroid.



Dr. Andy Barlow is a certified Chiropractic Neurologist and an expert in Functional Medicine. Dr. Barlow has identified specific codes that unlock the mysteries of chronic health problems. He is a two time best-selling author and his new book is The Code Breaker: Unlocking the Mysteries of Health and Vitality and Establishing the Foundation for a Disease-free Life.  Dr. Barlow’s website is BarlowBrainandBody.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, I’m excited to be speaking with Dr. Andy Barlow, and we’re going to be speaking about how to prevent various chronic diseases like autoimmune diseases using a chiropractic functional medicine approach. Dr. Andy Barlow is a chiropractor, a certified functional neurologist, and an expert in functional medicine. He’s identified specific codes that unlock the mysteries of chronic health problems. He’s a two-time bestselling author, and his new book, The Code Breaker: Unlocking the Mysteries of Health and Establishing the Foundation For a Disease-Free Life, was recently published. Dr. Barlow, thank you so much for joining us.

Dr. Barlow:          Dr. Weitz, thank you very much, and just so that you know, I’ve gotten three published books now.

Dr. Weitz:            Three.

Dr. Barlow:          Actually, all three of them have gone number one.

Dr. Weitz:            Wow, that’s great. Congratulations.

Dr. Barlow:          Thank you so much.

Dr. Weitz:            What’s the key to that?

Dr. Barlow:          Well, I think it’s just wanting to help people that nobody else can help. I see patients from all over the United States that come in to Tupelo, Mississippi for chronic health problems, everything from early onset dementia, brain fog, movement disorders, balance disorders, just things that you … I think most healthcare professionals see this. If the patient has a problem, yet their tissues or their body hasn’t deteriorated to the point where there’s actually a classical diagnosis. So it’s like, “Well, we don’t know what to do with you,” or you’re professional patient or you’re just looking for attention. You don’t really have a problem, it’s just in your head because we can’t find anything wrong with you.

Dr. Weitz:            Even if they do have a diagnosis, still, the point is, what are we going to do about the underlying causes of the problem instead of, “Here’s a symptom. We’ll treat that with this drug. Here’s another symptom. We’ll treat that with this drug”?

Dr. Barlow:          That’s the difference between functional medicine and traditional medicine. Traditional medicine often just treats the symptom. So you go to the doctor, you get a seven-minute office visit. Once you wait an hour and a half in the waiting room and an hour and a half in the actual exam room, you go in and watch your symptoms, and then here’s a drug for that. So they’re more symptoms-based. In what we do is we look at the overall underlying cause of the dysfunction. So we want to identify and address the causes of dysfunction and disease. We want to get it before it gets to a disease process.

                                So one of the things that happens is that’s a misnomer. People think that you’re either well or you’re sick. What happens is through this wellness over time, this may take decades sometimes where a person is in a state of dysfunction, but yet they’re not diseased yet. This is where we come in as functional healthcare professionals is we want to find out where is the dysfunction because let’s say somebody comes in with, I don’t know, depression. It could be fibromyalgia. If I have 10 patients with depression, I could literally sit here with them and go, “Tell me what your doctor has said about your gut health,” and they look at you like, “Well, nobody’s even talked to me about that.”

                                Well, my number one bestselling book is about that. I actually have it right here, so Highway to Health: The Roadmap to Overcoming Depression, Anxiety, Insomnia, and Chronic Pain through the Gut-Brain Connection because, see, the latest research shows that in order to optimize a person’s brain, if an individual has depression, you actually have to address their gut function as well. See, that’s the problem with, again, traditional medicine, not trying to belittle anybody or anything, there’s a time and the place for that.  The point is here is with traditional medicine, they segment the body into 11 different organ systems and they study that. When we were in chiropractic school, we studied them separately. Then they have specialized fields like for neurology or cardiovascular or gut health or … Well, there’s 11 different systems, so we could go into all that. The point is that they study them individually as though they function as an independent structure.

                                So see, my heart just can’t beat on its own. My gallbladder just can’t produce bile when it feels like it, and my pancreas just can’t release enzymes because, “Hey, I just feel like today just pumping out more enzymes,” because we know that’s not conducive to health. So instead of looking at each one of these organ systems as independent and working by themselves, we understand in functional medicine that they work together for the body as a whole.  So the goal, again, is you look at what’s the doctor’s goal. Traditional medicine is treat the symptom. From a functional medicine standpoint, our goal is to restore order to get the body back in a state of homeostasis, to optimize the recovery and the health status of this human being that’s sitting in front of us. That’s the biggest difference.

Dr. Weitz:            By the way, I don’t think there’s any reason why conventional medicine and functional medicine can’t exist side by side. In fact, I think most patients would be best suited having a conventional doctor and a functional medicine doctor. If you go to your conventional doctor and you get some medication that helps you deal with some of the symptoms, there’s nothing wrong with that because we don’t want to be in a state of distress.  The problem is just addressing those symptoms is not going to prevent the underlying pathophysiology. If you have, for example, Hashimoto’s thyroiditis, which is an autoimmune thyroid condition, your immune system, your body is attacking your thyroid. Getting your thyroid regulated with proper thyroid medication can be super helpful, is going to make you feel better, is going to allow your body to function better. However, your body’s going to continue to attack your thyroid unless you figure out the underlying root causes of why your immune system’s become dysregulated. So there’s no reason why a person shouldn’t have a functional medicine doctor like yourself, as well as a conventional doctor, and we can work together.

Dr. Barlow:          Also, for example, you brought up Hashimoto’s, hypothyroiditis. So what’s typically going to get treated there is a person’s going to have thyroid symptoms, if you will, and then they’re going to get some type of levothyroxine or some type of thyroid medication. Now, when we are dealing with this autoimmune disorder, thyroid, most of this is going to be linked to gluten sensitivity. See, people don’t know what they don’t know. So it’s, “I have a symptom, I’m going to this doctor, I’m getting treated, I feel a little bit okay or a little bit better, but really not to my feet level.”  Then we come in and we do all of this metabolic testing to find out the root causes because, again, it can be multifaceted, but I’ve discovered that through research and going to seminars for functional medicine that, basically, gluten sensitivity is one of the major drivers of this.  I write about that in my third book, The Code Breaker, and there’s a condition that’s called molecular mimicry. So the example that I use in my book is … My first name is Andy. So if we think of Andy, A-N-D-Y, let’s think of that as a protein. Proteins comes from or a peptide comes from protein, so that’s a peptide. See, each individual letter is an amino acid, so A-N-D-Y. There’s a lady that’s in town here, she’s a mortgage broker, and her name is Andi, but it’s spelled A-N-D-I. So see, if we just happened to be at the same conference somewhere and somebody yells across the room, “Hey, Andy,” guess who’s going to look or both are because the name sounds familiar.

                                So when it comes to molecular mimicry, what happens with gluten? Then we have, let’s just say, thyroid peroxidase or thyroid gland, thyroid hormone. I write about it in my book. I know the exact numbers, but we’ll just use the number 300. So there’s about 300 amino acids that are linked into the gluten protein. Then there’s a little over 200 amino acids linked in thyroid hormones. See, if we have five of these amino acids that link up together and your immune system attacks those five amino acid chains, and anything in your body that looks like those five amino acids it’s going to attack, and it could be your thyroid, it could be your cerebellum, it could be your myelin sheath, which leads to numbness and tingling, pins and needles in the feet. That’s just one example.  So typically, if people come in with the chronicity that they have, we may run up to 10 different labs, 10 different individual labs to specify and just finely tune what is the multifaceted, and that’s the key point there, multifaceted. Instead of using a silver bullet to try to treat the symptom, we realize with these chronic problems you need more birdshot. Instead of one pellet coming out, it’s multiple pellets coming out. We’re going to do multiple blood tests to find out what it is that’s causing this person to dysfunction and have this health crisis that they’re in.

Dr. Weitz:            You know what? Since you brought up this example, I guess I first brought up Hashimoto’s, and you started talking about these blood tests, if it’s okay with you, I’d like to drill down into how a clinician is going to order these tests, what these tests are really going to help us to manage the patient because I know if I order a blood sugar test and I see that they have high blood sugar, I know what to do with that. I know to help them to reduce their carbohydrates, et cetera, but I’m not always sure what to do with the results for some of these other panels. So can you go through some of the specific panels and then give us an idea, just an example because every patient’s different, of a result that might come out for a patient with Hashimoto’s thyroiditis and how that’s going to help you to manage a patient differently?

Dr. Barlow:          Okay. Well, one of the things that … Well, let’s just start with the first code in my book, which is chronic inflammation. So you look at what people do in their life that can trigger chronic inflammation. One of the things that I require patients to do is when they come in, they have to eliminate fast food, processed food, sodas and diet sodas. Basically, this is real simple when it comes to processed food. If you go and you go to the grocery store and you pick up a bag, and on that bag, you look at the product, which most people don’t. My thing is like this. If it has more than four, leave it in the store. That is, you read on the ingredients-

Dr. Weitz:            More than four, leave it in the store. That’s a good one.

Dr. Barlow:          So I may need to trademark that. I’ve never heard anybody say it before, but I like … So you see, it’s easy to remember. So more than four, leave it in the store. So you pick up a bag of Doritos, I don’t know how many different products is in there, but I’m sure it’s 12 to 15. We go by the rule of four and say, “If it’s more than four, leave it in the store.” See, let me give you an example just to go off to the side and make a lateral move here when it comes to cardiovascular disease.  The latest research shows, this is a 2021 study, I believe, it’s either 2021 or 2022, but there’s 121 million adults in America that have cardiovascular disease, 121 million. That’s 48%. Now, here’s what the heart association states. Now, this is, again, you don’t know what you don’t know, and that is, according to the American Heart Association, 90% of this, 90% is preventable if a person takes responsibility for their life, but see, most people don’t want to do that.

                                I can tell them what to do like, “One of the things that’s going to destroy your body, I don’t care what the symptom is, it can be Hashimoto’s, it can be cardiovascular disease, numbness and tingling of the feet, you got to stop eating fast food. You got to stop eating processed food. You got to stop drinking sodas.” Then I hear people go, “Well, I’m drinking diet soda.” Well, that actually can lead to cancer, and there’s a little neurotransmitter in your brain that’s called glutamate, and it excites that, and that causes brain fog, depression, anxiety, chronic pain, and people can’t sleep just from the side effect of drinking that diet soda.

                                So if we stop doing that, limit our refined carbohydrates like bread, cereal, pasta, and then we start eating, oh, here we go, green leafy, real food, fruits, and then we drink water, just the standard. The great standard to do is eight glasses of water a day. I know if you want to get specific, if you take your body weight and divide it by two, let’s just use the number 200. So a human being weighs 200 pounds, divide it by two, that’s 100 ounces of water a day. So if you want to cleanse and detox your body, the easiest way to do it is by drinking adequate amount of water and getting fiber in your diet. Eat green leafy vegetables, eat more fruit.  Then I tell patients all the time, “Do what I just asked you to do and see how much your life changes in one month,” because that has to do with inflammation. So here’s one of the things that our viewers can look at is with blood sugar 85 to 99, and I talked about this in my book, that’s the optimal functioning range. There’s a difference between … Can you see the screen okay?

Dr. Weitz:            Yeah.

Dr. Barlow:          Okay, because I can’t see my picture on here, so I wanted to make sure. So optimal functioning range 85 to 99. So once we get outside of this range from 100 to 125, this is what is called insulin resistance. See, again, this is the-

Dr. Weitz:            Also known as pre-diabetes.

Dr. Barlow:          Absolutely. Absolutely. So it’s like what you don’t know, you don’t know, and this could be very devastating, but you can stay in this plate, in this world right here for years if not decades. Here’s the crazy thing about this, Dr. Weitz, is that just insulin resistance can cause plaquing in your brain, the amyloid beta protein, and that plaquing is called protein aggregation, and that can lead to Alzheimer’s just because of this because it triggers inflammation. Then once you get over 126, that’s going to be type II diabetes. Now, the key thing is-

Dr. Weitz:            That’s why they refer to Alzheimer’s as type III diabetes.

Dr. Barlow:          Absolutely, it is, absolutely. See, again, most people don’t know that. They go, it’s like, “Well, my blood sugar’s managed,” and I’m like, “Well, how are you doing that?” They’re taking medication. I’m like, “Well, what you’re actually doing is you’re artificially manipulating your lab values to make you feel good. Give everybody a kumbaya hug,” because if you look at the side effect, what is it? Ozempic, that new drug Ozempic that-

Dr. Weitz:            Oh, absolutely.

Dr. Barlow:          I guess people, they lose weight. People don’t want to hear the side effects, but if you look up the side effects, thyroid cancer, pancreatic cancer, multiple types of cancer and pancreatitis on top of that, and all you have to do-

Dr. Weitz:            Intestinal obstruction because the way it works is by slowing down your intestinal function, your motility.

Dr. Barlow:          Absolutely. Then so again, instead of taking personal responsibility, it’s easier to go out and destroy my life and take a pill and think you’re doing something great for that.

Dr. Weitz:            I’ve already been talking about what I call POS, which is post-Ozempic syndrome. We’re going to have all these people who lost weight taking Ozempic, who didn’t change your diet or increase their exercise or do anything else, and they’re going to come off these drugs and their metabolism is going to be way more screwed up than it was before. Their digestive system’s not going to be working properly, and we’re going to have to try to get them fixed.

Dr. Barlow:          Absolutely. Again, it’s just about taking personal responsibility. Somewhere along the line as Americans, we’ve stopped doing that. So again-

Dr. Weitz:            “I don’t want to change my diet or exercise, I just want to take this pill or this shot.”

Dr. Barlow:          You can’t even make this up, but years ago when I was … I play racquetball four days a week. When I was at the gym, one guy, literally, you cannot make this up, but he goes, “The reason that I take statin drugs,” I think it was Lipitor, but whatever the name of it was, he said, “because that way I can keep my cholesterol under control and I can go out and I can eat Burger King, McDonald’s, Pizza Hut, drink the soda.” I’m like, “Well, I don’t really think that’s what that was designed for.”  So we got our A1C, and see, it needs to be 5.3 or below. Now, one of the things that happens when that gets too high, then this is called AGE or Advanced Glycosylated Endproduct, which means this is going to cause inflammation. Now, there’s a difference between acute inflammation, which I talk about in my third book, The Code Breaker, the difference between acute inflammation and chronic. Now, acute is actually serving to heal the body. So if I twist my ankle, of course, it’s going to swell up. The inflammatory processes are going to come down to my ankle and start the healing cascade. I use the acute inflammation like a fireplace in your home. It serves a purpose.

                                Chronic inflammation is like a wildfire. It destroys everything it touches. So if you have this inflammation which is in your blood, I ask patients all the time, “Where does your blood go? Everywhere,” so brain joints, nerves, tissue, organs. So A1C. C-reactor protein, it needs to be below, and all this is on your Labcorp blood work is 1.0 or below. So see, if it’s higher than 1.0, you have chronic inflammation in your body. Homocysteine. Homocysteine should be, and this is one thing a lot of people don’t know, it needs to be 7.0 or below. There is a direct correlation that the higher this number is, a direct correlation between cardiovascular disease and dementia or neurodegenerative disorders, which could be depression, anxiety, brain fog or movement disorders. So see, we can pick all of this up on any of our blood tests. So that’s inflammation.  I say one of the major triggers, major triggers to inflammation is leaky gut. See, that’s the major trigger. If the viewers, not now while you’re viewing, but afterwards, if you go on the internet and you Google percentage of Americans with leaky gut, if I were to ask you, how many people do you think have a leaky gut in America percentage-wise?

Dr. Weitz:            I would say 70%.

Dr. Barlow:          You’d be close. 90%. So see, 90% of people have leaky gut. Now, here’s what’s important. Now, see, we can do a Cyrex test. It’s called Cyrex Array number 2, and we can actually rule in or rule out leaky gut. Now, there are certain protocol that we use to actually help heal the leaky gut, but just think about it from this standpoint. Patient comes into the clinic with a chronic health problem. They have depression, anxiety, insomnia. They can’t sleep at night, chronic pain, numbness and tingling in their feet and, “Oh, my left knee hurts.”  So we go in and go, “Okay. This guy has to be completely inflamed.” Now, the question is, what’s triggering this inflammation? Diet could be more than likely because they’re eating an unhealthy diet. It’s called the standard American diet or SAD diet.

Dr. Weitz:            Correct.

Dr. Barlow:          That’s going to trigger an inflammatory cascade in the body. Then we end up, we have a leaky gut. 90% of people are going to have a leaky gut. So it goes into, “Hey, shouldn’t we actually look at this? If 90% of Americans have it, and that’s what the research state, shouldn’t we look at this?” Now, the reason you don’t see this on a TV commercial is because there’s no FDA-approved drug to treat it. So nobody wants to talk about it. So you take this Cyrex 2 test to your traditional doctor, and it’s the eyes rolling in the back of their head shoulder shrugs, scoffs because, see, they don’t know anything about it because they weren’t taught that because medicine is run by big pharma now. So let’s get for real. Anybody that doesn’t understand that is hiding under a rock. So big pharma controls medicine. There’s no FDA-approved drug to treat it, so it’s like let’s just ignore it.

                                What happens? Patients are actually suffering with this. See, this is another thing most people don’t know, and I talk about this part in my book. We’re ranked 37th in the world in overall healthcare. See, if I went out to the mall and just did a survey and go, “Where is America ranked in overall healthcare?” most people would probably say we’re number one. See, again, we’re actually 37th. Now, this is the amazing part. That’s not even the amazing part. We spend 4.5 trillion with a T, $4.5 trillion a year on this so-called healthcare. 17.8, maybe 17.3% our gross domestic product is spent on this disease care system. That’s what I call it. I don’t call it a healthcare because, see, nobody’s talking about healthcare. You and I are talking about healthcare, “Here’s what you need to do to regain health.”

                                See, again, it’s, what are the goals? When you go to a doctor, that’s what I ask everybody is, “What’s the goal of the doctor? What’s your goal when you come into the clinic?” Because if you just want to treat the symptom, that’s failed miserably. Now, if you want to reclaim your life, you want to optimize your recovery, you want to restore your health, you’re in the right place because we’re going to do this metabolic testing. I do a head-to-toe 7-point brain, body, gut exam. We combine neurology and functional medicine together to actually heal this person. So inflammation is a big trigger. Then the number one contributing factor to inflammation is going to be leaky gut.  Now, another one that most people don’t know is we look up mold. It’s called mycotoxins. This is another one. I know I live in Mississippi, but the average, if you Google percentage of households that have mold, what would you think the percentage is there?

Dr. Weitz:            I guess it depends on what the criteria is because mold is universal everywhere. You’re going to find some somewheres growing on your sidewalk, growing somewheres.

Dr. Barlow:          Research showed that 70% of homes in America have mold. See, these are high numbers here. So shouldn’t we test for these numbers? Shouldn’t we test to see if this person has mold to start with? Because see, what happens in my clinic, I’m actually shocked when people don’t have mold in their body. If you look up stachybotrys chartarum, just that one mold product spore can actually trigger almost any health problem that a human being has from-

Dr. Weitz:            A lot of people are surprised they have mold because they think only people who have old homes that aren’t kept up well, and the reality is the new construction methods are to insulate our homes, so they hold in the heat or keep the cold from coming in or keep the heat from coming in so they’re really sealed and insulated. If there’s any water leak, that gets between the walls and there’s no venting based on the new construction rules, and so you’re much more likely to have mold than you would’ve in an older home.

Dr. Barlow:          So one of the things, see, when we look at these numbers because the patient will ask me, “What do you think is causing this?” I’m like, “Well, I can probably tell you about 20 to 30 different things that’s causing it, but we don’t know for sure until we run the actual test.” So you got inflammation, major cause of inflammation, it’s going to be leaky gut, mold. Gluten sensitivity is going to be another one. We can actually … I encourage everyone to do this, and I’m going to share this with you, I’ve been running this one test for 17 years, and it’s called EnteroLab, E-N-T-E-R-O lab.com. So E-N-T-E-R-O lab.com, enterolab.com. Entero meaning gut. Enteric nervous system is where it comes from.

                                So if you order panel A2 … Now, here’s another one of those taking responsibility for your health. Anybody can do this. You don’t have to be a doctor to order this test. Now, to order Cyrex testing, you do have to be a doctor. You have to be a licensed physician to be able to do that. Now, this test here is going to look to see if you carry a gluten gene, to see if you carry the celiac gene, to see if the gene had been turned on, if you have malabsorption issues, sensitivity, milk, eggs, and soy. So you got a lot on this test right here. This test is $425, I believe. This is a huge investment in your health, and it’s about taking responsibility.

                                Now, again, and I wrote about this in my second book, I’ve had 1, 2, 3, 1, 2, 3, I’ve only had three patients in 17 years that we ran this test on that didn’t have a gluten sensitivity or, I’m sorry, that didn’t have a gluten gene or a celiac gene. So see, we need to let that sink in because if you have a gluten gene and it actually has become activated, you can actually test this on this same test, and this can lead to virtually any neurological disorder. Research shows, meaning depression, anxiety, movement disorders, numbness and tingling in the feet, stomach, gut, liver, gallbladder, depression, anxiety, all of that directly linked to gluten sensitivity.

                                So say you have patient going all over the place from doctor to doctor to doctor and they’re treating a symptom, and then this one actual trigger right here, this one code can cause a myriad of health problems. This is multifaceted here because if you actually have this problem, it can cause so many different neurological and chronic health disorders from headaches to movement disorders to pain, to cognitive decline. That’s just from gluten sensitivity. So that’s a test that we run.  Now, also, another one that we run is going to be environmental toxins. I think people have completely overlooked that. Now, without going into too much detail here, one of the things that we have-

Dr. Weitz:            This is another one of the Cyrex tests that you read?

Dr. Barlow:          It’s the Cyrex 11. So if you look at your lab test, Labcorp, there’s a test on there that’s for liver, and everybody should have this test ran. They can pull their Labcorp test that’s ran by their doctor, and you look under the hepatic ALT and it’s going to say AST under the liver score. Now, what happens here is when your liver is damaged, it starts to produce these enzymes. This is called AL for alanine, amino acid, amino transferase. This is aspartate amino transferase, so short, ALT and AST. This should not be above 24. Now, this is the optimal range. It should be 24 below.  Now, if you look on your lab test, it’s going to say something like 11 to 40. They call that the normal range, normal. Normal is your sick range. If you’re not familiar with what normal looks like, go to Walmart, and you look at all these fat people that can barely walk, that’s in these little go-kart or whatever you call them, and they’re like, “Oh, well, what’s wrong with you?” and they’re like, “Oh, they said I was normal.” So anyway, I can talk about that for another 30 minutes.

Dr. Weitz:            By the way, those normal change.

Dr. Barlow:          Yes, absolutely. See, normal, statistical, so not to try to confuse people, but to educate here, and again, you don’t know what you don’t know, for the lay person, they keep coming into my clinic and go, “My lab results are normal, but I’m still having all these problems.” Well, we have to define what normal is. As a society, we keep getting sicker and sicker. So as we send people to these labs, they take a statistical analysis. So I’m just throwing a hypothetical number out. 10 people go to this lab, I’m sorry, 10,000 people go to this lab, and then they find out, “Well, the average range here on this AST for your liver enzyme is point 11 and 40.” See, these would be normally sick people that are going to get this test.

                                The optimal range here is 24 or below 24. So if it’s above 24, then our liver is actually producing, it’s damaged and it’s producing enzymes, and those enzymes are being detected in our bloodstream. Now, why is that important? Because we have a phase one and phase two liver detox. So when we take these toxins into our body, which most people aren’t even aware that for ladies, just makeup that you put on your face or whenever you color your hair, those plastics, pesticide, herbicide, if you’re spraying your yard with roundup or pesticide, you have to detox from that. If your phase one, phase two liver detox is not functioning properly, you can’t get rid of these toxins.

                                Now, here’s the amazing thing. When you can’t get rid of these toxins, the term for that is called a neo antigen, which means that your body produces actually a new antigen that your body, that this can lead to cancer. This is what the research shows. So just because of your liver not being able to detox plastic, just for example, appropriate, I’m not saying … This is why we run the test. Do you have this problem or not? Because with my wife, her phase one, phase two liver detox is functioning properly, but we ran the test on her, this Cyrex 11, and I just told her, I said, “We get to the plastics, you’re going to light up.” She came back crystal clear. The reason it was clear is because her phase one, phase two liver detox was able to detox from these environmental toxins that’s come in.

                                I’ll use phase one, phase two as this example. Let’s say at Christmas, we’ll just use that as an example, you have a lot of people coming over to your house, but what happens if you can’t get the garbage out of your house? Well, it piles up. So that would be your phase one liver detox. You got this toxin that you can’t get out of your body, and like the garbage that you can’t get out of your house, it becomes putrid and everything gets stinky and terrible.

                                Now, the phase two is when you can actually take the garbage to the road, but waste management doesn’t come and bring it up. Then you’ve got neighbors complaining now. So see, we’ve got to be able to get our toxins from phase one through phase two, and then we have to excrete it through urine or feces. So if we can’t do that, then these toxins start to build up and we actually can test that through Cyrex Array number 11. So what we have to do with these toxins, number one is we have to clean the liver. That’s the first thing.

Dr. Weitz:            How do you clean the liver?

Dr. Barlow:          We have a liver detox. We use Apex Energetics, which is a company that’s out of California that we use for … We call it, we have a 10-week detox. So the 10-week detox that we use is we get a double whammy because we’re actually able to help with the leaky gut and we’re actually able to help with the liver enzymes and phase one, phase two liver detox. It also helps with pancreatic enzymes and the whole gut function.

Dr. Weitz:            What does that consist of?

Dr. Barlow:          That’s a lot. I have a handout on that, so it’s a lot. If you’re a doctor, you can actually call Apex. Is this going out to doctors or just going out to everybody?

Dr. Weitz:            Well, it’s going out to everybody, but a lot of our audience is functional medicine practitioners.

Dr. Barlow:          Okay. So if you’re a layperson and you call this company up, you have to be a doctor. So I can give you the contact information. Give me just a second. I didn’t know I was going to have to look this up or I’ve already have-

Dr. Weitz:            Oh, no, you don’t have to look it up. People can look up Apex Energetics.

Dr. Barlow:          It’s Apex Energetics. Then after years of working with all of this, and just from the scientific research, I’ve come up with the 10-week detox to help clean the gut and the liver. So it’s a combination of leaky gut and liver detoxification as well. So again, we’ve got to detect, we’ve got to look and see, do we have plastics, herbicides, pesticides? Do we have mercury that’s in our mouth? I have mercury that’s in my mouth, but guess what? Right now, I’m not having any antibodies that are attacking that. How do I know? Because I’ve ran all these tests?

                                The next person that comes in may have amalgam, but their immune system is overreacting, and it’s actually attacking the mercury that’s in their mouth. If that happens, which I do have a patient that happened to, this is why you need a traditional doctor because I have to send them to a holistic dentist to actually get this mercury out of their mouth. So whenever we … For example, Cyrex Array number 11, when people come in with dementia, early onset Alzheimer’s, brain fog, see, again, what you don’t know what you don’t know, that can hurt you because there’s a bacteria that’s in your mouth that’s called porphyromonas gingivalis or P. Gingivalis. That can lead to heart disease, lung disease, and Alzheimer’s. How many people are going to link your periodontal issues to Alzheimer’s?

                                So again, when people say, “I’ve got this cognitive decline, what can cause it?” I’m like, “Well, inflammation, blood sugar, leaky gut, bacteria that’s in your mouth, bacteria in your gut, small intestinal bacterial overgrowth. So what we’re going to do is we’re going to test and find out what your code is.” The way I explain this is when I do an outside talk, and this is why I came up with the book, The Code Breaker, and for anybody that’s watching, they can actually go online to thecodebreakeronline.com. I actually have about a 20-minute video of each one of my chapters. Of course, I would highly recommend you buy the book, but you go online to thecodebreaker.com and this is what it’s going to look like.  This is the first video. The first one is on the brain. You don’t have to log into that, but everything else after that, you’ll need to log in. So I talk about how the brain works, what you have to have to have optimal function. The reason I came up with the name Code Breaker is after doing my second book, which I swore I was never going to write another one after the second one, but The Code Breaker because it was an-

Dr. Weitz:            We can’t see your phone.

Dr. Barlow:          Phone, yeah. I talk about that in my book about it. When I do outside talks, I hand my phone to somebody and I go, “I want you to unlock my phone,” because there’s a certain code for this particular phone. Now, your phone may look exactly like mine, but the code to unlock this is completely different. Now, this phone only requires six codes, but they have to be punched in at the right frequency, the right order. In your body, I’ve determined that there’s seven codes. Now, there’s minor codes beside, but there’s seven big codes. See, that’s what we have to do and we actually have to do the test. See, if I gave you the code to my phone, you can unlock it in two seconds because I gave you the code.

                                See, everybody has a code or multiple codes just like a phone that’s causing their chronic health problem, and that’s where we use the Labcorp, EnteroLab and Cyrex in combination to find out what is this person’s code that’s causing them malfunction. Again, we’re not just doing functional medicine, we’re actually doing functional neurology together. So we want to do a neurological exam to find out which neurological pathways are impaired, and then we’re going to stimulate those neurological pathways through using certain modalities for each neurological pathway, and we’re going to create what is called neuroplasticity.  However, I tell patients all the time, “If I give you a ball-peen hammer and I tell you to come over here and hit this wall, that’s a trigger, and I can’t rebuild that wall until you stop hitting it.” See, all the triggers that we’re going to do the metabolic testing with, that’s going to tell us what’s the ball-peen hammer that you’re having that’s destroying your body. We have to remove that trigger, and then we can create neuroplasticity and actually help the body heal.

Dr. Weitz:            That’s awesome, Doc. I know you have a hard break at 9:00, right?

Dr. Barlow:          Yeah. So let me just go over this real quick and then I’ll … So we’ve got inflammation, blood sugar, environmental toxins. We have autoimmunity, vascular health, and if I didn’t say environmental toxin, then-

Dr. Weitz:            Then trauma.

Dr. Barlow:          Trauma is a big one. So let me end with this if you don’t mind.

Dr. Weitz:            Absolutely.

Dr. Barlow:          So what we have here, and I do talk about this in my book, if you want to order, of course you can go on Amazon and just type in Dr. Andy Barlow and three books will pop up, and The Code Breaker is the that’s in. So there’s three stages to autoimmunity. This is stage one. Stage one, and Cyrex has a lab that we can run here that’s called Cyrex Array number 5, and it tests for 25 different tissues, everything from brain to heart, to liver, to bone, to … So for example, let’s say somebody comes in with knee pain, and we’re going to use this person, actually a real patient. I went over their blood work about two weeks ago, and they have autoimmunity. They have antibodies against cartilage, osteocytes, and the actual bone, the joint itself.  So there’s three different antibodies that’s attacking the joints in this particular person. Their knee pain is actually the worst. The point is it can actually give us an explanation as to why is your body healing slower than everybody else’s. Well, you have an autoimmune attack to your joints, but here we go. So you got this stage one. This is when your immune system is producing antibodies, but there’s no symptom. This is called silent autoimmunity.

                                The only time that’s typically going to happen, nobody’s going to pay for this test to go, “Hey,” most people won’t. My wife has something like that, but most people want just go, “Hey, I want to invest in my life and I want to see if I actually have these predictive antibodies which can destroy my body and my life.” These predictive antibodies actually show up more than 20 years before a person actually has end-stage pathology.  Now, stage two, this is where most people are going to be hanging out right here because their immune system is producing antibodies, meaning that your immune system is over-aroused, it’s producing antibodies, your antibodies are attacking your own tissues that can trigger then lead to an autoimmune disorder. Then this person now is having symptoms. They go to the doctor and, see, they don’t have enough tissue that’s damaged yet, so the doctor’s like, “We can’t find anything wrong with these. You are normal.” See where that comes in? Normal. Again, this could be 20 years from here to here.

Dr. Weitz:            This is the key. This is pointing out the difference between healthcare and sick care. Our insurance-controlled sick care system doesn’t even allow the doctor to treat you until you’re sick because then you can have a diagnosis that’s billable because when you have predictive antibodies, at that point you don’t have a certifiable diagnosis so you actually can’t be treated, but if you want to prevent these diseases like autoimmunity from happening, we’ve got to get these diseases in stage one and stage two before the tissues are damaged.

Dr. Barlow:          Right, because again, it’s called predictive antibodies. Then what is the gateway to autoimmunity? The gateway to autoimmunity is leaky gut. So in my book, I talk about in autoimmunity, there’s a 30-70 split, which means that 30% of any type of autoimmunity is linked to genes, but then the 70% has to do with environmental epigenetics, which damages our genes. Then the crazy thing about epigenetics is even though you may damage the cell on the gene, once you remove the trigger, the body can heal. Then leaky gut, because leaky gut causes inflammation, confuses the nervous system and it starts attacking the tissue.

                                So stage three is terminal. That means we’re producing antibodies. Then we have enough tissue destruction that we actually have a name for that. It could be rheumatoid arthritis, lupus, ALS, MS, those kinds of things. Again, once you get into this, this is greater than a 20-year process, and this person has suffered for 20 years and their doctor’s like, “Well, you’re normal. You’re just looking for attention. You’re just a professional patient. You don’t really have anything wrong with you. We’re going to send you off to the psychiatrist because you actually have anxiety,” and it’s like, “Well, if I did this for 20 years and nobody could help me, I’d probably have anxiety too.”  We have seven codes. Those seven codes are in my book, The Code Breaker. So you can go online to thecodebreakeronline.com. I have the videos on there for each chapter, but also, it would help if you buy the book so you can read the book and then go online to each chapter. Each chapter is in the neighborhood of approximately 20 minutes long, and there’s a video to each chapter.

Dr. Weitz:            That’s great. Thank you so much, Dr. Barlow. How can listeners and viewers get in touch with you and find out about your programs?

Dr. Barlow:          Well, thank you. All right. So there’s two things they can do. Number one, if you’re a patient or you have questions, you can call my clinic. The lovely lady is up front that’s going to answer the phone is Sandy or Nikki. They’ll answer the phone. My office number is 662-844-1414. So again, 662-844-1414, and you can leave a message, we’ll call you back. Then also for doctors who would like to attend my seminars, I actually have online seminars and live seminars. They can go to barlowbrainandbody.com. That’s barlowbrainandbody.com. Let’s see if I have this up here. This is what this is going to look like. In two weeks, I’m actually giving a seminar in my clinic, well, two weeks from today, in my office on balance disorders, peripheral neuropathy and knee pain, and the metabolic components to all of those.  So we want to address the symptom, yes. We want to know, “Hey, what is wrong with you?” I call it the blinky light. “What’s the main thing that’s causing harm or dysfunction or lack of enjoyment and mobility in your life? What is that?” Then we also want to address the whole body and find out, just like with autoimmune disorders, hardly anybody just has one autoimmune disorder. When we start running these tests, we find they have, in some cases, multiple tissues that are actually being damaged.  So you can call my clinic as a patient or you can go to barlowbrainandbody.com. There’s a contact information for doctors on that website, and that’s the best way to get in touch with me.

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

Dr. Barlow:          Thank you for having me.



Dr. Weitz:            Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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.  Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111 and we’ll set you up for a new consultation for functional medicine, and I look forward to speaking to everybody next week.



A Functional Medicine Approach To Autoimmune Disease With Allison Samon: Rational Wellness Podcast 353

Allison Samon discusses A Functional Medicine Approach to Autoimmune Disease with Dr. Ben Weitz.

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


Podcast Highlights

1:33  Allison was suffering with chronic pain in her knees, her back, and her butt and had numbness in one of her feet.  She suffered with migraines and chronic fatigue.  Allison went to see orthopedists, neurologists, chiropractors, physical therapists, and acupuncturists.  Exploratory surgery was recommended to her.  She finally saw an alternative practitioner who asked her what she had for breakfast and she answered that she had Special K and a glass of orange juice and it turned out that she was feeding a blood sugar dysregulated cycle.  He recommended that Allison eat an orange instead of drinking orange juice and stop eating pasta or cereal or lean cuisines for dinner and start eating whole foods and her inflammation started going down, her knee sopped hurting, her migraines went away, and she eventually regained her health.

9:07  Autoimmune diseases. There are three factors that can result in autoimmune disease, which are a genetic predisposition, gut dysbiosis/leaky gut, and some kind of insult to the terrain, such as an infection, trauma, or microbial imbalance.  Autoimmune is when your body turns on itself and the immune system attacks your own tissues as if it is an invader or pathogen.  Triggers for autoimmune diseases can include blood sugar imbalances and inflammatory foods like gluten and dairy.  One common autoimmune disease is Raynaud’s, which many patients have and ignore.   

11:50  Common triggers for Autoimmune Diseases.  Some of the most common triggers for autoimmune diseases are blood sugar imbalances and inflammatory foods like gluten and dairy.



Allison Samon is a Functional Nutrition and Lifestyle Practitioner who works virtually with people to get out of chronic illness, escape from mystery symptoms, and help re-design their lifestyle so they can be fit, energized, and pain free in ways that are easy, fun, and sustainable. Allison struggled with unexplained chronic pain for over 10 years. Her remarkable healing journey became the basis for her programs: Reboot from Chronic Illness and the Chronic Illness Recovery Blueprint. She’s also written an ebook “Detoxing Endocrine Disruptors: Essential Checklist” and is a featured author in the Amazon International Best Seller: Teach Your Expertise. Her website is AllisonSamonFunctionalNutritionist.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 having a discussion with functional nutritionist, Allison Saman, about autoimmune diseases and a functional medicine approach. Allison is a functional nutritionist and lifestyle practitioner. She works virtually with people to get them out of chronic illness, help them escape from mystery symptoms and help redesign their lifestyle so they can be fit, energized, and pain-free.  Allison struggled with unexplained chronic pain for over 10 years. Her remarkable healing journey became the basis for her program, Reboot from Chronic Illness, and A Chronic Illness Recovery Blueprint. But her proudest accomplishment is becoming a first time mom over 40 and inspiring other women to successfully have healthy pregnancies despite being considered geriatric. Allison, thank you so much for joining us.

Allison:                 I’m thrilled to be here, Ben. Thank you.

Dr. Weitz:            Can you start by telling us about your personal health journey?

Allison:                 Yeah. What’s funny about that is I considered myself to be healthy and active. I was active, but I was anything but healthy. As you know, the more active you are, the more you are prone to get injured, and that was the conventional wisdom is that I started limping.  I was having chronic pain in my knees, my lower back, my butt, I had numbness in one foot where I was constantly having to stomp my foot on the ground because I didn’t feel it. If I was sitting down, it felt like I didn’t have a foot, and it kept progressing. I had migraines, I had chronic fatigue, and I had an injury that was, I think the initial injury was a skiing accident where I got plowed down, my ski went one way, my knee went the other. That, I think maybe created an initial tear, but being young and active, you heal, or you think that you heal.

                                Several months later, I ran a race and took a nap after the race. I was in college and I was waitressing at night, and got up after my nap and I was limping. I knew that that was a different kind of ouchie, that I must have twisted something while I was running, but you know the difference between like ooh, and that’s not right, something is wrong here.  When I went to orthopedist at the time, he said, “You’re young, you’re athletic, you’re fine.” That was what I was hearing, but I just knew something was different this time and it eventually healed, but not in the same way, and again, over time it just kept progressing and then to other parts of my body.

                                I did everything from seeing neurologists, chiropractors, physical therapists, I basically went to every single person who had a lotion or a potion or some kind of thing to help, and none of it really worked. Acupuncture helped a little bit, but not everything. Didn’t help my knees. It helped my back, it helped my butt, it didn’t help my knees. Sitting was excruciating. I had a long commute, I was in New York City at the time in a completely different career, I worked in television, and sitting… Just having to sit in a chair was just miserable.  The irony is the one thing that all of these practitioners, I went to top people in New York City, Wayne Gretzky’s guy, and nobody ever once asked about what I was eating, not one person. I never made the connection because I thought I was healthy, but I was also thinking if I’m not fat, therefore I’m healthy. That was the mentality, and so I was like I can eat that because I’m just going to work out and it’s going to be fine.  Over time, that’s not true anymore and eventually your body starts to crap out when you’re feeding it such crap. That was a 10-year struggle for me that basically culminated with this top guy saying, “Let’s do exploratory surgery because your scans are not consistent with your pain.” I was like, “That doesn’t sound like a good idea. You’re just going to cut me open to look around and you don’t know?” I didn’t know any better at the time, I just knew that something felt wrong.

                                I was finally introduced to somebody who asked me, he was an alternative practitioner, and he introduced me to the energetics of food. Without even putting anything in my body, what food did just on my body. I was like that’s crazy. He asked me, “What did you have for breakfast?” I was like, “I had Special K and a glass of orange juice and a multivitamin.” Duh, a healthy breakfast. That’s what I thought was the way to go. I had no idea that that actually was just feeding a blood sugar dysregulated cycle that I was subsisting on, and it was fueling all of these symptoms that I had, but I had no idea because it fit the model of the time.

Dr. Weitz:            We’ve all seen that model of the healthy breakfast.

Allison:                 Right, and it couldn’t be more wrong. The funny thing is I don’t even like orange juice, I hated it always. I was drinking it because of the vitamin C. I thought I was being a good girl.

Dr. Weitz:            You regained your health once you started changing your eating? How did you change your eating?

Allison:                 The first thing I did was when he told me I didn’t have to drink orange juice and I was like that is insane, but okay. Thrilled, I’m thrilled not to. He’s like, “Why don’t you eat an orange or have broccoli or strawberries?” I’m like, “I can do that?” That was the first thing I did was I just stopped drinking orange juice, and my knee didn’t hurt the next day. I was like that’s crazy. What more can I try?  I wanted to see what other foods could I take out and I think that’s how it started. What can I take out and still eat because at the time, I was eating pretty much like a bachelor. Pasta out of a pot, cereal for dinner. I worked television, I didn’t have time to think about any of that stuff, but this is what opened my eyes to oh, maybe there’s something I’m missing. There was a lot that I was missing and I didn’t realize it.  The Lean Cuisines that I was having, all those microwave meals that I thought were healthy weren’t serving me in the way that I had hoped. When I started, it just opened my eyes to oh, yeah. That’s a lot of preservatives and that’s a lot of sodium. Maybe I’m not eating very many actual foods, like whole foods. What if my body likes that? Oh my gosh, it really did.  The inflammation started going down, I started not having pain in my knees. It didn’t happen overnight, let’s be clear, but it started this obsession of this new religion that I was taking on, which is nutrition. Why don’t people know about this? Nobody talked to me about it. I wasn’t having migraines anymore. I was on medication for migraines and I didn’t have them anymore, and I think it was because I was dehydrated, I was constipated, I was malnourished, and all of these things and exhausted, not sleeping. All of these things, it was ripple effect of like oh, you take one thing out and things start to get better, things start to improve. It sounds so simple, and yet it is.

Dr. Weitz:            You regained your health and now one of the types of conditions that you often see patients for, we discussed earlier, are autoimmune diseases. Perhaps you can explain what is an autoimmune disease, what is some of the most common ones, and what can we do about them?

Allison:                 Yeah. Autoimmune, it’s funny because when I was going through all… Nobody could figure out what was wrong with me. And they were looking at lupus, and I did have Raynaud’s, my fingers would turn white, I’d go and get a gallon of milk out of the refrigerated section in the supermarket because I was drinking copious amounts of milk as well, and my fingers were turned white. They were talking to me about a bunch of autoimmune.  Autoimmune, what I always tell people is you have to win the trifecta for autoimmune to occur. One, there’s a genetic predisposition, and two, there has to be some kind of dysbiosis in the gut. There’s something in the terrain that is there, whether it’s an infection, a microbial imbalance, there’s something. Three would be some kind of insult, some kind of trauma, some kind of event.

                                Autoimmune is when your body starts to turn on itself, it starts to think that its tissues are actually a pathogen or an invader. I haven’t seen anybody in my clinical practice who hasn’t had trauma as part of their story, even if they don’t realize it, that it was a triggering event, because sometimes pregnancy can be the triggering event because they had that predisposition and then it’s a physical and emotional trauma. There’s major changes going on, and the trauma could even be blood sugar swings. I mentioned that briefly before.  I was having severe blood sugar swings, and I didn’t realize it was an issue because that was how I kept my energy up was sugar. Some people use coffee, soda, cigarettes. I didn’t do any of that because I was a healthy person, but I used fat-free candy. That was my way. You have those high highs and high lows, and that is actually stress on the body, which if you have an underlying autoimmune condition, that could be a trigger.

Dr. Weitz:            What are some of the most common triggers for autoimmune diseases? You mentioned blood sugar imbalances. What are some of the other ones?

Allison:                Depending, inflammatory foods, so things like gluten and dairy, those were things that were absolutely staples in my diet and they’re inflammatory in the gut. Again, if you-

Dr. Weitz:            Are they inflammatory to everybody or just to some patients?

Allison:                I would say that they’re inflammatory to everybody. I don’t think that they manifest the same in everybody. I always say if you don’t have hormonal issues, if you don’t have digestive issues, then it can be okay for you.  There’s a lot of pushback about that, but if you have an autoimmune gluten absolutely must come out of the diet because of what it does, how it can contribute to a leaky gut situation, which also feeds this autoimmune pattern that we can have.  You asked what are common autoimmune diseases? I mentioned Raynaud’s. That’s one that I think is common, but it’s not something that people really pay a lot of attention to because it’s usually one of many. The saying goes if you have one, you get three because often, people are just living with it and don’t realize that there’s things they can do about it. They just think-

Dr. Weitz:            Yeah, no, it’s definitely the case that if you have one autoimmune disease, you’re more predisposed to a second or a third.

Allison:                Yeah, and especially because it usually goes untreated. It’s like well, you have it and there’s nothing else you can do. That’s what they said to me with my hormone imbalance. Your body’s always going to do what your body’s always going to do. Now I know that that’s not true. We can actually change the course the way that our body is working-

Dr. Weitz:            Or you can take injectable drugs that block your immune system.

Allison:                You could do that too. You could do that too, yeah. For sure. I, personally, we take a more diet and lifestyle approach. That’s the functional nutritional way, following functional medicine where it’s a bio individual approach, but knowing that the field of epigenetics tells us that we can influence the way our genes are working and using our environment, using our food, using our movement, using our mindset, all of these things can contribute to a stress response and different triggers and just how our bodies respond.

Dr. Weitz:            When you’re consulting with a new client and you’re talking to them, what are some of the clues that make you suspect what their triggers might be? How do you try to whittle it down?

Allison:                 I always do a really thorough intake. I build a timeline and a matrix. This is the functional medicine way-

Dr. Weitz:            This is the IFM, Institute of Functional Medicine, matrix.

Allison:                 Yes, absolutely. I have an adapted version of that, but that’s exactly where it comes from. Really extensive timeline and there’s often things in there that people don’t realize matter, because it all matters. They’re like I had my gallbladder removed, but that was 15 years ago, so that doesn’t really matter, right? It’s like, yes. I was on the pill for 25 years. That doesn’t matter, does it? Yes.  All of these things matter, and people don’t realize how all of these things add up to what brought you here today, and thankfully that you’re thinking forward enough to say, I want to change. I’m not on the right path, and there’s something else I can do, and I would like to do that. I’m looking at that. I’m looking for the traumas.

                                Again, it could be a lost job, a death in the family, a divorce. There’s always something, or it could be something like oral surgery or a lot of surgeries or a lot of infections. I’ve seen that a lot too where somebody’s like I had this mystery infection, I had this, I had COVID. It’s like okay, these are incidents where things can take a turn after. When I look at what their diet is and I see they’re having digestive problems, or they don’t think that they have digestive problems, but they have things like rashes or they have brain fog or they have joint pain, I’m seeing all this as what’s that connected to? It’s all coming from the gut. There’s always some kind of gut issue that needs work with autoimmune. I don’t know that conventionally, that’s ever looked at.

Dr. Weitz:            When it comes to after your consultation, I’m assuming in a lot of your patients, you’re doing some testing?

Allison:                 Not in the beginning. I always want to see if they have recent labs that were within the last six months. Definitely want to see because there’s information that we can learn from basic functional labs. I would like to see them, but I don’t order testing. I do, as a functional nutritionist, I don’t order testing right away because usually there’s a foundation that’s missing. That’s where I start them with, like getting them off of the inflammatory foods. The gluten, the dairy, the sugar, alcohol, if that’s an issue for them, taking those things out of the diet, making those shifts, making sure…

                                Really, it’s these three non-negotiables is are they sleeping? Are they pooping? Is their blood sugar regulated? Are they having mastery really over blood sugar? That’s where I’ll start. When I find that there’s no movement or enough movement… I always say, and I actually learned this from one of the speakers in one of the functional meetups, and I don’t know if it was Tom O’Brien who said I took it and I run with it, and it is great. If I don’t move the needle with you within the first two weeks of us working together, I know that we’re not on the right track, but I always do. Poop, sleep, blood sugar, there’s always something there.

Dr. Weitz:            How do you know they’re having blood sugar problems?

Allison:                 Because they will say that either they’re not sleeping or I look at a food journal. We do a lot of that, a lot of tracking in my world. I’ll look at that and go huh. Sometimes to myself, huh, because they’re not eating, there’s a lot of people who come in on intermittent fasting, and not that there’s not a place for it, but not for somebody who is chronically ill. We don’t fast a sick person.  I’m often trying to undo that and say, we can go back to that when we get you into a place where you’re not having these crashes, when you’re sleeping well, when you’re not having this digestive distress, when you’re not having anxiety, that’s another sign.  They’re so anxious. It’s this dysregulated blood sugar. You could just tell in how somebody presents or when you start talking to them about diet, how they get triggered by it and they get really defensive. You’re not going to take that away from me. I can’t do that, or I can’t live without that. There’s certain tells. And then after a few weeks, we will do hormone testing where I’ll take a look at where is their cortisol. They’re completely flat lining or look at their having a W.

Dr. Weitz:            You’re talking about salivary cortisol testing?

Allison:                 Mm-hmm. Depending, I might do salivary, sometimes I do Dutch, but it’s really easy to show them on a ZRT saliva to see those graphs where Dutch can sometimes be like what am I looking at? That can be overwhelming, and so it really depends on the person, what they’re able to handle because some people, you have the know it all clients and you have the I am so freaked out about this whole process and making these changes and we have to go really baby steps.

Dr. Weitz:            Okay. Do you do stool testing? You talked about the gut.

Allison:                 I will do stool testing, but again, not right away. I have to do all of the non-negotiables first and building that foundation but yes, I have done the GI 360, Biome Effects. Those are the two tests that I’ve done.

Dr. Weitz:            The GI 360 from Doctor’s Data and the Biome Effects from Microbiome Labs?

Allison:                 Correct. It’s only when I’m suspecting that there’s infection and oftentimes we might think that there’s infection right away, but there’s no foundation, there’s no solid foundation. To jump into, let’s say a kill, they’re not ready for that yet. We have to build so they feel like okay, yeah, I’m going to the bathroom, I’m sleeping through the night, I’m eating throughout the day, I have more energy, my brain can focus, I can work, I’m nicer to my friends and family, I’m happier, and then it’s like okay, now we can move to this stage. It’s really just a systematic way of peeling back those layers and then rebuilding them.

Dr. Weitz:            You mentioned your non-negotiables that you start with. Why don’t we go through what exactly are you non-negotiables?

Allison:                 They have to be sleeping, they have to be pooping regularly, at least once a day. Nice poops, we talk about that.

Dr. Weitz:            Now, what if they’re not sleeping? They say I haven’t slept for years. I try, I wake up, I can’t fall back to sleep.

Allison:                 We’re going to work on their blood sugar balancing. It all goes back to that. If they’re not sleeping, it’s likely because they had low blood sugar. What I might do is start off with… There’s a couple of things. Start off with let’s have a snack before bed. Snack, not a meal. I always have to say a snack is a snack. It’s not a meal. Something that’s protein and fat, small before bed so that they can sleep. That usually helps, but also bringing in mindset.  We do a lot of calming, a lot of parasympathetic, just calming the body because if you can’t calm the mind, you can’t calm the body and it’s just this vicious cycle. I give them some tools where they can hopefully fall asleep faster or stay asleep. And then of course, if they’re still having trouble, if there’s other hormonal imbalances like let’s say estrogen dominance, and it’s waking them up in the middle of the night, I’ll bring in some adaptogenic herbs to try to help them sleep.  There’s lots of tools. I guess that’s the beauty of the functional way is that there isn’t one way. There’s so many different ways, and it depends on the person and what they’re willing to do and what their body is capable of handling or what they-

Dr. Weitz:            Your non-negotiables are they have to be sleeping, so you work on their sleep, you balance their blood sugar. What are the other non-negotiables?

Allison:                 Poop. They got to poop. Have to poop.

Dr. Weitz:            What if they’re not pooping?

Allison:                 We’re going to get them pooping. That’s usually the first thing I think that that happens is we get them pooping pretty much right away.

Dr. Weitz:            How do you get them pooping?

Allison:                 We take a look at what they’re eating. It’s often maybe they’re devoid of real food. Maybe they’re devoid of fiber, maybe they’re devoid of food that they can actually break down, so we might be working on stomach acid. It’s not exactly the way they’re thinking, I need to take a laxative or I need to take fiber pills. It’s like what if you don’t have the stomach acid to break down that food so that you can absorb that food so that you can poop out that food?

Dr. Weitz:            How do you decide if they have proper stomach acid?

Allison:                 That’s a good question. Based on what their symptoms are, if they’re presenting with a lot of bloating or they’re not pooping, or they say that they have trouble eating certain foods like meat, let’s say, can’t digest meat and they want to digest meat, their stomach acid may be low. They might have acid reflux, which as you know can be an indication of low stomach acid rather than high. There’s lots of different symptoms there and honestly, anybody in the autoimmune population, I know that there’s some kind of dysfunction in their digestion.

                                Having low stomach acid is often… It’s just very common and so I’m going to make that assumption there, that they need to either bring in some stomach acid and/or digestive enzymes to help with that digestive process. That often, right away, they’re like wow, I didn’t realize that I wasn’t eating my food properly. I’m like isn’t it amazing when you actually absorb the nutrients in your food, what happens right away? You don’t need a substance, you have food. It’s wild.

Dr. Weitz:            Okay. You get them pooping by using stomach acid or digestive enzymes, and that works most of the time for your patients?

Allison:                 Yes. Sometimes it’s the kinds of food that they’re eating, or maybe they’re not eating enough. I’ve seen that too, where they’re so afraid of overeating or gaining weight because now I want them eating regularly throughout the day and they are not really eating and they’re concerned that they’re pooping. It’s like you have to eat food in order to poop.   Making sure that they’re having nice balanced meals, and for some, it might have to be smoothies and pureed vegetables or just steamed vegetables, things that are soft, things that are easier to break down. It depends. It just depends on the person.

Dr. Weitz:            Okay. Let’s say you do some of these basic things, you add some hydrochloric acid, you get their blood sugar balance, but now they still have this hypothyroidism. What do you do next?

Allison:                 We’re making sure that their blood sugar is balanced, so we’re making sure that they have… When I say say balanced meals to support blood sugar balancing, that’s protein, fat, and fiber. There’s a lot of education around fiber and carbs. Everybody’s still so crazy over carbs.  I like to explain it that, think of it in terms of fiber, because all plants are carbohydrate. It depends on what plant you’re having and which ones have more fiber. Just think in terms of fiber, how can I get more fiber? Don’t be so afraid of carbs. It’s the refined carbs that we’re wanting to avoid, but not carbohydrate. Bringing in fiber, protein, fat, and fiber, and-

Dr. Weitz:            Give me an example. What’s a fiber?

Allison:                 What’s a source of fiber? We have cruciferous vegetables are really good-

Dr. Weitz:            Vegetables, okay.

Allison:                 Yeah, vegetables. Also, there’s so many different ways you can get fiber. Your leafy greens, but also things like nuts and seeds also have fiber that they’re forgotten. I love nuts and seeds and I like to, as I say [inaudible 00:28:48] up your meals and your snacks. You can always add some nuts and seeds as long as they can tolerate them. That is another test that I actually will run is-

Dr. Weitz:            Do you like legumes and whole grains?

Allison:                 Love, love, love, love, love. More things like green like seeds, so amaranth and quinoa and buckwheat, those kinds of grains. Yeah, love them. So many different ways that you can get fiber. Fruit, forgot about fruit, don’t forget fruit. So many ways.

Dr. Weitz:            Great. Let’s say your patient is still struggling with this autoimmune disease. Where do you go next? Let’s say they have rheumatoid arthritis and you’ve done some of these basic things.

Allison:                I am betting that they’re already starting to see some improvement, but I love, love, love for things like rheumatoid arthritis, anything with pain, and that’s something that is near and dear to my heart is SPMs. Making sure that not only do they have good quality fish oils that are just part of their diet, I think that that’s really helpful for digestive health, it’s really helpful for joints, brain, eyes, skin, hormones, but also I love SPMs. I wish that I knew about them when I was struggling so because they’re fantastic for helping to resolve that pain. Bringing them on board regularly, and then as time goes on, they can just have it in the emergency kit.

Dr. Weitz:            These SPMs are derivatives from fish oil that help to resolve inflammation.

Allison:                Yes. That’s the thing is that there’s so many naturally anti-inflammatory foods like turmeric, love, but the resolution of the inflammation to actually bring it to that other stage, the difference is noticeable. I love it all.

Dr. Weitz:            You see a noticeable difference. What kinds of dosages are you typically using for SPMs?

Allison:                Again, it depends on the person.

Dr. Weitz:            Of course.

Allison:                I will say two in the morning and two in the afternoon, so four. I’ve had people go up as high as eight when they had a lot of pain. The good thing is they don’t have to do that for more than a day or two, and then it usually comes down and that’s so wonderful about it. I definitely love SPMs as part of a chronic pain protocol, if you will. And then I love-

Dr. Weitz:            Yeah, go ahead. Go ahead.

Allison:                No, I was going to say, so I love bringing in… Using food as medicine and when I want people having snacks, having an anti-inflammatory tea that they can put protein powder in, they can put MCT in, they can put collagen in, whatever it is that they want to make it something more robust, but it feels really good on the hands, it feels tastes good in the body, and it just has all of these… Turmeric, and clove, and nutmeg, and cinnamon. It’s yummy and also just helps people. I’ve had people who hands were like this. It opens them up, which is amazing to see.

Dr. Weitz:            You’re saying if they make tea? What kind of tea is this? What are they putting in the tea?

Allison:                I have them make a turmeric tea latte.

Dr. Weitz:            Turmeric tea latte. Okay.

Allison:                Yeah. It’s absolutely delicious. What I also love about it is people sometimes have sensitivities to certain herbs or foods, and so because you’re making it yourself rather than a package, not that there’s anything wrong… There’s a lot of really great products out there, and not that there’s anything wrong with that, but if you have to… I can’t do this one spice. Okay, fine. Omit it from the recipe, but you can still have these anti-inflammatory herbs. You’re having it with a high protein, you can add fat to it or not, you can have it just as a tea or you can make it a more robust snack and it’s more bang for your buck, I think.

Dr. Weitz:            Okay. I’m not sure where to go next. What else do you want to say about autoimmune diseases?

Allison:                I think that they can all be… I don’t think that they’re a life sentence. I feel like when you have the tools, every single autoimmune can be, I don’t know what the word is. You can mitigate the symptoms. You have the tools where the flare-ups are going to be fewer and farther between, and if something comes up, you know why. Because I didn’t sleep, because I ate that crap I wasn’t supposed to be eating, because I forgot to eat, because I had that really stressful event happening with my family, and that was my trigger, but I know what to do.  I have different supplements, I might use foods, I might do mindset things I might, do all of the above. It’s not one thing. It’s not one thing that got you here. It’s not one thing that’s going to get you out of it. I feel like once upon a time, I maybe was afraid of a lot of these conditions that I didn’t experience, I didn’t know what they were, but now I know because I understand how the body works. I know that get them pooping, get them sleeping, get their blood sugar balance, and I know that everything else, once they’re functioning optimally…

                                Because look, if you’re not pooping, you’re not sleeping, and your blood sugar is imbalanced, then your liver is not working properly, then you are not detoxifying toxins and hormones, that backs up… It backs up, backs up, backs up, backs up into all of these other issues, neurological, and hormonal, and mood, and structural. If everything is backing up and then you’re creating leaky gut or if you’re having structural issues, it’s creating leaky gut, which then creates inflammatory and immune issues. It is just this vicious cycle.  If we get everything working properly, metabolizing properly, then it’s more of a ripple effect of positive benefits instead of going down this everything’s falling apart, which is I think where most people go. That’s definitely what was happening with me until I had this… It can happen really quickly for people, even if they’ve been struggling for 20 years with these things, we can get them into a place of relief and getting their livelihood back, 100%.

Dr. Weitz:            That’s great. Any final thoughts for our listeners and viewers, and then give your contact information?

Allison:                I would say do the work yourself in knowing what your non-negotiables are. Meaning when you go to a practitioner, know that you are taking care of yourself and advocate for yourself. Are you doing the sleep, poop, and blood sugar balancing? If you are working on that and you’re stuck, then work with somebody on how to get around that. Just know that your body wants to heal and there’s probably things that you didn’t know that haven’t yet been uncovered or nobody asked those questions, and that’s what we do in the functional approaches is we ask those questions, we ask all of these other questions.  It helps for you to know yourself and just know that anything is possible as long as you advocate for it, and also are willing to think outside the box and take some steps that might not be so comfortable to get to the other side of this complex thing by doing these simple things and your body and life will feel much better.

Dr. Weitz:            That’s great. How can listeners, viewers find out about working with you or signing up for some of your… You have some courses available?

Allison:                Yeah. I have a gift for your listeners. If they go to allisonsaman.com, and we’ll put that below, I have my roadmap to roadmap to chronic illness recovery. Essentially, it’s the five steps that I took. It took me 10 years to figure it out. It won’t take you 10 years to figure it out, but the five steps that will help you with these non-negotiables that you can do today or to tomorrow to move that needle within the next week or two where you’re starting to see change and it covers all the things that we were talking about. I feel like that would be the first great step.  I’m Health Allie on social media, Instagram, YouTube, Facebook. I would love to just hear how it works for you, what’s going on for you, and what you found to be most valuable.

Dr. Weitz:            That’s great. Thank you, Allison.

Allison:                Yeah, thanks so much for having me.

Dr. Weitz:            You’re welcome.

                                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 appreciate it if you could go to Apple Podcasts or Spotify and give us a five star ratings and review.  If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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.  Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395-3111, and we’ll set you up for a new consultation for functional medicine. I look forward to speaking to everybody next week.



An Integrative Approach to Hypertension with Dr. Mark Houston: Rational Wellness Podcast 352

Dr. Mark Houston discusses An Integrative Approach to Hypertension with Dr. Ben Weitz.

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


Podcast Highlights

3:20  Hypertension.  What causes high blood pressure are three finite vascular responses, which are inflammation of the arteries, oxidative stress in the arteries, and immune dysfunction in the arteries. And those lead to endothelial dysfunction, glycocalyx dysfunction, vascular and cardiac smooth muscle dysfunction, the arteries become very stiff, non-elastic and therefore, the amount of flow going through an artery is going to increase the pressure by simple physical principles of stiffness with increased blood flow.  So, that’s the basic physiology of hypertension.  And at the Hypertension Institute we measure a series of genes that may play a role in causing hypertension and helps you to treat hypertension with either a drug or nutrition or a supplement. 

4:59  Hypertension is blood pressure higher than 120 over 80 but several large cohort studies show that the risk starts at 110 over 70.  But no committee’s going to recommend 110 over 70 because it is so difficult to achieve 120 over 80 and very few can achieve 110 over 70.  It used to be thought that you did not need to worry about blood pressure until it went above 130 over 90, but we now know that there is an incremental risk for every one millimeter increase of either systolic or diastolic blood pressure. 

6:28  Untreated hypertension.  A number of patients have elevated blood pressure and don’t treat it because they don’t feel bad and they don’t want to take medication. But this is a bad idea because it’s going to damage every organ that requires a blood vessel going to it, which is everything in your body.  The biggest negative effects of uncontrolled hypertension are ischemic stroke, myocardial infarction, congestive heart failure, kidney disease and aortic aneurysms. 

7:15  Proper way to measure blood pressure. Most doctors and nurses do not do blood pressure measurements correctly.  You should tell your patients not to smoke, drink coffee or alcohol or do other things before they come into your office.  They should be seated in a chair with their feet on the ground, their back supported and they should rest for five minutes. The patient’s arm should be extended at the level of the heart and supported and the pressure should be checked with a cuff.  You should check both arms and both legs. You should also do a sitting, standing, and lying pressure on the first visit.

9:58  White Coat Hypertension.  Clinical studies show that having white coat hypertension–high blood pressure elevated while in the doctor’s office, but normal blood pressure at home–is not benign but actually increases the risk of heart disease. If you have high blood pressure when in the office means that whenever you are stressed your blood pressure will go up.

10:58  Genetic Factors. Dr. Houston has developed a gene test (the Cardia X profile) with Vibrant America that looks at 25 different SNPS, including some genes for high blood pressure, dyslipidemia, coronary heart disease, and diabetes genes. This helps to personalize the treatment, including which drugs will work best for that patient.

11:50  Plasma renin activity and serum aldosterone levels help guide care for patients with hypertension.  You need to measure plasma renin activity and serum aldosterone since these numbers tell you the type of hypertension that patients have physiologically and this tells you which drugs will work best in that patient.  For example, if you have high renin hypertension, the best drugs will be ACE inhibitors, ARBs and direct renin inhibitors, while if it’s low renin hypertension, it’s a diuretic and a calcium channel blocker.

13:57  Diet and Lifestyle.  There are four main diet factors that affect hypertension: 1. Low sodium–below 1.5 gms per day, 2. High potassium–at least 5 gm per day, 3. High magnesium–at least 1,000 mg per day, and 4. at least 12 servings of fruits and vegetables per day.  If you do these four things you will typically see a drop of 12-15 on the top and 6 to 8 on the bottom. While it has become popular in the Functional Medicine world to think that sodium is actually a good thing, esp. since the book, The Salt Fix by Dr. James DiNicolatonio, but Dr. Houston disagrees and he feels that sodium is toxic in any form. Not only will sodium raise your blood pressure, but it gets into your arteries and makes them stiff and then that leads to stroke, heart attack, heart failure, and kidney failure, proteinuria in the kidney.  It also reduces nitric oxide levels, which makes your vessels even stiffer.  Dr. Houston has developed a version of a healthy diet that he calls the HIP diet for the Hypertension Institute Program, which is a modified DASH2 diet with a little Mediterranean flavor thrown in.  It is low sodium, high potassium, high magnesium, lots of fruits and vegetables, includes high quality protein, and gets rid of refined carbohydrates.

16:48  Toxins. Toxins drive hypertension and also coronary heart disease and heart attack.  You need to measure the big ones: arsenic, lead, mercury, and then pesticides and organicides. And if those are elevated, you do your best to get rid of them.

17:11  Micronutrients.  Micronutrient deficiencies can drive hypertension and coronary heart disease, arterial stiffness, and all kinds of problems including endothelial and glycocalyx dysfunction. Dr. Houston measures micronutrients with Vibrant America labs, which measures both intracellular and extracellular micronutrients. 

17:48  Exercise. Dr. Houston recommends a combination of aerobic and resistance training for one hour per day, six days per week. Exercise improves arterial elasticity, raises nitric oxide, and reduces stroke and heart attack risk.  Regular training will reduce blood pressure by about 12 over 6. 

18:25  Endothelial dysfunction.  Endothelial dysfunction and glycocalyx dysfunction occurs decades before you get hypertension.  This can be identified using noninvasive vascular testing including the EndoPAT test and the computerized arterial pulse wave analysis.  The first step is that the glycocalyx, which is outside the endothelium, gets damaged and then the vascular smooth muscle wall gets damaged, and finally the endothelium, which reduces nitric oxide and cause the three finite responses of inflammation, oxidative stress and vascular immune dysfunction, and then those feed into stiffness of the arteries.  Then the artery wall gets thickened and the lumen gets narrowed and the long-term effect is reduced blood flow and oxygen through the artery to the organ. What you want to do is to promote the health of the glycocalyx by taking Arterosil by Calroy Labs. The other product is Vascanox, which is another product from Calroy that stimulates nitric oxide production and it is five times more potent than any other nitric oxide product on the market.  Using these two products together improves glycocalyx endothelial function and also improve arterial function.  The artery wall and the elasticity gets better and relaxes and the pressure starts to fall.  The two ways to measure endothelial function besides the machines are to test asymmetric dimethylarginine (ADMA) through Quest and to use the nitric oxide test strips that measure nitric oxide in the saliva.

24:12  Nutrients.  Potassium and magnesium are helpful in lowering blood pressure. The most impactful supplements are those that support nitic oxid and the glycocalyx, which are Arteriosil and Vascanox.  Then you’ve Co-enzyme Q10, Kyolic garlic, alpha-lipoic acid, and Taurine.   There are about 15 different nutrients that have been clinically studied to help lower blood pressure.  Dr. Houston recommends a product called CardioSirt BP that he developed with Biotics that contains six grams of taurine along with magnesium and several other nutrients. Some nutrients work synergistically with medications, including R-Lipoic acid with an ACE inhibitor and Magnesium with a calcium channel blocker.  But the key is to make sure whatever you’re doing gets the pressure down normal and pretty quick. 

27:32  Medications.  In order to select the most effective medications for that individual, it is helpful to do both genetic testing and the plasma renin and aldosterone levels.  The top classes of drugs that Dr. Houston likes to use are ACE inhibitors, angiotensin receptor blockers, one or two of the calcium blockers like amlodipine or nifedipine.  The best beta blockers are nebivolol, which is Bystolic, or Coreg, which is carvedilol. The only diuretic that I use is indapamide.  He does not use Hydrochlorothiazide anymore since it does nothing to reduce cardiovascular events and you run the risk of type II diabetes and of kidney disease. It also causes homocysteine to go up and potassium to go down.  Also if you put hydrochlorothiazide with what we would call a good medication like an ACE inhibitor or a ARB, it counterbalances the good effect of the other drug.  If the patient has the CYP11B2 gene that responds to aldosterone over-synthesis, this can only be blocked with a serum aldosterone receptor antagonists like spironolactone, KERENDIA or eplerenone.  But spironolactone can cause gynecomastia, so it is usually used only in women.

31:00  Niacin.  Dr. Stanley Hazen, the doctor and researcher from Cleveland Clinic who developed the theory about TMAO as being a risk factor for cardiovascular disease, has published a paper claiming that consuming additional niacin from fortification or supplementation is potentially damaging for your heart.  This paper was published in Nature, which is a very respected journal: Ferrell, M., Wang, Z., Anderson, J.T. et al. A terminal metabolite of niacin promotes vascular inflammation and contributes to cardiovascular disease risk. Nat Med 30, 424–434 (2024).  This paper looked at metabolites of niacin (2PY and 4PY) that were considered to be toxic, but in order for these to get formed, you have to have a certain genetic SNP, which is not very common.  And patients need to take high dose niacin, such as 1,500 to 2,000 mg per day, to have elevated levels of 2PY and 4PY.  Then Hazen and the other researchers quoted some bad clinical studies that were previously refuted by the following article that Dr. Houston wrote with Dr. Pizzorno in 2014:  “Niacin Doesn’t Work and Is Harmful!” Proclaim the Headlines. Yet Another Highly Publicized Questionable Study to Discredit Integrative Medicine.  Here is Dr. Houston’s message for the readers: “Don’t listen to the news media reporting on medicine, because they never get it right. If you’re going to say, “I don’t want to use niacin and I don’t believe in niacin,” and get all upset about it, go read the study. Read the study, read the methods, and decide for yourself, “Oh, that’s totally flawed. I’m not believing that.” And move on.”


Dr. Mark Houston is the director of the Hypertension Institute in Nashville, Tennessee and he is the go to expert on cardiovascular disease in the Functional Medicine world. Dr. Houston is tripled board certified in hypertension as an American Society of Hypertension (ASH) specialist and Fellow of the American Society of Hypertension (FASH), Internal Medicine (ABIM) and Anti-aging medicine (ABAARM). He also has a Masters degree in Human Nutrition from the University of Bridgeport, Connecticut and a Masters of Science degree in Functional and Metabolic Medicine from the University of South Florida in Tampa. Dr. Houston teaches doctors around the world about cardiovascular medicine as part of the A4M programs.  Dr. Houston is also a very prolific author, having written many books, the latest two being  Precision and Personalized Integrative Cardiovascular Medicine and Controlling High Blood Pressure through Nutrition, Nutritional Supplements, Lifestyle, and Drugs.  Dr. Houston’s web site is HypertensionInstitute.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 our topic is an integrative approach to hypertension with Dr. Mark Houston. From today’s discussion, I hope to gain a better understanding of what causes hypertension, why it’s so important to treat it properly, how to test for it, and the pluses and minuses of the various treatment options with a focus on diet, lifestyle, and nutritional supplements.

                                                Hypertension means that you have high blood pressure, and as Dr. Houston points out in his latest book, this does not mean that you are overly tense. High blood pressure means that your blood pressure is more than 120 over 80. According to the CDC in 2021, hypertension was a primary or contributing cause to 691,000 deaths in the US, and nearly half of adults are defined as having hypertension, 48.1%. And apparently in 2021, they’re defining hypertension as blood pressure greater than 130 over 80 or taking medication for hypertension.

                                                Dr. Mark Houston’s the director of the Hypertension Institute in Nashville, Tennessee, and he’s the go-to expert on cardiovascular disease in the functional medicine world. Dr. Houston is triple board certified in hypertension, and as an American Society of Hypertension specialist and Fellow of the American Society of Hypertension, Internal Medicine, and Anti-aging Medicine. He also has a master’s degree in human nutrition as well as a master’s of science degree in functional and metabolic medicine.  Dr. Houston teaches doctors around the world about cardiovascular medicine as part of the A4M program. Dr. Houston is also a very prolific author, having written many papers and books, the latest two being Precision and Personalized Integrative Cardiovascular Medicine, and Controlling High Blood Pressure through Nutrition, Nutritional Supplements, Lifestyle and Drugs. Dr. Houston, thank you so much for joining us.

Dr. Houston:                      Thank you, Ben, and thank you for the kind introduction. It’s good to be with you again.

Dr. Weitz:                          Yeah, by the way, this book is great.

Dr. Houston:                      Thank you.

Dr. Weitz:                          It’s really incredible. It’s got everything a clinician would want to understand hypertension better. So, help us understand-

Dr. Houston:                      That was one year out of my life writing that.

Dr. Weitz:                          I bet it was, and I thank you for that. So, tell us what is hypertension and what causes it?

Dr. Houston:                      Hypertension has really not been well-defined in the past by most of the hypertension world. So, the book was designed to allow people to understand what really causes high blood pressure. Everybody thinks, “Oh, it is my genes. That’s what causes high blood pressure.” Well, yeah, there’s clearly genetic reasons for high blood pressure, but there’s a lot of environmental influences that contribute to those genetic expressions of high blood pressure.   So, if you break down into three simple things, three finite vascular responses cause high blood pressure. Inflammation of the arteries, oxidative stress in the arteries, and immune dysfunction in the arteries. And those lead to endothelial dysfunction, glycocalyx dysfunction, vascular and cardiac smooth muscle dysfunction, the arteries become very stiff, non-elastic and therefore, the amount of flow going through an artery is going to increase the pressure by simple physical principles of stiffness with increased blood flow.  So, that’s the basic physiology of hypertension. And then if you start looking at genetics and we measure all that in the Hypertension Institute, we can determine what gene may be causing the hypertension and how to treat it with either a drug or nutrition or a supplement.

Dr. Weitz:                          Okay. Well, let’s make sure we get into that in a few minutes. So, currently, hypertension is blood pressure higher than 120 over 80. Is 120 over 80 ideal? For example, is 110 over 70 better?

Dr. Houston:                      There are several large cohort studies that have said the risk actually starts at 110 over 70.

Dr. Weitz:                          Oh, okay.

Dr. Houston:                      But no committee’s going to recommend that because no one can achieve 120 over 80. So, they’re not going to say [inaudible 00:05:32] 110 over 70, but you’re pretty good at 120 over 80. The risk doesn’t increase dramatically.  But the thing I think everyone needs to know is there’s an incremental increase in risk for every one millimeter of systolic and diastolic. So, if you’re 121 over 81, you’re increased risk over the 120 over 80, and it goes up proportional to that. So, to set some arbitrary level, let’s say it’s 130 over 90, misses the whole point of, well, there’s a people between 120 over 80 and 130 over 90. You have incremental increase in risk.

Dr. Weitz:                          And that was kind of the rule for a number of years was, yeah, it’s okay if it’s up till 130 over 90, you don’t really need to treat it until then, right?

Dr. Houston:                      Yeah. It turns out that is not the case.

Dr. Weitz:                          Right. Now, a lot of patients have elevated blood pressure and let it go because they don’t feel bad and they don’t really want to take medication, and I think they don’t realize how dangerous it is. So, why is elevated blood pressure so damaging?

Dr. Houston:                      Well, it’s going to damage every organ that requires a blood vessel going to it, which is everything in your body.

Dr. Weitz:                          Right.

Dr. Houston:                      The big ones are ischemic stroke, myocardial infarction, congestive heart failure, kidney disease, aortic aneurysms, and that’s usually the organ damage that is manifest under the cardiovascular consequences of hypertension.

Dr. Weitz:                          Now, what’s the proper way to measure blood pressure? My experience is you go to the doctor, maybe you’re standing in the hallway or you’re sitting, your arm’s down. They measure your blood pressure once in one arm, but that’s ideally not the best way to do it, correct?

Dr. Houston:                      No. No. 99% of the time you go into a office, the nurse and/or the doctor don’t do blood pressure measurements correctly. I’ve seen it. I know it happens.  So, let me tell you how you should do it. You tell your patients when they’re coming in for their visit, not to smoke, not to drink coffee and not to drink alcohol or take any other things that could raise their blood pressure. They come in hopefully having a good night’s sleep as well, and they have to sit in a chair with their feet on the ground and they’re back supported, and they rest for five minutes. And then you check their pressure with a cuff, with their arm extended right at the level of the heart, and supported. You do both arms and you do the leg pressures. You do a sitting, standing and lying blood pressure and a leg pressure on the first visit. That’s routine. After that-

Dr. Weitz:                          I don’t think I’ve ever been to a doctor or hospital anywhere that-

Dr. Houston:                      No. You won’t get that unless you go to a hypertension specialist probably. But on the subsequent visits, assuming all those were okay, you can do just one arm blood pressure in the proper position with the arm extended. And you got to teach people how to do it if they do home blood pressures because most people don’t do it right.

Dr. Weitz:                          And then ultimately, a 24-hour blood pressure is probably the most beneficial, right? Most significant.

Dr. Houston:                      Yeah. Once you’ve identified an office reading that’s high, you confirm that with a 24-hour ABM because you not only get the average pressure, but you also get other things that are important, like what’s the dipping pattern? What’s the nocturnal blood pressure? Are there morning surges? So, all of these things factor into risk, but also when and what medicines to treat them with.

Dr. Weitz:                          What’s the ideal way to do the 24-hour blood pressure? Do you have a specific product that you like to use?

Dr. Houston:                      We have several that we’ve used. The one we use mostly is either Spacelabs or Hewlett-Packard.

Dr. Weitz:                          Okay. Now, I read in your book I was surprised to read about white coat hypertension. So, what that means is you go to the doctor’s office, your blood pressure’s elevated, you go home, it’s not. And I think the thought among most people is, “Well, that’s no big deal. I was just stressed out, so I don’t have to worry about it.” But they really do need to worry about it. Correct?

Dr. Houston:                      That is correct. Used to we just blew off white coat hypertension as nothing but stress in the doctor’s office. Turns out clinical studies, and there’s many of them now having done thousands of patients, show that white coat hypertension has a risk that is in between being totally normal and having sustained high blood pressure. So, you are at risk and you probably need to be treated for white coat hypertension, because if you do that in the office and you get stressed out coming in there, you’re probably increasing your pressure all day every time you get under stress.

Dr. Weitz:                            Right. So, let’s get into, well, you mentioned genetic factors. So, you like to do genetic testing. How does the genetic testing help you to manage patients?

Dr. Houston:                      We developed a gene test with Vibrant labs in San Francisco that has 25 SNPs, including high blood pressure genes, dyslipidemia, coronary heart disease, and diabetes genes. And what has really helped us is when we get those hypertension genes back, you know exactly what’s driving the high blood pressure genetically and specifically what drugs you can use. And you don’t have to guess. Rather than saying, “Well, let’s just try this drug or try that drug.” You know exactly which drug is going to work the best.

Dr. Weitz:                            One thing you mentioned in your book was stratifying hypertension into these two different types, and you do this by measuring plasma renin and aldosterone. And I’d never heard of a doctor doing that. It sounds like that’s something that could be really beneficial, but I don’t think that’s being done by hardly anybody today.

Dr. Houston:                      You’re probably right. We’re one of the few institutes that actually does it, but also we’ve studied how much help it is in selecting therapy. So, it’s easy to do. You have the patients come in, they don’t have to reduce their salt intake or drink a lot of fluid. It’s just random. You get a plasma renin activity, it’s called a PRA, and a simultaneous serum aldosterone level. And they can’t be on medication, obviously, when they do this because that messes up the numbers.  And then whatever those numbers are tells you the type of hypertension that they have physiologically, not genetically, but physiologically, and it tells you what drug classes are most important. So, the two classes are high renin and low renin. So, the plasma renin activity over 0.65 is high renin hypertension. If it’s below 0.65, it’s low renin hypertension.  Now, the reason you do an aldosterone level with it is sometimes the PRA will come back right on the borderline and you can’t really tell which one it is. And then you do a ratio called the aldo-renin ratio, ARR, and that ratio will nail it like 99% of the time, and you know exactly what to do. So, if it’s, for example, high renin hypertension your best drugs are ACE inhibitors, ARBs, and direct renin inhibitors, but if it’s low renin hypertension, it’s a diuretic and a CCB or calcium channel blocker.

Dr. Weitz:                            Okay. Cool. Let’s get into diet and lifestyle. What are some of the most important lifestyle factors that can help to lower hypertension?

Dr. Houston:                      There’s three that are the most important. Well, actually four. Low sodium, below 1.5 grams per day. High potassium, at least five grams per day. High magnesium, like 1,000 milligrams a day, and at least 12 servings of fruits and vegetables per day. If you do those right there, that will drop your blood pressure typically about 12 to 15 on the top and 6 to 8 on the bottom.

Dr. Weitz:                            Now, the sodium thing is controversial. It’s gone back and forth in terms of how important it is. A lot of doctors say, “Well, only a percentage of patients are sodium sensitive.” How many patients do you think respond to reducing sodium?

Dr. Houston:                      So, what you just said that these doctors are saying that sodium is not important if you’re quote, “salt sensitive” is another major myth that we need to presently dispel ever-

Dr. Weitz:                            Okay.

Dr. Houston:                      … in the mind of your listeners. Sodium is toxic in any form.

Dr. Weitz:                            Okay.

Dr. Houston:                      Once you get over 1.5 grams per day, it’s not all about blood pressure. Your blood pressure may or may not be salt sensitive, but it gets into your arteries and it makes them stiff. And when you get that, then it leads to stroke, heart attack, heart failure, and kidney failure, proteinuria in the kidney. All those are related to sodium intake. It also reduces nitric oxide levels, which makes your vessels even stiffer.  So, sodium is important. It is toxic, and the more you eat, the worse you will be, whether your blood pressure goes up or not. Now, you balance the sodium problems with potassium and magnesium.

Dr. Weitz:                            Right. And what type of dietary approach is best for controlling hypertension?

Dr. Houston:                      So, in my book that you just showed there, we use what’s called the HIP diet, H-I-P. It was a cute name for Hypertension Institute Program. And what it is, it’s a modified DASH 2 diet with a little Mediterranean flavor thrown in, with the qualifications of sodium, potassium, magnesium, the fruits and vegetables, high quality protein, and getting rid of refined carbohydrates.  And if you do that and follow the HIP program, we’ve got recipes in the book, two chapters on nutrition. You can pretty well get that program going easily.

Dr. Weitz:                          What role do toxins play in hypertension?

Dr. Houston:                      Huge. Toxins drive, not just hypertension, but also coronary heart disease and heart attack. So, you got to measure the big ones, arsenic, lead, mercury, and then pesticides and organicides. And if those are elevated, you do your best to get rid of them.

Dr. Weitz:                          Okay. What about micronutrients?

Dr. Houston:                      So, micronutrient deficiencies can drive hypertension and coronary heart disease, arterial stiffness, all kinds of problems including endothelial and glycocalyx dysfunction.  We use micronutrient testing from Vibrant labs out of San Francisco, which is the same company that we do the genetic testing. I like it because it measures both intracellular and extracellular micronutrients.

Dr. Weitz:                          Right. Correct. Yeah, I love that test. What about the importance of exercise?

Dr. Houston:                      Very important. You need to do a combined aerobic and resistance training program for one hour a day, six days a week. When you do that program, the exercise reduces inflammation, it improves arterial elasticity, it raises nitric oxide, reduces stroke and heart attack risk. And typically once you’re training, the blood pressure will drop about 12 over 6 once you’re in good condition.

Dr. Weitz:                            Now, a lot of the way to understand blood pressure has to do with the arterial walls and the lining of the arteries, the endothelium. How do we address that? And maybe you can talk about the importance of the endothelial lining and the glycocalyx of the arteries.

Dr. Houston:                      Right. So, endothelial dysfunction and glycocalyx dysfunction occur decades before you get hypertension. I’m talking sometimes two or three decades. So, being able to identify those with noninvasive vascular testing is very important.  So, the glycocalyx is outside the endothelium, so it’s the one that gets hit first. Once it’s damaged then the endothelium gets damaged. And once it’s damaged, then the vascular smooth muscle wall gets damaged. So, think of it this way, the first thing that happens is functional changes in the endothelium, the glycocalyx, that reduce nitric oxide and cause the three finite responses of inflammation, oxidative stress and vascular immune dysfunction, and then those feed into stiffness of the arteries.

                                                Now you’ve got structural changes. The artery wall not only is stiff, but it starts to get thickened and the lumen gets narrowed, and then you have what’s called a narrow medial lumen ratio. And what’s happening there in essence is the artery is trying to protect the organ from damage by constricting to reduce that pressure that’s going into the organ. But when that happens, the long-term effect is you reduce blood flow and oxygen through the artery to the organ, and now you get ischemia. Well, if it’s a brain, it’s a stroke. If it’s your heart, it’s angina or heart attack.

                                                So, what you want to do is back up and start treating everything at the beginning so you don’t get to those bad things later. So, for the glycocalyx, you use a glycocalyx promoter, and there’s only one out there that I think is really powerful and proven in clinical trials. And that’s Arterosil, which is made by Calroy Labs.

Dr. Weitz:                            I think the guy who developed that for Calroy went on his own now and developed a newer product. Do you know about that one?

Dr. Houston:                      I have looked at all the products that are glycocalyx promoters, okay?

Dr. Weitz:                            Okay.

Dr. Houston:                      And I’ve looked at the science. And I will tell you that I don’t know the political history about who did what with where. I just know that the Arterosil by Calroy is superior to any other on the market by a landslide.  So, that’s the only one I’d recommend. It’s two capsules a day, one in the morning, one at night. Then you add to that a nitric oxide promoter, and once again, Calroy has the best one on the market, it’s called Vascanox. It’s five times more potent than any other nitric oxide on the market.

Dr. Weitz:                          Now, you used to recommend the Neo40, correct?

Dr. Houston:                      Yeah, Neo40 was a great product, the problem is it’s very short-lived, it only lasts about six hours, whereas Vascanox lasts for 24 hours and it stays above the magical threshold for arterial elasticity, which is around 200.

Dr. Weitz:                          What does it have in it that allows it to do that?

Dr. Houston:                      The Vascanox?

Dr. Weitz:                          Yeah.

Dr. Houston:                      Well, it has a lot of things in it that are nitrate, nitrite-like, but it also has hydrogen sulfide, which is a PDE5 inhibitor. So, you get a bidirectional hit that really jacks up the nitric oxide levels.

Dr. Weitz:                          Interesting.

Dr. Houston:                      So, if you use those two together, you can really improve glycocalyx endothelial function. And then interestingly, both of them together also improve the arterial function. The actual artery wall and the elasticity over time gets better, relaxes, and now the pressure actually starts to fall with those two products independent of a medication.

Dr. Weitz:                          Are there any lab tests that indicate that early endothelial glycocalyx dysfunction?

Dr. Houston:                      Yeah, there’s a couple. If you want to do blood tests, it’s asymmetric dimethylarginine, ADMA. You can get that from Cleveland Heart, which is part of Quest. You can also do the strips, you know, that go under your tongue?

Dr. Weitz:                          Okay.

Dr. Houston:                      Those strips are really good to see if your levels are high. And then of course, we have two machines that measure endothelial dysfunction. One of them is called EndoPAT, and the other one’s called computerized arterial pulse wave analysis. Both of those will measure endothelial dysfunction. And the pulse wave analysis gives you that and arterial stiffness in one test.

Dr. Weitz:                          Cool. What about any of the other lab tests like myeloperoxidase, or any of the other tests that are trying to pick up inflammation in the arteries?

Dr. Houston:                      Yeah, you should do a panel that looks at all those finite responses like with inflammation, C-reactive protein.

Dr. Weitz:                          Sure.

Dr. Houston:                      Interleukins, TNF alpha, oxidative stress molecules. You got a whole bunch of blood and urine tests for that. Myeloperoxidase is a great one for looking at oxidative stress, for example.

Dr. Weitz:                          Okay. So, you mentioned a couple of nutrients, potassium, magnesium. What other nutritional supplements help move the needle for patients with hypertension?

Dr. Houston:                      Well, the most important and most powerful is the nitric oxide and glycocalyx. They outweigh anything else you can do.

Dr. Weitz:                          Okay.

Dr. Houston:                      Then you’ve got a bunch of other things that have looked at clinically. You’ve got co-enzyme Q10, Kyolic garlic, alpha-lipoic acid, magnesium chelates.

Dr. Weitz:                          Taurine.

Dr. Houston:                      Taurine. Yeah. There’s about probably 15 really good nutrients that have been clinically studied that help to lower blood pressure.

Dr. Weitz:                          How do you decide which ones to recommend? How many do you recommend at a time?

Dr. Houston:                      Well, I measure what’s missing. So-

Dr. Weitz:                          So, you’re doing a micronutrient test.

Dr. Houston:                      Micronutrient test to see what’s missing and-

Dr. Weitz:                          So, start there. Yeah.

Dr. Houston:                      … then you replace those. Now, if it’s all normal, then you go by what’s got the best bang for the buck and replace those first based on the clinical studies.

Dr. Weitz:                          So, if you were going to put somebody … Let’s say the micronutrient test is normal and you want to put them on let’s say, four or five supplements, what would be the biggest bang for your buck?

Dr. Houston:                      All right. So, I definitely would do Vascanox and Arterosil in combination.

Dr. Weitz:                          Okay.

Dr. Houston:                      Then I’d probably add magnesium chelates, then co-enzyme Q10, and taurine. Now, there’s a really great product that I developed with Biotics. It’s called CardioSirt BP, and we’ve done a clinical trial with it. It’s a powder and it’s got a lot of taurine in it along with magnesium. So, you can get a lot of that just by doing the CardioSirt BP. It’s really good. It’s one scoop a day in water, and we got pressure reductions of like 12 over 6 with that one.

Dr. Weitz:                          And you got to go a fairly high dosage of taurine, right? What kind of dosage?

Dr. Houston:                      So, in that one we have six grams a day.

Dr. Weitz:                          Okay. And is that typically about the amount you’re going to recommend more or less?

Dr. Houston:                      Yeah. The peak effect of taurine on blood pressure is six grams.

Dr. Weitz:                          Okay. Cool. And you also list in your book certain supplements that when taken with hypertensive medications enhance the effectiveness of the medications.

Dr. Houston:                      So, there’s synergy or at least additive effects with a lot of the nutrients in the drugs. For example, I’ll give you a couple, R-lipoic acid with an ACE inhibitor. Very, very good together. Magnesium with a calcium channel blocker.  So, you can look at the nutrient, sometimes add that if your blood pressure is not controlled just with the medication, without having to do a second medication. But the key is to make sure whatever you’re doing gets the pressure down normal and pretty quick.

Dr. Weitz:                            So, when it comes to medications, you mentioned that you no longer use most of the diuretics. Which medications do you typically find to be the most effective?

Dr. Houston:                      So, after we do our genetic testing and our plasma renin and aldosterone, the top classes of drugs are ACE inhibitors, angiotensin receptor blockers, one or two of the calcium blockers like amlodipine or nifedipine. And then the best beta blockers are nebivolol, which is Bystolic, or Coreg, which is carvedilol. The only diuretic that I use is indapamide. And indapamide is the best. Hydrochlorothiazide, no, don’t use that one anymore. [inaudible 00:28:23].

Dr. Weitz:                          I still see a lot of patients on that.

Dr. Houston:                      Yeah, it’s one of those things that’s gotten ingrained in the medical pharmaceutical industry and once it gets in the pill, they can’t seem to get it out and people keep prescribing. But there’s data that HCTZ absolutely does nothing to reduce your cardiovascular events.  And here’s the really bad thing about it. If you give HCTZ by itself, you run a risk of type 2 diabetes and kidney disease that gets worse and worse by the year. Not to mention homocysteine going up, potassium going down, and other things. But if you put hydrochlorothiazide with what we would call a good medication like an ACE inhibitor or a ARB, it counterbalances the good effect of the other drug.

Dr. Weitz:                          Oh, wow.

Dr. Houston:                      So, you get something that’s halfway there. Not good.

Dr. Weitz:                          Another drug I see a lot of patients on is spironolactone.

Dr. Houston:                      Yes. Spironolactone, eplerenone, and KERENDIA are all serum aldosterone receptor antagonists or SARAs, and they are all very effective in most people with blood pressure. But particularly when you do the genetic testing, there’s a couple of genes that respond only to that class of drugs. CYP11B2, for example, is the gene that responds to aldosterone over-synthesis. And the only way you can block it is with spironolactone, KERENDIA or eplerenone.

Dr. Weitz:                          Yeah. I don’t know any doctors other than one or two, like yourself, who are doing those genetic tests.

Dr. Houston:                      Yeah. We need to get people doing genetic testing because that’s the only way you can personalize and do precision medicine in cardiovascular disease, particularly high blood pressure.

Dr. Weitz:                          Right. It seems like that spironolactone is the preferred drug for women, for some reason.

Dr. Houston:                      Yeah, well, there’s a good reason for that. Spironolactone causes gynecomastia.

Dr. Weitz:                          Oh, okay.

Dr. Houston:                      So, men don’t like it, but women like it. Right?

Dr. Weitz:                          Great. I think those are the main things that I wanted to discuss. I think we covered a lot in a short period of time.

Dr. Houston:                      Yeah, you got those questions lined up and banged them out. There must be a pretty smart guy back there.

Dr. Weitz:                          I’m thinking maybe we should try that controversial topic I asked you about before we started. There is a new controversy in cardiovascular medicine that’s hit the news. Apparently, Dr. Stanley Hazen, who’s the guy who developed the theory about TMAO as being a risk factor for cardiovascular disease, has started a controversy and people are now nervous about taking niacin because of this paper that he published.

Dr. Houston:                     Well, let me comment on the paper. I have read the paper ad nauseum. It’s published in Nature. Nature’s a pretty good journal.

Dr. Weitz:                          Very respected journal. Yeah.

Dr. Houston:                      Very good journal. It’s not a real clinical journal, it’s more of a research journal. So, let’s say that upfront. So, they take studies that are considered pretty high science and otherwise they don’t get published. So, having said that, I don’t have any issues with Nature. I don’t have any issues with the fact that the study is in Nature and the study says what it says.  Now, then you get to what does the study really say and how did people take it out of context to blow niacin off the map again, very inappropriately? So, without getting too detailed, I’ll give you the big picture. The study was designed to look at some metabolites of niacin, and those metabolites were not considered very nice metabolites. They were thought to be toxic metabolites of niacin and you don’t want them. But in order to get those metabolites, you had to have a certain genetic SNP. So, how many people have that genetic SNP? Well, I don’t know, but it can’t be very common. And so, if you don’t have the SNP, you probably don’t get those metabolites. So, it’s not a universal issue by any means. It’s probably a very small part of the population.

                                                The second piece was it was high-dose niacin. We’re talking 1,500, 2,000 milligrams a day. Well, we don’t do that anymore. I mean, I haven’t prescribed that much in a decade. If I give niacin, it’s like 250 twice a day. You’re not going to get in trouble at that dose with metabolites because it’s low-dose niacin and you may not even have the SNP. So, the study was taken totally out of context by a lot of people, not so much Dr. Hazen, but other people said, “Oh my God, look, it’s going to cause you to die from coronary heart disease and you can’t use niacin anymore. It’s terrible.” And they start quoting clinical studies that are bad studies. So, they’re taking a study out of context and then tying it to a previously bad study to prove the point, which makes it even worse.

Dr. Weitz:                          Right.

Dr. Houston:                      And we’ve already gone through that controversy seven or eight years ago, and that was all taken out of context as well.  So, there’s a lot of things niacin does. It’s good. I mean, all the clinical trials with niacin using correct doses showed improvements in HDL, triglycerides, LDL, LDL particle number, coronary heart disease risk, MI risk. But you got to know what you’re doing and you got to know when to use it and what to combine it with.  So, my message, after having said all that is, niacin is alive and well. You don’t need to stop niacin. You need to use low doses of niacin and know what you’re doing. And the only people that might get into trouble, and it’s probably not big, is if you gave high doses of niacin to those people with that genetic SNP, but not in the general population. Niacin is one of a few things that actually improves HDL dysfunction. [inaudible 00:35:08].

Dr. Weitz:                            And also lowers lipoprotein A.

Dr. Houston:                      Yeah, LP little a. So, it’s got a lot of good uses, so you don’t want to throw it out just because of one little study that wasn’t designed to even answer the question that people are all upset about now.

Dr. Weitz:                            It’s funny how this simple vitamin, which you and I and a bunch of other especially integrative doctors have been using for years with all sorts of benefits, is getting attacked again, and I don’t quite know why, but…

Dr. Houston:                      I can’t begin to understand why they keep picking on niacin. I mean, it’s a nutrient. It’s vitamin B3. It’s pretty benign. It’s in our food for goodness gracious. I just think we need to back off a little bit.  Here’s my message for your readers. Don’t listen to the news media reporting on medicine, because they never get it right. If you’re going to say, “I don’t want to use niacin and I don’t believe in niacin,” and get all upset about it, go read the study. Read the study, read the methods, and decide for yourself, “Oh, that’s totally flawed. I’m not believing that.” And move on.

Dr. Weitz:                          Right. Thank you, Dr. Houston.

Dr. Houston:                      Okay.

Dr. Weitz:                          How can our listeners and viewers find out about your books and more about you if they want to work with you?

Dr. Houston:                      So, you can go to the Hypertension Institute website. We got all kinds of information there you can download for free, and you can also make appointments to see us as a cardiovascular consult. The books are all on Amazon, so they’re easy to find. You just put in my name and it’ll pull up all the books that we’ve-

Dr. Weitz:                          How many books do you have? It’s a lot.

Dr. Houston:                      I think I’m up to 10 now.

Dr. Weitz:                          Okay.

Dr. Houston:                      Yeah.

Dr. Weitz:                          Thank you so much, Dr. Houston.

Dr. Houston:                      Thank you, Ben. I appreciate being on your show.



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 appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review.  If you would like to work with me personally to help you improve your health, I do accept a limited number of new patients per month for a functional medicine consultation. Some of the areas I specialize in include helping patients with specific health issues like gut problems, neurodegenerative conditions, 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. Please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at (310) 395 3111, and we’ll set you up for a new consultation for functional medicine. And I look forward to speaking to everybody next week.